Table: enrolled_medi_cal_fee_for_service_ffs_providers , legal_name like L*

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

objectid	provider_source	provider_number	npi	owner_number	service_location_number	legal_name	enroll_status_eff_dt	provider_taxonomy	nemt_nmt_provider_type	anc_provider_type	fi_provider_type_cd	fi_provider_type	provider_license	fi_provider_specialty_cd	fi_provider_specialty	out_of_state_indicator	in_out_state	address_attention	address	address2	city	state	zip	zip_4	dhcs_county_cd	fips_county_cd	latitude	longitude	countyname
11	Fee-for-Service	1124283056	1124283056	1	1	LEE, MELVIN G MD	8/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108721	07	Dermatology	0	In state provider	None	611 SOUTH MILPITAS	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
26	Fee-for-Service	1578834164	1578834164	1	1	LA CLINICA DE LA RAZA INC	10/29/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2021 MAIN ST	None	OAKLEY	CA	94561	3302	07	06013	38.00403621	-121.7329113	Contra Costa County
83	Fee-for-Service	1609886464	1609886464	1	1	LIN, HAN-MING J MD	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94431	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
93	Fee-for-Service	1114538899	1114538899	1	1	LEE, JI YUN PSYD	3/12/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
97	Fee-for-Service	1376124610	1376124610	1	1	LAI, NOK HANG DPM	4/10/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	25150 HANCOCK AVE	STE 206	MURRIETA	CA	92562	5989	33	06065	33.56635084	-117.1823956	Riverside County
106	Fee-for-Service	1831257344	1831257344	1	1	LIFSHITZ, FIMA MD	5/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50946	67	Endocrinology	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
127	Fee-for-Service	1134332216	1134332216	1	1	LYNN, DEBORAH E MD	5/16/2018	2084P0804X	NA	Psychiatry	026	PHYSICIANS	82003	36	Psychiatry	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
140	Fee-for-Service	1306952908	1306952908	1	1	LAS VENTANAS SURGERY CTR	3/17/2004	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1441 CONSTITUTION BLVD	BLDG 400 STE 103	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
163	Fee-for-Service	1790912970	1790912970	1	1	LLANO DIALYSIS, LLC	1/1/2010	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	13352 SAN PABLO	None	SAN PABLO	CA	94806	3953	07	06013	37.95500507	-122.3349081	Contra Costa County
172	Fee-for-Service	1457471161	1457471161	1	1	LINK, PATRICK E MD	8/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91545	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
207	Fee-for-Service	1386671147	1386671147	1	1	LIS, STEVEN T MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67909	30	Radiology	0	In state provider	None	9851 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	33	06065	33.918192	-117.4547295	Riverside County
209	Fee-for-Service	1790709681	1790709681	1	1	LOEFFLER, PAUL M MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65275	30	Radiology	0	In state provider	None	5189 HOSPITAL ROAD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
216	Fee-for-Service	1205472073	1205472073	1	1	LOS FELIZ HOME HEALTH	6/29/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3171 LOS FELIZ BLVD	214	LOS ANGELES	CA	90039	1527	19	06037	34.12369709	-118.2682266	Los Angeles County
222	Fee-for-Service	1376171579	1376171579	1	1	LYNCH, ANDREW D MD	2/10/2023	390200000X	NA	Other	026	PHYSICIANS	179627	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
229	Fee-for-Service	1932530052	1932530052	1	1	LOCKIE, ROBIN ANN	12/3/2013	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1926 GEARY AVENUE	None	SANGER	CA	93657	2059	10	06019	36.71879877	-119.5639515	Fresno County
235	Fee-for-Service	1033584248	1033584248	1	1	LYNDALE DIALYSIS, LLC	10/11/2017	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	4401 MACK RD	None	SACRAMENTO	CA	95823	4545	34	06067	38.474811	-121.452426	Sacramento County
251	Fee-for-Service	1205864865	1205864865	1	1	LEICHMAN, JOSHUA G MD	8/9/2018	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	106468	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	31537 RANCHO PUEBLO	SUITE 204	TEMECULA	CA	92592	4841	33	06065	33.47933034	-117.1103293	Riverside County
252	Fee-for-Service	1013952308	1013952308	1	1	LIEH, HAYWON MD	7/31/1991	207L00000X	NA	Other	026	PHYSICIANS	47721	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
255	Fee-for-Service	1841658697	1841658697	1	1	LESO, ELIZABETH ELAINE	1/27/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	33068 SAINT EMILLION CT	None	WINCHESTER	CA	92595	3306	33	06065	33.606387	-117.082026	Riverside County
266	Fee-for-Service	1265094163	1265094163	1	1	LIVLIFE HOME HEALTH INC	10/9/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	22151 VENTURA BLVD	STE 203	WOODLAND HILLS	CA	91364	1666	19	06037	34.16870042	-118.6099445	Los Angeles County
271	Fee-for-Service	1437789674	1437789674	1	1	LARA LMFT INC.	9/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1910 HILLHURST AVE	None	LOS ANGELES	CA	90027	2712	19	06037	34.105716	-118.2873845	Los Angeles County
282	Fee-for-Service	1487817383	1487817383	1	1	LAO, DAVID S MD	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	90449	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
314	Fee-for-Service	1578834164	1578834164	1	1	LA CLINICA DE LA RAZA INC	11/4/2013	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	2021 MAIN ST	None	OAKLEY	CA	94561	3302	07	06013	38.00403621	-121.7329113	Contra Costa County
328	Fee-for-Service	1770640492	1770640492	1	1	LAW-GREENBERG, CLAUDIA PHD	9/12/2014	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8899 UNIVERSITY CTR LN	STE 170	SAN DIEGO	CA	92122	1009	37	06073	32.8702653	-117.2280462	San Diego County
337	Fee-for-Service	1972538833	1972538833	1	1	LEE, PING NGA A MD	6/16/2016	207R00000X	NA	Other	026	PHYSICIANS	54273	41	Internal Medicine	0	In state provider	None	400 EVELYN AVE	None	ALBANY	CA	94706	9999	01	06001	37.89873243	-122.2971602	Alameda County
339	Fee-for-Service	1992185755	1992185755	1	1	LU, HSUAN DO	11/14/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	15210	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
355	Fee-for-Service	1932387974	1932387974	1	1	LEE, MICHAEL J MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87262	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
365	Fee-for-Service	1023628401	1023628401	1	1	LI, EILEEN OT	2/22/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	911 BERN CT	STE 140	SAN JOSE	CA	95112	1242	43	06085	37.37594797	-121.8941096	Santa Clara County
394	Fee-for-Service	1831257344	1831257344	1	1	LIFSHITZ, FIMA MD	5/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50946	40	Pediatrics	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
412	Fee-for-Service	1881984391	1881984391	1	1	LEE, YOUNG H MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134991	07	Dermatology	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
466	Fee-for-Service	1679839385	1679839385	1	1	LEE, ROBERT DO	5/1/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	17421	36	Psychiatry	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
474	Fee-for-Service	1669610812	1669610812	1	1	LIEBEN, KATRINA R CNM	4/5/2018	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	333 LAWS AVE	None	UKIAH	CA	95482	6540	23	06045	39.12772164	-123.2111168	Mendocino County
481	Fee-for-Service	1104852045	1104852045	1	1	LEE,DARLENE M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 N BEAVER ST	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
489	Fee-for-Service	1205944485	1205944485	1	1	LOMBARDO, DAWN M DO	10/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9218	01	General Practice	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
502	Fee-for-Service	1306878616	1306878616	1	1	LEE, MELANIE H MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80135	41	Internal Medicine	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2268	07	06013	37.98417931	-122.0361585	Contra Costa County
508	Fee-for-Service	1801258249	1801258249	1	1	LANGNAS, ERICA MD	6/2/2021	390200000X	NA	Other	026	PHYSICIANS	154706	None	None	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
517	Fee-for-Service	1932530052	1932530052	1	1	LOCKIE, ROBIN ANN	12/3/2013	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1926 GEARY AVENUE	None	SANGER	CA	93657	2059	10	06019	36.71879877	-119.5639515	Fresno County
518	Fee-for-Service	1205397874	1205397874	1	1	LEE, MATTHEW C DO	9/13/2023	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
540	Fee-for-Service	1245734888	1245734888	1	1	LO, DEANNA C MD	3/21/2024	208M00000X	NA	Other	026	PHYSICIANS	166461	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
543	Fee-for-Service	1841658697	1841658697	1	1	LESO, ELIZABETH ELAINE	1/27/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	33068 SAINT EMILLION CT	None	WINCHESTER	CA	92595	3306	33	06065	33.606387	-117.082026	Riverside County
578	Fee-for-Service	1306959051	1306959051	1	1	LEE, SEREI Y DPM	5/7/2007	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	27 W MAIN ST	STE G	ALHAMBRA	CA	91801	3500	19	06037	34.09489351	-118.1274697	Los Angeles County
588	Fee-for-Service	1235348038	1235348038	1	1	LE, ANH T MD	2/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	117420	40	Pediatrics	0	In state provider	None	3501 S HARBOR BLVD	None	SANTA ANA	CA	92704	6919	30	06059	33.69981147	-117.9194272	Orange County
602	Fee-for-Service	1578834164	1578834164	1	1	LA CLINICA DE LA RAZA INC	10/29/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2021 MAIN ST	None	OAKLEY	CA	94561	3302	07	06013	38.00403621	-121.7329113	Contra Costa County
642	Fee-for-Service	1215088828	1215088828	1	1	LORI B HELLER M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	747 BROADWAY	None	SEATTLE	WA	98122	4379	00	None	47.608326	-122.3207985	King County
649	Fee-for-Service	1356653141	1356653141	1	1	LAUS, ARNADLO F DO	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
661	Fee-for-Service	1194973990	1194973990	1	1	LIAO, LUCY P MD	6/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102540	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
674	Fee-for-Service	1750548228	1750548228	1	1	LYNCH, CHRISTINE M	9/4/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5528 N PALM AVE	STE 113	FRESNO	CA	93704	1947	10	06019	36.817821	-119.8082425	Fresno County
675	Fee-for-Service	1922201854	1922201854	1	1	LOPEZ, EDUARDO A MD	4/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109370	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
701	Fee-for-Service	1710419486	1710419486	1	1	LOUGHRAN, DAVID MD	8/1/2022	207P00000X	NA	Other	026	PHYSICIANS	178588	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
719	Fee-for-Service	1275514234	1275514234	1	1	LIM, EMMANUEL R MD	10/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43525	08	Family Practice	0	In state provider	None	6200 WILSHIRE BLVD	STE 1510	LOS ANGELES	CA	90048	5816	19	06037	34.06319291	-118.3636025	Los Angeles County
774	Fee-for-Service	1952321689	1952321689	1	1	LOUISELL, CHRISTOPHER MD	7/31/1985	207P00000X	NA	Other	026	PHYSICIANS	55971	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2251 HAWTHORNE ST	None	SACRAMENTO	CA	95815	2958	34	06067	38.607948	-121.4587935	Sacramento County
777	Fee-for-Service	1699721514	1699721514	1	1	LOMA LINDA UNIVERSITY	8/1/1994	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	RADIATION MEDICINE	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
785	Fee-for-Service	1205944485	1205944485	1	1	LOMBARDO, DAWN M DO	10/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9218	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
806	Fee-for-Service	1184647869	1184647869	1	1	LARSEN, RANAE L MD	6/8/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	50588	40	Pediatrics	0	In state provider	None	800 MAGNOLIA AVE	STE 101	CORONA	CA	92879	3123	33	06065	33.85979137	-117.5527252	Riverside County
841	Fee-for-Service	1548373491	1548373491	1	1	LU, SCARLETT T DO	3/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8387	01	General Practice	0	In state provider	None	2030 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56292466	-121.7715423	Yolo County
843	Fee-for-Service	1487019949	1487019949	1	1	LIN, KAUNG S	3/28/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
863	Fee-for-Service	1902486673	1902486673	1	1	LOPEZ, ISAI MD	7/22/2024	207P00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1111 LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
881	Fee-for-Service	1881040970	1881040970	1	1	LENAERTS, CAROLINE NP	9/29/2023	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
951	Fee-for-Service	1952437709	1952437709	1	1	LAMENDOLA, CYNTHIA A NP	10/29/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
957	Fee-for-Service	1164656229	1164656229	1	1	LAQUER, VIVIAN T MD	7/20/2017	207N00000X	NA	Dermatology	026	PHYSICIANS	113693	07	Dermatology	0	In state provider	None	101 THE CITY DRIVE S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
960	Fee-for-Service	1205031804	1205031804	1	1	LEE, WEI A DO	7/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8465	67	Endocrinology	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
972	Fee-for-Service	1437169307	1437169307	1	1	LU, DAVID Q MD INC	3/20/2006	207L00000X	NA	Other	026	PHYSICIANS	85335	05	Anesthesiology	0	In state provider	None	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
995	Fee-for-Service	1295742021	1295742021	1	1	LU, TIM TING-L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	315 MARTIN LUTHER KING J	None	TACOMA	WA	98405	4234	00	None	47.25960844	-122.4534238	Pierce County
998	Fee-for-Service	1790963403	1790963403	1	1	LANDA, RAFAEL MFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
1042	Fee-for-Service	1497139570	1497139570	1	1	LE, NANCY LMFT	10/31/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
1044	Fee-for-Service	1033195128	1033195128	1	1	LIM, PAUL MD	9/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	75239	41	Internal Medicine	0	In state provider	None	7205 GREENLEAF AVE	STE A	WHITTIER	CA	90602	1317	19	06037	33.97673227	-118.0374057	Los Angeles County
1049	Fee-for-Service	1396921425	1396921425	1	1	LIANG, LING-CHIH MD	7/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104482	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
1057	Fee-for-Service	1295361632	1295361632	1	1	LLAXMI RX INC	4/22/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	436 S. RIVERSIDE	None	RIALTO	CA	92376	6523	36	06071	34.093089	-117.3703775	San Bernardino County
1074	Fee-for-Service	1700044518	1700044518	1	1	LEE, JEANETTE J MD	3/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147097	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
1131	Fee-for-Service	1245473941	1245473941	1	1	LEMOS, BIANCA C MD	9/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125175	07	Dermatology	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
1142	Fee-for-Service	1386739639	1386739639	1	1	LOPEZ,HEIDI R CRNA	11/1/2000	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4906 REGAL CT	None	ROCKLIN	CA	95765	5025	31	06061	38.81714283	-121.2516023	Placer County
1178	Fee-for-Service	1912075235	1912075235	1	1	LEE, CHUNG MIN MD	12/31/1980	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	36083	40	Pediatrics	0	In state provider	None	12121 CARSON ST	None	HAWAIIAN GARDENS	CA	90716	1154	19	06037	33.83154949	-118.0733216	Los Angeles County
1221	Fee-for-Service	1144308628	1144308628	1	1	LAL, ANAND MD	3/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	50940	83	Rheumatology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
1227	Fee-for-Service	1376123836	1376123836	1	1	LAU, CALVIN E MD	10/2/2024	208M00000X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
1238	Fee-for-Service	1396888095	1396888095	1	1	LAGOC, RAILEEN C MD INC	12/8/2005	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	72405	40	Pediatrics	0	In state provider	None	1832 BUENAVENTURA BLVD	STE B	REDDING	CA	96001	3828	45	06089	40.55644085	-122.3971882	Shasta County
1276	Fee-for-Service	1225394000	1225394000	1	1	LEMON, ANTHON J MD	2/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
1284	Fee-for-Service	1194228908	1194228908	1	1	LEWIS, ALEXANDRA A DO	8/30/2021	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
1288	Fee-for-Service	1831884196	1831884196	1	1	LOBODA, TATYANA	6/28/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	333 UNIVERSITY AVE.	#140	SACRAMENTO	CA	95825	6535	34	06067	38.570976	-121.416651	Sacramento County
1295	Fee-for-Service	1447783626	1447783626	1	1	LOVE, SHAWN M MD	3/8/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	159394	None	None	0	In state provider	None	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
1310	Fee-for-Service	1831488337	1831488337	1	1	LEE, CHARLENE S MD	1/1/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	128450	68	Hematology	0	In state provider	None	200 JOSE FIGUERES AVE	SUITE 245	SAN JOSE	CA	95116	1500	43	06085	37.36122014	-121.8505998	Santa Clara County
1311	Fee-for-Service	1003311960	1003311960	1	1	LU, ERIC X MD	8/4/2021	207R00000X	NA	Other	026	PHYSICIANS	173403	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
1313	Fee-for-Service	1649266479	1649266479	1	1	LIN, YONG JIAN MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72004	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
1314	Fee-for-Service	1548360084	1548360084	1	1	LOPEZ-BERMEJO, MELISSA Z MD	12/31/1995	207R00000X	NA	Other	026	PHYSICIANS	54168	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
1322	Fee-for-Service	1538365002	1538365002	1	1	LAZAR, DAVID A MD	7/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	105968	85	Surgery-Pediatric	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
1361	Fee-for-Service	1700318128	1700318128	1	1	LEBA, CHRISTOPHER T MD	8/22/2023	207R00000X	NA	Other	026	PHYSICIANS	170006	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
1370	Fee-for-Service	1104011527	1104011527	1	1	LEONG, JOEANN K MD	7/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
1386	Fee-for-Service	1013028943	1013028943	1	1	LIAN, FANGRU, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIVERSITY MEDICAL CNTR	1501 N CAMPBELL	None	TUCSON	AZ	85724	0000	00	None	32.240493	-110.9460825	Pima County
1392	Fee-for-Service	1891281754	1891281754	1	1	LAI, CAROLYN MD	2/19/2019	207T00000X	NA	General Surgery	026	PHYSICIANS	156734	14	Neurological Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
1401	Fee-for-Service	1144703406	1144703406	1	1	LOU, CALEB MD	6/21/2024	390200000X	NA	Other	026	PHYSICIANS	189524	66	Emergency Medicine (Urgent Care)	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
1416	Fee-for-Service	1609287614	1609287614	1	1	LIPINSKA, JUDYTA A MD	10/13/2021	208600000X	NA	General Surgery	026	PHYSICIANS	162991	None	None	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
1423	Fee-for-Service	1710081880	1710081880	1	1	LENEVE, ANDREA D LMFT	9/13/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5887 BROCKTON AVE	STE A	RIVERSIDE	CA	92506	1858	33	06065	33.96266399	-117.3956871	Riverside County
1457	Fee-for-Service	1518119510	1518119510	1	1	LEONG, DANIEL B MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105830	08	Family Practice	0	In state provider	None	975 S FAIRMONT AVENUE	None	LODI	CA	95242	3635	39	06077	38.12188356	-121.285872	San Joaquin County
1465	Fee-for-Service	1104182542	1104182542	1	1	LAI, ANDREW INC	7/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	91702	77	Infectious Disease	0	In state provider	None	959 E WALMUT ST	STE 120	PASADENA	CA	91106	5364	19	06037	34.14962102	-118.1305187	Los Angeles County
1480	Fee-for-Service	1487744330	1487744330	1	1	LA SPADA, ALBERT R MD	12/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88598	70	Clinic (mixed specialty)	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
1497	Fee-for-Service	1558363416	1558363416	2	1	LADENHEIM, MARC L MD	10/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49875	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2625 W ALAMEDA AVE	STE 412	BURBANK	CA	91505	4818	19	06037	34.1577056	-118.329779	Los Angeles County
1511	Fee-for-Service	1447713854	1447713854	1	1	LOUBE, DEANNE KENNEDY MD	7/1/2024	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	180200	13	Neurology (M.D. only)	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
1513	Fee-for-Service	1528086816	1528086816	1	1	LIU, SHIRLEY X MD	4/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94673	05	Anesthesiology	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
1517	Fee-for-Service	1275579252	1275579252	1	1	LAKESIDE MEDICAL ASSOC	3/24/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	15211 VANOWEN ST	STE 206	VAN NUYS	CA	91405	3620	19	06037	34.19395411	-118.4642527	Los Angeles County
1575	Fee-for-Service	1700957685	1700957685	1	1	LIANG, JOHN MD	8/31/1986	207RH0000X	NA	Hematology	026	PHYSICIANS	53809	01	General Practice	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
1591	Fee-for-Service	1194884718	1194884718	1	1	LINKE, MELANIE K DO	6/15/1985	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5124	01	General Practice	0	In state provider	None	3737 E CENTURY BLVD	None	LYNWOOD	CA	90262	0000	19	06037	33.9208801	-118.1881395	Los Angeles County
1610	Fee-for-Service	1538365002	1538365002	1	1	LAZAR, DAVID A MD	7/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	105968	02	General Surgery	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
1615	Fee-for-Service	1205085610	1205085610	1	1	LIN, RICHARD Y D DO	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	11544	None	None	0	In state provider	None	341 MAGNOLIA AVE	STE 101	CORONA	CA	92879	3331	33	06065	33.85291987	-117.5664344	Riverside County
1627	Fee-for-Service	1902394596	1902394596	1	1	LAI, WINSTON DO	11/18/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17853	None	None	0	In state provider	None	1245 WILSHIRE BLVD.	SUITE 307	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
1630	Fee-for-Service	1891942512	1891942512	1	1	LIAO, CHRISTINA C MD	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120613	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
1659	Fee-for-Service	1619296811	1619296811	1	1	LIU, JAZMIN DPM	10/13/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	6 WILLARD	None	IRVINE	CA	92604	4694	30	06059	33.67534801	-117.7900415	Orange County
1689	Fee-for-Service	1932604261	1932604261	1	1	LEWIS, MANUEL D DO	8/11/2021	208M00000X	NA	Other	026	PHYSICIANS	18972	None	None	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
1691	Fee-for-Service	1902880818	1902880818	1	1	LOWTHER, DAVID N MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	79089	30	Radiology	0	In state provider	None	1316 NELSON AVE	None	MODESTO	CA	95350	5341	50	06099	37.66206042	-120.9881734	Stanislaus County
1693	Fee-for-Service	1164570941	1164570941	1	1	LO, JONATHAN I MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66923	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
1697	Fee-for-Service	1265440010	1265440010	1	1	LOS ANGELES CO	4/28/1997	261Q00000X	NA	Other	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	MID VALLEY COMP HLTH CTR	7515 VAN NUYS BLVD	None	VAN NUYS	CA	91405	1949	19	06037	34.207344	-118.4487995	Los Angeles County
1704	Fee-for-Service	1154828358	1154828358	1	1	LIN, KATRINA MD DO	11/6/2023	2084P0804X	NA	Psychiatry	026	PHYSICIANS	20936	None	None	0	In state provider	None	375 LAGUNA HONDA	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
1726	Fee-for-Service	1962450254	1962450254	1	1	LEE, JANE S MD	2/5/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	169390	None	None	0	In state provider	None	1057 E GRAND AVE	None	ARROYO GRANDE	CA	93420	2504	40	06079	35.1190684	-120.5953068	San Luis Obispo County
1775	Fee-for-Service	1861607277	1861607277	1	1	LEE, SONIA MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103207	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
1808	Fee-for-Service	1275579252	1275579252	1	1	LAKESIDE MEDICAL ASSOC	3/24/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	15211 VANOWEN ST	STE 206	VAN NUYS	CA	91405	3620	19	06037	34.19395411	-118.4642527	Los Angeles County
1809	Fee-for-Service	1932304276	1932304276	1	1	LEWIS, JOHN K	10/7/2016	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	95 N MARENGO AVE	SUITE 205	PASADENA	CA	91101	1755	19	06037	34.14788105	-118.1459721	Los Angeles County
1824	Fee-for-Service	1144384157	1144384157	1	1	LYN, KYAW MD INC	1/3/2006	193400000X	NA	Other	026	PHYSICIANS	54425	47	Miscellaneous	0	In state provider	None	906 S SUNSET AVE	SUITE 101	WEST COVINA	CA	91790	3400	19	06037	34.06466364	-117.9424724	Los Angeles County
1851	Fee-for-Service	1255313110	1255313110	1	1	LECHNER, ANTHONY C DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	LECHNER CHIROPRACTIC	401 S LINCOLN AVE	STE D	CORONA	CA	92882	7139	33	06065	33.87915099	-117.5829663	Riverside County
1875	Fee-for-Service	1508308420	1508308420	1	1	LOPEZ, SARAH J DO	9/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15031	01	General Practice	0	In state provider	None	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
1879	Fee-for-Service	1518161728	1518161728	1	1	LIAO, MARTHA L MD	8/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91141	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7630 SOUTH PAINTER AVE	None	WHITTIER	CA	90602	2357	19	06037	33.972534	-118.032652	Los Angeles County
1904	Fee-for-Service	1235740663	1235740663	1	1	LOST COAST FAMILY THERAPY	12/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	791 8TH ST.	SUITE S	ARCATA	CA	95521	6319	12	06023	40.86820448	-124.0869718	Humboldt County
1907	Fee-for-Service	1144547217	1144547217	1	1	LE, VIET H MD	5/3/2019	208600000X	NA	General Surgery	026	PHYSICIANS	161908	02	General Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
1928	Fee-for-Service	1083657258	1083657258	2	1	LONGS DRUG STORES CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18441 VENTURA BLVD	None	TARZANA	CA	91356	4201	19	06037	34.16832895	-118.5348941	Los Angeles County
1978	Fee-for-Service	1073612735	1073612735	1	1	LIN, STEPHEN A MD	10/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	74809	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	1421 OAKDALE RD	# 2	MODESTO	CA	95355	3359	50	06099	37.664802	-120.9576055	Stanislaus County
1979	Fee-for-Service	1902880818	1902880818	1	1	LOWTHER, DAVID N MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	79089	78	Neoplastic Diseases/Oncology	0	In state provider	None	1316 NELSON AVE	None	MODESTO	CA	95350	5341	50	06099	37.66206042	-120.9881734	Stanislaus County
1986	Fee-for-Service	1235187345	1235187345	1	1	LEE, CHANHUNG MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72407	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
1993	Fee-for-Service	1851590996	1851590996	1	1	LOZANO, NIA MD	7/2/2024	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	89255	-	NOT APPLICABLE	0	In state provider	None	7233 SOUTH DELIVERY RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88418172	-121.2882227	San Joaquin County
2018	Fee-for-Service	1043849193	1043849193	1	1	LEECE, REBECCA L MD	8/1/2023	207P00000X	NA	Other	026	PHYSICIANS	181886	None	None	0	In state provider	None	2825 CAPITOL AVENUE	None	SACRAMENTO	CA	95816	6039	34	06067	38.570805	-121.4696385	Sacramento County
2077	Fee-for-Service	1700170669	1700170669	1	1	LIN, MARAGARET J MD	5/12/2017	207P00000X	NA	Other	026	PHYSICIANS	147904	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
2093	Fee-for-Service	1275579252	1275579252	1	1	LAKESIDE MEDICAL ASSOC	3/24/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	15211 VANOWEN ST	STE 206	VAN NUYS	CA	91405	3620	19	06037	34.19395411	-118.4642527	Los Angeles County
2107	Fee-for-Service	1740458868	1740458868	1	1	LEE, PEN H MD INC	8/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	600 N GARFIELD AVE	STE 110	MONTEREY PARK	CA	91754	1168	19	06037	34.06820797	-118.1228835	Los Angeles County
2147	Fee-for-Service	1194221325	1194221325	1	1	LEE, JEFFREY MD	6/13/2024	208800000X	NA	Other	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
2209	Fee-for-Service	1144310715	1144310715	1	1	LILE,CSOTT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	#653	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
2217	Fee-for-Service	1346440518	1346440518	1	1	LAI, DOMINIC W MD	5/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99008	41	Internal Medicine	0	In state provider	None	450 E ROMIE LANE	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
2218	Fee-for-Service	1346827557	1346827557	1	1	LE, JENNIFER MD	10/3/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	189502	08	Family Practice	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
2225	Fee-for-Service	1831694967	1831694967	1	1	LEMESHKO, INNA NP	6/6/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95023978	-	NOT APPLICABLE	0	In state provider	None	18646 OXNARD STREET	None	TARZANA	CA	91356	1411	19	06037	34.17993229	-118.5397265	Los Angeles County
2231	Fee-for-Service	1215227434	1215227434	1	1	LEWIS, SHERRON K LMFT	9/24/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 W MORTON AVE	SUITE F	PORTERVILLE	CA	93257	1974	54	06107	36.07322509	-119.0407529	Tulare County
2255	Fee-for-Service	1740429885	1740429885	1	1	LIN, PEI-FEN MD	4/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110396	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
2277	Fee-for-Service	1851590996	1851590996	1	1	LOZANO, NIA MD	9/3/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	89255	36	Psychiatry	0	In state provider	None	7233 SOUTH DELIVERY RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88418172	-121.2882227	San Joaquin County
2281	Fee-for-Service	1235634437	1235634437	1	1	LAO, LUE MD	11/1/2023	207R00000X	NA	Other	026	PHYSICIANS	163863	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
2345	Fee-for-Service	1700841319	1700841319	1	1	LIU, LINDA L MD	1/31/1995	207L00000X	NA	Other	026	PHYSICIANS	78362	05	Anesthesiology	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
2363	Fee-for-Service	1811951957	1811951957	1	1	LINKER, CHARLES A MD	1/1/1982	207RX0202X	NA	Oncology	026	PHYSICIANS	30910	68	Hematology	0	In state provider	None	1318 9TH AVE	None	SAN FRANCISCO	CA	94122	2309	38	06075	37.76367261	-122.4662163	San Francisco County
2366	Fee-for-Service	1679658819	1679658819	1	1	LEE, EMILY R	3/25/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
2371	Fee-for-Service	1205903200	1205903200	1	1	LIN, MELISSA MD	4/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85107	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
2396	Fee-for-Service	1942362785	1942362785	1	1	LEE, YEON S LCSW	12/2/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD RD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
2399	Fee-for-Service	1518352970	1518352970	1	1	LEE, KAREN K MD	7/28/2021	2080P0207X	NA	Hematology	026	PHYSICIANS	154276	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
2418	Fee-for-Service	1922095256	1922095256	1	1	LEE, DAMON MD	5/31/1987	207R00000X	NA	Other	026	PHYSICIANS	35705	38	Geriatrics	0	In state provider	None	1800 SULLIVAN AVE	RM 311	DALY CITY	CA	94015	2228	41	06081	37.68077723	-122.4728941	San Mateo County
2505	Fee-for-Service	1215946579	1215946579	1	1	LANCELLOTTI, PAOLA P NP	8/30/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
2513	Fee-for-Service	1871053025	1871053025	1	1	LIZARRAGA, BIANCA MD	12/27/2022	390200000X	NA	Other	026	PHYSICIANS	178536	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
2524	Fee-for-Service	1588738991	1588738991	1	1	LIU, TANE MD	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67013	45	Nephrology (Renal-Kidney)	0	In state provider	None	1200 W GONZALES RD	STE 300	OXNARD	CA	93036	3075	56	06111	34.21910561	-119.1919869	Ventura County
2525	Fee-for-Service	1356454623	1356454623	1	1	LIEBER, DANIEL J MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36051	41	Internal Medicine	0	In state provider	None	2001 SANTA MONICA BLVD	STE 560W	SANTA MONICA	CA	90404	2182	19	06037	34.02891163	-118.4797466	Los Angeles County
2545	Fee-for-Service	1871702852	1871702852	1	1	LANIER, BROCK J MD	6/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130654	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
2548	Fee-for-Service	1073661922	1073661922	1	1	LUEVANOS, LOUIS A MD	1/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	49092	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
2623	Fee-for-Service	1568507259	1568507259	1	1	LABASAN, GERARDO P MD	5/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86436	05	Anesthesiology	0	In state provider	None	9212 MIRA ESTE CT	STE 204	SAN DIEGO	CA	92126	6337	37	06073	32.88927901	-117.1482338	San Diego County
2637	Fee-for-Service	1699979591	1699979591	1	2	LIN, CHRISTINE M MD	7/25/2022	207RC0200X	NA	Other	026	PHYSICIANS	178140	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
2664	Fee-for-Service	1447308028	1447308028	1	1	LAND, KELLY M PSYD	2/23/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
2678	Fee-for-Service	1609173871	1609173871	1	1	LINARES, DEBBIE A LMFT	7/9/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	265 S RANDOLPH AVE	290	BREA	CA	92821	5702	30	06059	33.91513051	-117.8897392	Orange County
2686	Fee-for-Service	1114337326	1114337326	1	2	LEO EICKHOFF MD INC	9/4/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	1825 SONOMA ST	None	REDDING	CA	96001	2519	45	06089	40.5756004	-122.3928987	Shasta County
2696	Fee-for-Service	1073692406	1073692406	1	1	LEDUC MEDICAL GROUP INC	5/22/2013	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	11160 WARNER AVE	SUITE 101	FOUNTAIN VALLEY	CA	92708	4010	30	06059	33.71630854	-117.934317	Orange County
2700	Fee-for-Service	1740861590	1740861590	1	1	LEWIS, MARK MD	1/16/2025	208600000X	NA	General Surgery	026	PHYSICIANS	188704	02	General Surgery	0	In state provider	None	10880 WILSHIRE BLVD	1101	LOS ANGELES	CA	90024	4112	19	06037	34.05897499	-118.4431123	Los Angeles County
2706	Fee-for-Service	1922095256	1922095256	1	1	LEE, DAMON MD	5/31/1987	207R00000X	NA	Other	026	PHYSICIANS	35705	41	Internal Medicine	0	In state provider	None	1800 SULLIVAN AVE	RM 311	DALY CITY	CA	94015	2228	41	06081	37.68077723	-122.4728941	San Mateo County
2737	Fee-for-Service	1326507112	1326507112	1	1	LEDER, JESSICA DO	8/24/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19343	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
2795	Fee-for-Service	1366103368	1366103368	1	1	LA GOOD CARE	12/24/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3415 S SEPULVEDA BLVD	STE 1171	LOS ANGELES	CA	90034	6060	19	06037	34.02086527	-118.4235306	Los Angeles County
2814	Fee-for-Service	1356454623	1356454623	1	1	LIEBER, DANIEL J MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36051	78	Neoplastic Diseases/Oncology	0	In state provider	None	2001 SANTA MONICA BLVD	STE 560W	SANTA MONICA	CA	90404	2182	19	06037	34.02891163	-118.4797466	Los Angeles County
2820	Fee-for-Service	1093886046	1093886046	1	1	LANGER, ROBERT A MD	12/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	43964	07	Dermatology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
2824	Fee-for-Service	1962445221	1962445221	2	1	LONGS DRUG STORES CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1325 W SHIELDS AVE	None	FRESNO	CA	93705	3341	10	06019	36.77927861	-119.8272255	Fresno County
2833	Fee-for-Service	1871702852	1871702852	1	1	LANIER, BROCK J MD	6/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130654	24	Plastic Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
2860	Fee-for-Service	1407440423	1407440423	1	1	LOUIS, PAIGE PT	4/9/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2600 STANWELL DRIVE	SUITE 104	CONCORD	CA	94520	4862	07	06013	37.98689836	-122.047993	Contra Costa County
2866	Fee-for-Service	1053500652	1053500652	2	1	LEVEL HOME HEALTH, INC	7/17/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	260 S LOS ROBLES AVE	SUITE 101	PASADENA	CA	91101	2824	19	06037	34.141437	-118.1413435	Los Angeles County
2878	Fee-for-Service	1255719597	1255719597	1	1	LEE, IVAN MD	6/6/2020	2080P0201X	NA	Neurology	026	PHYSICIANS	143768	43	Pediatric Allergy	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
2894	Fee-for-Service	1558393678	1558393678	1	1	LUCAS EHMER, HEATHER L DO	6/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10369	None	None	0	In state provider	None	300 PASTEUR DR	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
2899	Fee-for-Service	1093941270	1093941270	1	2	LIN, CHRISTIE E PHD	12/12/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
2914	Fee-for-Service	1023724036	1023724036	1	1	LATHERS, KAREN NP	3/18/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23456 HAWTHORNE BLVD	140	TORRANCE	CA	90505	4716	19	06037	33.812631	-118.3510145	Los Angeles County
2944	Fee-for-Service	1790982387	1790982387	1	1	LANDER, RANDIE J LMFT	12/10/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
2958	Fee-for-Service	1104169168	1104169168	1	1	LEW, THOMAS K MD	10/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131684	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
2967	Fee-for-Service	1790980258	1790980258	1	1	LE, DAN V DO	2/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9597	08	Family Practice	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
2971	Fee-for-Service	1518987155	1518987155	1	1	LI, LAWRENCE B MD	4/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	84878	None	None	0	In state provider	None	38485 INLAND VALLEY DRIV	None	WILDOMAR	CA	92595	9681	33	06065	33.59408721	-117.2367937	Riverside County
2987	Fee-for-Service	1073692406	1073692406	1	1	LEDUC MEDICAL GROUP INC	5/22/2013	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	11160 WARNER AVE	SUITE 101	FOUNTAIN VALLEY	CA	92708	4010	30	06059	33.71630854	-117.934317	Orange County
3044	Fee-for-Service	1588229512	1588229512	1	1	LOVEJOY HOMECARE LLC	3/11/2019	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	10293 ROCKINGHAM DRIVE	None	SACRAMENTO	CA	95827	2529	34	06067	38.574288	-121.3074045	Sacramento County
3090	Fee-for-Service	1659647147	1659647147	1	1	LILLI, DANA R MD	4/12/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	171257	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
3095	Fee-for-Service	1366636862	1366636862	1	1	LE, HUONG P MD	4/18/2013	207L00000X	NA	Other	026	PHYSICIANS	118922	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
3099	Fee-for-Service	1407946395	1407946395	1	1	LEWIS CHARLOTTE W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY NE	STE 100	SEATTLE	WA	98105	3954	00	None	47.66165594	-122.2864502	King County
3118	Fee-for-Service	1235165077	1235165077	1	1	LENA ROSE MD	1/2/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
3191	Fee-for-Service	1093289688	1093289688	1	1	LIM, RICHMOND L RCP	6/13/2021	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
3193	Fee-for-Service	1184381550	1184381550	1	1	LENUS HEALTH CARE INC	5/30/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	121 LEXINGTON DR	UNIT B168C	GLENDALE	CA	91203	2230	19	06037	34.1517575	-118.2560706	Los Angeles County
3205	Fee-for-Service	1629558713	1629558713	1	1	LONG BEACH - LAKEWOOD ORTHOP	7/30/2019	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	L & MEDICAL GROUP	3828 SCHAUFELE AVE	STE 320	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
3216	Fee-for-Service	1285673293	1285673293	1	1	LAWTON, CHRISTOPHER S MD	10/29/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	41857	30	Radiology	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
3228	Fee-for-Service	1790857829	1790857829	1	1	LEIVA, CLAUDIA N MD	4/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95246	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
3259	Fee-for-Service	1831592229	1831592229	1	1	LE, STEVEN KHOA-TRAN MD INC	11/6/2014	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	104836	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11100 WARNER AVENUE	SUITE 114	FOUNTAIN VALLEY	CA	92708	7500	30	06059	33.716291	-117.9355051	Orange County
3272	Fee-for-Service	1073692406	1073692406	1	1	LEDUC MEDICAL GROUP INC	5/22/2013	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	11160 WARNER AVE	SUITE 101	FOUNTAIN VALLEY	CA	92708	4010	30	06059	33.71630854	-117.934317	Orange County
3293	Fee-for-Service	1710434279	1710434279	1	1	LO, DAVIS LCSW	10/31/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
3340	Fee-for-Service	1811296858	1811296858	1	1	LANDRUM, ARIEL L M LMFT	1/19/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	91156	-	NOT APPLICABLE	0	In state provider	None	1926 W BEVERLY BLVD	None	LOS ANGELES	CA	90057	2402	19	06037	34.06588198	-118.2686209	Los Angeles County
3344	Fee-for-Service	1265797831	1265797831	1	1	LOSCH, CHRISTIAN LCSW	11/20/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5820 OBERLIN DR	203	SAN DIEGO	CA	92121	3744	37	06073	32.89348634	-117.1937337	San Diego County
3354	Fee-for-Service	1023051877	1023051877	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7 W MAIN ST	None	WOODLAND	CA	95695	3015	57	06113	38.67750051	-121.784571	Yolo County
3382	Fee-for-Service	1487147435	1487147435	1	1	LATON, MATTHEW MD	12/20/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178983	08	Family Practice	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
3488	Fee-for-Service	1194892026	1194892026	1	1	LEE, JULIE H MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76770	41	Internal Medicine	0	In state provider	ATTN MGA OFFICE	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
3493	Fee-for-Service	1629558713	1629558713	1	1	LONG BEACH - LAKEWOOD ORTHOP	7/30/2019	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	46	Hand Surgery	0	In state provider	L & MEDICAL GROUP	3828 SCHAUFELE AVE	STE 320	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
3496	Fee-for-Service	1992299077	1992299077	1	1	LE, ANNIE LCSW	9/6/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
3547	Fee-for-Service	1831592229	1831592229	1	1	LE, STEVEN KHOA-TRAN MD INC	11/6/2014	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	104836	41	Internal Medicine	0	In state provider	None	11100 WARNER AVENUE	SUITE 114	FOUNTAIN VALLEY	CA	92708	7500	30	06059	33.716291	-117.9355051	Orange County
3597	Fee-for-Service	1154536365	1154536365	1	1	LOYDS LIBERTY HOMES INC	3/11/1997	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3301 COLONY OAK ST	None	BAKERSFIELD	CA	93311	2402	15	06029	35.32429089	-119.100501	Kern County
3638	Fee-for-Service	1235117078	1235117078	1	1	LA MONICA, JOANNE M MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54236	34	Urology and Urological Surgery	0	In state provider	None	275 HOSPITAL DRIVE	None	UKIAH	CA	95482	4533	23	06045	39.15305697	-123.2037774	Mendocino County
3646	Fee-for-Service	1073538112	1073538112	1	1	LAZAREFF, JORGE A MD	1/1/1998	207T00000X	NA	General Surgery	026	PHYSICIANS	64276	14	Neurological Surgery	0	In state provider	None	300 MEDICAL PLAZA	STE 200	LOS ANGELES	CA	90024	0000	19	06037	34.06473399	-118.445865	Los Angeles County
3711	Fee-for-Service	1346515632	1346515632	1	1	LEWIS, JONATHAN D MD	7/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
3723	Fee-for-Service	1154855757	1154855757	1	1	LI, KEFU MD	8/28/2020	208M00000X	NA	Other	026	PHYSICIANS	147155	41	Internal Medicine	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
3724	Fee-for-Service	1629777545	1629777545	1	1	LEE, INWHAN J OD	10/30/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
3743	Fee-for-Service	1225517949	1225517949	1	1	LEWIN, RACHAEL PT	5/16/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
3784	Fee-for-Service	1629558713	1629558713	1	1	LONG BEACH - LAKEWOOD ORTHOP	7/30/2019	207X00000X	NA	Orthopedic Surgery	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	L & MEDICAL GROUP	3828 SCHAUFELE AVE	STE 320	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
3799	Fee-for-Service	1386675254	1386675254	1	1	LERAMO, OLUSEGUN B MD	8/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	43014	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2601 OSWELL ST	STE 101	BAKERSFIELD	CA	93306	3173	15	06029	35.39259632	-118.9496489	Kern County
3805	Fee-for-Service	1043398803	1043398803	1	1	LAI, GEORGE MD	6/6/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63853	41	Internal Medicine	0	In state provider	None	377 E CHAPMAN AVE	STE 240	PLACENTIA	CA	92870	5091	30	06059	33.87122847	-117.8635161	Orange County
3841	Fee-for-Service	1811004559	1811004559	1	1	LUM, PAULA J MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53746	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	STE 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
3853	Fee-for-Service	1376773861	1376773861	1	1	LITTLE, NATASHA N LMFT	12/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	SUITE 215	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
3907	Fee-for-Service	1679546907	1679546907	1	1	LABORATORY PRACTICE	12/22/1986	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	10301 BOLSA AVE	STE 204	WESTMINSTER	CA	92683	6784	30	06059	33.74508782	-117.9495976	Orange County
3926	Fee-for-Service	1598293136	1598293136	1	1	LAURY, RAQUELE	7/12/2024	207ZP0102X	NA	Other	026	PHYSICIANS	None	22	Pathology (M.D. only)	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
3964	Fee-for-Service	1053084715	1053084715	1	1	LANDON-LANE, RENEE AU	12/13/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
3981	Fee-for-Service	1881431393	1881431393	1	1	LYNNEA MOLINA LICENSED CLINI	12/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3316 LAGUNA WAY	None	OAKLAND	CA	94602	2818	01	06001	37.79632144	-122.2117852	Alameda County
3989	Fee-for-Service	1467442749	1467442749	1	1	LUCILE SALTER PACKARD	7/3/1989	282NC2000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CHILDRENS HOSP/STANFORD	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
4090	Fee-for-Service	1386675254	1386675254	1	1	LERAMO, OLUSEGUN B MD	8/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	43014	09	Gynecology (D.O. only)	0	In state provider	None	2601 OSWELL ST	STE 101	BAKERSFIELD	CA	93306	3173	15	06029	35.39259632	-118.9496489	Kern County
4130	Fee-for-Service	1801982301	1801982301	1	1	LERNER, GARY R MD	8/1/1996	2080P0210X	NA	Nephrology	026	PHYSICIANS	40014	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
4194	Fee-for-Service	1598862922	1598862922	1	1	LOPEZ, RICARDO PT	3/11/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6133 BRISTOL PKWY	STE 200	CULVER CITY	CA	90230	6670	19	06037	33.98472747	-118.3891179	Los Angeles County
4202	Fee-for-Service	1366824807	1366824807	1	1	LEE, MICHELLE DO	6/28/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	18862	None	None	0	In state provider	None	1111 EXPOSITION BLVD	STE 400A	SACRAMENTO	CA	95815	4336	34	06067	38.598876	-121.4502885	Sacramento County
4229	Fee-for-Service	1376543975	1376543975	1	1	LIU, SHAOXIONG MD	3/6/2023	207L00000X	NA	Other	026	PHYSICIANS	54050	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
4231	Fee-for-Service	1720070121	1720070121	1	1	LOTA, MUNIR M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	655 E. MED CTR BLVD	None	WEBSTER	TX	77598	4328	00	None	29.54726197	-95.11676047	Harris County
4244	Fee-for-Service	1063945962	1063945962	1	1	LIEU, VIRGINIA Y MD	5/12/2022	390200000X	NA	Other	026	PHYSICIANS	158873	None	None	0	In state provider	None	6620 COYLE AVE	STE 212	CARMICHAEL	CA	95608	6337	34	06067	38.66751	-121.310028	Sacramento County
4260	Fee-for-Service	1235821893	1235821893	1	1	LOS ANGELES CENTER FOR ALCOH	6/15/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	OL AND DRUG ABUSE	9300 SANTA FE SPRINGS RD	None	SANTA FE SPRINGS	CA	90670	2621	19	06037	33.95558756	-118.0540452	Los Angeles County
4262	Fee-for-Service	1457420978	1457420978	1	1	LYNTON, RICHARD C MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	70542	41	Internal Medicine	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
4278	Fee-for-Service	1467442749	1467442749	1	1	LUCILE SALTER PACKARD	7/3/1989	282NC2000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CHILDRENS HOSP/STANFORD	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
4295	Fee-for-Service	1891764833	1891764833	1	1	LAHIJANI, SHERMIN	8/24/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1300 N VERMONT AVE	DOCTORS TOWER STE 101	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
4302	Fee-for-Service	1316969934	1316969934	1	1	LOS ANGELES CO	7/1/2000	282N00000X	NA	Hospitals	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	LA CO OLIVE VIEW-UCLA	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	19	06037	34.32450186	-118.4456317	Los Angeles County
4316	Fee-for-Service	1639338502	1639338502	1	1	LUNG, AUDREY E MD	11/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96457	40	Pediatrics	0	In state provider	None	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
4335	Fee-for-Service	1265450621	1265450621	1	1	LEE, MANSUR H MD	8/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94778	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
4376	Fee-for-Service	1386675254	1386675254	1	1	LERAMO, OLUSEGUN B MD	8/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	43014	14	Neurological Surgery	0	In state provider	None	2601 OSWELL ST	STE 101	BAKERSFIELD	CA	93306	3173	15	06029	35.39259632	-118.9496489	Kern County
4390	Fee-for-Service	1073176723	1073176723	1	1	LYNCH, FREDERICK T MD	7/13/2022	207P00000X	NA	Other	026	PHYSICIANS	179421	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
4412	Fee-for-Service	1699066928	1699066928	1	1	LAU, JESSICA W Y NP	5/4/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	517 S MYRTLE AVE	SUITE 101	MONROVIA	CA	91016	6100	19	06037	34.14639513	-118.0009744	Los Angeles County
4415	Fee-for-Service	1912324054	1912324054	1	1	LAGUNA, BENJAMIN A MD	6/21/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	138890	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
4419	Fee-for-Service	1801982301	1801982301	1	1	LERNER, GARY R MD	8/1/1996	2080P0210X	NA	Nephrology	026	PHYSICIANS	40014	79	Neurology-Child	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
4439	Fee-for-Service	1982642153	1982642153	1	1	LILLEY, JAMES C MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	81163	20	Orthopedic Surgery	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
4443	Fee-for-Service	1790129245	1790129245	1	1	LIN, WILSON MD	7/18/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	131826	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
4477	Fee-for-Service	1043455363	1043455363	1	1	LAM, HARRY C MD	12/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104293	41	Internal Medicine	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
4529	Fee-for-Service	1548332349	1548332349	1	1	LAWSON, DEBORAH D	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	63309	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
4543	Fee-for-Service	1881821080	1881821080	1	1	LEVAKA, RADHIKA MD	8/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114247	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
4579	Fee-for-Service	1780899484	1780899484	1	1	LA MAESTRA FAMILY CLINIC	10/1/2006	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	165 S 1ST ST	None	EL CAJON	CA	92019	4795	37	06073	32.794002	-116.944563	San Diego County
4590	Fee-for-Service	1316969934	1316969934	1	1	LOS ANGELES CO	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	LA CO OLIVE VIEW-UCLA	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	19	06037	34.32450186	-118.4456317	Los Angeles County
4620	Fee-for-Service	1477866846	1477866846	1	1	LEE, NAMJONG S DPM	9/17/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
4624	Fee-for-Service	1609062744	1609062744	1	1	LONERGAN, DEVIN M MD	9/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	96479	04	Otology, Laryngology, Rhinology	0	In state provider	None	1701 4TH ST	STE 120	SANTA ROSA	CA	95404	3661	49	06097	38.448801	-122.699439	Sonoma County
4692	Fee-for-Service	1023377660	1023377660	1	1	LANGSTON, ANGELIQUE M LCSW	1/14/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
4729	Fee-for-Service	1982642153	1982642153	1	1	LILLEY, JAMES C MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	81163	46	Hand Surgery	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
4743	Fee-for-Service	1609239227	1609239227	1	1	LEUNG, KENNETH K MD	10/18/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	150593	None	None	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
4750	Fee-for-Service	1194846725	1194846725	1	1	LAM, BRIAN T LCSW	11/1/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16052 BEACH BLVD	214	HUNTINGTON BEACH	CA	92647	3801	30	06059	33.72889962	-117.9891397	Orange County
4782	Fee-for-Service	1104210426	1104210426	1	1	LEE, REBECCA MD	7/22/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
4827	Fee-for-Service	1942464623	1942464623	1	1	LOOP CARE, INC	7/3/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	522 EAST 157TH STREET	None	GARDENA	CA	90248	2517	19	06037	33.8895165	-118.267551	Los Angeles County
4861	Fee-for-Service	1477633402	1477633402	1	1	LUNDQUIST, CHRISTOPHER R	11/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	45191	01	General Practice	0	In state provider	MD	2874 E IMPERIAL HWY	None	BREA	CA	92821	6714	30	06059	33.91098502	-117.85851	Orange County
4884	Fee-for-Service	1366576662	1366576662	1	1	LANGEWISCH, EIRC D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PARK	None	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
4885	Fee-for-Service	1316022072	1316022072	1	1	LIPPERT, RANDOLPH MD	6/28/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	36664	03	Allergy	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
4886	Fee-for-Service	1043555956	1043555956	1	1	LAWRENCE HEARING SERVICES	8/21/2015	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	INC	2777 JEFFERSON ST	STE 101	CARLSBAD	CA	92008	1743	37	06073	33.16370246	-117.3476018	San Diego County
4887	Fee-for-Service	1407563307	1407563307	1	1	LOS ALAMITOS WOMEN'S HEALTH	2/13/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	INCORPORATED	10861 CHERRY ST	STE 109	LOS ALAMITOS	CA	90720	5400	30	06059	33.80465174	-118.0680053	Orange County
4894	Fee-for-Service	1750895017	1750895017	1	1	LAU, VICTOR CRNA	3/5/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
4916	Fee-for-Service	1932398989	1932398989	1	1	LABANA, SUBIR S MD	2/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134868	41	Internal Medicine	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
4922	Fee-for-Service	1265068050	1265068050	1	1	LEU, KATHERINE S NP	8/18/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
4924	Fee-for-Service	1821038985	1821038985	1	1	LIRA, JOSE A MD INC	12/11/2002	207R00000X	NA	Other	026	PHYSICIANS	30733	41	Internal Medicine	0	In state provider	None	5475 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02627053	-117.684846	San Bernardino County
4940	Fee-for-Service	1306350699	1306350699	1	1	LUGA HOME HEALTH CARE	8/29/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC	121 W LEXINGTON DR	SUITE 202	GLENDALE	CA	91203	2203	19	06037	34.1517575	-118.2560706	Los Angeles County
4970	Fee-for-Service	1477904837	1477904837	1	1	LAM, CARMEN DO	11/29/2022	390200000X	NA	Other	026	PHYSICIANS	19825	None	None	0	In state provider	None	3003 OAK RD	STE 103 & 104	WALNUT CREEK	CA	94597	4500	07	06013	37.92940805	-122.0581829	Contra Costa County
4979	Fee-for-Service	1427510973	1427510973	1	1	LIU, JESSICA T DO	4/18/2023	207L00000X	NA	Other	026	PHYSICIANS	20782	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
4980	Fee-for-Service	1053873356	1053873356	1	1	LOPEZ, MONIQUE Y MD	8/10/2022	208M00000X	NA	Other	026	PHYSICIANS	178955	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
5004	Fee-for-Service	1851620439	1851620439	1	1	LEE, DAE P PSYD	5/20/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	12220 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28134147	-118.4023977	Los Angeles County
5017	Fee-for-Service	1336414689	1336414689	1	1	LIESER, STEPHANIE M MD	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130969	40	Pediatrics	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
5024	Fee-for-Service	1194748541	1194748541	1	1	LEE, SIMON K MD APC	7/18/2008	207R00000X	NA	Other	026	PHYSICIANS	83169	41	Internal Medicine	0	In state provider	None	950 STOCKTON STREET	SUITE 202	SAN FRANCISCO	CA	94108	1619	38	06075	37.79469747	-122.4079497	San Francisco County
5041	Fee-for-Service	1346231644	1346231644	1	1	LABSON, JERRY D MD	2/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	60918	08	Family Practice	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
5062	Fee-for-Service	1427274679	1427274679	1	1	LESSER, DANIEL J MD	4/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89883	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
5087	Fee-for-Service	1295915601	1295915601	1	1	LY, KA B LCSW	7/19/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
5098	Fee-for-Service	1104311216	1104311216	1	1	LIU, FANG-YU MD	10/28/2021	207R00000X	NA	Other	026	PHYSICIANS	173998	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
5139	Fee-for-Service	1902202765	1902202765	1	1	LEWIS, ALISHA C CNM	5/26/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
5154	Fee-for-Service	1902092034	1902092034	1	1	LAKHA, RUMI K DO	9/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	5074	08	Family Practice	0	In state provider	None	711 N ALVARADO ST	STE 101	LOS ANGELES	CA	90026	4016	19	06037	34.07424293	-118.2655575	Los Angeles County
5168	Fee-for-Service	1063536431	1063536431	1	1	LEE, KEVIN T MD	3/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99354	08	Family Practice	0	In state provider	None	5739 ROSEMEAD BLVD	None	TEMPLE CITY	CA	91780	1850	19	06037	34.10421459	-118.0737197	Los Angeles County
5186	Fee-for-Service	1871645143	1871645143	1	1	LUCKMAN, JEAN B LCSW	4/1/2001	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1037 W YOSEMITE AVE	APT 4	MERCED	CA	95348	2162	24	06047	37.3322175	-120.4854705	Merced County
5216	Fee-for-Service	1922047752	1922047752	1	1	LINKER, CAREY S MD	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	74439	30	Radiology	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
5227	Fee-for-Service	1114313145	1114313145	1	1	LEE, BRIAN A MD	5/27/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	172123	None	None	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
5231	Fee-for-Service	1538149778	1538149778	1	1	LARGE, RANDY S DO	11/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	5330 SOUTH HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
5239	Fee-for-Service	1396911806	1396911806	1	1	LAUREL PEDIATRICS	7/2/2014	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	3055 MACARTHUR BLVD	None	OAKLAND	CA	94602	3211	01	06001	37.79662303	-122.20399	Alameda County
5296	Fee-for-Service	1114030095	1114030095	1	1	LEON, HUGO A JR MD	9/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96477	08	Family Practice	0	In state provider	None	1040 MANGROVE AVENUE	None	CHICO	CA	95926	3509	04	06007	39.7403994	-121.8373152	Butte County
5306	Fee-for-Service	1215913058	1215913058	1	1	LAWRENCE, KEVIN O MD	4/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84093	25	Physical Medicine and Rehabilitation	0	In state provider	None	538 MISSION ST	None	SOUTH PASADENA	CA	91030	3036	19	06037	34.11573349	-118.163565	Los Angeles County
5312	Fee-for-Service	1881836104	1881836104	1	1	LEE, MARC B MD	2/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120286	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
5316	Fee-for-Service	1841077450	1841077450	1	1	LUGO, BRIANA DOULA	1/3/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
5328	Fee-for-Service	1669091393	1669091393	1	1	LAO, BREANNA BELLE MD	12/18/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
5329	Fee-for-Service	1346231644	1346231644	1	1	LABSON, JERRY D MD	2/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	60918	20	Orthopedic Surgery	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
5332	Fee-for-Service	1265797146	1265797146	1	1	LIM, STEPHANIE Z PHD	5/21/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
5348	Fee-for-Service	1992866412	1992866412	1	1	LITTLE, JAMES B MD	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	910 VIA DE LA PAZ	STE 101	PACIFIC PALISADES	CA	90272	3538	19	06037	34.04731974	-118.5270397	Los Angeles County
5351	Fee-for-Service	1043398894	1043398894	1	1	LOWE, XIU R MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75892	36	Psychiatry	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
5352	Fee-for-Service	1568475333	1568475333	1	1	LEE, JASON T MD	12/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	70898	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
5364	Fee-for-Service	1538502414	1538502414	1	1	LAROCCA, THOMAS J MD	5/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135487	40	Pediatrics	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
5372	Fee-for-Service	1447219720	1447219720	1	1	LANIER, BRENT J MD	5/24/1995	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	50104	04	Otology, Laryngology, Rhinology	0	In state provider	None	1351 E SPRUCE AVE	None	FRESNO	CA	93720	3342	10	06019	36.84136088	-119.7588077	Fresno County
5379	Fee-for-Service	1124222732	1124222732	1	1	LU, SEYMOUR C MD	7/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98949	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
5416	Fee-for-Service	1780896027	1780896027	1	1	LIVINGSTON-CARR, JEFFREY D M	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	99970	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
5431	Fee-for-Service	1225092596	1225092596	1	1	LEONG, STANLEY P L MD	9/30/1990	208600000X	NA	General Surgery	026	PHYSICIANS	38735	02	General Surgery	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
5441	Fee-for-Service	1659763589	1659763589	1	1	LATTY, KENDRA L CNP	7/28/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1150 BAKER ST	None	COSTA MESA	CA	92626	4111	30	06059	33.68015852	-117.906831	Orange County
5492	Fee-for-Service	1194258707	1194258707	1	1	LEONG, JEFFREY MD	6/7/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	158987	-	NOT APPLICABLE	0	In state provider	None	14140 BEACH BLVD	STE 120, 155, 200	WESTMINSTER	CA	92683	4453	30	06059	33.756966	-117.9894915	Orange County
5501	Fee-for-Service	1588879837	1588879837	1	1	LE, LOAN M DO	1/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9760	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
5511	Fee-for-Service	1205271590	1205271590	1	1	LICHTE, MELISSA L MD	12/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133585	01	General Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 210	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
5594	Fee-for-Service	1891165155	1891165155	1	1	LOO, MARILEN E NP	9/18/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	14011 PARK AVE	None	VICTORVILLE	CA	92392	2413	36	06071	34.505647	-117.3265457	San Bernardino County
5597	Fee-for-Service	1942566443	1942566443	1	1	LEE, CHRISTOPHER MD	8/29/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	130829	20	Orthopedic Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
5637	Fee-for-Service	1801974332	1801974332	1	1	LEVINE, MARC A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31455	02	General Surgery	0	In state provider	None	909 HYDE ST	STE 325	SAN FRANCISCO	CA	94109	4841	38	06075	37.78939387	-122.4170945	San Francisco County
5647	Fee-for-Service	1194205195	1194205195	1	1	LANSANGAN, PAOLO RCP	10/26/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
5648	Fee-for-Service	1124386909	1124386909	1	1	LOVE, BRYAN E MD	9/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	126011	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
5657	Fee-for-Service	1861926024	1861926024	1	1	LEE, CHIH-HAN MD	12/29/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	159632	None	None	0	In state provider	None	11165 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1113	19	06037	34.2738618	-118.4678337	Los Angeles County
5680	Fee-for-Service	1376710350	1376710350	1	1	LOUIE, KINGMAN J OD	9/1/1979	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7215 FLORIN MALL DR	None	SACRAMENTO	CA	95823	2783	34	06067	38.494863	-121.4337645	Sacramento County
5682	Fee-for-Service	1164500914	1164500914	1	1	LEHMER, JEFFREY M MD INC	7/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	68581	18	Ophthalmology	0	In state provider	CENTRL VLY RETINA MED	5329 OFFICE CENTER CT	STE 120	BAKERSFIELD	CA	93309	7400	15	06029	35.3605026	-119.061931	Kern County
5702	Fee-for-Service	1841725413	1841725413	1	1	LUU, RONALD T MD	2/6/2020	207P00000X	NA	Other	026	PHYSICIANS	158264	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
5736	Fee-for-Service	1982932877	1982932877	1	1	LIEM, DAVID J	10/28/2012	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1390 S BEACH BLVD	None	LA HABRA	CA	90631	6374	30	06059	33.91385482	-117.9710903	Orange County
5748	Fee-for-Service	1265851893	1265851893	1	1	LEUNG, STEVEN C MD	8/1/2022	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	167872	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
5751	Fee-for-Service	1164941092	1164941092	1	1	LONGEVITY METRICS MEDICAL GR	2/7/2018	207SG0201X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	OUP INC	320 SUPERIOR AVE	SUITE 280	NEWPORT BEACH	CA	92663	6140	30	06059	33.62657138	-117.9330754	Orange County
5755	Fee-for-Service	1386796704	1386796704	2	1	LAM, PHU V OD	6/21/2010	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	333 W GARVEY AVE	#D	MONTEREY PARK	CA	91754	7498	19	06037	34.06255751	-118.127178	Los Angeles County
5773	Fee-for-Service	1225216393	1225216393	1	1	LACUNA, EDUARDO M B JR MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109359	None	None	0	In state provider	None	1552 COFFEE RD	1ST FL	MODESTO	CA	95355	3107	50	06099	37.666872	-120.975684	Stanislaus County
5789	Fee-for-Service	1538168372	1538168372	2	2	LIFENET, INC.	2/5/2022	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	155 KAPALULU PL	STE 103	HONOLULU	HI	96819	1826	00	None	21.32047557	-157.9107422	City and County of Honolulu
5801	Fee-for-Service	1851429369	1851429369	1	1	LI, LORETTA M OD	12/1/1982	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9022 BOLSA AVE	None	WESTMINSTER	CA	92683	5531	30	06059	33.744693	-117.9713148	Orange County
5807	Fee-for-Service	1164635108	1164635108	1	1	LEE, CHIA-YI J MD	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93476	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
5828	Fee-for-Service	1013232859	1013232859	1	1	LEE, WINSTON Y MD	11/3/2022	207ZH0000X	NA	Other	026	PHYSICIANS	183081	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
5875	Fee-for-Service	1083066740	1083066740	1	1	LEIBNER, NICHOLAS K	12/21/2016	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2700 N MAIN ST	STE 340	SANTA ANA	CA	92705	6634	30	06059	33.7737545	-117.8687284	Orange County
5896	Fee-for-Service	1790250751	1790250751	1	1	LEE, SANNA J CRNA	10/14/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
5900	Fee-for-Service	1154772515	1154772515	1	1	LU, JOYCE MD	9/16/2021	2086S0129X	NA	General Surgery	026	PHYSICIANS	170348	None	None	0	In state provider	None	820 S AKERS ST	STE 100	VISALIA	CA	93277	8306	54	06107	36.323757	-119.3491755	Tulare County
5929	Fee-for-Service	1396161980	1396161980	1	1	LARSON, BRENT K DO	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12618	22	Pathology (M.D. only)	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
5967	Fee-for-Service	1053345637	1053345637	1	1	LE, DINH V DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	WEST LANE CHIROPRACTIC	7743 WEST LN	STE A4	STOCKTON	CA	95210	3350	39	06077	38.01951553	-121.2949841	San Joaquin County
5997	Fee-for-Service	1073678504	1073678504	1	1	LIU, HONG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
6076	Fee-for-Service	1699188854	1699188854	1	1	LOPEZ, JOE LMFT	12/7/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
6079	Fee-for-Service	1598791907	1598791907	1	1	LOSCH, MARTHA S MD	1/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75910	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
6105	Fee-for-Service	1730122581	1730122581	2	1	LONGS DRUG STORE CAL LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3475 MCKEE AVE	None	SAN JOSE	CA	95127	2233	43	06085	37.38070827	-121.8273776	Santa Clara County
6117	Fee-for-Service	1427550102	1427550102	1	1	LOVIE, MACKENZIE L LCSW	1/20/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1300 OLIVER ROAD	193 & 195	FAIRFIELD	CA	94534	3413	48	06095	38.25596102	-122.0674133	Solano County
6134	Fee-for-Service	1598846859	1598846859	1	1	LARKIN, KATHLEEN L MD	11/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98733	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
6138	Fee-for-Service	1164702361	1164702361	1	1	LEON, CRISTINA P LCSW	5/11/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
6186	Fee-for-Service	1538302260	1538302260	1	1	LENNARD CARL JENSEN D.O.	3/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3460 S PIONEER PKWY	None	WEST VALLEY	UT	84120	2049	00	None	40.697982	-111.9903965	Salt Lake County
6200	Fee-for-Service	1932201258	1932201258	1	1	LE, JONATHAN L MD	1/25/2011	208200000X	NA	General Surgery	026	PHYSICIANS	83710	24	Plastic Surgery	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
6207	Fee-for-Service	1922595602	1922595602	1	1	LORENTE, OMAR B LMFT	11/13/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
6223	Fee-for-Service	1508917204	1508917204	1	1	LINAM,MARK S DPM	8/31/1988	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	NAL CORP	12820 STUDEBAKER RD	STE 200	NORWALK	CA	90650	2583	19	06037	33.91419086	-118.0991425	Los Angeles County
6224	Fee-for-Service	1578815809	1578815809	2	1	LUECK, KELLY J NP	2/18/2021	208D00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
6227	Fee-for-Service	1881892792	1881892792	1	1	LANG, KING-HWA LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
6238	Fee-for-Service	1013548734	1013548734	1	1	LIBRA HOSPICE CARE INC	7/27/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1259 S GLENDALE AVE	SUITE E	GLENDALE	CA	91205	3280	19	06037	34.13003451	-118.2525595	Los Angeles County
6246	Fee-for-Service	1700950136	1700950136	1	2	LOUKA, SAMY E MD	11/9/2016	207L00000X	NA	Other	026	PHYSICIANS	89609	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
6279	Fee-for-Service	1508298332	1508298332	1	1	LIM-VU, RACHEL LMFT	4/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
6287	Fee-for-Service	1366627069	1366627069	1	1	LEU, GRACE MD	12/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104297	84	Surgery-Head and Neck	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
6298	Fee-for-Service	1265793566	1265793566	1	1	LI, ANJIE MD	6/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143101	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
6300	Fee-for-Service	1568753069	1568753069	1	1	LIU, ERIC T MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123483	30	Radiology	0	In state provider	None	10833 LE CONTE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
6316	Fee-for-Service	1013408731	1013408731	1	1	LARIVIERE, MARISE LMFT	7/2/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3101 GLENDALE BLVD	None	LOS ANGELES	CA	90039	1805	19	06037	34.11622921	-118.2629015	Los Angeles County
6324	Fee-for-Service	1366512469	1366512469	1	1	LEON, HILDA C LMFT	11/8/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4371 SONOMA HIGHWAY	None	SANTA ROSA	CA	95409	4132	49	06097	38.45797206	-122.6762409	Sonoma County
6351	Fee-for-Service	1548559370	1548559370	1	1	LEE, JULIANNE J Y MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141596	05	Anesthesiology	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
6356	Fee-for-Service	1316109275	1316109275	1	1	LEVINE, MARIA MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116208	36	Psychiatry	0	In state provider	None	4650 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
6386	Fee-for-Service	1104360932	1104360932	1	1	LAW, MANDY LMFT	12/2/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
6395	Fee-for-Service	1396106282	1396106282	1	1	LIN, EDWARD B DO	5/7/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15831	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
6429	Fee-for-Service	1285934802	1285934802	1	1	LEONARD, JENNIFER A LMFT	9/18/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	205 CLAYDELLE AVE	206	EL CAJON	CA	92020	4556	37	06073	32.79381683	-116.9587603	San Diego County
6439	Fee-for-Service	1770648586	1770648586	1	1	LACAYO, NORMAN JAMES MD	1/31/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	71335	40	Pediatrics	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
6440	Fee-for-Service	1184095531	1184095531	1	1	LONG, TESI T LCSW	4/2/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	110038	-	NOT APPLICABLE	0	In state provider	None	560 COHASSET ROAD	STE 165	CHICO	CA	95926	2460	04	06007	39.7519137	-121.8477606	Butte County
6442	Fee-for-Service	1932201589	1932201589	1	1	LOWE, SPENCER L MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	35173	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3132 W MARCH LN	STE 2	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
6451	Fee-for-Service	1760490312	1760490312	1	1	LING, JACK C MD INC	7/31/1989	207L00000X	NA	Other	026	PHYSICIANS	37386	05	Anesthesiology	0	In state provider	None	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
6477	Fee-for-Service	1790823011	1790823011	1	1	LEAMY, DONALD P MA	2/8/2015	237600000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2674 E MAIN ST	STE I	VENTURA	CA	93003	2800	56	06111	34.27388698	-119.2602437	Ventura County
6486	Fee-for-Service	1831354307	1831354307	1	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	333 ACADEMY AVE	None	SANGER	CA	93657	2408	10	06019	36.71145436	-119.5570034	Fresno County
6503	Fee-for-Service	1487876348	1487876348	1	1	LUANZON, RONALDO MD	9/16/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
6520	Fee-for-Service	1508929407	1508929407	1	1	LEE, DAVID S	12/7/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8351 ELK GROVE BLVD	STE 200	ELK GROVE	CA	95758	5515	34	06067	38.409813	-121.3964415	Sacramento County
6526	Fee-for-Service	1245626712	1245626712	1	1	LANE, KYRSTIN MD	7/24/2020	207RE0101X	NA	Endocrinology	026	PHYSICIANS	155305	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
6528	Fee-for-Service	1013548734	1013548734	1	1	LIBRA HOSPICE CARE INC	7/27/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1259 S GLENDALE AVE	SUITE E	GLENDALE	CA	91205	3280	19	06037	34.13003451	-118.2525595	Los Angeles County
6549	Fee-for-Service	1093700064	1093700064	1	1	LIANG, PAULYNNE P MD	6/22/2009	207R00000X	NA	Other	026	PHYSICIANS	66406	41	Internal Medicine	0	In state provider	None	1211 W LA PALMA AVE	STE 303	ANAHEIM	CA	92801	2811	30	06059	33.84718298	-117.933758	Orange County
6564	Fee-for-Service	1215949524	1215949524	1	1	LONGJOHN, DONALD BLAIR	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	72658	20	Orthopedic Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 322	LOS ANGELES	CA	90033	5305	19	06037	34.06287152	-118.2029433	Los Angeles County
6571	Fee-for-Service	1861529133	1861529133	1	1	LOPES, INGRID C DO	7/17/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	6731	08	Family Practice	0	In state provider	None	528 CAPITOLA AVE	None	CAPITOLA	CA	95010	2750	44	06087	36.97685082	-121.9534096	Santa Cruz County
6581	Fee-for-Service	1619960705	1619960705	1	1	LEE, WILLIAM A MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50628	77	Infectious Disease	0	In state provider	None	9240 GARDEN GROVE BLVD	STE 15	GARDEN GROVE	CA	92844	1400	30	06059	33.77385717	-117.9712457	Orange County
6631	Fee-for-Service	1598798118	1598798118	1	1	LATHY, WALTER E LMFT	9/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3160 TELEGRAPH RD	STE 200	VENTURA	CA	93003	3250	56	06111	34.27228149	-119.2529119	Ventura County
6664	Fee-for-Service	1992334262	1992334262	1	1	LEWIS, KATHRYN E MD	7/2/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	500 SOUTH ANAHEIM HILLS	234	ANAHEIM	CA	92856	6526	30	06059	33.8427954	-117.7772895	Orange County
6666	Fee-for-Service	1073690087	1073690087	1	1	LOWE, JANICE A MD	11/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87306	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
6670	Fee-for-Service	1932227626	1932227626	1	1	LEE, BRIAN W MD	9/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97884	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
6677	Fee-for-Service	1235197138	1235197138	1	1	LEVIN, STELLA OD	1/27/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2687 CASTRO VALLEY BLVD	None	CASTRO VALLEY	CA	94546	4405	01	06001	37.69413822	-122.0867719	Alameda County
6704	Fee-for-Service	1629012067	1629012067	2	1	LONGS DRUG STORE CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1471 W COVELL BLVD	None	DAVIS	CA	95616	5932	57	06113	38.56098067	-121.7664661	Yolo County
6713	Fee-for-Service	1467512509	1467512509	1	1	LEVENTHAL, BENNETT L MD	5/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56029	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
6726	Fee-for-Service	1770648586	1770648586	1	1	LACAYO, NORMAN JAMES MD	1/31/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	71335	68	Hematology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
6729	Fee-for-Service	1932201589	1932201589	1	1	LOWE, SPENCER L MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	35173	04	Otology, Laryngology, Rhinology	0	In state provider	None	3132 W MARCH LN	STE 2	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
6767	Fee-for-Service	1336227024	1336227024	1	1	LACAYO, KARLA T MD	5/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88556	36	Psychiatry	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
6773	Fee-for-Service	1134103484	1134103484	1	1	LOWMAN, DENNIS G OD	4/27/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	56970 YUCCA TRL	# 100	YUCCA VALLEY	CA	92284	3753	36	06071	34.12059645	-116.420985	San Bernardino County
6781	Fee-for-Service	1699302091	1699302091	1	1	LEE, CHRISTOPHER M MD	3/4/2024	207L00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
6794	Fee-for-Service	1720094501	1720094501	1	1	LE, HANSEN DO	7/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8087	05	Anesthesiology	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
6796	Fee-for-Service	1962664771	1962664771	1	1	LERMA, AMBER F MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125837	26	Psychiatry (child)	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
6799	Fee-for-Service	1336640226	1336640226	1	1	LEAKE, MADELEINE B PSYD	9/5/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
6813	Fee-for-Service	1245626712	1245626712	1	1	LANE, KYRSTIN MD	7/24/2020	207RE0101X	NA	Endocrinology	026	PHYSICIANS	155305	67	Endocrinology	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
6856	Fee-for-Service	1720584378	1720584378	1	1	LAVENDER, CHARLES MD	4/11/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	176557	10	Gastroenterology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
6864	Fee-for-Service	1881613412	1881613412	1	1	LEE, BYONG-WHA E MD	7/1/1993	207R00000X	NA	Other	026	PHYSICIANS	68100	41	Internal Medicine	0	In state provider	None	11165 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1113	19	06037	34.2738618	-118.4678337	Los Angeles County
6873	Fee-for-Service	1497914691	1497914691	1	1	LANCASTER, SAMANTHA C MD	1/7/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	147021	None	None	0	In state provider	None	830 2ND ST	STE A	SANTA ROSA	CA	95404	4620	49	06097	38.440746	-122.7085605	Sonoma County
6882	Fee-for-Service	1467831420	1467831420	1	1	LIN, BONNIE DPM APC	7/27/2015	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	705 W LA VETA AVE	SUITE 100	ORANGE	CA	92868	4402	30	06059	33.78062272	-117.8600738	Orange County
6899	Fee-for-Service	1184067852	1184067852	1	1	LEE, KENNETH H MD	1/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138214	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
6908	Fee-for-Service	1659909141	1659909141	1	1	LEONE, MARIANA MD	6/19/2023	390200000X	NA	Other	026	PHYSICIANS	185744	None	None	0	In state provider	None	1332 NATIVIDAD RD	C	SALINAS	CA	93906	3133	27	06053	36.69909137	-121.635247	Monterey County
6943	Fee-for-Service	1063775104	1063775104	1	1	LINK, JAMES T MD	7/1/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	127331	78	Neoplastic Diseases/Oncology	0	In state provider	None	715 TANK FARM RD	STE C	SAN LUIS OBISPO	CA	93401	7068	40	06079	35.24853234	-120.642458	San Luis Obispo County
6975	Fee-for-Service	1417344128	1417344128	1	1	LARROW, ANNIE MD	10/21/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	147181	40	Pediatrics	0	In state provider	None	7910 FROST ST	STE 350	SAN DIEGO	CA	92123	2753	37	06073	32.80027449	-117.153846	San Diego County
6987	Fee-for-Service	1417426248	1417426248	1	1	LEE, KYONG-JIN MD	12/8/2020	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	170504	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
7056	Fee-for-Service	1003078981	1003078981	1	1	LEE, PAUL C MD	8/26/2019	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	110986	25	Physical Medicine and Rehabilitation	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
7085	Fee-for-Service	1912105297	1912105297	1	1	LEE, JAE H MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109172	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
7126	Fee-for-Service	1235119835	1235119835	1	1	LEVIN, LARRY C MD	1/1/1982	207RE0101X	NA	Endocrinology	026	PHYSICIANS	28019	67	Endocrinology	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
7182	Fee-for-Service	1871500199	1871500199	1	1	LIU, CHAO-HSU J MD	3/14/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	69528	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
7191	Fee-for-Service	1689602609	1689602609	1	1	LIN, JOHN MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77035	41	Internal Medicine	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
7220	Fee-for-Service	1447442504	1447442504	1	1	LEE, PERCY P MD	8/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88897	78	Neoplastic Diseases/Oncology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
7230	Fee-for-Service	1063775104	1063775104	1	1	LINK, JAMES T MD	7/1/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	127331	41	Internal Medicine	0	In state provider	None	715 TANK FARM RD	STE C	SAN LUIS OBISPO	CA	93401	7068	40	06079	35.24853234	-120.642458	San Luis Obispo County
7233	Fee-for-Service	1740267046	1740267046	1	1	LEE, STEVEN W MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	77498	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
7244	Fee-for-Service	1891447066	1891447066	1	1	LY, NICOLE LCSW	11/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	SUITE 465	ENCINO	CA	91436	4620	19	06037	34.15682212	-118.4871886	Los Angeles County
7253	Fee-for-Service	1225732761	1225732761	1	1	LEVERETTE, LORNA	4/22/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
7256	Fee-for-Service	1871558627	1871558627	1	1	LEE, RAY J MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98008	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
7282	Fee-for-Service	1962578955	1962578955	1	1	LEE, ALEX L MD	12/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99563	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
7348	Fee-for-Service	1679709166	1679709166	1	1	LONG, ELIZABETH LMFT	3/6/2025	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	512 PAULDING CIR	None	ARROYO GRANDE	CA	93420	2857	40	06079	35.12480448	-120.5741901	San Luis Obispo County
7353	Fee-for-Service	1417511205	1417511205	1	1	LIMA NOBRE DE QUEIROZ, FELLI	12/12/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181652	None	None	0	In state provider	PE MD	40595 WESTLAKE DRIVE	None	OAKHURST	CA	93644	9024	20	06039	37.33873736	-119.6691473	Madera County
7379	Fee-for-Service	1568882801	1568882801	1	1	LANDINEZ, GINA P MD	2/10/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171376	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
7410	Fee-for-Service	1235119835	1235119835	1	1	LEVIN, LARRY C MD	1/1/1982	207RE0101X	NA	Endocrinology	026	PHYSICIANS	28019	41	Internal Medicine	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
7416	Fee-for-Service	1851569784	1851569784	1	1	LINDER PSYCHIATRIC GROUP, IN	7/24/2020	1041C0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	C.	508 GISON DRIVE	SUITE 150	ROSEVILLE	CA	95650	1234	31	06061	38.77866166	-121.2745528	Placer County
7458	Fee-for-Service	1003198342	1003198342	1	2	LA JOLLA SKILLED INC	4/8/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3884 NOBEL DR	None	SAN DIEGO	CA	92122	5700	37	06073	32.8685973	-117.2228979	San Diego County
7479	Fee-for-Service	1689602609	1689602609	1	1	LIN, JOHN MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77035	40	Pediatrics	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
7498	Fee-for-Service	1801345772	1801345772	1	1	LAKE MERRITT HEALTHCARE	11/1/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER LLC	309 MACARTHUR BLVD	None	OAKLAND	CA	94610	3233	01	06001	37.81428418	-122.2515188	Alameda County
7516	Fee-for-Service	1063775104	1063775104	1	1	LINK, JAMES T MD	7/1/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	127331	68	Hematology	0	In state provider	None	715 TANK FARM RD	STE C	SAN LUIS OBISPO	CA	93401	7068	40	06079	35.24853234	-120.642458	San Luis Obispo County
7517	Fee-for-Service	1376832402	1376832402	1	1	LEECH, IRENE P MD INC	9/30/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	41993	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	125 E 8TH STREET	SUITE 100	LONG BEACH	CA	90813	4309	19	06037	33.77660846	-118.1915505	Los Angeles County
7525	Fee-for-Service	1811574577	1811574577	1	1	LE, HOAN N DO	5/16/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21974	08	Family Practice	0	In state provider	None	2025 E ROUTE 66	None	GLENDORA	CA	91740	4670	19	06037	34.12802719	-117.8255325	Los Angeles County
7543	Fee-for-Service	1518523489	1518523489	1	1	LIPARI, MELISSA DPM	12/31/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	576 N SUNRISE AVE	STE 230	ROSEVILLE	CA	95661	2841	31	06061	38.75781026	-121.253352	Placer County
7546	Fee-for-Service	1346848793	1346848793	1	1	LEE, MICHAEL PT	1/27/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
7550	Fee-for-Service	1538229638	1538229638	1	2	LYON, DAVID H MD	1/31/1992	207R00000X	NA	Other	026	PHYSICIANS	43180	41	Internal Medicine	0	In state provider	None	825 DELBON AVENUE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
7560	Fee-for-Service	1083642730	1083642730	1	1	LUM, SHARON S MD	6/19/2000	208600000X	NA	General Surgery	026	PHYSICIANS	85777	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
7584	Fee-for-Service	1770902710	1770902710	1	1	LI, ALLEN DO	6/9/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	17033	30	Radiology	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
7612	Fee-for-Service	1740368588	1740368588	1	1	LING, JOHN C MD	11/28/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	23841	01	General Practice	0	In state provider	None	6283 BRISTOL PKWY	None	CULVER CITY	CA	90230	6903	19	06037	33.9827686	-118.3912717	Los Angeles County
7632	Fee-for-Service	1992981161	1992981161	1	1	LEE, PHILIP H DO	8/28/2008	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	3502	01	General Practice	0	In state provider	None	421 E ANGELENO AVE	STE 102	BURBANK	CA	91501	2286	19	06037	34.18278568	-118.3048911	Los Angeles County
7635	Fee-for-Service	1679709166	1679709166	1	1	LONG, ELIZABETH LMFT	3/6/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	512 PAULDING CIR	None	ARROYO GRANDE	CA	93420	2857	40	06079	35.12480448	-120.5741901	San Luis Obispo County
7688	Fee-for-Service	1881853018	1881853018	1	1	LIPNICK, MICHAEL S MD	4/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115950	41	Internal Medicine	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
7703	Fee-for-Service	1417335621	1417335621	1	1	LO, LAUREN	4/5/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15272 SUMMIT AVE	None	FONTANA	CA	92336	0231	36	06071	34.152624	-117.4724415	San Bernardino County
7744	Fee-for-Service	1891147351	1891147351	1	1	LEE, JENNIFER OD	12/11/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
7746	Fee-for-Service	1609473438	1609473438	1	1	LONG BEACH MEMORIAL MEDICAL	4/1/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2701 ATLANTIC AVE	STE 100	LONG BEACH	CA	90806	2701	19	06037	33.807735	-118.1850575	Los Angeles County
7747	Fee-for-Service	1467649152	1467649152	1	1	LOS ANGELES INTERNATIONAL	6/20/1995	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	HEARING AID CENTER	6225 WILSHIRE BLVD	None	LOS ANGELES	CA	90048	5103	19	06037	34.06329087	-118.3640158	Los Angeles County
7756	Fee-for-Service	1023433059	1023433059	1	1	LEE-LAUDUSKI, ALICIA A LMFT	5/5/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
7766	Fee-for-Service	1689602609	1689602609	1	1	LIN, JOHN MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77035	66	Emergency Medicine (Urgent Care)	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
7768	Fee-for-Service	1396286720	1396286720	1	1	LIM, NATHAN I MD	1/17/2024	207R00000X	NA	Other	026	PHYSICIANS	157848	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
7780	Fee-for-Service	1013545474	1013545474	1	1	LEVY, RACHEL MD	6/24/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	179609	09	Gynecology (D.O. only)	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
7789	Fee-for-Service	1336594027	1336594027	1	1	LIU, JEN H OD INC	3/1/2018	193400000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	19209 COLIMA ROAD	STE C	ROWLAND HEIGHTS	CA	91748	3009	19	06037	33.98725533	-117.8845408	Los Angeles County
7843	Fee-for-Service	1972525822	1972525822	1	1	LA CLINICA DE LA RAZA	7/10/2000	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	LA CLINICA PITTBURG-MED	2240 GLADSTONE DR	None	PITTSBURG	CA	94565	5126	07	06013	38.00627609	-121.8667626	Contra Costa County
7888	Fee-for-Service	1861658585	1861658585	1	1	LUO, ESTHER J MD	4/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104699	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
7917	Fee-for-Service	1063867513	1063867513	1	1	LA, JUSTIN MD	11/27/2023	208800000X	NA	Other	026	PHYSICIANS	152841	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
7921	Fee-for-Service	1093899072	1093899072	1	1	LAVAYSSE, ROBERT J MD	8/15/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	58295	01	General Practice	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
7924	Fee-for-Service	1386676294	1386676294	1	1	LEE, JENNIFER C MD	3/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82800	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	19582 BEACH BLVD	STE 206	HUNTINGTON BEACH	CA	92648	5950	30	06059	33.67831649	-117.9885198	Orange County
7926	Fee-for-Service	1013085778	1013085778	1	1	LA CLINICA DE LA RAZA	5/15/2006	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	TECHNICLINIC	4351 BROADWAY	None	OAKLAND	CA	94611	4612	01	06001	37.8317327	-122.2541001	Alameda County
7952	Fee-for-Service	1184042202	1184042202	1	1	LEONG, BENJAMIN S MD	10/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141044	01	General Practice	0	In state provider	None	26740 TOWNE CENTRE DR	BLDG C	FOOTHILL RANCH	CA	92610	2839	30	06059	33.67417214	-117.6625276	Orange County
7985	Fee-for-Service	1538375902	1538375902	1	1	LOYDS LIBERTY HOMES INC	7/1/1991	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4315 WOODLAKE DR	None	BAKERSFIELD	CA	93309	1764	15	06029	35.36286635	-119.0510678	Kern County
7988	Fee-for-Service	1669511655	1669511655	1	1	LU, DAVE C MD	12/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103619	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
7990	Fee-for-Service	1881853018	1881853018	1	1	LIPNICK, MICHAEL S MD	4/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115950	05	Anesthesiology	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
8010	Fee-for-Service	1457303117	1457303117	1	1	LOIS, JUAN F MD	11/30/1986	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	30368	30	Radiology	0	In state provider	None	2231 S WESTERN AVE	None	LOS ANGELES	CA	90018	1302	19	06037	34.03512469	-118.3090138	Los Angeles County
8018	Fee-for-Service	1568570364	1568570364	1	1	LEVIN, PETER S	3/31/1988	207W00000X	NA	Ophthalmology	026	PHYSICIANS	52783	18	Ophthalmology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
8025	Fee-for-Service	1386177707	1386177707	1	1	LIU, SERENA M MD	8/17/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	171675	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
8030	Fee-for-Service	1336338508	1336338508	1	1	LOWINGER, JANET L	10/7/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	500 N CENTRAL AVENUE	SUITE 440	GLENDALE	CA	91203	3951	19	06037	34.15321627	-118.2578985	Los Angeles County
8033	Fee-for-Service	1700115722	1700115722	1	1	LOS NINOS CHILDRENS MEDICAL	10/14/2004	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	CLINIC APC	409 E MERCED AVE	SUITE A	WEST COVINA	CA	91790	5061	19	06037	34.05501985	-117.9380648	Los Angeles County
8052	Fee-for-Service	1164517108	1164517108	1	1	LIMBOS, MARYANN P MD	7/1/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	77419	40	Pediatrics	0	In state provider	None	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
8065	Fee-for-Service	1417375486	1417375486	1	1	LEE, ANDREW MD	5/4/2019	390200000X	NA	Other	026	PHYSICIANS	139830	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
8069	Fee-for-Service	1013545474	1013545474	1	1	LEVY, RACHEL MD	6/24/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	179609	15	Obstetrics (D.O. only)	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
8095	Fee-for-Service	1215098298	1215098298	1	1	LIN, SUN S MD	8/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108360	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PARKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
8099	Fee-for-Service	1023332673	1023332673	1	1	LEVY, TAMSIN H MD	6/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114336	41	Internal Medicine	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
8124	Fee-for-Service	1982771705	1982771705	1	1	LABIB, SAMEH S MD	2/27/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78080	13	Neurology (M.D. only)	0	In state provider	None	4000 14TH ST	STE 408	RIVERSIDE	CA	92501	4010	33	06065	33.97771007	-117.3818381	Riverside County
8131	Fee-for-Service	1972525822	1972525822	1	1	LA CLINICA DE LA RAZA	1/1/2000	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	LA CLINICA PITTBURG-MED	2240 GLADSTONE DR	None	PITTSBURG	CA	94565	5126	07	06013	38.00627609	-121.8667626	Contra Costa County
8144	Fee-for-Service	1447309471	1447309471	1	1	LEONG, KALMAN C OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3000 ALAMO DR	STE 207	VACAVILLE	CA	95687	6352	48	06095	38.33530454	-121.9544235	Solano County
8146	Fee-for-Service	1760835821	1760835821	1	1	LY, JANET LMFT	7/10/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
8159	Fee-for-Service	1619150612	1619150612	1	1	LILLIAN F. LIAO, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DRIVE	None	SAN ANTONIO	TX	78229	0000	00	None	29.508012	-98.578683	Bexar County
8165	Fee-for-Service	1043738156	1043738156	1	1	LA COMFORT HOME CARE INC	5/28/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1864 E WASHINGTON BLVD	STE 212	PASADENA	CA	91104	1667	19	06037	34.16910848	-118.112022	Los Angeles County
8173	Fee-for-Service	1477797868	1477797868	1	1	LEE, JOON K MD	5/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114402	30	Radiology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
8180	Fee-for-Service	1750300612	1750300612	1	1	LAWRENCE J DASILVA MD	3/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
8199	Fee-for-Service	1194348805	1194348805	1	1	LAI, XUE L DO	4/17/2024	207R00000X	NA	Other	026	PHYSICIANS	20476	41	Internal Medicine	0	In state provider	None	450 E HUNTINGTON DR	None	ARCADIA	CA	91006	3748	19	06037	34.14015053	-118.0208745	Los Angeles County
8216	Fee-for-Service	1770639577	1770639577	1	1	LORIG, MILTON L MD	1/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	37014	36	Psychiatry	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
8217	Fee-for-Service	1013085778	1013085778	1	1	LA CLINICA DE LA RAZA	11/30/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	TECHNICLINIC	4351 BROADWAY	None	OAKLAND	CA	94611	4612	01	06001	37.8317327	-122.2541001	Alameda County
8255	Fee-for-Service	1669430518	1669430518	1	1	LIM, ROBERT M MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102567	None	None	0	In state provider	RADIOLOGY DEPARTMENT	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
8307	Fee-for-Service	1568570364	1568570364	1	1	LEVIN, PETER S	3/31/1988	207W00000X	NA	Ophthalmology	026	PHYSICIANS	52783	01	General Practice	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
8382	Fee-for-Service	1386686673	1386686673	2	1	LAKE, JEAN L MD	1/19/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	44387	14	Neurological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
8408	Fee-for-Service	1194284554	1194284554	1	1	LUU, XING MD	4/15/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	179104	40	Pediatrics	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
8421	Fee-for-Service	1972525822	1972525822	1	1	LA CLINICA DE LA RAZA	1/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	LA CLINICA PITTBURG-MED	2240 GLADSTONE DR	None	PITTSBURG	CA	94565	5126	07	06013	38.00627609	-121.8667626	Contra Costa County
8431	Fee-for-Service	1407525264	1407525264	1	1	LA PAZ PHARMACY, INC.	10/5/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2355 N OXNARD BLVD	None	OXNARD	CA	93036	2065	56	06111	34.22731336	-119.1778098	Ventura County
8452	Fee-for-Service	1669550455	1669550455	1	1	LEVIT, ARTHUR F MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36378	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
8468	Fee-for-Service	1275824583	1275824583	1	1	LEE, REBECCA H MD	2/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123329	40	Pediatrics	0	In state provider	None	3000 Q ST	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
8480	Fee-for-Service	1295849669	1295849669	1	1	LANGGA-SHARIFI, EULY M MD	10/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	58660	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
8500	Fee-for-Service	1336503861	1336503861	1	1	LEE, JOCELYN S DO	5/1/2020	207R00000X	NA	Other	026	PHYSICIANS	16063	41	Internal Medicine	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
8504	Fee-for-Service	1629274782	1629274782	1	1	LIU, MINGHUI MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107140	None	None	0	In state provider	None	1541 FLORIDA AVE	STE 103	MODESTO	CA	95350	4423	50	06099	37.666863	-120.9962775	Stanislaus County
8507	Fee-for-Service	1013085778	1013085778	1	1	LA CLINICA DE LA RAZA	5/15/2006	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	TECHNICLINIC	4351 BROADWAY	None	OAKLAND	CA	94611	4612	01	06001	37.8317327	-122.2541001	Alameda County
8525	Fee-for-Service	1528285012	1528285012	1	1	LE, RICHARD D MD	11/25/2008	207RP1001X	NA	Pulmonology	026	PHYSICIANS	88276	None	None	0	In state provider	None	1801 W ROMNEYA DR	STE 409	ANAHEIM	CA	92801	1830	30	06059	33.8506615	-117.946413	Orange County
8541	Fee-for-Service	1598150989	1598150989	1	1	LINDSAY, BYRON J CRNA	11/4/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
8549	Fee-for-Service	1649598160	1649598160	1	1	LYKES, AMY LMFT	9/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
8553	Fee-for-Service	1518069160	1518069160	1	1	LONGMIRE, KIMBERLY A MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	52306	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
8565	Fee-for-Service	1235665589	1235665589	1	1	LI, JOHN MD	11/16/2023	207R00000X	NA	Other	026	PHYSICIANS	187640	None	None	0	In state provider	None	1120 HUTCHINSON DRIVE	None	DAVIS	CA	95616	5270	57	06113	38.53834973	-121.7626055	Yolo County
8570	Fee-for-Service	1437332863	1437332863	1	1	LOEWENBEIN, JOSEPH MD	11/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93334	None	None	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
8576	Fee-for-Service	1811457302	1811457302	1	1	LIU, SERENA MD	8/8/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178774	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
8591	Fee-for-Service	1568951838	1568951838	1	1	LIU, LUCY Y MD	2/27/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	163589	None	None	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
8596	Fee-for-Service	1740477017	1740477017	1	1	LAU, GARY K MD	5/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99891	None	None	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
8597	Fee-for-Service	1346583242	1346583242	1	1	LEE, BRIAN T MD	10/1/2020	207RT0003X	NA	Other	026	PHYSICIANS	132796	41	Internal Medicine	0	In state provider	None	197 E CAROLINE ST	None	SAN BERNARDINO	CA	92408	3731	36	06071	34.06143353	-117.2822085	San Bernardino County
8604	Fee-for-Service	1922276096	1922276096	1	1	LEE, LILLIAN K MD	1/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100719	05	Anesthesiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
8615	Fee-for-Service	1184638090	1184638090	1	1	LEHMAN, AARON M MD	7/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81096	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5003	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
8627	Fee-for-Service	1982040416	1982040416	1	1	LAI, SAI EN MD	12/4/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	145350	13	Neurology (M.D. only)	0	In state provider	None	5250 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91601	3186	19	06037	34.1665161	-118.3755868	Los Angeles County
8632	Fee-for-Service	1356403448	1356403448	1	1	LY, PETER H PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	288 GRECIA CT	None	SAN JOSE	CA	95116	1520	43	06085	37.36117962	-121.8531715	Santa Clara County
8647	Fee-for-Service	1164691549	1164691549	1	1	LU, CHRISTIAN C MD	7/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102711	41	Internal Medicine	0	In state provider	None	2865 ATLANTIC AVE	STE 104	LONG BEACH	CA	90806	7406	19	06037	33.809418	-118.185058	Los Angeles County
8663	Fee-for-Service	1285708065	1285708065	1	1	LEE, SIMON K DC INC	3/14/2006	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	WELLNESS CHIRO CLINIC	730 E EL CAMINO REAL	STE B	SUNNYVALE	CA	94087	2971	43	06085	37.35861852	-122.021349	Santa Clara County
8668	Fee-for-Service	1386686673	1386686673	2	1	LAKE, JEAN L MD	1/19/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	44387	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
8687	Fee-for-Service	1659502185	1659502185	1	1	LILJE, KATHRYN CCC-SLP	12/14/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4211 B VALLEY VIEW AVE	None	NORCO	CA	92860	3502	33	06065	33.943446	-117.5498725	Riverside County
8711	Fee-for-Service	1972525822	1972525822	1	1	LA CLINICA DE LA RAZA	5/8/2000	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	LA CLINICA PITTBURG-MED	2240 GLADSTONE DR	None	PITTSBURG	CA	94565	5126	07	06013	38.00627609	-121.8667626	Contra Costa County
8714	Fee-for-Service	1598702284	1598702284	1	1	LITLE, VIRGINIA MD	12/6/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	74440	33	Thoracic Surgery	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
8716	Fee-for-Service	1285287490	1285287490	1	1	LOZANO ORTIZ, MARIA ALEJANDR	11/16/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	A	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
8726	Fee-for-Service	1609814797	1609814797	1	1	LAWDER, CYNTHIA R MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	78486	08	Family Practice	0	In state provider	None	347 ANDRIEUX ST	None	SONOMA	CA	95476	6811	49	06097	38.28843573	-122.4651035	Sonoma County
8733	Fee-for-Service	1649482910	1649482910	1	1	LUSSENDEN, RYAN R MD	4/30/2018	208600000X	NA	General Surgery	026	PHYSICIANS	105216	02	General Surgery	0	In state provider	None	1095 MARSHALL WAY	STE 202	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
8739	Fee-for-Service	1710302880	1710302880	1	1	LU, SAM MD	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128751	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
8745	Fee-for-Service	1811161870	1811161870	1	1	LY, MICHELLE W DO	8/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10691	66	Emergency Medicine (Urgent Care)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
8779	Fee-for-Service	1306801469	1306801469	1	1	LALAKEA, MARY L MD	8/20/1995	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	59969	04	Otology, Laryngology, Rhinology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
8797	Fee-for-Service	1477624443	1477624443	1	1	LEE, JEA H MD	2/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67080	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
8820	Fee-for-Service	1952450066	1952450066	1	1	LARSCHEID, RYAN C	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	80089	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
8885	Fee-for-Service	1346583242	1346583242	1	1	LEE, BRIAN T MD	10/1/2020	207RT0003X	NA	Other	026	PHYSICIANS	132796	10	Gastroenterology (M.D. only)	0	In state provider	None	197 E CAROLINE ST	None	SAN BERNARDINO	CA	92408	3731	36	06071	34.06143353	-117.2822085	San Bernardino County
8898	Fee-for-Service	1124061486	1124061486	2	1	LONGS DRUG STORES CA LLC	12/15/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16995 WALNUT GROVE DR	None	MORGAN HILL	CA	95037	4440	43	06085	37.12923812	-121.6378864	Santa Clara County
8900	Fee-for-Service	1184638090	1184638090	1	1	LEHMAN, AARON M MD	7/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81096	41	Internal Medicine	0	In state provider	None	3020 CHILDREN'S WAY	MC 5003	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
8927	Fee-for-Service	1568481968	1568481968	1	1	LEUNG, MEGAN L MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71458	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
8934	Fee-for-Service	1346297462	1346297462	2	1	LOZANO, KAY MD	12/16/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	82164	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
8952	Fee-for-Service	1215385323	1215385323	1	1	LE, KIM T MD	7/23/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164771	None	None	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
8957	Fee-for-Service	1386686673	1386686673	2	1	LAKE, JEAN L MD	1/19/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	44387	13	Neurology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
8963	Fee-for-Service	1871512749	1871512749	1	1	LIU, WU H MD	12/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66869	41	Internal Medicine	0	In state provider	None	3948 PECK RD	STE 10	EL MONTE	CA	91732	2256	19	06037	34.07745077	-118.0210415	Los Angeles County
8964	Fee-for-Service	1922754142	1922754142	1	1	LEAMON, TRISHA L LMFT	11/13/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
8978	Fee-for-Service	1336843010	1336843010	1	1	LUMOWAH, KAYLA LPCC	11/15/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
8995	Fee-for-Service	1871652784	1871652784	1	1	LUI, WAI PING CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3318 DEL MAR AVE	STE 203	ROSEMEAD	CA	91770	2373	19	06037	34.06859814	-118.0994741	Los Angeles County
9009	Fee-for-Service	1538413877	1538413877	1	1	LYONS, KELLY L CNP	5/17/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12595 HESPERIA RD	STE 101	VICTORVILLE	CA	92395	8318	36	06071	34.47992741	-117.2908165	San Bernardino County
9011	Fee-for-Service	1932556875	1932556875	1	1	LUDWIG, CHASE A MD	8/15/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	156503	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
9050	Fee-for-Service	1770028797	1770028797	1	1	LYONS, REBECCA LMFT	3/19/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1801 TAHITI DR	None	COSTA MESA	CA	92626	3633	30	06059	33.67631336	-117.9321936	Orange County
9070	Fee-for-Service	1306801469	1306801469	1	1	LALAKEA, MARY L MD	8/20/1995	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	59969	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
9072	Fee-for-Service	1174532121	1174532121	1	1	LEVINSOHN, DAVID G MD	1/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	67296	20	Orthopedic Surgery	0	In state provider	None	7910 FROST STREET	SUITE 340	SAN DIEGO	CA	92123	2753	37	06073	32.80027449	-117.153846	San Diego County
9081	Fee-for-Service	1255425724	1255425724	1	1	LEHMAN, DAVID H MD	5/11/2001	207RR0500X	NA	Other	026	PHYSICIANS	24295	83	Rheumatology	0	In state provider	None	5025 J ST	STE 315	SACRAMENTO	CA	95819	3839	34	06067	38.566773	-121.441851	Sacramento County
9094	Fee-for-Service	1346024767	1346024767	1	1	LEE, YEE NP	11/1/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
9108	Fee-for-Service	1508229303	1508229303	1	1	LIN, TAMMY Q MD	3/26/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153237	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
9190	Fee-for-Service	1043446024	1043446024	1	1	LE FOYER INCORPORATED	4/12/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	16438 BLACKHAWK ST	None	GRANADA HILLS	CA	91344	2000	19	06037	34.25835109	-118.4906706	Los Angeles County
9208	Fee-for-Service	1295040640	1295040640	1	1	LUCAS, LAUREL D LMFT	6/7/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4405 W RIVERSIDE DR	SUITE 106	BURBANK	CA	91505	4072	19	06037	34.15222929	-118.3480509	Los Angeles County
9220	Fee-for-Service	1861508335	1861508335	1	1	LEE, DIANE D MD	4/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	78611	13	Neurology (M.D. only)	0	In state provider	None	400 EVELYN AVE	STE 224	ALBANY	CA	94706	4007	01	06001	37.89873243	-122.2971602	Alameda County
9235	Fee-for-Service	1427083112	1427083112	1	1	LEUNG, CHEUNG K TOM MD	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	61548	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9360 N NAME UNO	STE 110	GILROY	CA	95020	3535	43	06085	37.035801	-121.569858	Santa Clara County
9240	Fee-for-Service	1710274964	1710274964	1	1	LONG, THOMAS J MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124487	66	Emergency Medicine (Urgent Care)	0	In state provider	None	103 PROVIDENCE MINE ROAD	SUITE 202	NEVADA CITY	CA	95959	2949	29	06057	39.25342304	-121.0327954	Nevada County
9245	Fee-for-Service	1851756175	1851756175	1	1	LOWE, WESCINA PSYD	8/14/2024	103K00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
9250	Fee-for-Service	1528050754	1528050754	1	1	LIN, MARK D MD	6/27/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75404	41	Internal Medicine	0	In state provider	None	4580 CALIFORNIA AVE	None	BAKERSFIELD	CA	93309	1104	15	06029	35.36605632	-119.0531502	Kern County
9261	Fee-for-Service	1447459599	1447459599	2	1	LERNER, UMA MD	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	92872	36	Psychiatry	0	In state provider	None	2340 CLAY ST 7TH FLOOR	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
9288	Fee-for-Service	1114933637	1114933637	1	1	LANCE, SHAWN T MD	8/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91261	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
9306	Fee-for-Service	1750673570	1750673570	1	1	LOCKE, ROBERT S MD	11/11/2019	207L00000X	NA	Other	026	PHYSICIANS	162691	05	Anesthesiology	0	In state provider	None	4053 LONE TREE WAY	200	ANTIOCH	CA	94531	6210	07	06013	37.97569499	-121.800733	Contra Costa County
9339	Fee-for-Service	1356395842	1356395842	1	1	LATHAM, GEOFFREY H NP	6/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
9349	Fee-for-Service	1801114095	1801114095	1	1	LAM, KHOA D MD	11/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119678	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
9356	Fee-for-Service	1376545194	1376545194	1	1	LITMAN, DAVID A MD	9/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	63260	22	Pathology (M.D. only)	0	In state provider	None	17821 PIONEER BLVD	None	ARTESIA	CA	90701	3901	19	06037	33.8691791	-118.0823685	Los Angeles County
9361	Fee-for-Service	1174532121	1174532121	1	1	LEVINSOHN, DAVID G MD	1/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	67296	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7910 FROST STREET	SUITE 340	SAN DIEGO	CA	92123	2753	37	06073	32.80027449	-117.153846	San Diego County
9367	Fee-for-Service	1255425724	1255425724	1	1	LEHMAN, DAVID H MD	5/11/2001	207RR0500X	NA	Other	026	PHYSICIANS	24295	41	Internal Medicine	0	In state provider	None	5025 J ST	STE 315	SACRAMENTO	CA	95819	3839	34	06067	38.566773	-121.441851	Sacramento County
9370	Fee-for-Service	1780738641	1780738641	1	1	LIU, THERESA OD	11/26/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE STREET	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
9379	Fee-for-Service	1992878342	1992878342	1	1	LIN, ELLY PHD	7/9/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	SUITE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
9382	Fee-for-Service	1497026140	1497026140	1	1	LEACH, BENJAMIN I MD	1/4/2018	207RX0202X	NA	Oncology	026	PHYSICIANS	122493	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
9383	Fee-for-Service	1790728020	1790728020	1	1	LEE, TIMOTHY D MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81416	30	Radiology	0	In state provider	None	845 JACKSON ST	None	SAN FRANCISCO	CA	94133	4851	38	06075	37.79571919	-122.4089166	San Francisco County
9393	Fee-for-Service	1710120530	1710120530	1	1	LUM, DEIRDRE A MD	8/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107141	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
9415	Fee-for-Service	1306006457	1306006457	1	1	LA ROCHELLE, JEFFREY C	3/21/2008	208800000X	NA	Other	026	PHYSICIANS	100296	34	Urology and Urological Surgery	0	In state provider	MD	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	7002	19	06037	34.06373445	-118.443537	Los Angeles County
9436	Fee-for-Service	1184808925	1184808925	1	1	LOYD'S LIBERTY HOMES INC	3/2/2007	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	450 EL PORTAL DR	None	MERCED	CA	95340	0935	24	06047	37.32626815	-120.4648099	Merced County
9451	Fee-for-Service	1215482773	1215482773	1	1	LOPEZ DE SAN ROMAN, JOAQUIN	6/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7385 HEALDSBURG AVE	None	SEBASTOPOL	CA	95472	3224	49	06097	38.40523147	-122.830461	Sonoma County
9486	Fee-for-Service	1194904755	1194904755	1	1	LOEB, LOLA J MD	12/4/2015	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55800	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	329 W 8TH ST	STE 101	HANFORD	CA	93230	4533	16	06031	36.32698307	-119.6503466	Kings County
9488	Fee-for-Service	1689729246	1689729246	1	1	LOS ANGELES COUNTY CCS	9/29/1993	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	GARDENA MTU	15805 S BUDLONG AVE	None	GARDENA	CA	90247	4303	19	06037	33.88775717	-118.2960212	Los Angeles County
9489	Fee-for-Service	1164787107	1164787107	1	1	LOS ANGELES CENTERS FOR	8/30/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	ALCOHOL AND DRUG ABUSE	15301 YOUNGWOOD DRIVE	CLASSROOM A210	WHITTIER	CA	90605	1345	19	06037	33.955947	-117.996489	Los Angeles County
9491	Fee-for-Service	1477595288	1477595288	2	1	LONGS DRUG STORE CAL LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2133 SHAW AVE	None	CLOVIS	CA	93611	8937	10	06019	36.80867341	-119.6756564	Fresno County
9544	Fee-for-Service	1164549630	1164549630	1	1	LVOFF-LEVSKY, NATALYA M MD	5/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86079	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
9611	Fee-for-Service	1881081206	1881081206	1	2	LEE, YOUNG LAC	5/26/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	20700 VENTURA BLVD ,	STE 130	WOODLAND HILLS	CA	91364	6277	19	06037	34.16687239	-118.5840442	Los Angeles County
9630	Fee-for-Service	1629412341	1629412341	1	1	LONG, ALLEGRA G MD	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144004	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
9656	Fee-for-Service	1255425724	1255425724	1	1	LEHMAN, DAVID H MD	5/11/2001	207RR0500X	NA	Other	026	PHYSICIANS	24295	39	Preventive (M.D. only)	0	In state provider	None	5025 J ST	STE 315	SACRAMENTO	CA	95819	3839	34	06067	38.566773	-121.441851	Sacramento County
9670	Fee-for-Service	1497026140	1497026140	1	1	LEACH, BENJAMIN I MD	1/4/2018	207RX0202X	NA	Oncology	026	PHYSICIANS	122493	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
9673	Fee-for-Service	1427139591	1427139591	1	1	LEVIN, MICHAEL H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	16918	36	Psychiatry	0	In state provider	PROFESSIONAL CORP	130 LA CASA VIA	None	WALNUT CREEK	CA	94598	3045	07	06013	37.91175467	-122.0414101	Contra Costa County
9712	Fee-for-Service	1366519225	1366519225	1	1	LOPEZ, JUANITA L MD	3/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	59014	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
9764	Fee-for-Service	1518055011	1518055011	1	1	LEVY, DONALD S MD	12/31/1989	207K00000X	NA	Other	026	PHYSICIANS	56847	03	Allergy	0	In state provider	None	705 W LA VETA AVE	STE 101	ORANGE	CA	92868	4447	30	06059	33.78062272	-117.8600738	Orange County
9770	Fee-for-Service	1407978497	1407978497	1	1	LEPPERT, JOHN T MD	7/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83607	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
9776	Fee-for-Service	1750918397	1750918397	1	1	LORENZO QUINTERO, ANABELL M	2/14/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183217	08	Family Practice	0	In state provider	D	5401 WHITE LANE	None	BAKERSFIELD	CA	93309	6279	15	06029	35.31803715	-119.0627831	Kern County
9787	Fee-for-Service	1164560348	1164560348	1	1	LAWRENCE, RANDOLPH S MD	12/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	32240	02	General Surgery	0	In state provider	None	1320 LAS TABLAS RD	STE C	TEMPLETON	CA	93465	9711	40	06079	35.5544315	-120.7225935	San Luis Obispo County
9819	Fee-for-Service	1033928718	1033928718	1	1	LEIGH, MAYURI BIRTH DOULA	1/6/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
9824	Fee-for-Service	1922063825	1922063825	1	1	LEE, JOOYOUNG MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79721	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1400 S GRAND AVE	None	LOS ANGELES	CA	90015	3048	19	06037	34.03692236	-118.2655238	Los Angeles County
9857	Fee-for-Service	1568572717	1568572717	1	1	LAM, ALBERT Y MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	29172	02	General Surgery	0	In state provider	None	4477 W 118TH ST	STE 200	HAWTHORNE	CA	90250	2257	19	06037	33.92734752	-118.354221	Los Angeles County
9871	Fee-for-Service	1174601975	1174601975	1	1	LIPSITT, ERIC D MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	59139	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
9895	Fee-for-Service	1528172392	1528172392	1	1	LEE, JANE A MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140999	18	Ophthalmology	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
9906	Fee-for-Service	1679083356	1679083356	1	1	L E BRAND, MD CORPORATION	2/13/2023	208600000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	4542 LAS POSAS ROAD	SUITE D	CAMARILLO	CA	93010	2521	56	06111	34.24290282	-119.0105325	Ventura County
9914	Fee-for-Service	1871708529	1871708529	1	1	LOCKMAN, ANNE E MD	3/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	102955	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
9916	Fee-for-Service	1336182161	1336182161	2	1	LONGS DRUG STORES CA LLC	12/26/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4242 S EL CAMINO REAL	None	SAN MATEO	CA	94403	5133	41	06081	37.52998003	-122.288512	San Mateo County
9922	Fee-for-Service	1962527770	1962527770	1	1	LIU, SARA A MD	9/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84355	40	Pediatrics	0	In state provider	None	4145 CLARES ST	STE A	CAPITOLA	CA	95010	2053	44	06087	36.97837345	-121.964319	Santa Cruz County
9933	Fee-for-Service	1760502058	1760502058	1	1	LE GRANGE, PETRUS D F PHD	5/25/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
9973	Fee-for-Service	1497791214	1497791214	1	1	LEON, AFREDO MD INC	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	20685	41	Internal Medicine	0	In state provider	None	420 W ACACIA ST	STE 6	STOCKTON	CA	95203	2441	39	06077	37.96135715	-121.2996632	San Joaquin County
10023	Fee-for-Service	1447203989	1447203989	1	1	LAKEWOOD HOSPITAL	2/4/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	14519 DETROIT AVE	None	LAKEWOOD	OH	44107	4316	00	None	41.48527894	-81.79643923	Cuyahoga County
10032	Fee-for-Service	1447456926	1447456926	1	1	LEE, JOHN S J MD	8/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	87022	22	Pathology (M.D. only)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
10037	Fee-for-Service	1790833713	1790833713	1	1	LAI, ANDREW MD	12/26/2007	207R00000X	NA	Other	026	PHYSICIANS	91702	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
10054	Fee-for-Service	1407934094	1407934094	1	1	LASHAY, NANETTE O MD	1/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82673	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
10063	Fee-for-Service	1952614182	1952614182	1	1	LOPES, DUSTIN M DO	9/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12061	01	General Practice	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
10090	Fee-for-Service	1225149222	1225149222	1	1	LAGUNA BEACH COMM CLINIC	12/1/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	362 3RD ST	None	LAGUNA BEACH	CA	92651	2307	30	06059	33.54392197	-117.780894	Orange County
10123	Fee-for-Service	1144230913	1144230913	1	1	LIMA, ANGELA S DO	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14648	36	Psychiatry	0	In state provider	None	1320 STANDIFORD AVENUE	SUITE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
10147	Fee-for-Service	1568572717	1568572717	1	1	LAM, ALBERT Y MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	29172	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4477 W 118TH ST	STE 200	HAWTHORNE	CA	90250	2257	19	06037	33.92734752	-118.354221	Los Angeles County
10149	Fee-for-Service	1003271859	1003271859	1	1	LONG, ALIXANDRE J LCSW	9/19/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
10152	Fee-for-Service	1821146887	1821146887	1	1	LIM, MELVIN J MD	5/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	58090	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
10153	Fee-for-Service	1164935086	1164935086	1	1	LUNEAU, PAIGE M CNM	2/13/2018	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3343 4TH AVE	None	SAN DIEGO	CA	92103	5703	37	06073	32.740353	-117.1612435	San Diego County
10163	Fee-for-Service	1063669158	1063669158	1	1	LEWIS, JOSHUA L MD	12/10/2019	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
10183	Fee-for-Service	1750593257	1750593257	1	1	LANG, LINDA J	11/18/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
10187	Fee-for-Service	1457395899	1457395899	2	1	LONGS DRUGS STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8063 SAN MIGUEL CANYON R	None	SALINAS	CA	93907	1244	27	06053	36.80083452	-121.6652993	Monterey County
10190	Fee-for-Service	1346769270	1346769270	1	1	LUNA PLUS HOME HEALTH INC	6/27/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6308 WOODMAN AVE	SUITE 116	VAN NUYS	CA	91401	2387	19	06037	34.185123	-118.4312405	Los Angeles County
10191	Fee-for-Service	1235193970	1235193970	1	1	LEE, DONNA J MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	46242	18	Ophthalmology	0	In state provider	None	1300 CRANE STREET	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
10202	Fee-for-Service	1871708529	1871708529	1	1	LOCKMAN, ANNE E MD	3/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	102955	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
10203	Fee-for-Service	1871574814	1871574814	1	1	LIU, VINCENT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV OF IOWA HOSP & CLNS	200 HAWKINS DR	None	IOWA CITY	IA	52242	0000	00	None	41.659929	-91.548099	Johnson County
10214	Fee-for-Service	1720405087	1720405087	1	1	LU, KATHERINE N MD	4/30/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	152052	07	Dermatology	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
10287	Fee-for-Service	1932593027	1932593027	1	1	LOCKWOOD, MEGAN M MD	2/4/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	149989	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
10306	Fee-for-Service	1578041646	1578041646	1	1	LEE, LEI Y RCP	10/24/2018	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
10312	Fee-for-Service	1447203989	1447203989	1	1	LAKEWOOD HOSPITAL	2/4/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	14519 DETROIT AVE	None	LAKEWOOD	OH	44107	4316	00	None	41.48527894	-81.79643923	Cuyahoga County
10336	Fee-for-Service	1033298724	1033298724	2	1	LEE, PAUL H	11/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	68537	None	None	0	In state provider	None	3132 WEST MARCH LANE	SUITE 5	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
10363	Fee-for-Service	1659353530	1659353530	1	1	LEEK, JAMES C MD	7/18/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	22979	41	Internal Medicine	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
10376	Fee-for-Service	1225149222	1225149222	1	1	LAGUNA BEACH COMM CLINIC	12/1/2018	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	362 3RD ST	None	LAGUNA BEACH	CA	92651	2307	30	06059	33.54392197	-117.780894	Orange County
10377	Fee-for-Service	1477204170	1477204170	1	1	LI, LE CRNA	3/10/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
10382	Fee-for-Service	1548603517	1548603517	1	1	LYONS, MARJAN E MD	9/27/2024	207R00000X	NA	Other	026	PHYSICIANS	141569	41	Internal Medicine	0	In state provider	None	1250 LA VENTA DRIVE	100, 101A, 105, 207, 211	WESTLAKE VILLAGE	CA	91361	3774	19	06037	34.14827603	-118.8227637	Ventura County
10391	Fee-for-Service	1255795092	1255795092	1	1	LIU, HANNA K MD	2/25/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	152556	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
10406	Fee-for-Service	1659880946	1659880946	1	5	LIGHTHOUSE COUNSELING AND FA	8/6/2020	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	MILY RESOURCE CENTER	110 GATEWAY DR	210 AND 230	LINCOLN	CA	95648	3306	31	06061	38.88433725	-121.2931529	Placer County
10421	Fee-for-Service	1992738991	1992738991	1	3	LIVINGWATER'S MEDICAL CLINIC	9/19/2023	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	, INC.	24910 LAS BRISAS RD	111	MURRIETA	CA	92562	4010	33	06065	33.57522424	-117.1828078	Riverside County
10456	Fee-for-Service	1679645402	1679645402	1	1	LEE, NICHOLAS B MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75625	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11815 EDUCATION ST	None	AUBURN	CA	95602	2410	31	06061	38.94431878	-121.1009419	Placer County
10464	Fee-for-Service	1851754451	1851754451	1	1	LAW, KENDRICK MD	10/18/2019	207P00000X	NA	Other	026	PHYSICIANS	162473	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
10469	Fee-for-Service	1710380654	1710380654	1	1	LE, JASMINE T	2/7/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8800 WHITTIER BLVD	None	PICO RIVERA	CA	90660	2658	19	06037	34.00205052	-118.0857646	Los Angeles County
10503	Fee-for-Service	1841406303	1841406303	1	1	LEE, EUNICE S MD	2/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95762	05	Anesthesiology	0	In state provider	None	514 WEST PUEBLO STREET	2ND FLOOR	SANTA BARBARA	CA	93105	4294	42	06083	34.4279775	-119.7247284	Santa Barbara County
10512	Fee-for-Service	1730364654	1730364654	1	1	LE, ELIZABETH N MD	5/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130069	07	Dermatology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
10515	Fee-for-Service	1891181616	1891181616	1	1	LITTLEFIELD, LESLIE MD	2/3/2018	390200000X	NA	Other	026	PHYSICIANS	150611	41	Internal Medicine	0	In state provider	None	515 MICHIGAN BLVD	None	WEST SACRAMENTO	CA	95691	2705	57	06113	38.58298316	-121.5265736	Yolo County
10536	Fee-for-Service	1710183637	1710183637	1	1	LEAH BETHEL	2/20/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1229 C AVE E	None	OSKALOOSA	IA	52577	4246	00	None	41.29857054	-92.630799	Mahaska County
10544	Fee-for-Service	1508944224	1508944224	1	1	LO, ELEANOR FUNG YEE MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74849	02	General Surgery	0	In state provider	None	2000 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56289303	-121.7715238	Yolo County
10553	Fee-for-Service	1588010870	1588010870	1	1	LE, LONG B MD	6/17/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	152605	10	Gastroenterology (M.D. only)	0	In state provider	None	43944 15TH ST	201	LANCASTER	CA	93534	5207	19	06037	34.681626	-118.1566845	Los Angeles County
10578	Fee-for-Service	1164460721	1164460721	1	1	LAB-ALL, INC	4/15/1996	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	2200 W 7TH ST	STE 305	LOS ANGELES	CA	90057	4002	19	06037	34.05703657	-118.278102	Los Angeles County
10616	Fee-for-Service	1023514130	1023514130	1	1	LENANE, ZACHARY M MD	7/29/2020	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	164119	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
10650	Fee-for-Service	1497237051	1497237051	1	1	LEE, TERESA G	4/29/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2722 ABORN RD	None	SAN JOSE	CA	95121	1204	43	06085	37.31364749	-121.7928998	Santa Clara County
10655	Fee-for-Service	1952084345	1952084345	1	1	LIBOVA, YELENA NP	1/6/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
10662	Fee-for-Service	1225149222	1225149222	1	1	LAGUNA BEACH COMM CLINIC	12/1/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	362 3RD ST	None	LAGUNA BEACH	CA	92651	2307	30	06059	33.54392197	-117.780894	Orange County
10687	Fee-for-Service	1619238045	1619238045	1	1	LOPATA, LINDSAY MD	2/18/2019	207L00000X	NA	Other	026	PHYSICIANS	146097	05	Anesthesiology	0	In state provider	None	2601 E CHAPMAN AVENUE	None	ORANGE	CA	92869	3206	30	06059	33.78785251	-117.826365	Orange County
10693	Fee-for-Service	1861818239	1861818239	1	1	LAMPA MEDICAL INC	8/29/2014	261Q00000X	NA	Other	026	PHYSICIANS	128829	36	Psychiatry	0	In state provider	None	1930 TIENDA DRIVE	SUITE 204	LODI	CA	95242	3935	39	06077	38.11681837	-121.2959834	San Joaquin County
10700	Fee-for-Service	1851470983	1851470983	1	1	LERNO, LAWRENCE C MD	2/5/2019	207R00000X	NA	Other	026	PHYSICIANS	47532	39	Preventive (M.D. only)	0	In state provider	None	1510 E 7TH ST	None	LONG BEACH	CA	90813	5002	19	06037	33.77531254	-118.1728263	Los Angeles County
10703	Fee-for-Service	1245461722	1245461722	1	1	LE, ALYSSA K MD	10/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103300	41	Internal Medicine	0	In state provider	None	26800 CROWN VALLEY PKWY	STE 305	MISSION VIEJO	CA	92691	8533	30	06059	33.56286021	-117.6673449	Orange County
10734	Fee-for-Service	1366471401	1366471401	1	1	LU, FRANCIS G MD	5/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	35309	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
10749	Fee-for-Service	1730423328	1730423328	1	1	LEMBO, GIANCARLO MD	3/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128543	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
10773	Fee-for-Service	1356996649	1356996649	1	1	LAND OF PEACE 5	4/10/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	22625 KITTRIDGE ST	None	WEST HILLS	CA	91307	3609	19	06037	34.19152648	-118.6199325	Los Angeles County
10774	Fee-for-Service	1831260884	1831260884	1	1	LUEG, EDGAR A MD	7/1/1998	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	52915	84	Surgery-Head and Neck	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
10792	Fee-for-Service	1437169026	1437169026	1	1	LENNOX, JOHN F DO	12/1/2003	174400000X	NA	Other	026	PHYSICIANS	4836	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	770 LOS PALOS MNR	None	LAFAYETTE	CA	94549	5124	07	06013	37.87973678	-122.0989667	Contra Costa County
10814	Fee-for-Service	1336132331	1336132331	1	1	LANDERS, CHARLES F MD	1/1/1979	207RP1001X	NA	Pulmonology	026	PHYSICIANS	26198	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
10833	Fee-for-Service	1508944224	1508944224	1	1	LO, ELEANOR FUNG YEE MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74849	01	General Practice	0	In state provider	None	2000 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56289303	-121.7715238	Yolo County
10873	Fee-for-Service	1407045933	1407045933	1	1	LURYE, BIANA MD	9/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102511	05	Anesthesiology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
10889	Fee-for-Service	1306176193	1306176193	1	1	LANGTON, ZACHARY M CRNA	4/23/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXP WAY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
10952	Fee-for-Service	1861788770	1861788770	1	1	LINDQUESTER, JAQUALINE R MD	10/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122625	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
10992	Fee-for-Service	1942211818	1942211818	1	1	LARRY SHOWALTER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 W ROBBINS RD	None	BOISE	ID	83702	4565	00	None	43.61650152	-116.1923121	Ada County
11000	Fee-for-Service	1801473657	1801473657	1	1	LEES, CHRISTOPHER R MD	4/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
11037	Fee-for-Service	1093730301	1093730301	1	1	LIM, CYNTHIA MD	9/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	73071	None	None	0	In state provider	None	1646 BROADWAY ST	None	VALLEJO	CA	94590	2405	48	06095	38.12536599	-122.2503047	Solano County
11045	Fee-for-Service	1518310507	1518310507	1	1	LICHTENSTEIN, SETH J MD	9/3/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	161705	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
11059	Fee-for-Service	1700338779	1700338779	1	1	LAKESIDE OPTOMETRY PC	1/20/2017	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3461 BROOKSIDE ROAD	SUITE A-1	STOCKTON	CA	95219	1741	39	06077	37.9853082	-121.3551622	San Joaquin County
11072	Fee-for-Service	1053617019	1053617019	1	1	LUSARIA, CHESTER R CRNA	9/30/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
11079	Fee-for-Service	1487623427	1487623427	1	1	LEVY, STEVEN B MD	11/27/1985	207RN0300X	NA	Nephrology	026	PHYSICIANS	29011	45	Nephrology (Renal-Kidney)	0	In state provider	None	3796 N 1ST ST	None	FRESNO	CA	93726	5601	10	06019	36.785925	-119.7723515	Fresno County
11089	Fee-for-Service	1285647933	1285647933	1	1	LAC+USC MEDICAL CENTER	7/1/2005	282N00000X	NA	Hospitals	060	COUNTY HOSPITAL INPATIENT	-	-	NOT APPLICABLE	0	In state provider	GENERAL HOSP RM 735	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
11107	Fee-for-Service	1215226311	1215226311	1	1	LEVY, ADAM S MD	4/21/2020	208200000X	NA	General Surgery	026	PHYSICIANS	166437	24	Plastic Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 465	LOS ANGELES	CA	90095	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
11123	Fee-for-Service	1356631469	1356631469	1	1	LUONG-PLAYER, ADELINA T MD	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107634	22	Pathology (M.D. only)	0	In state provider	None	1401 GARCES HWY	None	DELANO	CA	93215	3690	15	06029	35.76144847	-119.238912	Kern County
11124	Fee-for-Service	1508094988	1508094988	1	1	LIU, JENNY A MD	5/22/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3001 SILLECT AVE	None	BAKERSFIELD	CA	93308	6337	15	06029	35.38601911	-119.0400416	Kern County
11139	Fee-for-Service	1417954306	1417954306	1	1	LEE, RONALD MD	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45368	01	General Practice	0	In state provider	None	9930 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166152	-117.955521	Orange County
11151	Fee-for-Service	1760809941	1760809941	1	1	LAPE, ALEXANDRA A	6/2/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	12	06023	0	0	None
11156	Fee-for-Service	1881295251	1881295251	1	1	LOYAL HOME HEALTH SERVICES	10/12/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4119 W BURBANK BLVD	STE 173	BURBANK	CA	91505	2122	19	06037	34.1730175	-118.3553514	Los Angeles County
11194	Fee-for-Service	1457521742	1457521742	1	1	LANDRY, JENNIFER OT	12/14/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4211 B VALLEY VIEW AVE	None	NORCO	CA	92860	3502	33	06065	33.943446	-117.5498725	Riverside County
11214	Fee-for-Service	1649590258	1649590258	1	1	LU, ELAINE I MD	2/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113541	36	Psychiatry	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
11241	Fee-for-Service	1740349323	1740349323	1	1	LIN, ANTONY T MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65352	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
11244	Fee-for-Service	1669496535	1669496535	1	1	LUI, GENE S DO	8/2/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	22882	36	Psychiatry	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
11263	Fee-for-Service	1598221939	1598221939	1	1	LOI, ELIZABETH PHD	10/3/2024	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
11288	Fee-for-Service	1386977346	1386977346	1	1	LOMELI, OSVALDO LCSW	5/11/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	120 BIRMINGHAM DRIVE	240A	CARDIFF BY THE SE	CA	92007	1757	37	06073	33.02310224	-117.2826142	San Diego County
11301	Fee-for-Service	1275143653	1275143653	1	1	LOVE & FAITH HOSPICE SERVICE	2/20/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	7365 CARNELIAN ST	STE 115	RANCHO CUCAMONGA	CA	91730	1156	36	06071	34.12038413	-117.6160525	San Bernardino County
11309	Fee-for-Service	1033146022	1033146022	1	1	LEE, BRENDAN J JR MD	1/31/1990	207P00000X	NA	Other	026	PHYSICIANS	5957	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
11331	Fee-for-Service	1962648626	1962648626	1	1	LITA & AVA INCORPORATED	11/1/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1250 S WINCHESTER BLVD	None	SAN JOSE	CA	95128	3906	43	06085	37.30254286	-121.9498662	Santa Clara County
11345	Fee-for-Service	1376500249	1376500249	1	1	LEE, YING-CHIEN MD	9/15/2006	208600000X	NA	General Surgery	026	PHYSICIANS	29620	02	General Surgery	0	In state provider	None	440 N GREENFIELD AVE	STE I	HANFORD	CA	93230	3513	16	06031	36.32904	-119.6582155	Kings County
11346	Fee-for-Service	1710637319	1710637319	1	1	LEE, GWENDOLYN MD	3/18/2025	207R00000X	NA	Other	026	PHYSICIANS	188714	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
11357	Fee-for-Service	1952076895	1952076895	1	1	LOTUS WELLSPRING ACUPUNCTURE	8/30/2021	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	INC	4950 BARRANCA PKWY	SUITE 301	IRVINE	CA	92604	4631	30	06059	33.67620851	-117.7948348	Orange County
11361	Fee-for-Service	1144731449	1144731449	1	1	LIFETOUCH CARE, INC	4/3/2019	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2701 WINTHROP AVE	None	ARCADIA	CA	91007	8436	19	06037	34.1073031	-118.0468532	Los Angeles County
11372	Fee-for-Service	1215967948	1215967948	1	1	LOWRE, CHERI A MD	4/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86790	None	None	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
11373	Fee-for-Service	1447694633	1447694633	1	1	LEE, TIMOTHY D MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149885	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
11377	Fee-for-Service	1568500684	1568500684	1	1	LAGHAEE. SHAHIN MD INC	5/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82720	10	Gastroenterology (M.D. only)	0	In state provider	None	250 S OAK AVE	BLDG A STE 3	OAKDALE	CA	95361	3572	50	06099	37.75888818	-120.8609099	Stanislaus County
11403	Fee-for-Service	1164746137	1164746137	1	1	LOCATELLI, ELIZABETH MSW LC	10/28/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
11423	Fee-for-Service	1659309128	1659309128	1	1	LEE, JEFFREY D MD	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	65191	33	Thoracic Surgery	0	In state provider	None	24411 HEALTH CENTER DR	STE 680	LAGUNA HILLS	CA	92653	3692	30	06059	33.6087201	-117.7076948	Orange County
11426	Fee-for-Service	1437511607	1437511607	1	1	LIU, BERT MD	1/3/2022	390200000X	NA	Other	026	PHYSICIANS	154347	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
11464	Fee-for-Service	1225418189	1225418189	1	1	LENT, JASON DO	9/5/2019	207L00000X	NA	Other	026	PHYSICIANS	16790	05	Anesthesiology	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
11482	Fee-for-Service	1134149156	1134149156	1	1	LANG, OLIVIA MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	65350	40	Pediatrics	0	In state provider	None	1650 WALNUT ST	None	BERKELEY	CA	94709	1606	01	06001	37.87689376	-122.267835	Alameda County
11499	Fee-for-Service	1538296785	1538296785	1	1	LIN, LI MEI MD	7/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131615	14	Neurological Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
11501	Fee-for-Service	1538101365	1538101365	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5170 MOORPARK AVE	None	SAN JOSE	CA	95129	2139	43	06085	37.30947145	-121.9945583	Santa Clara County
11507	Fee-for-Service	1881869998	1881869998	1	1	LEE, NANCY S MD	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110692	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
11511	Fee-for-Service	1326496167	1326496167	1	1	LIU, WILSON DO	2/20/2020	207R00000X	NA	Other	026	PHYSICIANS	16858	41	Internal Medicine	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
11517	Fee-for-Service	1154335982	1154335982	1	1	LOS ANGELES COUNTY	7/1/2000	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	LONG BEACH COMPREHENSIVE	1333 CHESTNUT AVE	None	LONG BEACH	CA	90813	2944	19	06037	33.78354312	-118.1963702	Los Angeles County
11539	Fee-for-Service	1295895068	1295895068	1	1	LOUIS, D MD AMC	4/8/2016	193400000X	NA	Other	026	PHYSICIANS	39231	01	General Practice	0	In state provider	None	350 30TH STREET	SUITE 540	OAKLAND	CA	94609	3487	01	06001	37.81892183	-122.2640154	Alameda County
11550	Fee-for-Service	1285769182	1285769182	1	1	LAU, JACOB E MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75621	07	Dermatology	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
11588	Fee-for-Service	1275143653	1275143653	1	1	LOVE & FAITH HOSPICE SERVICE	2/20/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	7365 CARNELIAN ST	STE 115	RANCHO CUCAMONGA	CA	91730	1156	36	06071	34.12038413	-117.6160525	San Bernardino County
11607	Fee-for-Service	1972987329	1972987329	1	1	LOVING HANDS ENTERPRISES LLC	5/8/2018	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5252 E. BEVERLY BLVD	None	LOS ANGELES	CA	90022	2002	19	06037	34.03119511	-118.1521775	Los Angeles County
11615	Fee-for-Service	1356482855	1356482855	1	1	LIN, HANK M MD	5/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94174	30	Radiology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
11627	Fee-for-Service	1912942749	1912942749	1	1	LAMPROPOULOS, CONSTANTNA	8/31/1989	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	68443	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
11637	Fee-for-Service	1326381104	1326381104	1	1	LIPPNER, MATTHEW MD	1/24/2018	207R00000X	NA	Other	026	PHYSICIANS	138670	41	Internal Medicine	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
11655	Fee-for-Service	1659922151	1659922151	1	1	LE, CHRISTOPHER V PSYD	11/26/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	31194 LA BAYA DR	STE 100	WESTLAKE VILLAGE	CA	91362	6420	19	06037	34.15643887	-118.8025233	Los Angeles County
11657	Fee-for-Service	1235355751	1235355751	1	1	LU, DAVID Q MD	1/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	85335	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
11663	Fee-for-Service	1447694633	1447694633	1	1	LEE, TIMOTHY D MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149885	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
11664	Fee-for-Service	1023037405	1023037405	1	1	LAMERS, MYRA M	6/7/1995	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	435 ARDEN AVE	STE 440	GLENDALE	CA	91203	4063	19	06037	34.15848148	-118.2628845	Los Angeles County
11697	Fee-for-Service	1992013866	1992013866	1	1	LANCASTER, ALLISON T LMFT	9/29/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	81231	-	NOT APPLICABLE	0	In state provider	None	20094 MISSION BLVD	None	HAYWARD	CA	94541	1237	01	06001	37.68697869	-122.1024518	Alameda County
11709	Fee-for-Service	1659309128	1659309128	1	1	LEE, JEFFREY D MD	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	65191	02	General Surgery	0	In state provider	None	24411 HEALTH CENTER DR	STE 680	LAGUNA HILLS	CA	92653	3692	30	06059	33.6087201	-117.7076948	Orange County
11739	Fee-for-Service	1588923791	1588923791	1	1	LORENZO, JAVIER MD	8/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110397	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
11775	Fee-for-Service	1790212397	1790212397	1	1	LEUNG, SABRINA	10/31/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	191075	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
11778	Fee-for-Service	1265883912	1265883912	1	1	LOPEZ, ANTHONY DO	4/29/2024	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	18949	39	Preventive (M.D. only)	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
11781	Fee-for-Service	1174799779	1174799779	1	1	LE, HOE H MD INC	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	43614	08	Family Practice	0	In state provider	None	9225 CARLTON HILLS BVD	SUITE 4	SANTEE	CA	92071	7901	37	06073	32.84437402	-116.9978523	San Diego County
11787	Fee-for-Service	1235684945	1235684945	1	1	LEVIN, CINDI S LCSW	7/10/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	840 HINCKLEY	STE 235	BURLINGAME	CA	94010	1547	41	06081	37.59825831	-122.3684871	San Mateo County
11805	Fee-for-Service	1154335982	1154335982	1	1	LOS ANGELES COUNTY	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	LONG BEACH COMPREHENSIVE	1333 CHESTNUT AVE	None	LONG BEACH	CA	90813	2944	19	06037	33.78354312	-118.1963702	Los Angeles County
11811	Fee-for-Service	1508923350	1508923350	1	1	LEE, RUSSELL G OD	12/4/1998	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
11814	Fee-for-Service	1346300274	1346300274	1	1	LEE, ROBERT A MD	10/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109496	07	Dermatology	0	In state provider	None	3883 AIRWAY DRIVE	SUITE 203	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
11859	Fee-for-Service	1447073895	1447073895	1	1	LAFFOON, TIFFANY CNP	3/21/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	491 E ALESSANDRO BLVD	None	RIVERSIDE	CA	92508	6071	33	06065	33.91628714	-117.3230954	Riverside County
11930	Fee-for-Service	1558547331	1558547331	1	1	LINDO, FAE A NP	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
11948	Fee-for-Service	1902003213	1902003213	1	1	LUKE, PRISCILLA K MD	2/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107548	18	Ophthalmology	0	In state provider	None	11370 ANDERSON ST	STE 1800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
11949	Fee-for-Service	1427116359	1427116359	1	1	LOGSDON, CATHERINE N LMFT	4/26/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
11957	Fee-for-Service	1760774988	1760774988	1	1	LERLO, ESTELLA LMFT	9/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
11969	Fee-for-Service	1407986425	1407986425	1	1	LOPEZ, LOURDES LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
12027	Fee-for-Service	1588923791	1588923791	1	1	LORENZO, JAVIER MD	8/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110397	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
12041	Fee-for-Service	1942317284	1942317284	1	1	L&D PROFESSIONAL, INC.	4/5/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	TER	8110 MANGO AVE	SUITE 102	FONTANA	CA	92335	3603	36	06071	34.10549796	-117.4314604	San Bernardino County
12042	Fee-for-Service	1811476807	1811476807	1	1	LIU, CONNIE PT	12/30/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
12049	Fee-for-Service	1003064999	1003064999	1	1	LARSON, DOUGLAS G MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LANE	STE 100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
12060	Fee-for-Service	1821230988	1821230988	1	1	LU, JONATHAN K MD	10/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	118235	02	General Surgery	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
12064	Fee-for-Service	1649293283	1649293283	1	1	LAWRENCE DELORENZO MD	11/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 WOODS RD	None	VALHALLA	NY	10595	1530	00	None	41.08902532	-73.80449573	Westchester County
12142	Fee-for-Service	1104966373	1104966373	1	1	LIANG, DAVID H MD	9/30/1992	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	69354	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2900 WHIPPLE AVE	None	REDWOOD CITY	CA	94062	2843	41	06081	37.4783072	-122.2551089	San Mateo County
12187	Fee-for-Service	1871526327	1871526327	1	1	LINNIK, WILLIAM J MD	9/30/1989	207P00000X	NA	Other	026	PHYSICIANS	64880	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
12193	Fee-for-Service	1467649814	1467649814	1	1	LOBELL, ALLEGRA E MD	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	97175	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
12206	Fee-for-Service	1144976176	1144976176	1	1	LIN, LILI NP	10/16/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
12230	Fee-for-Service	1841806734	1841806734	1	1	LIFESPRING HOME HEALTH INC	12/28/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2233 HONOLULU AVE	UNIT 304	MONTROSE	CA	91020	1635	19	06037	34.2052531	-118.22622	Los Angeles County
12235	Fee-for-Service	1710187448	1710187448	1	2	LATIF, ALAA MD INC	5/9/2011	207RH0003X	NA	Oncology	026	PHYSICIANS	51955	None	None	0	In state provider	None	1900 ROYALTY DR.,	SUITE 140	POMONA	CA	91767	3021	19	06037	34.07754346	-117.7463466	Los Angeles County
12262	Fee-for-Service	1508944406	1508944406	1	1	LEE, RAYNELL T MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
12271	Fee-for-Service	1275506412	1275506412	1	1	LIM, NANCY G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42912	08	Family Practice	0	In state provider	None	9675 MONTE VISTA AVE	STE B	MONTCLAIR	CA	91763	2213	36	06071	34.079004	-117.6982135	San Bernardino County
12276	Fee-for-Service	1801984125	1801984125	1	1	LENER, JULIET P MD	5/31/1994	174400000X	NA	Other	026	PHYSICIANS	78124	40	Pediatrics	0	In state provider	None	15725 WHITTIER BLVD	None	WHITTIER	CA	90603	2347	19	06037	33.94435533	-117.9931159	Los Angeles County
12287	Fee-for-Service	1316910177	1316910177	1	1	LAXA, BERNADETTE U MD	10/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121181	02	General Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
12309	Fee-for-Service	1265096515	1265096515	1	1	LIU, WEIER MD	8/22/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176631	None	None	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
12372	Fee-for-Service	1780782938	1780782938	1	1	LEE, RESSIA MD	9/6/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	71070	40	Pediatrics	0	In state provider	None	25485 MEDICAL CENTER DR	#100	MURRIETA	CA	92562	6927	33	06065	33.55785761	-117.1842222	Riverside County
12375	Fee-for-Service	1962013201	1962013201	1	1	LPILOSSYAN	6/22/2021	207RR0500X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	13321 VICTORY BLVD	None	VAN NUYS	CA	91401	1832	19	06037	34.18670353	-118.4233635	Los Angeles County
12381	Fee-for-Service	1073632857	1073632857	1	1	LOPEZ, DAVID LMFT	1/5/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 MITCHELL RD	STE 10	MODESTO	CA	95351	4901	50	06099	37.610712	-120.9387115	Stanislaus County
12413	Fee-for-Service	1245319383	1245319383	1	1	LIU, AMY MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	76141	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
12429	Fee-for-Service	1255411625	1255411625	1	1	LATTER, MITCHELL C MD	5/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	40013	18	Ophthalmology	0	In state provider	None	10230 ARTESIA BLVD	STE 204	BELLFLOWER	CA	90706	6768	19	06037	33.8728276	-118.1160403	Los Angeles County
12434	Fee-for-Service	1831196922	1831196922	1	1	LAUFER, FREDERICK J MD	4/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	75078	30	Radiology	0	In state provider	None	2800 L STREET	STE 610	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
12449	Fee-for-Service	1073879300	1073879300	1	1	LI, NATASHA Y MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136064	40	Pediatrics	0	In state provider	None	11370 ANDERSON STREET	SUITE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
12472	Fee-for-Service	1285686782	1285686782	1	1	LE, TIEN J	6/13/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
12477	Fee-for-Service	1780242081	1780242081	1	1	LIFE & LOVE HOSPICE CARE	3/13/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	GROUP	11331 VENTURA BLVD	STE 305	STUDIO CITY	CA	91604	3147	19	06037	34.14024752	-118.377123	Los Angeles County
12482	Fee-for-Service	1467649814	1467649814	1	1	LOBELL, ALLEGRA E MD	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	97175	05	Anesthesiology	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
12530	Fee-for-Service	1174549554	1174549554	1	1	LEONGARDT, DMITRY MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78047	41	Internal Medicine	0	In state provider	None	5TH ESPLANADE	None	CHICO	CA	95926	0000	04	06007	39.74133607	-121.8503698	Butte County
12565	Fee-for-Service	1174288203	1174288203	1	1	LEONARD, KIMBERLY J LCSW	2/10/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8775 AERO DRIVE	STE 238	SAN DIEGO	CA	92123	1756	37	06073	32.80965551	-117.1391563	San Diego County
12603	Fee-for-Service	1467871970	1467871970	1	2	LOUIE, MICHELLE K F MD	11/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137916	40	Pediatrics	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
12613	Fee-for-Service	1982018305	1982018305	1	1	LIM, DANIEL DO	2/25/2020	208600000X	NA	General Surgery	026	PHYSICIANS	17218	02	General Surgery	0	In state provider	None	1233 W LA HABRA BLVD	None	LA HABRA	CA	90631	5226	30	06059	33.93188146	-117.959868	Orange County
12627	Fee-for-Service	1831638824	1831638824	1	1	LOCKHEART, KAREN NP	12/12/2017	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
12628	Fee-for-Service	1407910847	1407910847	1	1	LIN, SAMUEL MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	79985	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
12639	Fee-for-Service	1306495007	1306495007	1	1	LIAO, WINNIE LCSW	2/19/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
12649	Fee-for-Service	1851336234	1851336234	1	1	LINCARE INC	11/2/2000	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	LINCARE INC	7545 N DEL MAR AVE	SUITE 102	FRESNO	CA	93711	6872	10	06019	36.84671043	-119.7959216	Fresno County
12667	Fee-for-Service	1659150910	1659150910	1	1	LYNCH, KALLIE KATHLEEN PT	1/26/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	17270 BEAR VALLEY RD	STE 105	VICTORVILLE	CA	92395	7751	36	06071	34.47103946	-117.2849598	San Bernardino County
12679	Fee-for-Service	1992985923	1992985923	1	1	LAMORINDA ENT FACE & NECK	12/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	85934	None	None	0	In state provider	SURGERY INC	911 MORAGA ROAD	STE 102	LAFAYETTE	CA	94549	4591	07	06013	37.88758326	-122.1181419	Contra Costa County
12695	Fee-for-Service	1669491825	1669491825	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	26180 IRIS AVE	None	MORENO VALLEY	CA	92555	3004	33	06065	33.89135692	-117.206447	Riverside County
12701	Fee-for-Service	1245319383	1245319383	1	1	LIU, AMY MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	76141	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
12715	Fee-for-Service	1851820708	1851820708	1	1	LIZOTTE, SHARON S LMFT	8/27/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	119279	-	NOT APPLICABLE	0	In state provider	None	2000 W BRIGGSMORE AVE	STE I	MODESTO	CA	95350	3839	50	06099	37.67139252	-121.0281273	Stanislaus County
12717	Fee-for-Service	1508672676	1508672676	1	1	LUCERO, JESUS	12/26/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1020 TIERRA DEL REY	A1	CHULA VISTA	CA	91910	7886	37	06073	32.6377383	-117.0196092	San Diego County
12746	Fee-for-Service	1255654323	1255654323	1	1	LUM, CHRISTOPHER G LCSW	10/23/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
12767	Fee-for-Service	1780242081	1780242081	1	1	LIFE & LOVE HOSPICE CARE	3/13/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	GROUP	11331 VENTURA BLVD	STE 305	STUDIO CITY	CA	91604	3147	19	06037	34.14024752	-118.377123	Los Angeles County
12802	Fee-for-Service	1124339346	1124339346	1	1	LYNCH, CRISTAL M MD INC	11/3/2014	193400000X	NA	Other	026	PHYSICIANS	48358	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3440 LOMITA BLVD	SUITE 240	TORRANCE	CA	90505	4801	19	06037	33.81328127	-118.3452927	Los Angeles County
12806	Fee-for-Service	1942593082	1942593082	1	1	LING, NICOLE L MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116547	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
12814	Fee-for-Service	1497789630	1497789630	1	1	LAVU, SWATI MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72305	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
12830	Fee-for-Service	1669939427	1669939427	1	1	LABIB, RHONDA M AU	12/12/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
12832	Fee-for-Service	1538193024	1538193024	1	1	LEE, DONNA JEE-YOUNG MD	12/31/1992	207N00000X	NA	Dermatology	026	PHYSICIANS	76498	07	Dermatology	0	In state provider	None	23861 MCBEAN PKWY	STE E14	VALENCIA	CA	91355	2077	19	06037	34.39567343	-118.5542698	Los Angeles County
12870	Fee-for-Service	1255433850	1255433850	1	1	LEBECK, SHERRY L PHD	6/16/2003	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3626 SACRAMENTO ST	STE 1	SAN FRANCISCO	CA	94118	1720	38	06075	37.78750304	-122.4524939	San Francisco County
12894	Fee-for-Service	1942331087	1942331087	1	1	LEE CHAR, SUSAN J MD	7/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	103548	02	General Surgery	0	In state provider	None	3801 SACRAMENTO ST	SUITE 100	SAN FRANCISCO	CA	94118	1618	38	06075	37.78707021	-122.4555217	San Francisco County
12906	Fee-for-Service	1114087533	1114087533	1	1	LEVINE, BARRETT G MD	8/31/1993	2084P0800X	NA	Psychiatry	026	PHYSICIANS	35389	36	Psychiatry	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
12934	Fee-for-Service	1447460050	1447460050	1	1	LE, JOAN T MD	9/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99391	25	Physical Medicine and Rehabilitation	0	In state provider	None	11406 LOMA LINDA DR	STE 3	LOMA LINDA	CA	92354	3711	36	06071	34.04642588	-117.2480303	San Bernardino County
12955	Fee-for-Service	1598795114	1598795114	1	2	LUU, NGHI MD	11/22/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	50832	-	NOT APPLICABLE	0	In state provider	None	614 TULLY ROAD	None	SAN JOSE	CA	95111	1048	43	06085	37.30851705	-121.8465917	Santa Clara County
12964	Fee-for-Service	1952805517	1952805517	1	1	LEE, MING YEH MD	3/15/2024	2080P0205X	NA	Endocrinology	026	PHYSICIANS	165067	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
12973	Fee-for-Service	1770634917	1770634917	1	1	LEEMING-MARTINEZ, ROBIN A	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
13028	Fee-for-Service	1083825095	1083825095	1	1	LEITSON, SAGE K LMFT	9/29/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	46656	-	NOT APPLICABLE	0	In state provider	None	10850 MACARTHUR BLVD	STE 200	OAKLAND	CA	94605	5266	01	06001	37.7414325	-122.1498379	Alameda County
13034	Fee-for-Service	1275895252	1275895252	1	1	LAUREN PANGLE	10/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
13035	Fee-for-Service	1992803183	1992803183	1	1	LOTERY, JENNIFER L PHD	6/25/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	493 MAIN ST	STE D	DIAMOND SPRINGS	CA	95619	9173	09	06017	38.694285	-120.8178945	El Dorado County
13064	Fee-for-Service	1992191506	1992191506	1	1	LADDARAN, LESTER MD	12/2/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	7325 MEDICAL CENTER DR	STE 200	WEST HILLS	CA	91307	4108	19	06037	34.20369349	-118.629837	Los Angeles County
13082	Fee-for-Service	1407804669	1407804669	1	1	LOWELL GENERAL HOSPITAL	4/1/2002	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	295 VARNUM AVE	None	LOWELL	MA	01854	2193	00	None	42.647166	-71.3414115	Middlesex County
13083	Fee-for-Service	1932312600	1932312600	1	1	LOPEZ, LILLIAN Y DO	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	10228	01	General Practice	0	In state provider	None	33758 YUCAIPA BLVD	None	YUCAIPA	CA	92399	2243	36	06071	34.03407872	-117.0672458	San Bernardino County
13088	Fee-for-Service	1144842550	1144842550	1	1	LYONS, EMILY	7/30/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3800 GEER RD	STE 101	TURLOCK	CA	95382	1146	50	06099	37.52713247	-120.8488664	Stanislaus County
13107	Fee-for-Service	1972517167	1972517167	1	1	LIU, GENE C MD	8/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90107	04	Otology, Laryngology, Rhinology	0	In state provider	None	8631 W 3RD STREET	None	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
13111	Fee-for-Service	1659375103	1659375103	1	1	LARKINS, PHILIP E DPM	1/1/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	925 E PENNSYLVANIA AVE	SUITE H	ESCONDIDO	CA	92025	3432	37	06073	33.12797417	-117.0702597	San Diego County
13118	Fee-for-Service	1710507207	1710507207	1	1	LEE, JENNIFER E DO	3/28/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	20950	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
13120	Fee-for-Service	1598056715	1598056715	1	1	LEAHY, MARYA E MD	8/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125778	05	Anesthesiology	0	In state provider	None	7417 N CEDAR AVENUE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
13142	Fee-for-Service	1871502435	1871502435	1	1	LOEB, ROBERT S MD	5/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53042	30	Radiology	0	In state provider	None	1516 COTNER AVENUE	None	LOS ANGELES	CA	90025	3303	19	06037	34.04905416	-118.4477438	Los Angeles County
13155	Fee-for-Service	1457487670	1457487670	1	1	LICURSE, DEBORAH A LMFT	6/15/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1588 HOMESTEAD RD	MB 10, SUITE B	SANTA CLARA	CA	95050	4771	43	06085	37.34637328	-121.9509049	Santa Clara County
13173	Fee-for-Service	1275694531	1275694531	1	1	L. BRUCE MEBINE O.D.	5/31/1990	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	340 W PORTAL AVE	None	SAN FRANCISCO	CA	94127	1412	38	06075	37.73744363	-122.4697471	San Francisco County
13201	Fee-for-Service	1780751511	1780751511	1	1	LI, XIAN MD	10/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88221	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
13235	Fee-for-Service	1447782206	1447782206	1	1	LEE, CHRISTINE L MD	7/1/2022	2080P0204X	NA	Other	026	PHYSICIANS	159291	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
13260	Fee-for-Service	1699781187	1699781187	1	1	LWIN, NYUNT MD	2/5/2013	207L00000X	NA	Other	026	PHYSICIANS	40744	01	General Practice	0	In state provider	None	5451 WALNUT AVE	None	MONTCLAIR	CA	91763	0000	36	06071	34.02626886	-117.6858645	San Bernardino County
13273	Fee-for-Service	1356519144	1356519144	1	1	LEW, PETER P MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106893	30	Radiology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
13293	Fee-for-Service	1851479919	1851479919	1	1	LEVINE, GABRIELLE K MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	60643	02	General Surgery	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
13340	Fee-for-Service	1548898505	1548898505	1	1	LE, LAURA	8/23/2023	207P00000X	NA	Other	026	PHYSICIANS	186489	None	None	0	In state provider	None	1050 LINDEN AVENUE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
13370	Fee-for-Service	1407804669	1407804669	1	1	LOWELL GENERAL HOSPITAL	1/29/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	295 VARNUM AVE	None	LOWELL	MA	01854	2193	00	None	42.647166	-71.3414115	Middlesex County
13382	Fee-for-Service	1609479484	1609479484	1	1	LEGACY HOSPICE INC	8/17/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7311 VAN NUYS BLVD	UNIT 11	VAN NUYS	CA	91405	1999	19	06037	34.203393	-118.4487795	Los Angeles County
13409	Fee-for-Service	1164476511	1164476511	1	1	LAN, YUHUAN MD	6/1/1998	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	78928	25	Physical Medicine and Rehabilitation	0	In state provider	None	2690 PACIFIC AVE	STE 290	LONG BEACH	CA	90806	2631	19	06037	33.805854	-118.1936805	Los Angeles County
13412	Fee-for-Service	1851735286	1851735286	1	1	LUK, TIFFANIE I MD	5/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133881	01	General Practice	0	In state provider	None	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.8531521	-117.8160824	Orange County
13413	Fee-for-Service	1972769446	1972769446	1	1	LYNN, BETHANY MD	5/13/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	107411	None	None	0	In state provider	None	590 S INDIAN HILL BLVD	None	CLAREMONT	CA	91711	5212	19	06037	34.085313	-117.7191945	Los Angeles County
13418	Fee-for-Service	1811986375	1811986375	1	1	LUNDGREN, DANIEL	9/11/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
13435	Fee-for-Service	1396998811	1396998811	1	1	LANDES, LISA E LCSW	2/20/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4237 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3001	38	06075	37.78090113	-122.4649862	San Francisco County
13447	Fee-for-Service	1649383464	1649383464	1	1	LOS ANGELES COUNTY	7/1/2000	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	SOUTH VALLEY HEALTH CTR	38350 40TH ST E	STE 100	PALMDALE	CA	93552	3075	19	06037	34.57927533	-118.0582951	Los Angeles County
13460	Fee-for-Service	1497829006	1497829006	1	1	LAPPIN, MICHAEL B MD	3/8/1976	No Taxonomy Provided	NA	None	026	PHYSICIANS	30285	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	9209 COLIMA RD	STE 3400	WHITTIER	CA	90605	1819	19	06037	33.9505367	-118.0054552	Los Angeles County
13489	Fee-for-Service	1780751511	1780751511	1	1	LI, XIAN MD	10/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88221	38	Geriatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
13501	Fee-for-Service	1336653013	1336653013	1	1	LAUWO, RUWAICHI S	8/2/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	29139 GUAVA STREET	None	MENIFEE	CA	92584	7290	33	06065	33.70114086	-117.1505873	Riverside County
13569	Fee-for-Service	1346240967	1346240967	1	1	LOVELL, ERIC R MD	4/30/1992	207P00000X	NA	Other	026	PHYSICIANS	63261	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
13570	Fee-for-Service	1356519474	1356519474	1	1	LOO, ARIEL G NP	11/20/2019	364SM0705X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
13573	Fee-for-Service	1396382636	1396382636	1	1	LURATO, INC.	1/28/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	470 PLUMAS BLVD.	STE. 103	YUBA CITY	CA	95991	5077	51	06101	39.13270038	-121.6141985	Sutter County
13603	Fee-for-Service	1700947264	1700947264	1	1	LENS, MARIAIDALIA O NP	2/19/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
13605	Fee-for-Service	1396007571	1396007571	1	1	LUNGAY, MELANIE J MD	10/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128901	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
13614	Fee-for-Service	1770618571	1770618571	1	1	LOMPOC ARTIFICIAL KIDNEY	12/10/1998	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER, LLC	127 W PINE AVE	None	LOMPOC	CA	93436	4023	42	06083	34.65025624	-120.4589575	Santa Barbara County
13626	Fee-for-Service	1053634162	1053634162	1	1	LYNCH, ERIN M CRNA	6/22/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
13644	Fee-for-Service	1144080946	1144080946	1	1	LUNA, STACY V NP	1/7/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	833 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4735	19	06037	34.01035039	-118.109564	Los Angeles County
13646	Fee-for-Service	1669190716	1669190716	1	1	LEE, VIVIAN PT	1/23/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2262 N. 1ST ST	None	SAN JOSE	CA	95131	2022	43	06085	37.37772646	-121.921374	Santa Clara County
13653	Fee-for-Service	1154170975	1154170975	1	1	LABOR OF LOVE	5/20/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	43	06085	0	0	None
13672	Fee-for-Service	1609479484	1609479484	1	1	LEGACY HOSPICE INC	8/17/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7311 VAN NUYS BLVD	UNIT 11	VAN NUYS	CA	91405	1999	19	06037	34.203393	-118.4487795	Los Angeles County
13730	Fee-for-Service	1891820627	1891820627	2	1	LAKTINEH, SOLOMON MD	5/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50421	40	Pediatrics	0	In state provider	None	1040 ELM AVE	STE 304	LONG BEACH	CA	90813	3267	19	06037	33.779799	-118.1879535	Los Angeles County
13732	Fee-for-Service	1982752846	1982752846	1	1	LORENZO, IMELDA T. MD	1/31/1989	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	47965	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
13737	Fee-for-Service	1649383464	1649383464	1	1	LOS ANGELES COUNTY	12/27/2010	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	SOUTH VALLEY HEALTH CTR	38350 40TH ST E	STE 100	PALMDALE	CA	93552	3075	19	06037	34.57927533	-118.0582951	Los Angeles County
13742	Fee-for-Service	1386177921	1386177921	1	1	LEE, LORI W MD	7/20/2023	2080P0214X	NA	Pulmonology	026	PHYSICIANS	157007	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
13747	Fee-for-Service	1497829006	1497829006	1	1	LAPPIN, MICHAEL B MD	3/8/1976	No Taxonomy Provided	NA	None	026	PHYSICIANS	30285	18	Ophthalmology	0	In state provider	None	9209 COLIMA RD	STE 3400	WHITTIER	CA	90605	1819	19	06037	33.9505367	-118.0054552	Los Angeles County
13789	Fee-for-Service	1336653013	1336653013	1	1	LAUWO, RUWAICHI S	8/2/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	29139 GUAVA STREET	None	MENIFEE	CA	92584	7290	33	06065	33.70114086	-117.1505873	Riverside County
13806	Fee-for-Service	1740762343	1740762343	1	1	LOPEZ, MARITZA M CNP	9/30/2019	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
13829	Fee-for-Service	1912310566	1912310566	1	1	LA FAMILIA MEDICAL CLINIC	3/9/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	INC	15243 VANOWEN ST	STE 107	VAN NUYS	CA	91405	3633	19	06037	34.19394848	-118.4654115	Los Angeles County
13836	Fee-for-Service	1205198314	1205198314	1	1	LAIRD, DANIEL J MD	6/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127986	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 DOYLE PARK DR	SUITE 303	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
13852	Fee-for-Service	1437194131	1437194131	1	1	LUNDQUIST, KURT F MD	10/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81268	22	Pathology (M.D. only)	0	In state provider	None	3701 S HIGUERA ST	STE 200	SAN LUIS OBISPO	CA	93401	7462	40	06079	35.2507845	-120.6712168	San Luis Obispo County
13875	Fee-for-Service	1245273457	1245273457	1	1	LEE, VICTOR W MD	8/12/1988	207ZP0102X	NA	Other	026	PHYSICIANS	43800	90	Pathology-Forensic	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
13907	Fee-for-Service	1255348140	1255348140	1	1	LOMA LINDA UNIVERSITY	7/1/1980	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
13930	Fee-for-Service	1497044341	1497044341	1	1	LAUBE, JUSTIN G MD	3/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124767	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
13966	Fee-for-Service	1417908872	1417908872	1	1	LINCOLN A GODFREY	11/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	624 HOSPITAL DR	None	MOUNTAIN HOME	AR	72653	2955	00	None	36.342738	-92.3962095	Baxter County
13971	Fee-for-Service	1942242771	1942242771	2	1	LONGS DRUG STORE CAL LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8900 SEPULVEDA WESTWAY	None	LOS ANGELES	CA	90045	3619	19	06037	33.955812	-118.398154	Los Angeles County
13975	Fee-for-Service	1093826992	1093826992	1	1	LASHER, MICHAEL E DO	12/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8462	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
14014	Fee-for-Service	1396322004	1396322004	1	1	LIZARRAGA, JOSEPH J PT	6/1/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
14024	Fee-for-Service	1649383464	1649383464	1	1	LOS ANGELES COUNTY	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	SOUTH VALLEY HEALTH CTR	38350 40TH ST E	STE 100	PALMDALE	CA	93552	3075	19	06037	34.57927533	-118.0582951	Los Angeles County
14025	Fee-for-Service	1386652600	1386652600	1	1	LEWIS, GRACIA C MD	8/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	38978	01	General Practice	0	In state provider	None	526 W 17TH ST	None	SANTA ANA	CA	92706	3619	30	06059	33.75995449	-117.8736165	Orange County
14046	Fee-for-Service	1497054100	1497054100	1	1	LAKDAWALA, RAVI S MD	6/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130619	45	Nephrology (Renal-Kidney)	0	In state provider	None	8635 WEST 3RD STREET	SUITE 485W	LOS ANGELES	CA	90048	6156	19	06037	34.07361928	-118.3803143	Los Angeles County
14047	Fee-for-Service	1548441454	1548441454	1	1	LIN, KEVIN MD	8/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89771	78	Neoplastic Diseases/Oncology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
14071	Fee-for-Service	1477833978	1477833978	1	1	LINDNER, AMBER R	9/27/2011	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	44407 10TH ST W	None	LANCASTER	CA	93534	3345	19	06037	34.68965953	-118.148053	Los Angeles County
14103	Fee-for-Service	1891888327	1891888327	1	1	LARRETA, BORIS R MD	4/23/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	49084	None	None	0	In state provider	None	2601 W ALAMEDA AVE	STE 100	BURBANK	CA	91505	4808	19	06037	34.15783817	-118.3293969	Los Angeles County
14106	Fee-for-Service	1265168371	1265168371	1	1	LACEY, TIFFANY DOULA	1/2/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	49	06097	0	0	None
14107	Fee-for-Service	1720136674	1720136674	1	1	LEVINE, JOEL J MD	9/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42335	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
14114	Fee-for-Service	1932435385	1932435385	1	1	LUKIANOFF-ODELL, BARBARA R	4/17/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	1643 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
14118	Fee-for-Service	1912310566	1912310566	1	1	LA FAMILIA MEDICAL CLINIC	3/9/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC	15243 VANOWEN ST	STE 107	VAN NUYS	CA	91405	3633	19	06037	34.19394848	-118.4654115	Los Angeles County
14136	Fee-for-Service	1194765354	1194765354	1	1	LOPEZ, ALFRED MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74287	05	Anesthesiology	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
14138	Fee-for-Service	1437194131	1437194131	1	1	LUNDQUIST, KURT F MD	10/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81268	07	Dermatology	0	In state provider	None	3701 S HIGUERA ST	STE 200	SAN LUIS OBISPO	CA	93401	7462	40	06079	35.2507845	-120.6712168	San Luis Obispo County
14164	Fee-for-Service	1245273457	1245273457	1	1	LEE, VICTOR W MD	8/12/1988	207ZP0102X	NA	Other	026	PHYSICIANS	43800	22	Pathology (M.D. only)	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
14167	Fee-for-Service	1225455157	1225455157	1	1	LOCKE, MIRIAM MD	3/31/2022	208800000X	NA	Other	026	PHYSICIANS	162641	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
14185	Fee-for-Service	1902217854	1902217854	1	1	LENG, CATHERINE C DO	11/27/2017	390200000X	NA	Other	026	PHYSICIANS	15547	08	Family Practice	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
14216	Fee-for-Service	1275240772	1275240772	1	1	LEE, YE RIN PT	5/25/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
14236	Fee-for-Service	1174640692	1174640692	1	1	LIM, DANIEL A MD	2/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87344	14	Neurological Surgery	0	In state provider	None	533 PARNASSUS AVE	U126	SAN FRANCISCO	CA	94122	2722	38	06075	37.76304484	-122.4592904	San Francisco County
14261	Fee-for-Service	1093826992	1093826992	1	1	LASHER, MICHAEL E DO	12/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8462	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
14265	Fee-for-Service	1629226337	1629226337	1	1	LIN, EDWARD J MD	12/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99277	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 OLD RIVER ROAD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
14277	Fee-for-Service	1356686737	1356686737	1	1	LONG, ABBE LMFT	9/14/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2525 CAMINO DEL RIO S	STE 245	SAN DIEGO	CA	92108	1702	37	06073	32.76765181	-117.1387992	San Diego County
14294	Fee-for-Service	1740065465	1740065465	1	1	LEVINE, JENNIFER OD	2/26/2025	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	280 COHASSET RD	None	CHICO	CA	95926	2210	04	06007	39.75172831	-121.8517257	Butte County
14312	Fee-for-Service	1386652600	1386652600	1	1	LEWIS, GRACIA C MD	8/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	38978	40	Pediatrics	0	In state provider	None	526 W 17TH ST	None	SANTA ANA	CA	92706	3619	30	06059	33.75995449	-117.8736165	Orange County
14328	Fee-for-Service	1497054100	1497054100	1	1	LAKDAWALA, RAVI S MD	6/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130619	41	Internal Medicine	0	In state provider	None	8635 WEST 3RD STREET	SUITE 485W	LOS ANGELES	CA	90048	6156	19	06037	34.07361928	-118.3803143	Los Angeles County
14345	Fee-for-Service	1043302052	1043302052	1	1	LEWIS, ROYA MD	3/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90817	36	Psychiatry	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
14349	Fee-for-Service	1760947451	1760947451	1	1	LOYOLA FAMILY HEALTH CENTER,	10/9/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4225 TWEEDY BLVD	STE B	SOUTH GATE	CA	90280	6217	19	06037	33.94330446	-118.1970199	Los Angeles County
14355	Fee-for-Service	1285120345	1285120345	1	1	LEW, VALERIE MD	11/3/2023	207P00000X	NA	Other	026	PHYSICIANS	184855	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
14363	Fee-for-Service	1215385901	1215385901	1	1	LEE, JENNAE L MD	7/11/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	161721	40	Pediatrics	0	In state provider	None	260 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.65808446	-121.6456618	Monterey County
14380	Fee-for-Service	1962530303	1962530303	1	1	LIPSON, JAFI A MD	5/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92300	30	Radiology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
14383	Fee-for-Service	1912074840	1912074840	1	1	LEVY, DENIS J MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	48925	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	4405 VANDEVER AVE	None	SAN DIEGO	CA	92120	3315	37	06073	32.78765609	-117.09908	San Diego County
14385	Fee-for-Service	1073133419	1073133419	1	1	LIN, BILLY MD	5/3/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181608	08	Family Practice	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
14390	Fee-for-Service	1962649210	1962649210	1	2	LATTER, MITCHELL C MD INC	8/24/2009	193400000X	NA	Other	026	PHYSICIANS	40013	None	None	0	In state provider	None	10230 ARTESIA BLVD	STE 204	BELLFLOWER	CA	90706	6768	19	06037	33.8728276	-118.1160403	Los Angeles County
14462	Fee-for-Service	1053463208	1053463208	1	1	LOUIE, TRACY D OD	2/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
14498	Fee-for-Service	1417933789	1417933789	1	1	LANGSVILLE, FRANK R. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
14531	Fee-for-Service	1871140434	1871140434	1	1	LEKAR HOME HEALTH CARE INC	1/20/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6742 VAN NUYS BLVD	STE 205	VAN NUYS	CA	91405	4611	19	06037	34.19343344	-118.4487213	Los Angeles County
14532	Fee-for-Service	1871270561	1871270561	1	1	LOCKWOOD, LESLIE H CCC-SLP	2/8/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2192 GALLERIA AT TYLER	None	RIVERSIDE	CA	92503	4146	33	06065	33.90941655	-117.4576347	Riverside County
14533	Fee-for-Service	1023429925	1023429925	1	1	LIST, JEB MD	10/22/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	173143	30	Radiology	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
14563	Fee-for-Service	1043650443	1043650443	1	1	LONDON, SEAN S MD	9/1/2020	2085B0100X	NA	MRI Provider	026	PHYSICIANS	161034	None	None	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
14618	Fee-for-Service	1386356921	1386356921	1	1	LAWSON, LAUREL S PT	3/20/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
14628	Fee-for-Service	1386673606	1386673606	1	1	LU, SHELLY C MD	2/8/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	51743	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
14670	Fee-for-Service	1912074840	1912074840	1	1	LEVY, DENIS J MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	48925	40	Pediatrics	0	In state provider	None	4405 VANDEVER AVE	None	SAN DIEGO	CA	92120	3315	37	06073	32.78765609	-117.09908	San Diego County
14753	Fee-for-Service	1710187026	1710187026	1	1	LOGAN, JULIA S MD	2/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100562	08	Family Practice	0	In state provider	None	2210 DEL PASO RD	STE A	SACRAMENTO	CA	95834	9676	34	06067	38.655189	-121.5091575	Sacramento County
14772	Fee-for-Service	1770819641	1770819641	1	1	LENAGHAN, PATRICK N MD	3/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110584	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
14777	Fee-for-Service	1962468983	1962468983	1	1	LOS ANGELES CARDIOLOGY	2/6/1986	193200000X	NA	Other	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	ASSOCIATES	1245 WILSHIRE BLVD	STE 703	LOS ANGELES	CA	90017	4807	19	06037	34.05362775	-118.2661889	Los Angeles County
14795	Fee-for-Service	1235471665	1235471665	1	1	LEUNG, WAI H MD	6/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136144	01	General Practice	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
14805	Fee-for-Service	1801057278	1801057278	1	1	LEE, JENNY MD	10/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102898	None	None	0	In state provider	None	18300 HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
14845	Fee-for-Service	1205317880	1205317880	1	1	LUDIN, SAMATHA J PHD	11/5/2020	390200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
14867	Fee-for-Service	1093841041	1093841041	1	1	LEE, SANG J	9/26/1980	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2732 W OLYMPIC BLVD	None	LOS ANGELES	CA	90006	2633	19	06037	34.05264547	-118.293192	Los Angeles County
14877	Fee-for-Service	1760190722	1760190722	1	1	LU, WESLEY PT	8/27/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
14879	Fee-for-Service	1760685952	1760685952	1	1	LEE, ELIZABETH M MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121182	41	Internal Medicine	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
14898	Fee-for-Service	1194204669	1194204669	1	1	LIN, WAN-TING LAC	2/26/2021	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	9939 GARVEY AVE	A	EL MONTE	CA	91733	4712	19	06037	34.06277368	-118.0516203	Los Angeles County
14944	Fee-for-Service	1053808048	1053808048	1	1	LEE, HEATHER F MD	10/10/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164702	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
14960	Fee-for-Service	1255979985	1255979985	1	1	LESLIE COX EMDR & THERAPY IN	1/27/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	C.	2522 CHAMBERS RD	STE 124	TUSTIN	CA	92780	6962	30	06059	33.71785088	-117.8076329	Orange County
14962	Fee-for-Service	1962649210	1962649210	1	1	LATTER, MITCHELL C MD INC	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	40013	None	None	0	In state provider	APC	1499 HUNTINGTON DR	STE 508	SOUTH PASADENA	CA	91030	5464	19	06037	34.10404853	-118.150551	Los Angeles County
14975	Fee-for-Service	1144030404	1144030404	1	1	LA CITY CARE PC	3/26/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6715 S WESTERN AVE	None	LOS ANGELES	CA	90047	1837	19	06037	33.978123	-118.3089965	Los Angeles County
14993	Fee-for-Service	1639422272	1639422272	1	1	LYNN L ROCKWELL	9/1/2012	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	215 OAKVALE AVENUE	None	OROVILLE	CA	95966	9494	04	06007	39.49847607	-121.4928969	Butte County
14995	Fee-for-Service	1356550339	1356550339	1	1	LEUNG, ANNA M MD	10/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108934	78	Neoplastic Diseases/Oncology	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
14998	Fee-for-Service	1598812133	1598812133	1	1	LI, JENNY SY MD	9/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85494	08	Family Practice	0	In state provider	None	600 N GARFIELD AVE	STE 111	MONTEREY PARK	CA	91754	1167	19	06037	34.06820797	-118.1228835	Los Angeles County
15000	Fee-for-Service	1134350606	1134350606	1	1	LIN, KEVIN C DO	8/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11454	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
15006	Fee-for-Service	1750405957	1750405957	1	1	LEITER, FREDDA L MD	8/1/2000	2084P0805X	NA	Psychiatry	026	PHYSICIANS	80656	36	Psychiatry	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
15010	Fee-for-Service	1649594979	1649594979	1	1	LAM, KHANH M LAC	5/7/2021	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	340 FOURTH AVE	SUITE 19	CHULA VISTA	CA	91910	3813	37	06073	32.63831293	-117.0833536	San Diego County
15049	Fee-for-Service	1063463230	1063463230	1	1	LADD, WILLIAM A MD	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	63024	30	Radiology	0	In state provider	None	25405 HANCOCK AVE	STE 107	MURRIETA	CA	92562	5978	33	06065	33.5580833	-117.1850127	Riverside County
15065	Fee-for-Service	1962468983	1962468983	1	1	LOS ANGELES CARDIOLOGY	2/6/1986	193200000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	ASSOCIATES	1245 WILSHIRE BLVD	STE 703	LOS ANGELES	CA	90017	4807	19	06037	34.05362775	-118.2661889	Los Angeles County
15069	Fee-for-Service	1588046734	1588046734	1	1	LOW, MADELEINE R OD	12/12/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
15077	Fee-for-Service	1629084876	1629084876	1	1	LESLIE, FRANCES PT	9/24/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
15081	Fee-for-Service	1780969295	1780969295	1	1	LOKAR, HEATHER R	1/30/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
15082	Fee-for-Service	1891890570	1891890570	1	1	LEE, JIN Y MD	4/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42438	02	General Surgery	0	In state provider	None	100 OCONNOR DR	STE 12	SAN JOSE	CA	95128	1638	43	06085	37.32372033	-121.9372658	Santa Clara County
15246	Fee-for-Service	1912968868	1912968868	1	1	LAI, KIN-MAN MD	1/1/1997	208600000X	NA	General Surgery	026	PHYSICIANS	63651	02	General Surgery	0	In state provider	None	2200 W 3RD ST	STE 300	LOS ANGELES	CA	90057	1936	19	06037	34.06329642	-118.2739484	Los Angeles County
15326	Fee-for-Service	1659670909	1659670909	1	1	LIU, ISABELLE Y MD	11/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126007	84	Surgery-Head and Neck	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
15368	Fee-for-Service	1720440738	1720440738	1	1	LEE, BRETT MD	4/14/2020	390200000X	NA	Other	026	PHYSICIANS	151980	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2083	19	06037	34.39696803	-118.5525278	Los Angeles County
15374	Fee-for-Service	1912942772	1912942772	1	1	LUI, SHIU-LAN MD	6/30/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	65975	01	General Practice	0	In state provider	None	27212 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63229023	-122.0896425	Alameda County
15380	Fee-for-Service	1619243086	1619243086	1	1	LEE, ELAINE	12/21/2020	208600000X	NA	General Surgery	026	PHYSICIANS	128258	None	None	0	In state provider	None	1480 64TH ST	STE 100, 125, 175	EMERYVILLE	CA	94608	2038	01	06001	37.84431239	-122.2926758	Alameda County
15388	Fee-for-Service	1477884161	1477884161	1	1	LATA, KUSUM MD	6/8/2010	207R00000X	NA	Other	026	PHYSICIANS	110487	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
15394	Fee-for-Service	1063675437	1063675437	1	1	LEMOS, ANNA PT	6/12/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
15413	Fee-for-Service	1700934734	1700934734	1	1	LIN, YUN C MD	1/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	76525	22	Pathology (M.D. only)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
15415	Fee-for-Service	1124326574	1124326574	1	1	LEE, PETER J MD	4/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115340	08	Family Practice	0	In state provider	None	5256 MISSION BLVD	None	RIVERSIDE	CA	92509	4624	33	06065	33.99261717	-117.3987262	Riverside County
15416	Fee-for-Service	1770642365	1770642365	1	1	LIU, KENG-MING D MD	8/31/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	46107	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
15453	Fee-for-Service	1982617924	1982617924	1	1	LAPATKA, DAVID F MD	10/31/1984	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	44032	04	Otology, Laryngology, Rhinology	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
15469	Fee-for-Service	1104081298	1104081298	1	1	LULU, SABEEN T MD	6/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120357	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
15480	Fee-for-Service	1619952538	1619952538	1	1	LOMELINO,MIRIAM E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72626	08	Family Practice	0	In state provider	None	1320 LAS TABLAS RD	STE F	TEMPLETON	CA	93465	9711	40	06079	35.5544315	-120.7225935	San Luis Obispo County
15491	Fee-for-Service	1265584692	1265584692	1	1	LINDEN, KENNETH G MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55737	07	Dermatology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
15509	Fee-for-Service	1518345354	1518345354	1	1	LAIRMORE, RACHEL M LMFT	11/12/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
15527	Fee-for-Service	1760825590	1760825590	1	1	LIN, CONNIE H MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135421	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
15532	Fee-for-Service	1912968868	1912968868	1	1	LAI, KIN-MAN MD	1/1/1997	208600000X	NA	General Surgery	026	PHYSICIANS	63651	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2200 W 3RD ST	STE 300	LOS ANGELES	CA	90057	1936	19	06037	34.06329642	-118.2739484	Los Angeles County
15552	Fee-for-Service	1548566474	1548566474	1	1	LINDBLOM, KEVIN C	7/21/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1610 ARDEN WAY	SUITE 195	SACRAMENTO	CA	95815	4035	34	06067	38.598597	-121.42863	Sacramento County
15571	Fee-for-Service	1508009796	1508009796	1	1	LEVIN, CAREY E MD	4/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107287	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	RM 6E	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
15573	Fee-for-Service	1184804072	1184804072	1	1	LESLIE, SHARON	9/9/2008	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
15578	Fee-for-Service	1174580955	1174580955	1	1	LEW, MICHAEL W MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73219	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
15588	Fee-for-Service	1780625020	1780625020	1	1	LWIN, KYAW OO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	84236	05	Anesthesiology	0	In state provider	None	2900 WHIPPLE AVE	STE 225	REDWOOD CITY	CA	94062	2851	41	06081	37.4783072	-122.2551089	San Mateo County
15602	Fee-for-Service	1235217894	1235217894	1	1	LEUNG, LINDA S MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	66703	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
15606	Fee-for-Service	1376674085	1376674085	1	1	LANE, JENNIFER E LCSW	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	23507	-	NOT APPLICABLE	0	In state provider	None	43520 DIVISION STREET	None	LANCASTER	CA	93535	4089	19	06037	34.673445	-118.130143	Los Angeles County
15625	Fee-for-Service	1902499858	1902499858	1	1	LACHAPELL, VICTORIA M NP	5/5/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3400 WEST BALL ROAD	SUITE 202	ANAHEIM	CA	92804	3735	30	06059	33.81724472	-118.0083216	Orange County
15628	Fee-for-Service	1750452033	1750452033	1	1	LEIPZIG, GREGORY J MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	82112	05	Anesthesiology	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
15644	Fee-for-Service	1215085154	1215085154	1	1	LEVY, HOWARD B MD	12/31/1982	207W00000X	NA	Ophthalmology	026	PHYSICIANS	39847	66	Emergency Medicine (Urgent Care)	0	In state provider	None	14860 ROSCOE BLVD	STE 211	PANORAMA CITY	CA	91402	4694	19	06037	34.2214515	-118.4573205	Los Angeles County
15665	Fee-for-Service	1700859279	1700859279	1	1	LUND, GUY L MD	2/20/2008	207RN0300X	NA	Nephrology	026	PHYSICIANS	68839	41	Internal Medicine	0	In state provider	None	7920 FROST ST	STE 300	SAN DIEGO	CA	92123	2769	37	06073	32.80027449	-117.153846	San Diego County
15677	Fee-for-Service	1801915384	1801915384	1	1	LOPEZ, JUAN A MD	3/28/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
15681	Fee-for-Service	1912267121	1912267121	1	1	LUO, RUIHONG MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147862	77	Infectious Disease	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
15693	Fee-for-Service	1730399387	1730399387	1	1	LAKHERA, NIVEDITA MD	10/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132837	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	STE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
15702	Fee-for-Service	1104228766	1104228766	1	1	LANGEL, BREANNA	4/10/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
15768	Fee-for-Service	1922060680	1922060680	1	1	LOH, SAMUEL J MD	4/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	36150	05	Anesthesiology	0	In state provider	None	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
15781	Fee-for-Service	1033406780	1033406780	1	1	LEARNED, DANIEL L MD	5/26/2017	207W00000X	NA	Ophthalmology	026	PHYSICIANS	146139	18	Ophthalmology	0	In state provider	None	5329 OFFICE CENTER CT	STE 120	BAKERSFIELD	CA	93309	7400	15	06029	35.3605026	-119.061931	Kern County
15795	Fee-for-Service	1164028932	1164028932	1	1	LAWS, SARAH	9/28/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
15796	Fee-for-Service	1457844532	1457844532	1	1	LIMM, ELIZABETH DO	2/15/2023	207L00000X	NA	Other	026	PHYSICIANS	17710	None	None	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
15818	Fee-for-Service	1316231780	1316231780	1	1	LAM, ALEXANDER H MD	7/5/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	133408	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
15829	Fee-for-Service	1396066460	1396066460	1	1	LEAL, JASON A CPO	10/31/2002	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	1	Border provider	None	1355 RAMAR RD	STE 4B	BULLHEAD CITY	AZ	86442	7100	00	None	35.115705	-114.599817	Mohave County
15870	Fee-for-Service	1841486396	1841486396	1	1	LEE, YUNNIE MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	100816	26	Psychiatry (child)	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
15877	Fee-for-Service	1174648687	1174648687	1	1	LEE, JAEHOON DO	5/27/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	71956 MAGNESIA FALLS DR	None	RANCHO MIRAGE	CA	92270	4901	33	06065	33.73550164	-116.4089224	Riverside County
15894	Fee-for-Service	1346567773	1346567773	1	1	LEWALLEN-HOMME, KELLY	4/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43585 MONTEREY AVE	SUITE 1	PALM DESERT	CA	92260	9342	33	06065	33.731946	-116.3912695	Riverside County
15922	Fee-for-Service	1689235848	1689235848	1	1	LEE, BRIAN MD	6/25/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
15953	Fee-for-Service	1700859279	1700859279	1	1	LUND, GUY L MD	2/20/2008	207RN0300X	NA	Nephrology	026	PHYSICIANS	68839	45	Nephrology (Renal-Kidney)	0	In state provider	None	7920 FROST ST	STE 300	SAN DIEGO	CA	92123	2769	37	06073	32.80027449	-117.153846	San Diego County
15957	Fee-for-Service	1528591187	1528591187	1	1	LANZO, SHANNON M MD	6/11/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176016	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
15961	Fee-for-Service	1912267121	1912267121	1	1	LUO, RUIHONG MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147862	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
16005	Fee-for-Service	1801841077	1801841077	1	1	LACY, ERIK R MD	7/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83901	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
16006	Fee-for-Service	1972568681	1972568681	1	1	LUND, DENNIS P MD	8/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135070	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
16046	Fee-for-Service	1477917177	1477917177	1	1	LIU, TERESA MD	9/16/2019	207R00000X	NA	Other	026	PHYSICIANS	151562	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
16063	Fee-for-Service	1952856502	1952856502	1	1	LU, WEIYA NP	4/25/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
16085	Fee-for-Service	1073884375	1073884375	1	1	LATTING, MICHELLE E MD	8/28/2020	207WX0200X	NA	Ophthalmology	026	PHYSICIANS	168532	18	Ophthalmology	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
16095	Fee-for-Service	1396373619	1396373619	1	1	LOZANO, JUAN CARLOS MD	6/24/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184062	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
16097	Fee-for-Service	1093985731	1093985731	1	1	LUHAN, ANNE	9/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	104117	66	Emergency Medicine (Urgent Care)	0	In state provider	None	863 N DOUGLAS STREET	SUITE 100	EL SEGUNDO	CA	90245	2081	19	06037	33.92830583	-118.3831669	Los Angeles County
16124	Fee-for-Service	1427122472	1427122472	1	1	LANDSMAN, LORI A OD	2/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
16222	Fee-for-Service	1538128459	1538128459	1	1	LUZANO, FLORANTE E MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	25727	29	Pulmonary Diseases (M.D. only)	0	In state provider	A PROF CORP	3801 KATELLA AVE	STE 223	LOS ALAMITOS	CA	90720	6904	30	06059	33.80318951	-118.066068	Orange County
16223	Fee-for-Service	1386687135	1386687135	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	25880 MCBEAN PKWY	None	VALENCIA	CA	91355	2004	19	06037	34.40360638	-118.5522028	Los Angeles County
16264	Fee-for-Service	1053708305	1053708305	1	1	LEE, JENNIFER MD	9/11/2020	207WX0108X	NA	Ophthalmology	026	PHYSICIANS	168637	18	Ophthalmology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
16285	Fee-for-Service	1083669048	1083669048	1	1	LUNA, JOSEPH A MD	7/1/1998	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	71562	30	Radiology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
16296	Fee-for-Service	1598708117	1598708117	1	1	LE, THINH T DPM INC	10/22/2007	213ES0131X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	127 S BRAND BLVD	STE 200	GLENDALE	CA	91204	1357	19	06037	34.145289	-118.255096	Los Angeles County
16297	Fee-for-Service	1306864897	1306864897	1	1	LEE, YEN-CHUNG A MD	1/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	70226	None	None	0	In state provider	None	5575 W LAS POSITAS BLVD	SUITE #210	PLEASANTON	CA	94588	6208	01	06001	37.69214859	-121.8796532	Alameda County
16306	Fee-for-Service	1447599725	1447599725	1	1	LING, EVELYN B MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140187	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
16344	Fee-for-Service	1487221677	1487221677	1	1	LOPEZ, DEBBIE OD	2/21/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12737 GLENOAKS BLVD	STE 3	SYLMAR	CA	91342	4724	19	06037	34.30181336	-118.4422626	Los Angeles County
16364	Fee-for-Service	1821017096	1821017096	2	1	LONGS DRUG STORE CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10776 WESTVIEW PKWY	None	SAN DIEGO	CA	92126	2962	37	06073	32.916357	-117.1205185	San Diego County
16385	Fee-for-Service	1093985731	1093985731	1	1	LUHAN, ANNE	9/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	104117	02	General Surgery	0	In state provider	None	863 N DOUGLAS STREET	SUITE 100	EL SEGUNDO	CA	90245	2081	19	06037	33.92830583	-118.3831669	Los Angeles County
16398	Fee-for-Service	1942242045	1942242045	1	1	LINDO, RUTH C MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68038	40	Pediatrics	0	In state provider	None	1720 BROOKLYN AVE	None	LOS ANGELES	CA	90033	0000	19	06037	34.040502	-118.191954	Los Angeles County
16423	Fee-for-Service	1255805792	1255805792	1	1	LEKANDER, RHONDA L RCP	1/4/2023	2279E1000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
16449	Fee-for-Service	1477597813	1477597813	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1107 N WILLOW AVE	None	CLOVIS	CA	93611	4408	10	06019	36.850014	-119.7296205	Fresno County
16457	Fee-for-Service	1275079980	1275079980	1	1	LIVING WATERS HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA, LLC	6030 RIVERSIDE DR	SUITE F	CHINO	CA	91710	4441	36	06071	34.01922782	-117.6733524	San Bernardino County
16469	Fee-for-Service	1336310424	1336310424	1	1	LIN, FLORENCE F MD INC	4/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89252	05	Anesthesiology	0	In state provider	None	911 SUNSET DRIVE	None	HOLLISTER	CA	95023	5606	35	06069	36.83504962	-121.3858245	San Benito County
16473	Fee-for-Service	1619137809	1619137809	1	1	LEE, JACQUELINE I MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136691	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
16509	Fee-for-Service	1407335029	1407335029	1	1	LILIT AYRAPETYAN COUNSELING,	10/21/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC	595 E COLORADO BLVD	STE 324	PASADENA	CA	91101	2021	19	06037	34.14588202	-118.1380722	Los Angeles County
16510	Fee-for-Service	1538128459	1538128459	1	1	LUZANO, FLORANTE E MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	25727	41	Internal Medicine	0	In state provider	A PROF CORP	3801 KATELLA AVE	STE 223	LOS ALAMITOS	CA	90720	6904	30	06059	33.80318951	-118.066068	Orange County
16520	Fee-for-Service	1184851891	1184851891	1	1	LARKIN, NANCY E MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119851	01	General Practice	0	In state provider	None	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
16527	Fee-for-Service	1841398344	1841398344	1	1	LEONARD-ISO, ELIZABETH F LMF	12/15/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	830 HILLVIEW COURT	SUITE 260	MILPITAS	CA	95035	4553	43	06085	37.43732734	-121.891	Santa Clara County
16536	Fee-for-Service	1700225422	1700225422	1	1	LEE, JULIA S MD	10/10/2018	207K00000X	NA	Other	026	PHYSICIANS	133831	03	Allergy	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
16553	Fee-for-Service	1194889972	1194889972	1	1	LEE, YOUNG H MD	11/2/2007	207R00000X	NA	Other	026	PHYSICIANS	99013	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	39755 DATE ST	STE 101	MURRIETA	CA	92563	2007	33	06065	33.54596475	-117.1538436	Riverside County
16571	Fee-for-Service	1528378833	1528378833	1	1	LUKOSE, SUSAN K MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138615	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
16603	Fee-for-Service	1538558051	1538558051	1	1	LEPINE, MICHELLE L LMFT	10/2/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23236 LYONS AVE	STE 212	SANTA CLARITA	CA	91321	5223	19	06037	34.37979236	-118.5390969	Los Angeles County
16618	Fee-for-Service	1568466431	1568466431	1	1	LEE, EDWARD M MC	4/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77837	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
16661	Fee-for-Service	1295858439	1295858439	1	1	LIN, JOEL G DO	2/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
16673	Fee-for-Service	1932186467	1932186467	1	1	LEVIN, ROBERT D MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	88775	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
16681	Fee-for-Service	1942242045	1942242045	1	1	LINDO, RUTH C MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68038	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 BROOKLYN AVE	None	LOS ANGELES	CA	90033	0000	19	06037	34.040502	-118.191954	Los Angeles County
16682	Fee-for-Service	1285641514	1285641514	1	1	LONG ISLAND JEWISH MEDICAL	5/23/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	270-05 76TH AVE	None	NEW HYDE PARK	NY	11040	1402	00	None	40.75318311	-73.70703519	Queens County
16714	Fee-for-Service	1063867968	1063867968	1	1	LEE, GREGORY D MD	6/25/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158297	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
16718	Fee-for-Service	1871944884	1871944884	1	1	LU, HSIANG-CHIH MD	6/12/2020	207ZP0101X	NA	Other	026	PHYSICIANS	165722	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
16722	Fee-for-Service	1740222553	1740222553	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3320 N TRACY BLVD	None	TRACY	CA	95376	1721	39	06077	37.760859	-121.4350325	San Joaquin County
16739	Fee-for-Service	1275079980	1275079980	1	1	LIVING WATERS HOSPICE	11/1/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA, LLC	6030 RIVERSIDE DR	SUITE F	CHINO	CA	91710	4441	36	06071	34.01922782	-117.6733524	San Bernardino County
16750	Fee-for-Service	1518103589	1518103589	1	1	LOCATELLI, BERIT A	2/8/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1920 JORDAN COURT	None	MCKINLEYVILLE	CA	95519	3977	12	06023	40.94357118	-124.0934968	Humboldt County
16753	Fee-for-Service	1619642162	1619642162	1	1	LEE, MATTHEW PT	2/17/2023	2251N0400X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
16769	Fee-for-Service	1861579641	1861579641	1	1	LEUNG, FRANCES W OD	3/12/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1411 SECRET RAVINE PKWY	STE 120	ROSEVILLE	CA	95661	6042	31	06061	38.76424823	-121.2440842	Placer County
16770	Fee-for-Service	1194753004	1194753004	1	1	LU, DANIELLE W MD	11/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82727	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
16775	Fee-for-Service	1407375520	1407375520	1	1	LEONTINA BALOS	3/5/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	10452 MILDRED AVE	None	GARDEN GROVE	CA	92843	1165	30	06059	33.77095875	-117.9467472	Orange County
16780	Fee-for-Service	1154460517	1154460517	1	2	LIBKE, DANIEL G MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1050 WEST GALLERIA DRIVE	None	HENDERSON	NV	89011	4800	00	None	36.07123413	-115.0308684	Clark County
16793	Fee-for-Service	1023495504	1023495504	1	1	LACOCQUE, JEREMY A DO	3/7/2020	207P00000X	NA	Other	026	PHYSICIANS	17180	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
16799	Fee-for-Service	1861535981	1861535981	1	1	LOUIS, TAMARA C LCSW	11/24/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1103 BUTTE HOUSE RD	SUITE E	YUBA CITY	CA	95991	3109	51	06101	39.14536728	-121.6306637	Sutter County
16805	Fee-for-Service	1619756061	1619756061	1	1	LISA STEKERT, LCSW, LICENSED	10/24/2023	261QM0801X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	VE	600 N LAKE BLVD	STE M	TAHOE CITY	CA	96145	2274	31	06061	39.17216485	-120.1394424	Placer County
16822	Fee-for-Service	1235534710	1235534710	1	1	LOWE, SUSANNAH C LMFT	4/11/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	572 DUNHOLME WAY	None	SUNNYVALE	CA	94087	3300	43	06085	37.34482247	-122.0283135	Santa Clara County
16835	Fee-for-Service	1154385961	1154385961	1	1	LAI, ALBERT MD	1/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	86192	25	Physical Medicine and Rehabilitation	0	In state provider	None	1695 NORTH SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
16841	Fee-for-Service	1356872030	1356872030	1	1	LIZARDO, IAN MD	5/12/2020	390200000X	NA	Other	026	PHYSICIANS	159189	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
16847	Fee-for-Service	1184085243	1184085243	1	1	LEVY, JARED LMFT	8/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
16877	Fee-for-Service	1982990099	1982990099	1	1	LOZA, HILDA LCSW	9/20/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	335 KALMIA ST	None	ESCONDIDO	CA	92025	4208	37	06073	33.12027367	-117.0786053	San Diego County
16889	Fee-for-Service	1114024346	1114024346	1	1	LEE, HANSON T MD INC APC	2/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	71457	10	Gastroenterology (M.D. only)	0	In state provider	None	612 W DUARTE RD	STE 502	ARCADIA	CA	91007	9207	19	06037	34.12647805	-118.051994	Los Angeles County
16906	Fee-for-Service	1568466431	1568466431	1	1	LEE, EDWARD M MC	4/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77837	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
16925	Fee-for-Service	1558959130	1558959130	1	1	LYONS, DANIEL LMFT	8/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
16927	Fee-for-Service	1891792305	1891792305	1	1	LEICHMAN, LAWRENCE P MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	42308	78	Neoplastic Diseases/Oncology	0	In state provider	None	1180 N INDIAN CANYON DR	STE E218	PALM SPRINGS	CA	92262	4885	33	06065	33.839505	-116.5455735	Riverside County
16954	Fee-for-Service	1518256130	1518256130	1	1	LIU, TING TING MD	5/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136354	18	Ophthalmology	0	In state provider	None	1850 SULLIVAN AVE	STE 500	DALY CITY	CA	94015	2200	41	06081	37.68085904	-122.4728842	San Mateo County
16970	Fee-for-Service	1841331923	1841331923	1	1	LIPMAN, STEVEN S MD	2/1/2001	207L00000X	NA	Other	026	PHYSICIANS	65976	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
16972	Fee-for-Service	1285641514	1285641514	1	1	LONG ISLAND JEWISH MEDICAL	5/23/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	270-05 76TH AVE	None	NEW HYDE PARK	NY	11040	1402	00	None	40.75318311	-73.70703519	Queens County
16989	Fee-for-Service	1205936861	1205936861	1	1	LEONI, JAMES F MD	3/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	56154	08	Family Practice	0	In state provider	None	104 LYNCH CREEK WAY	STE 10	PETALUMA	CA	94954	2355	49	06097	38.25218808	-122.6339241	Sonoma County
16995	Fee-for-Service	1386987600	1386987600	1	1	LUCERO, ANNA S DO	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13578	01	General Practice	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
17021	Fee-for-Service	1659303675	1659303675	1	1	LAFIR, KANEEZA PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LAFIRS PROF SERVICES	12006 ROSECRANS AVE	None	NORWALK	CA	90650	4119	19	06037	33.90213596	-118.0777274	Los Angeles County
17058	Fee-for-Service	1114194750	1114194750	1	1	LEE GOERNER	2/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	94-800 UKEE ST	STE 303	WAIPAHU	HI	96797	4044	00	None	21.41257872	-158.0008603	Honolulu County
17066	Fee-for-Service	1164465928	1164465928	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1190 N MAIN ST	None	MANTECA	CA	95336	3208	39	06077	37.81373245	-121.2170837	San Joaquin County
17156	Fee-for-Service	1588129589	1588129589	1	1	LEE, CAITLYN DPM	9/27/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	241 W OLIVE	None	BURBANK	CA	91502	1825	19	06037	34.17425363	-118.3157858	Los Angeles County
17159	Fee-for-Service	1699891168	1699891168	1	1	LIMCAY, MILDRED V	4/12/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
17174	Fee-for-Service	1942926498	1942926498	1	1	LEE, KAYLYN CRNA	4/2/2023	163WC0200X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
17180	Fee-for-Service	1114024346	1114024346	1	1	LEE, HANSON T MD INC APC	2/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	71457	41	Internal Medicine	0	In state provider	None	612 W DUARTE RD	STE 502	ARCADIA	CA	91007	9207	19	06037	34.12647805	-118.051994	Los Angeles County
17186	Fee-for-Service	1730194689	1730194689	1	1	LIKES, MAGGIE L MD	3/9/2023	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	3181 SW SAM JACKSON PARK	RD	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
17215	Fee-for-Service	1891792305	1891792305	1	1	LEICHMAN, LAWRENCE P MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	42308	01	General Practice	0	In state provider	None	1180 N INDIAN CANYON DR	STE E218	PALM SPRINGS	CA	92262	4885	33	06065	33.839505	-116.5455735	Riverside County
17220	Fee-for-Service	1205883873	1205883873	1	1	LIMON, JOLIE A MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63943	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
17245	Fee-for-Service	1174727200	1174727200	1	1	LIM, LILY S MD	12/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	42284	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
17303	Fee-for-Service	1679570980	1679570980	1	1	LOS ANGELES USD	11/1/2018	No Taxonomy Provided	NA	None	101	UNIFIED SCHOOL DISTRICT	-	-	NOT APPLICABLE	0	In state provider	None	333 S BEAUDRY AVE	FL 29	LOS ANGELES	CA	90017	1466	19	06037	34.05611213	-118.2570905	Los Angeles County
17308	Fee-for-Service	1417278359	1417278359	1	1	LU, ERICK C DO	7/19/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	11483	None	None	0	In state provider	None	500 N GARFIELD AVE	STE 204	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
17336	Fee-for-Service	1679150965	1679150965	1	1	LIARA HOSPICE INC	5/5/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	401 N BRAND BLVD	STE 344	GLENDALE	CA	91203	4434	19	06037	34.151958	-118.255149	Los Angeles County
17400	Fee-for-Service	1699392845	1699392845	1	1	LUU, BRENDA B OD	10/10/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 WILSHIRE BLVD.	SUITE 1275	LOS ANGELES	CA	90025	7143	19	06037	34.04370122	-118.4678993	Los Angeles County
17402	Fee-for-Service	1487751897	1487751897	1	1	LE, HA MINH MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	80374	30	Radiology	0	In state provider	None	2224 MEDICAL CENTER DR	None	PERRIS	CA	92571	2638	33	06065	33.8123212	-117.2217309	Riverside County
17441	Fee-for-Service	1124195276	1124195276	1	1	LEE, SUNG H MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35193	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
17501	Fee-for-Service	1891792305	1891792305	1	1	LEICHMAN, LAWRENCE P MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	42308	68	Hematology	0	In state provider	None	1180 N INDIAN CANYON DR	STE E218	PALM SPRINGS	CA	92262	4885	33	06065	33.839505	-116.5455735	Riverside County
17506	Fee-for-Service	1205883873	1205883873	1	1	LIMON, JOLIE A MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63943	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
17514	Fee-for-Service	1831500164	1831500164	1	1	LYU, HEE-SANG MD	5/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140891	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
17515	Fee-for-Service	1972689172	1972689172	1	1	LAKE HOSPITAL SYSTEM	7/5/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	10 E WASHINGTON ST	None	PAINESVILLE	OH	44077	3472	00	None	41.72265695	-81.2436701	Lake County
17548	Fee-for-Service	1669514618	1669514618	1	1	LOPEZ, SONIA LMFT	6/28/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1745 W ORANGEWOOD AVE	STE 101	ORANGE	CA	92868	2041	30	06059	33.79522413	-117.8714299	Orange County
17561	Fee-for-Service	1619189636	1619189636	1	1	LE, DANIEL Q A PROFESSIONAL	2/7/1996	208VP0014X	NA	Other	026	PHYSICIANS	71070	05	Anesthesiology	0	In state provider	MEDICAL CORPORATION	17 CORPORATE PLAZA	SUITE 110	NEWPORT BEACH	CA	92660	7925	30	06059	33.60949608	-117.8771456	Orange County
17563	Fee-for-Service	1417901653	1417901653	1	1	LUKASHOK,SOPHIE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2001 PEACHTREE RD NE	None	ATLANTA	GA	30309	0000	00	None	33.80906963	-84.39323928	Fulton County
17569	Fee-for-Service	1184795122	1184795122	1	1	LONDONO, JOHN J MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72855	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
17588	Fee-for-Service	1679570980	1679570980	1	1	LOS ANGELES USD	4/8/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	333 S BEAUDRY AVE	FL 29	LOS ANGELES	CA	90017	1466	19	06037	34.05611213	-118.2570905	Los Angeles County
17590	Fee-for-Service	1649287780	1649287780	1	2	LA JOLLA CARDIOVASCULAR	3/1/2002	193400000X	NA	Other	026	PHYSICIANS	80033	06	Cardiovascular Disease (M.D. only)	0	In state provider	MEDICAL ASSOC INC	501 WASHINGTON ST	STE 512	SAN DIEGO	CA	92103	2231	37	06073	32.74986289	-117.1599343	San Diego County
17596	Fee-for-Service	1134131196	1134131196	1	1	LIANG, LEONARD W MD	2/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	66024	34	Urology and Urological Surgery	0	In state provider	None	201 S ALVARADO	STE 215	LOS ANGELES	CA	90057	2388	19	06037	34.06417777	-118.2719543	Los Angeles County
17605	Fee-for-Service	1982642377	1982642377	1	1	LEVENZON, SERGIO H MD	5/13/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	30834	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MAIN STREET PRENATAL MED	520 N MAIN ST	STE 100	SANTA ANA	CA	92701	4623	30	06059	33.749316	-117.868123	Orange County
17625	Fee-for-Service	1679150965	1679150965	1	1	LIARA HOSPICE INC	5/5/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	401 N BRAND BLVD	STE 344	GLENDALE	CA	91203	4434	19	06037	34.151958	-118.255149	Los Angeles County
17644	Fee-for-Service	1730560889	1730560889	1	1	LAM-LUU, JULIE T OD	5/25/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	425 W BONITA AVE	STE 110B	SAN DIMAS	CA	91773	0000	19	06037	34.10669347	-117.814932	Los Angeles County
17669	Fee-for-Service	1912020744	1912020744	1	1	LOCKWOOD, LYNDA F LVN	6/14/2006	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5635 W UNIVERSITY AVE	None	FRESNO	CA	93722	8742	10	06019	36.76661448	-119.8929915	Fresno County
17695	Fee-for-Service	1609826684	1609826684	1	1	LAMBERT RADIOLOGY MED GR	5/19/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
17712	Fee-for-Service	1124638366	1124638366	1	1	LIFE RENEWAL HOSPICE CARE,	11/16/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	16442 VANOWEN ST	STE C	LAKE BALBOA	CA	91406	4729	19	06037	34.19387848	-118.491723	Los Angeles County
17742	Fee-for-Service	1588212526	1588212526	1	1	LOY, ALLISON P	7/18/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	760 POLHEMUS RD	None	SAN MATEO	CA	94402	3938	41	06081	37.52051982	-122.3386627	San Mateo County
17770	Fee-for-Service	1225291768	1225291768	1	1	LIJIMENEZ, RAFAEL E MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114957	40	Pediatrics	0	In state provider	None	1100 DELBON AVE	None	TURLOCK	CA	95382	2021	50	06099	37.5106124	-120.8356611	Stanislaus County
17800	Fee-for-Service	1972689172	1972689172	1	1	LAKE HOSPITAL SYSTEM	3/8/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	10 E WASHINGTON ST	None	PAINESVILLE	OH	44077	3472	00	None	41.72265695	-81.2436701	Lake County
17820	Fee-for-Service	1679515480	1679515480	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 OAKDALE RD	#F	MODESTO	CA	95355	4591	50	06099	37.654479	-120.9574555	Stanislaus County
17828	Fee-for-Service	1225138936	1225138936	1	1	LOPEZ, JANUARY K MD	4/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92095	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
17833	Fee-for-Service	1780857235	1780857235	1	1	LIN, MELANIE I MD	11/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100349	08	Family Practice	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
17850	Fee-for-Service	1881231066	1881231066	1	1	LACSON, CARALISA L NP	3/18/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
17858	Fee-for-Service	1295894806	1295894806	1	1	LAI, LIEN D MD	3/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80721	03	Allergy	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
17866	Fee-for-Service	1245318021	1245318021	1	1	LINCOLN, TODD L MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	69301	20	Orthopedic Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
17876	Fee-for-Service	1679570980	1679570980	1	1	LOS ANGELES USD	2/6/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	333 S BEAUDRY AVE	FL 29	LOS ANGELES	CA	90017	1466	19	06037	34.05611213	-118.2570905	Los Angeles County
17895	Fee-for-Service	1659922177	1659922177	1	1	LEE, RYANT PT	2/27/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
17898	Fee-for-Service	1558627901	1558627901	1	1	LEE, JENNIE E MD	8/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128520	40	Pediatrics	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
17908	Fee-for-Service	1588752836	1588752836	1	1	LIECHTY, KENNETH W MD	12/13/2019	2086S0120X	NA	General Surgery	026	PHYSICIANS	-	85	Surgery-Pediatric	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
17911	Fee-for-Service	1013189919	1013189919	1	2	LIBURD, CHINITA M	10/1/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2929 BUTTERFLY WAY	None	CHULA VISTA	CA	91914	4322	37	06073	32.67086425	-116.9455679	San Diego County
17917	Fee-for-Service	1962857532	1962857532	1	1	LIM, SOPHIA M MD	10/10/2019	103TF0000X	NA	Mental Health Outpatient Services	026	PHYSICIANS	153192	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
17924	Fee-for-Service	1720144348	1720144348	1	1	LE, LE-LAN CRNA	6/2/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
17936	Fee-for-Service	1588783583	1588783583	1	1	LIN, GEORGE F MD	12/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137369	None	None	0	In state provider	None	6655 ALVARADO ROAD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
17956	Fee-for-Service	1912020744	1912020744	1	1	LOCKWOOD, LYNDA F LVN	6/14/2006	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5635 W UNIVERSITY AVE	None	FRESNO	CA	93722	8742	10	06019	36.76661448	-119.8929915	Fresno County
17960	Fee-for-Service	1053845974	1053845974	1	1	LE, ANDREW N MD	3/1/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16886	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
18000	Fee-for-Service	1124638366	1124638366	1	1	LIFE RENEWAL HOSPICE CARE,	11/16/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	16442 VANOWEN ST	STE C	LAKE BALBOA	CA	91406	4729	19	06037	34.19387848	-118.491723	Los Angeles County
18049	Fee-for-Service	1871942243	1871942243	1	1	LEE, DAVID MD	4/24/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	153279	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
18072	Fee-for-Service	1073041851	1073041851	1	2	LIVINGWATER'S MEDICAL CLINIC	10/10/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	, INC.	255 N GILBERT ST	C2-3	HEMET	CA	92543	4078	33	06065	33.75067797	-116.976072	Riverside County
18073	Fee-for-Service	1801964317	1801964317	1	1	LOS ALAMITOS HEMATOLOGY/	12/21/1977	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	ONCOLOGY MED GRP INC	3801 KATELLA AVE	STE 207	LOS ALAMITOS	CA	90720	3382	30	06059	33.80318951	-118.066068	Orange County
18083	Fee-for-Service	1538167911	1538167911	1	1	LARSON, RUTH A MD	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	41388	07	Dermatology	0	In state provider	None	15525 POMERADO RD	STE A2	POWAY	CA	92064	2425	37	06073	32.99479918	-117.0579468	San Diego County
18084	Fee-for-Service	1518990803	1518990803	1	1	LADA, SAMUEL J MD	7/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83969	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
18094	Fee-for-Service	1164699104	1164699104	1	1	LESCH, EMILY E DO	6/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12137	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3779 PIEDMONT AVE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
18097	Fee-for-Service	1144866492	1144866492	1	1	LEWIS, JACLYN LMFT	8/26/2022	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4199 CAMPUS DR	SUITE 550, OFFICE 57	IRVINE	CA	92612	4684	30	06059	33.650775	-117.838296	Orange County
18146	Fee-for-Service	1295894806	1295894806	1	1	LAI, LIEN D MD	3/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80721	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
18170	Fee-for-Service	1124681358	1124681358	1	1	LANG, ALEXANDER P MD	9/15/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	188223	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
18180	Fee-for-Service	1396275756	1396275756	1	1	LAVINDER, NATALIE C OD	9/25/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5414 WALNUT AVE	STE B	IRVINE	CA	92604	2520	30	06059	33.68908239	-117.7705473	Orange County
18197	Fee-for-Service	1689098519	1689098519	1	1	LEROSE HOME HEALTH CARE INC	4/1/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12410 BURBANK BLVD	SUITE 201	VALLEY VILLAGE	CA	91607	4743	19	06037	34.17210753	-118.403775	Los Angeles County
18199	Fee-for-Service	1013979673	1013979673	1	1	LEPOR, NORMAN E MD APC	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	41453	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	99 N LA CIENEGA BLVD	SUITE # 203	BEVERLY HILLS	CA	90211	2222	19	06037	34.06736471	-118.3763201	Los Angeles County
18200	Fee-for-Service	1013189919	1013189919	1	2	LIBURD, CHINITA M	10/1/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2929 BUTTERFLY WAY	None	CHULA VISTA	CA	91914	4322	37	06073	32.67086425	-116.9455679	San Diego County
18235	Fee-for-Service	1659689644	1659689644	1	1	LAWRENCE, HOLLLEE H LMFT	9/7/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	86492	-	NOT APPLICABLE	0	In state provider	None	277 SOUTH STREET	SUITE T	SAN LUIS OBISPO	CA	93401	5039	40	06079	35.2695025	-120.6663615	San Luis Obispo County
18254	Fee-for-Service	1194388470	1194388470	1	1	LIM, MICHELLE J DO	9/7/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20156	None	None	0	In state provider	None	2675 PLEASANT HILL	None	PLEASANT HILL	CA	94523	2033	07	06013	37.95521179	-122.0898401	Contra Costa County
18256	Fee-for-Service	1316252893	1316252893	1	1	LARRAZABAL MARTINEZ, LUIS MD	4/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	115533	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
18275	Fee-for-Service	1912920026	1912920026	1	1	LEONARD NORONHA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNM MEDICAL GROUP INC	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
18331	Fee-for-Service	1003994997	1003994997	1	1	LIPPMANN, LAWRENCE A MD	4/2/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	32063	08	Family Practice	0	In state provider	None	2980 EL RANCHO DR	None	SANTA CRUZ	CA	95060	1103	44	06087	37.0337706	-122.0213553	Santa Cruz County
18352	Fee-for-Service	1396334108	1396334108	1	1	LC FOOT AND ANKLE CARE INC	3/4/2025	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	8737 BEVERLY BLVD	103	WEST HOLLYWOOD	CA	90048	1835	19	06037	34.07687959	-118.381876	Los Angeles County
18360	Fee-for-Service	1962864033	1962864033	1	1	LEE, KENNY	1/9/2025	208600000X	NA	General Surgery	026	PHYSICIANS	153940	02	General Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
18364	Fee-for-Service	1922028901	1922028901	1	1	LAUBER, MARTIN A MD	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	48859	41	Internal Medicine	0	In state provider	None	1191 PHELPS AVENUE	None	COALINGA	CA	93210	9609	10	06019	36.15152163	-120.340676	Fresno County
18381	Fee-for-Service	1528197761	1528197761	1	1	LEACH, LORNE LMFT	5/22/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	37168	-	NOT APPLICABLE	0	In state provider	None	6838 SUNSET BLVD	None	HOLLYWOOD	CA	90028	7008	19	06037	34.09794248	-118.340001	Los Angeles County
18416	Fee-for-Service	1942925151	1942925151	1	1	LIEVANO, FRANCISCO E CRNA	12/16/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
18445	Fee-for-Service	1346262292	1346262292	1	1	LA CLINICA DENTAL AT	3/1/2004	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CHILDREN'S HOSP, OAKLAND	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
18454	Fee-for-Service	1982884888	1982884888	1	1	LARRANCE, CONNIE L	12/11/2007	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2550 HIGHWAY 32	None	CHICO	CA	95973	8668	04	06007	39.7428978	-121.8852358	Butte County
18472	Fee-for-Service	1891834925	1891834925	1	1	LEWIS, CHRISTOPHER S PT	2/16/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1150 MORTON	B	PORTERVILLE	CA	93257	1940	54	06107	36.07332205	-119.0428201	Tulare County
18474	Fee-for-Service	1386711455	1386711455	1	1	LONG, JOHN B MD A PROFESSION	3/14/2011	193400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	AL CORPORATION	3838 CALIFORNIA ST	STE 612	SAN FRANCISCO	CA	94118	1508	38	06075	37.78591809	-122.4575439	San Francisco County
18498	Fee-for-Service	1730288291	1730288291	1	1	LARSON, ANESSA Y PYSD	7/24/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
18515	Fee-for-Service	1578098307	1578098307	1	1	LU, JIAJIE MD	11/3/2023	207ZP0102X	NA	Other	026	PHYSICIANS	158113	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
18521	Fee-for-Service	1164507141	1164507141	2	1	LINCARE INC	1/20/2021	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4824 STRATOS WAY	SUITE A	MODESTO	CA	95356	8892	50	06099	37.709361	-121.0001625	Stanislaus County
18548	Fee-for-Service	1902069669	1902069669	1	1	LAI, JENNIFER C MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105715	07	Dermatology	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
18550	Fee-for-Service	1477650406	1477650406	1	1	LEARN. ALISON A MD	8/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	78450	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	15525 POMERADO RD	STE C-1	POWAY	CA	92064	2425	37	06073	32.99479918	-117.0579468	San Diego County
18568	Fee-for-Service	1932167293	1932167293	1	1	LAESCH, PAMELA S MD	11/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85548	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
18592	Fee-for-Service	1881750081	1881750081	1	1	LEHMAN, TARA A MD	11/5/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	91139	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
18617	Fee-for-Service	1104176668	1104176668	1	1	LUKMAN, REVANA T MD	7/16/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	129808	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
18618	Fee-for-Service	1003994997	1003994997	1	1	LIPPMANN, LAWRENCE A MD	4/2/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	32063	41	Internal Medicine	0	In state provider	None	2980 EL RANCHO DR	None	SANTA CRUZ	CA	95060	1103	44	06087	37.0337706	-122.0213553	Santa Cruz County
18624	Fee-for-Service	1881648087	1881648087	1	1	LINDSEY-BROWN, CASAUNDRA	11/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LN	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
18626	Fee-for-Service	1760489694	1760489694	1	1	LEWIS, TAMSIN M NMW	4/3/2010	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	720 E LATHAM AVE	STE 3	HEMET	CA	92543	4371	33	06065	33.74940948	-116.9648415	Riverside County
18630	Fee-for-Service	1235613696	1235613696	1	1	LINZMEYER, COLE T DO	11/8/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	20108	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
18663	Fee-for-Service	1154766301	1154766301	2	1	LIFELINK HOSPICE &	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	211 W FOOTHILL BLVD	STE B	GLENDORA	CA	91741	3357	19	06037	34.13603747	-117.8672175	Los Angeles County
18664	Fee-for-Service	1063585164	1063585164	1	1	LEIBOVICI, SAMUEL	11/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	55251	41	Internal Medicine	0	In state provider	None	1020 29TH ST	STE 120	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
18665	Fee-for-Service	1255419842	1255419842	1	1	LAU, ERNEST K MD	8/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79972	41	Internal Medicine	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
18673	Fee-for-Service	1184932899	1184932899	1	1	LINH T PHAM	7/23/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 E MARKET ST	None	IOWA CITY	IA	52245	2633	00	None	41.664114	-91.5284205	Johnson County
18685	Fee-for-Service	1063864452	1063864452	1	1	LU, LISA L OD	6/25/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7075 N SHARON AVE	None	FRESNO	CA	93720	3329	10	06019	36.83882737	-119.7590708	Fresno County
18690	Fee-for-Service	1154416022	1154416022	1	1	LOWE, CLAVIN MD	7/1/1996	2080P0204X	NA	Other	026	PHYSICIANS	73346	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
18712	Fee-for-Service	1831752682	1831752682	1	1	LEE, CHIA-YUAN M DO	8/2/2023	207P00000X	NA	Other	026	PHYSICIANS	20828	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
18714	Fee-for-Service	1689733321	1689733321	1	1	LIU, WENHUI MD	12/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92258	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
18735	Fee-for-Service	1346262292	1346262292	1	1	LA CLINICA DENTAL AT	3/1/2004	261QD0000X	NA	Dental Clinic	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CHILDREN'S HOSP, OAKLAND	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
18748	Fee-for-Service	1508467044	1508467044	1	1	LAM, VICTORIA MD	10/3/2022	208G00000X	NA	General Surgery	026	PHYSICIANS	170347	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
18767	Fee-for-Service	1629509229	1629509229	1	1	LOH, TIFFANY Y MD	8/19/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	172346	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
18778	Fee-for-Service	1750581351	1750581351	1	1	LIGNELL, DEBBIE A LMFT	10/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
18785	Fee-for-Service	1073654604	1073654604	1	1	LA JOLLA NEUROSURGICAL	12/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	50766	None	None	0	In state provider	ASSOCIATES A MEDICAL COR	9834 GENESEE AVE	STE 411	LA JOLLA	CA	92037	1264	37	06073	32.884074	-117.225855	San Diego County
18786	Fee-for-Service	1811191661	1811191661	1	1	LAKSHMI, MAGGE V MD	10/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88598	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
18802	Fee-for-Service	1013951847	1013951847	2	1	LONGS DRUG STORES CA LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	872 N DELAWARE ST	None	SAN MATEO	CA	94401	1828	41	06081	37.57987303	-122.3339313	San Mateo County
18812	Fee-for-Service	1396846416	1396846416	1	1	LAU, BENJAMIN CK MD INC	10/1/1998	193400000X	NA	Other	026	PHYSICIANS	60654	25	Physical Medicine and Rehabilitation	0	In state provider	None	4306 GEARY BLVD	STE 201	SAN FRANCISCO	CA	94118	3067	38	06075	37.78104545	-122.4655475	San Francisco County
18814	Fee-for-Service	1710914254	1710914254	1	1	LEE, HA-SUNG MD	7/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	32767	40	Pediatrics	0	In state provider	None	903 S CRENSHAW BLVD	STE 104	LOS ANGELES	CA	90019	1965	19	06037	34.05617593	-118.3221956	Los Angeles County
18860	Fee-for-Service	1326520404	1326520404	1	1	LEI, FREDA HIO TONG LCSW	7/12/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
18870	Fee-for-Service	1083956213	1083956213	1	1	LO, IRENE J MD	6/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125005	02	General Surgery	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
18878	Fee-for-Service	1265631766	1265631766	1	1	LETMANYI, ILONA H MD	2/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	101221	01	General Practice	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
18887	Fee-for-Service	1134299183	1134299183	1	1	LEAMING, TROY R DPM	7/1/2002	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	6552 BOLSA AVE	STE H	HUNTINGTON BEACH	CA	92647	2656	30	06059	33.74431776	-118.0144684	Orange County
18888	Fee-for-Service	1326235011	1326235011	1	1	LEE, JENNIFER W MD	8/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96881	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
18893	Fee-for-Service	1194118224	1194118224	1	1	LI, YI MD	8/11/2023	208800000X	NA	Other	026	PHYSICIANS	144878	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
18896	Fee-for-Service	1316365570	1316365570	1	1	LIN, RUOXI MD	9/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149545	41	Internal Medicine	0	In state provider	None	225 JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.35500597	-121.8401901	Santa Clara County
18945	Fee-for-Service	1801974464	1801974464	1	1	LAI, GORDON K MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71455	30	Radiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
18947	Fee-for-Service	1477952117	1477952117	1	1	LIBRA PAIN CARE	8/3/2018	208VP0014X	NA	Other	026	PHYSICIANS	126658	01	General Practice	0	In state provider	None	1433 WEST MERCED AVE	STE 311	WEST COVINA	CA	91790	3402	19	06037	34.06252177	-117.9477117	Los Angeles County
18950	Fee-for-Service	1154766301	1154766301	2	1	LIFELINK HOSPICE &	3/8/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	211 W FOOTHILL BLVD	STE B	GLENDORA	CA	91741	3357	19	06037	34.13603747	-117.8672175	Los Angeles County
18955	Fee-for-Service	1386635332	1386635332	1	1	LEATHERS, MICHAEL W MD	6/30/1991	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	36832	20	Orthopedic Surgery	0	In state provider	None	2801 K ST	STE 330	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
18957	Fee-for-Service	1134302391	1134302391	1	1	LEGASPI, ALMA OT	3/6/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2221 WANKEL WAY	None	OXNARD	CA	93030	0192	56	06111	34.21677352	-119.1475125	Ventura County
18970	Fee-for-Service	1275875312	1275875312	1	1	LURIE, LOUIS J MD	9/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139869	41	Internal Medicine	0	In state provider	None	26357 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.41257644	-118.5597683	Los Angeles County
18977	Fee-for-Service	1154416022	1154416022	1	1	LOWE, CLAVIN MD	7/1/1996	2080P0204X	NA	Other	026	PHYSICIANS	73346	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
18989	Fee-for-Service	1245418730	1245418730	1	1	LURIE, TERESA	5/3/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
18990	Fee-for-Service	1215132816	1215132816	1	1	LINGUA, ANNE C	3/29/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
18998	Fee-for-Service	1336795608	1336795608	1	1	LYUBOV BURGINA INC.	3/4/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14903 S NORMANDIE AVE	UNIT 214	GARDENA	CA	90247	2968	19	06037	33.89635356	-118.3004719	Los Angeles County
19014	Fee-for-Service	1851333280	1851333280	1	1	LIMM, MONA MD	5/9/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	67681	05	Anesthesiology	0	In state provider	None	3788 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1408	15	06029	35.39420177	-119.0081678	Kern County
19015	Fee-for-Service	1609294974	1609294974	1	1	LAPIN, ARYEH Z MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
19036	Fee-for-Service	1144336181	1144336181	1	1	LA CLINICA DE LA RAZA	9/1/2004	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3451 E 12TH ST	None	OAKLAND	CA	94601	3425	01	06001	37.77571135	-122.2233908	Alameda County
19042	Fee-for-Service	1396816294	1396816294	1	1	LOPEZ, LAURENCE C MD	7/31/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	54813	40	Pediatrics	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
19047	Fee-for-Service	1487072427	1487072427	1	1	LEW, DAVID J MD	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139167	41	Internal Medicine	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
19055	Fee-for-Service	1548363492	1548363492	1	1	LEE, JONG IN MD	7/31/1981	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	37705	01	General Practice	0	In state provider	None	5471 LA PALMA AVE	STE 205	LA PALMA	CA	90623	1733	30	06059	33.84643649	-118.0377675	Orange County
19080	Fee-for-Service	1639765878	1639765878	1	1	LOPEZ, CRISTAL PHD	11/8/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
19106	Fee-for-Service	1073896031	1073896031	1	1	LORETO, ALFREDO PT	3/21/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	23110 ATLANTIC CIR STE D	None	MORENO VALLEY	CA	92553	5920	33	06065	33.93308206	-117.2597707	Riverside County
19120	Fee-for-Service	1689817710	1689817710	1	1	LIM, JAMES H MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121902	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
19129	Fee-for-Service	1144484247	1144484247	1	1	LIAO, HENRY K MD	8/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100050	08	Family Practice	0	In state provider	None	2601 E MAIN ST	STE 104	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
19143	Fee-for-Service	1255779120	1255779120	1	2	LANGLEY, LESLIE A NP	7/15/2021	364SP0808X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	14390 PARK AVE.	None	VICTORVILLE	CA	92392	2910	36	06071	34.512453	-117.324936	San Bernardino County
19155	Fee-for-Service	1780768762	1780768762	1	1	LAZZARESCHI, GERRY V MD	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60900	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
19168	Fee-for-Service	1265631766	1265631766	1	1	LETMANYI, ILONA H MD	2/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	101221	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
19183	Fee-for-Service	1942363635	1942363635	1	1	LENCIONI, LAURA A PHD	11/13/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4785 N FIRST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
19184	Fee-for-Service	1285789487	1285789487	1	1	LA VIDA-KPC MEDICAL	2/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	GROUP INC	605 W 6TH ST	None	SAN PEDRO	CA	90731	2523	19	06037	33.73875028	-118.2904334	Los Angeles County
19196	Fee-for-Service	1174179303	1174179303	1	1	LAYSON, HAZEL NP	4/5/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
19269	Fee-for-Service	1710075270	1710075270	1	1	LEE, FAYE MD AMC	5/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	39905	41	Internal Medicine	0	In state provider	None	1245 WILSHIRE BLVD	STE 812	LOS ANGELES	CA	90017	4808	19	06037	34.05362775	-118.2661889	Los Angeles County
19299	Fee-for-Service	1417186438	1417186438	1	1	LUO, NANCY Y MD	9/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	158036	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
19304	Fee-for-Service	1134891146	1134891146	1	1	LEE, JAMIE J	11/12/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
19325	Fee-for-Service	1144336181	1144336181	1	1	LA CLINICA DE LA RAZA	3/3/2014	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	3451 E 12TH ST	None	OAKLAND	CA	94601	3425	01	06001	37.77571135	-122.2233908	Alameda County
19335	Fee-for-Service	1538229638	1538229638	1	4	LYON, DAVID H MD	3/4/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	43180	-	NOT APPLICABLE	0	In state provider	None	1116 ALICE ST	None	MODESTO	CA	95350	5905	50	06099	37.64725064	-121.007524	Stanislaus County
19342	Fee-for-Service	1548363492	1548363492	1	1	LEE, JONG IN MD	7/31/1981	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	37705	40	Pediatrics	0	In state provider	None	5471 LA PALMA AVE	STE 205	LA PALMA	CA	90623	1733	30	06059	33.84643649	-118.0377675	Orange County
19352	Fee-for-Service	1497794515	1497794515	1	1	LONG, NATHAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	353 FAIRMONT BLVD	None	RAPID CITY	SD	57701	7375	00	None	44.05854729	-103.2246985	Pennington County
19362	Fee-for-Service	1386668465	1386668465	1	1	LEE, DANIEL T MD	9/30/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51175	08	Family Practice	0	In state provider	None	1255 15TH ST	None	SANTA MONICA	CA	90404	1101	19	06037	34.02660948	-118.4867435	Los Angeles County
19370	Fee-for-Service	1164926150	1164926150	1	1	LAIKIJRUNG, PATSORN MD	9/25/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	185854	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
19434	Fee-for-Service	1992884647	1992884647	1	1	LE, ALAN H MD	6/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85861	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
19443	Fee-for-Service	1780768762	1780768762	1	1	LAZZARESCHI, GERRY V MD	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60900	01	General Practice	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
19452	Fee-for-Service	1194082354	1194082354	1	1	LIVE WELL MEDICAL SUPPLIES	6/28/2012	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC	7338 SYCAMORE CANYON BL	SUITE 1	RIVERSIDE	CA	92508	2318	33	06065	33.91856936	-117.2920337	Riverside County
19453	Fee-for-Service	1033504246	1033504246	1	1	LAM, WANDA C MD	8/3/2020	208600000X	NA	General Surgery	026	PHYSICIANS	168584	02	General Surgery	0	In state provider	None	197 E CAROLINE ST	None	SAN BERNARDINO	CA	92408	3731	36	06071	34.06143353	-117.2822085	San Bernardino County
19551	Fee-for-Service	1871025551	1871025551	1	1	LIVINGSTON, WESLEY DO	11/3/2021	208M00000X	NA	Other	026	PHYSICIANS	19084	None	None	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
19556	Fee-for-Service	1710075270	1710075270	1	1	LEE, FAYE MD AMC	5/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	39905	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1245 WILSHIRE BLVD	STE 812	LOS ANGELES	CA	90017	4808	19	06037	34.05362775	-118.2661889	Los Angeles County
19574	Fee-for-Service	1649210691	1649210691	1	1	LESCH, RICHARD S PHD	9/13/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	222 WELLER ST	None	PETALUMA	CA	94952	3183	49	06097	38.2356644	-122.636877	Sonoma County
19603	Fee-for-Service	1609910876	1609910876	1	1	LUCKS, BONNIE D PHD	5/27/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7200 PARKWAY DRIVE	STE 113	LA MESA	CA	91942	1534	37	06073	32.77297454	-117.0419524	San Diego County
19611	Fee-for-Service	1144336181	1144336181	1	1	LA CLINICA DE LA RAZA	9/1/2004	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3451 E 12TH ST	None	OAKLAND	CA	94601	3425	01	06001	37.77571135	-122.2233908	Alameda County
19665	Fee-for-Service	1003235482	1003235482	1	1	LOYA, REBECA LMFT	5/27/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1307 W 6TH ST	212C	CORONA	CA	92882	1642	33	06065	33.87790309	-117.589666	Riverside County
19707	Fee-for-Service	1083902324	1083902324	1	1	LAMPONE, ALEXANDER R MD	2/25/2020	207P00000X	NA	Other	026	PHYSICIANS	25058	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
19726	Fee-for-Service	1538479472	1538479472	1	1	LE, DE HIEU MD APC	3/31/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	35088	01	General Practice	0	In state provider	None	312 13TH STREET	None	OAKLAND	CA	94612	3917	01	06001	37.80237169	-122.2683109	Alameda County
19757	Fee-for-Service	1679063754	1679063754	1	1	LOPEZ GARCIA, JULISSA MD	12/1/2023	390200000X	NA	Other	026	PHYSICIANS	183534	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
19770	Fee-for-Service	1275708182	1275708182	1	1	LIWANAG, EMELITA C MD	2/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
19776	Fee-for-Service	1649237975	1649237975	1	1	LIU, CHIENYING MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	65469	67	Endocrinology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
19787	Fee-for-Service	1154364925	1154364925	2	1	LONGS DRUG STORES CA LLC	12/22/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	455 S MAIN ST	None	RED BLUFF	CA	96080	4315	52	06103	40.16609786	-122.2281944	Tehama County
19793	Fee-for-Service	1164427001	1164427001	1	1	LEUNG, BRYANT C MD	3/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	69385	25	Physical Medicine and Rehabilitation	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
19826	Fee-for-Service	1154321495	1154321495	1	1	LAKESHORE FIRE PRO DIST	10/1/1997	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	14815 OLYMPIC DR	None	CLEARLAKE	CA	95422	9522	17	06033	38.96180553	-122.634792	Lake County
19828	Fee-for-Service	1487732376	1487732376	1	1	LEE, BECKY N MD	7/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76692	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
19869	Fee-for-Service	1851321269	1851321269	1	1	LIN, FLORENCE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89252	05	Anesthesiology	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
19876	Fee-for-Service	1861570574	1861570574	1	1	LESTER, KAREN M MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	83769	40	Pediatrics	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
19898	Fee-for-Service	1538361993	1538361993	1	1	LAI, THOMAS T MD	8/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90103	40	Pediatrics	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
19900	Fee-for-Service	1144336181	1144336181	1	1	LA CLINICA DE LA RAZA	1/12/2007	3336C0002X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3451 E 12TH ST	None	OAKLAND	CA	94601	3425	01	06001	37.77571135	-122.2233908	Alameda County
19922	Fee-for-Service	1588162002	1588162002	1	1	LEE, KIMBERLY A NP	8/10/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10511 S WESTERN AVE	None	LOS ANGELES	CA	90047	4458	19	06037	33.940584	-118.309059	Los Angeles County
19933	Fee-for-Service	1164473799	1164473799	1	1	LAURA SUE WALTRIP MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7900 FM 1826	None	AUSTIN	TX	78737	1407	00	None	30.226617	-97.8921405	Travis County
19935	Fee-for-Service	1134495450	1134495450	1	1	LIU, TIMOTHY Y MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128408	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
19969	Fee-for-Service	1225416860	1225416860	1	1	LARSON, MICHAEL C	8/16/2021	390200000X	NA	Other	026	PHYSICIANS	173330	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
19986	Fee-for-Service	1821249327	1821249327	1	1	LONGS DRUG STORES CA LLC	12/26/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1385 TAVERN RD	None	ALPINE	CA	91901	3833	37	06073	32.83576956	-116.7758893	San Diego County
19988	Fee-for-Service	1154317022	1154317022	2	1	LAI, TUNG N MD	2/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	76454	41	Internal Medicine	0	In state provider	None	10737 CAMINO RUIZ	STE 200	SAN DIEGO	CA	92126	2371	37	06073	32.91416051	-117.1437943	San Diego County
19996	Fee-for-Service	1619965506	1619965506	1	1	LATIF, ALAA M MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51955	None	None	0	In state provider	None	1910 ROYALTY DRIVE	None	POMONA	CA	91767	3021	19	06037	34.07871356	-117.7454184	Los Angeles County
20037	Fee-for-Service	1811023088	1811023088	1	1	LIU, JULIANA C NP	11/2/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
20046	Fee-for-Service	1083858401	1083858401	1	1	LLAMAS CABALTICA, MITZI NP	1/13/2025	163WP0808X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
20096	Fee-for-Service	1679952808	1679952808	1	1	LIU, YAN MD	7/1/2020	207ZP0101X	NA	Other	026	PHYSICIANS	151664	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
20102	Fee-for-Service	1487146916	1487146916	1	1	LANNON, KELSEY E DO	9/12/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	657 TOWN CENTER	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
20117	Fee-for-Service	1760433221	1760433221	1	1	LITT, RICHARD L MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	2231 W CHARLESTON BLVD	2ND FL	LAS VEGAS	NV	89102	2308	00	None	36.15879115	-115.1718806	Clark County
20140	Fee-for-Service	1588744072	1588744072	1	1	LI, TIANHONG MD	6/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53681	68	Hematology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
20145	Fee-for-Service	1194765479	1194765479	1	1	LEE, STANFORD C MD	11/30/1986	207P00000X	NA	Other	026	PHYSICIANS	50429	66	Emergency Medicine (Urgent Care)	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91507	0000	19	06037	34.158213	-118.328112	Los Angeles County
20174	Fee-for-Service	1215022934	1215022934	1	1	LABUWI, CHARLES M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	KLAMATH PEDIATRIC CLINIC	2310 MOUNTAIN VIEW BLVD	None	KLAMATH FALLS	OR	97601	1134	00	None	42.25121145	-121.7845244	Klamath County
20186	Fee-for-Service	1144336181	1144336181	1	1	LA CLINICA DE LA RAZA	8/21/2006	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	3451 E 12TH ST	None	OAKLAND	CA	94601	3425	01	06001	37.77571135	-122.2233908	Alameda County
20189	Fee-for-Service	1700174851	1700174851	1	1	LAHIRI, SHOURI MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137448	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
20228	Fee-for-Service	1851551501	1851551501	1	1	LAHIJI, ARTA MD	2/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	107772	01	General Practice	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
20235	Fee-for-Service	1912126616	1912126616	1	1	LOBERT, PHILIP F MD	5/28/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	149334	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
20244	Fee-for-Service	1609041581	1609041581	1	1	LOC, KIET M MD	1/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119338	13	Neurology (M.D. only)	0	In state provider	None	24451 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3665	30	06059	33.60848903	-117.7079742	Orange County
20259	Fee-for-Service	1912141300	1912141300	1	1	LEUNG, AMY MD	2/13/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	118161	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
20268	Fee-for-Service	1700127792	1700127792	1	1	LASTER, MARCIANA L MD	5/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123624	45	Nephrology (Renal-Kidney)	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
20274	Fee-for-Service	1982610218	1982610218	1	1	LONG, HUONG-ANH	6/30/1989	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	62453	25	Physical Medicine and Rehabilitation	0	In state provider	None	1621 W 25TH ST	STE 161	SAN PEDRO	CA	90732	4301	19	06037	33.72329176	-118.3134326	Los Angeles County
20276	Fee-for-Service	1154317022	1154317022	2	1	LAI, TUNG N MD	2/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	76454	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10737 CAMINO RUIZ	STE 200	SAN DIEGO	CA	92126	2371	37	06073	32.91416051	-117.1437943	San Diego County
20285	Fee-for-Service	1699218610	1699218610	1	1	LOGAN, GREGORY A LMFT	7/1/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	112204	-	NOT APPLICABLE	0	In state provider	None	1303 WEST WALNUT PKWY	None	COMPTON	CA	90220	5030	19	06037	33.87724562	-118.2446904	Los Angeles County
20338	Fee-for-Service	1043251143	1043251143	1	1	LEE, CAROL H MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68496	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
20340	Fee-for-Service	1013473511	1013473511	1	1	LIMA, LYNN A CNP	11/30/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	511 N HOLLYWOOD WAY	None	BURBANK	CA	91505	3406	19	06037	34.15985598	-118.3431272	Los Angeles County
20377	Fee-for-Service	1477616571	1477616571	1	1	LENOX HILL HOSPITAL	1/26/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	100 E 77TH ST	None	NEW YORK	NY	10021	1853	00	None	40.773969	-73.960884	New York County
20384	Fee-for-Service	1679952808	1679952808	1	1	LIU, YAN MD	7/1/2020	207ZP0101X	NA	Other	026	PHYSICIANS	151664	22	Pathology (M.D. only)	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
20392	Fee-for-Service	1114267481	1114267481	1	1	LEWIS, JANET LMFT	11/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
20407	Fee-for-Service	1518198266	1518198266	1	1	LIM, MARY C CRNA	6/23/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
20409	Fee-for-Service	1194257063	1194257063	1	1	LATSHAW, RACHAEL A MD	8/12/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	20000	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
20416	Fee-for-Service	1215162086	1215162086	1	1	LAM, ELENE DO	1/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10698	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
20419	Fee-for-Service	1366683112	1366683112	1	1	LAN, LI MD	4/13/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	166372	36	Psychiatry	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
20420	Fee-for-Service	1265894448	1265894448	1	1	LINDQUIST, SHAREENE MD	7/3/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	151526	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
20429	Fee-for-Service	1588744072	1588744072	1	1	LI, TIANHONG MD	6/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53681	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
20463	Fee-for-Service	1306055678	1306055678	1	1	LEE MARSHALL	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	RADIOLOGY IMAGING CONS	1400 E BOULDER	None	COLORADO SPRING	CO	80909	8090	00	None	38.8388119	-104.7995065	El Paso County
20467	Fee-for-Service	1083832810	1083832810	1	1	LAPPEN, NANCY LCSW	3/23/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27209 HIGHWAY 189	None	LAKE ARROWHEAD	CA	92317	2253	36	06071	34.24609449	-117.2103374	San Bernardino County
20474	Fee-for-Service	1942638648	1942638648	1	1	LYNN, ELIZABETH A CNP	4/20/2020	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
20482	Fee-for-Service	1942228366	1942228366	1	1	LEONARD, JEFFREY R	3/12/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	-	None	None	2	Out of state provider	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
20492	Fee-for-Service	1437826468	1437826468	1	1	LIFE OF HOME HOME HEALTH	8/25/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	671 W BROADWAY	SUITE 101	GLENDALE	CA	91204	1007	19	06037	34.14680392	-118.2695599	Los Angeles County
20505	Fee-for-Service	1114290087	1114290087	1	1	LAWSHAWN T CHEVALIER	3/16/2002	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	314 E HILLCREST BLVD	None	INGLEWOOD	CA	90301	2423	19	06037	33.95973995	-118.3510077	Los Angeles County
20518	Fee-for-Service	1447485206	1447485206	1	1	LIU, JAMES H MD INC	8/1/1998	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	64811	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1730 S SAN GABRIEL BLVD	STE C	SAN GABRIEL	CA	91776	3928	19	06037	34.077654	-118.0907045	Los Angeles County
20523	Fee-for-Service	1164459764	1164459764	1	1	LYON, HOWARD S MD	5/11/1995	207R00000X	NA	Other	026	PHYSICIANS	70629	41	Internal Medicine	0	In state provider	None	550 WASHINGTON ST	STE 500	SAN DIEGO	CA	92103	2229	37	06073	32.75003652	-117.1603431	San Diego County
20526	Fee-for-Service	1881675221	1881675221	1	1	LE GRAS, MARC D MD	2/8/2015	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	LE GRAS, MARC D MD	501 N GRAHAM ST	STE 330	PORTLAND	OR	97227	2001	00	None	45.54285348	-122.671035	Multnomah County
20530	Fee-for-Service	1609810928	1609810928	1	1	LANNIN, JANANI K OD	6/1/1994	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1950 COURT ST	None	REDDING	CA	96001	1823	45	06089	40.57884166	-122.3939309	Shasta County
20540	Fee-for-Service	1386762532	1386762532	1	1	LI, JENNY J CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	SHAWLI ACUPUNCTURE AND H	177 DARCY PKWY	None	LATHROP	CA	95330	9222	39	06077	37.80318575	-121.2960301	San Joaquin County
20558	Fee-for-Service	1700127792	1700127792	1	1	LASTER, MARCIANA L MD	5/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123624	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
20568	Fee-for-Service	1629623368	1629623368	1	1	LEUNG, KIN LOK PT	5/16/2020	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
20589	Fee-for-Service	1780974584	1780974584	1	1	LARSON, CLAIRE K MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123117	38	Geriatrics	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
20596	Fee-for-Service	1972677946	1972677946	1	1	LIBUNAO, JOSE R II	10/24/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
20646	Fee-for-Service	1437704061	1437704061	1	1	LEAL, JORGE LCSW	9/15/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
20665	Fee-for-Service	1477616571	1477616571	1	1	LENOX HILL HOSPITAL	1/26/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	100 E 77TH ST	None	NEW YORK	NY	10021	1853	00	None	40.773969	-73.960884	New York County
20681	Fee-for-Service	1851310676	1851310676	1	1	LEVIN, LARA J MD	11/30/2018	207RE0101X	NA	Endocrinology	026	PHYSICIANS	156950	67	Endocrinology	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
20717	Fee-for-Service	1588744072	1588744072	1	1	LI, TIANHONG MD	6/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53681	41	Internal Medicine	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
20724	Fee-for-Service	1518977560	1518977560	1	1	LAO-DOMINGO, FELICIDAD G	2/8/2015	207K00000X	NA	Other	026	PHYSICIANS	33817	41	Internal Medicine	0	In state provider	None	700 W 6TH ST	STE I	GILROY	CA	95020	6014	43	06085	37.00407753	-121.5779365	Santa Clara County
20756	Fee-for-Service	1316470941	1316470941	1	1	LAVI, JONATHAN R MD	9/2/2022	2084P0804X	NA	Psychiatry	026	PHYSICIANS	169525	None	None	0	In state provider	None	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
20759	Fee-for-Service	1750458758	1750458758	1	1	LITVAK, DAVID A MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	81550	None	None	0	In state provider	None	1328 22ND ST	FL 3	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
20774	Fee-for-Service	1720374721	1720374721	1	1	LEE, THOMAS MD	3/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128890	41	Internal Medicine	0	In state provider	None	1515 EAST OCEAN AVE	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
20793	Fee-for-Service	1861557076	1861557076	1	1	LEGORBURU, NOEL S LCSW	9/28/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1001 SNEATH LN	STE 104	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
20798	Fee-for-Service	1275681249	1275681249	1	1	LAALY, KOUROSH C DO	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	6951	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
20799	Fee-for-Service	1750765830	1750765830	1	1	LEE, JOOYEON MD	8/17/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	156259	None	None	0	In state provider	None	11303 W WASHINGTON BLVD	100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
20812	Fee-for-Service	1881675221	1881675221	1	1	LE GRAS, MARC D MD	2/8/2015	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	35	Pediatric Cardiology (M.D. only)	1	Border provider	LE GRAS, MARC D MD	501 N GRAHAM ST	STE 330	PORTLAND	OR	97227	2001	00	None	45.54285348	-122.671035	Multnomah County
20854	Fee-for-Service	1235467143	1235467143	1	1	LU, NGHI M MD	11/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120216	30	Radiology	0	In state provider	None	47111 MONROE STREET	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
20880	Fee-for-Service	1922368851	1922368851	1	1	LOUIE, RYAN K MD	5/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144170	36	Psychiatry	0	In state provider	None	1199 BUSH ST	STE 650	SAN FRANCISCO	CA	94109	5975	38	06075	37.7891291	-122.4167087	San Francisco County
20897	Fee-for-Service	1467233247	1467233247	1	1	LE-WONG, HOLLY CNP	12/5/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1700 LOMBARD ST	STE 110	OXNARD	CA	93030	8211	56	06111	34.21699272	-119.149297	Ventura County
20942	Fee-for-Service	1093713190	1093713190	1	1	LIEB, JEREMY ISAAC MD	7/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79348	None	None	0	In state provider	None	2222 EAST ST	STE 250	CONCORD	CA	94520	2096	07	06013	37.98125538	-122.0329375	Contra Costa County
20963	Fee-for-Service	1295023208	1295023208	1	1	LOVETRO, BLAINE K MD	5/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122893	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
20968	Fee-for-Service	1801215926	1801215926	1	1	LONGARDNER, KATHERINE M MD	6/25/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	137963	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
20988	Fee-for-Service	1245818897	1245818897	1	1	LO, LAUREN MD	10/21/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
21012	Fee-for-Service	1518977560	1518977560	1	1	LAO-DOMINGO, FELICIDAD G	2/8/2015	207K00000X	NA	Other	026	PHYSICIANS	33817	03	Allergy	0	In state provider	None	700 W 6TH ST	STE I	GILROY	CA	95020	6014	43	06085	37.00407753	-121.5779365	Santa Clara County
21028	Fee-for-Service	1275851255	1275851255	1	1	LYDIA FISHER MD	3/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1550 S POTOMAC ST	STE 270	AURORA	CO	80012	5456	00	None	39.689235	-104.830335	Arapahoe County
21049	Fee-for-Service	1235389644	1235389644	1	1	LEE, ANGELA S MD	1/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98887	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7601 STONERIDGE DRIVE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
21057	Fee-for-Service	1316996911	1316996911	1	1	LYASS, SERGEY MD APC	7/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80181	02	General Surgery	0	In state provider	None	8631 W 3RD ST	STE 900E	LOS ANGELES	CA	90048	5912	19	06037	34.07361928	-118.3803143	Los Angeles County
21114	Fee-for-Service	1811908056	1811908056	1	1	LEFEVRE,PETER M MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70856	41	Internal Medicine	0	In state provider	None	1131 WILSHIRE BLVD	# 100200	SANTA MONICA	CA	90401	2061	19	06037	34.02509887	-118.4909994	Los Angeles County
21151	Fee-for-Service	1477084713	1477084713	1	1	LENIO, STEVEN MD	7/14/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	172124	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
21166	Fee-for-Service	1003129479	1003129479	1	1	LEVIT, KIMBERLY PHD	4/24/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
21175	Fee-for-Service	1174522700	1174522700	1	1	LOTUS HEALTHCARE PARTNERS	12/14/1995	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	414 S PROSPECTORS ROAD	SUITE G	DIAMOND BAR	CA	91765	1615	19	06037	34.0175153	-117.8122207	Los Angeles County
21220	Fee-for-Service	1114245883	1114245883	1	1	LEE, YONG LUKE MEDICAL	4/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	39217	01	General Practice	0	In state provider	None	255 E BONITA AVE	None	POMONA	CA	91769	6001	19	06037	34.097913	-117.7474635	Los Angeles County
21242	Fee-for-Service	1619945417	1619945417	1	1	LIU, KENNETH A MD	12/26/2007	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	98315	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
21251	Fee-for-Service	1689881591	1689881591	1	1	LAEEQ, AMBREEN MD	3/30/2018	208G00000X	NA	General Surgery	026	PHYSICIANS	143249	33	Thoracic Surgery	0	In state provider	None	1575 SOQUEL DRIVE	SUITE C	SANTA CRUZ	CA	95065	1700	44	06087	36.98861921	-121.9831127	Santa Cruz County
21278	Fee-for-Service	1992119564	1992119564	1	1	LUNGLIFE AI, INC	11/17/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	2545 W HILLCREST DR STE	None	THOUSAND OAKS	CA	91320	2296	56	06111	34.18762436	-118.9332612	Ventura County
21284	Fee-for-Service	1467778878	1467778878	1	1	LEE, DANIEL J MD	1/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118609	25	Physical Medicine and Rehabilitation	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	7303	56	06111	34.27623479	-119.2520218	Ventura County
21331	Fee-for-Service	1720084163	1720084163	1	1	LIFELONG MEDICAL CARE	3/10/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	WEST BERKELEY FAMILY	2031 6TH ST	None	BERKELEY	CA	94710	2006	01	06001	37.86709575	-122.2973759	Alameda County
21347	Fee-for-Service	1548324379	1548324379	1	1	LETO, MARISA F LMFT	5/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
21357	Fee-for-Service	1457454738	1457454738	1	1	LIU, ALLEN K MD	11/1/2013	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54483	08	Family Practice	0	In state provider	None	25455 BARTON RD	None	LOMA LINDA	CA	92354	3130	36	06071	34.04805253	-117.249534	San Bernardino County
21383	Fee-for-Service	1376555284	1376555284	1	1	LOWE, DAVID D MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70858	05	Anesthesiology	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
21399	Fee-for-Service	1730384801	1730384801	2	1	L&S DRUGS, INC	12/24/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1730 W VERDUGO AVE	None	BURBANK	CA	91506	2148	19	06037	34.1675806	-118.3239625	Los Angeles County
21412	Fee-for-Service	1457353062	1457353062	1	1	LASTER, DANIEL R MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71169	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2627 E WASHINGTON BLVD	None	PASADENA	CA	91107	1412	19	06037	34.16917853	-118.096371	Los Angeles County
21423	Fee-for-Service	1275196370	1275196370	1	1	LEUNG, LAWRENCE J MD	2/2/2025	207R00000X	NA	Other	026	PHYSICIANS	180122	41	Internal Medicine	0	In state provider	None	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
21426	Fee-for-Service	1073786315	1073786315	1	1	LAKAMSANI, ROBYN A	10/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87255	None	None	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
21429	Fee-for-Service	1023320090	1023320090	1	1	LARSON, ROBERT D PSYD	5/2/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
21432	Fee-for-Service	1811379266	1811379266	1	1	LU, TIFFANY S MD	10/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144325	01	General Practice	0	In state provider	None	2500 ALHAMBRA AVENUE	None	MARTINEZ	CA	94553	3156	07	06013	38.00658519	-122.1309063	Contra Costa County
21447	Fee-for-Service	1851479406	1851479406	1	1	LASMAN, TODD E MD	1/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	60640	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2800 BENEDICT DR	None	SAN LEANDRO	CA	94577	6840	01	06001	37.71593435	-122.131151	Alameda County
21463	Fee-for-Service	1053487728	1053487728	1	1	LOO, BRENT T PT	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
21468	Fee-for-Service	1588920888	1588920888	1	1	LEE, CHUAN M MD	8/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	126872	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
21539	Fee-for-Service	1831162593	1831162593	1	2	LIAN, GEORGE MD	6/30/1990	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	53716	20	Orthopedic Surgery	0	In state provider	None	2801 K ST	STE 500	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
21558	Fee-for-Service	1316393762	1316393762	1	1	LE, ANH VU N MD	6/5/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	151046	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
21575	Fee-for-Service	1275796963	1275796963	1	1	LU, CHARLES J MD	9/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91549	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
21601	Fee-for-Service	1992225080	1992225080	1	1	LACORTE, NATALIE C MD	9/29/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163663	08	Family Practice	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
21604	Fee-for-Service	1255683793	1255683793	1	1	LUDLOW, LAURA W	12/24/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
21615	Fee-for-Service	1942336615	1942336615	1	1	LU, AMY C MD	2/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	56065	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
21618	Fee-for-Service	1720084163	1720084163	1	1	LIFELONG MEDICAL CARE	9/21/2007	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	WEST BERKELEY FAMILY	2031 6TH ST	None	BERKELEY	CA	94710	2006	01	06001	37.86709575	-122.2973759	Alameda County
21622	Fee-for-Service	1124192448	1124192448	1	1	LAM, KIMHAI N MD	8/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74229	None	None	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
21632	Fee-for-Service	1841637162	1841637162	1	1	LEE, MICHAEL H MD	6/12/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	168234	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
21655	Fee-for-Service	1245626639	1245626639	1	2	LEE, EUN KYUNG J MD	5/29/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	145174	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
21676	Fee-for-Service	1104143403	1104143403	1	1	LOW, DOROTHY LAC	1/9/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
21694	Fee-for-Service	1538386602	1538386602	1	1	LARA, PATRICIA T LMFT	3/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	109 CENTRAL AVE	207B	SALINAS	CA	93901	0007	27	06053	36.67653613	-121.6581049	Monterey County
21697	Fee-for-Service	1457353062	1457353062	1	1	LASTER, DANIEL R MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71169	20	Orthopedic Surgery	0	In state provider	None	2627 E WASHINGTON BLVD	None	PASADENA	CA	91107	1412	19	06037	34.16917853	-118.096371	Los Angeles County
21733	Fee-for-Service	1851479406	1851479406	1	1	LASMAN, TODD E MD	1/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	60640	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2800 BENEDICT DR	None	SAN LEANDRO	CA	94577	6840	01	06001	37.71593435	-122.131151	Alameda County
21748	Fee-for-Service	1528590585	1528590585	1	1	LAZO, GUADA NP	12/19/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23181 VERDUGO DR	STE 103A	LAGUNA HILLS	CA	92653	1313	30	06059	33.62609529	-117.7293191	Orange County
21770	Fee-for-Service	1306908108	1306908108	1	1	LIN, LILY K MD	3/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90256	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	# 400	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
21867	Fee-for-Service	1376999821	1376999821	1	1	LULLO, JENNA J MD	12/10/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	150350	07	Dermatology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
21901	Fee-for-Service	1306330220	1306330220	1	1	LIVING HOPE HOME HEALTH CARE	11/3/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3795 LA CRESENTA AVE	SUITE 203	GLENDALE	CA	91208	1074	19	06037	34.211313	-118.2400265	Los Angeles County
21904	Fee-for-Service	1457988750	1457988750	1	1	LEE, MICHAEL MD	12/20/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	183544	07	Dermatology	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
21905	Fee-for-Service	1023252855	1023252855	1	1	LIN, SALLY C MD	9/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113467	18	Ophthalmology	0	In state provider	None	3772 HOWE STREET	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
21910	Fee-for-Service	1720084163	1720084163	1	1	LIFELONG MEDICAL CARE	2/3/1997	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	WEST BERKELEY FAMILY	2031 6TH ST	None	BERKELEY	CA	94710	2006	01	06001	37.86709575	-122.2973759	Alameda County
21932	Fee-for-Service	1679663744	1679663744	1	1	LEWIS, SCOTT B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 3RD AVE SW	None	MINOT	ND	58701	3880	00	None	48.23336909	-101.2951165	Ward County
21938	Fee-for-Service	1003250424	1003250424	1	1	LE, THUY-LIEN T MD	10/25/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	137889	08	Family Practice	0	In state provider	None	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
21979	Fee-for-Service	1831420488	1831420488	1	2	LEPAGE-SMITH, JESSICA LCSW	4/29/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES	50 IRON POINT CIR	SUITE 140	FOLSOM	CA	95630	8516	34	06067	38.644128	-121.1423175	Sacramento County
21994	Fee-for-Service	1902034812	1902034812	1	1	LEE, ERNEST J MD	4/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113652	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
22029	Fee-for-Service	1104902790	1104902790	1	1	LIFECARE INC	8/2/2004	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	8900 BENSON AVENUE	SUITE E	MONTCLAIR	CA	91763	1669	36	06071	34.09232227	-117.6810176	San Bernardino County
22035	Fee-for-Service	1366591695	1366591695	1	1	LE, JOHN N DO	1/13/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	8146	08	Family Practice	0	In state provider	None	2905 W EDINGER AVE	None	SANTA ANA	CA	92704	3926	30	06059	33.72751552	-117.90837	Orange County
22062	Fee-for-Service	1215673686	1215673686	1	1	LI, ANTHONY	8/23/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	500 W GLENOAKS BLVD	None	GLENDALE	CA	91202	2813	19	06037	34.15937082	-118.2644042	Los Angeles County
22063	Fee-for-Service	1073003943	1073003943	1	1	LAVENE, LANDON PT	12/6/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1535 RIVER PARK	STE 2000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
22068	Fee-for-Service	1649713249	1649713249	1	1	LEE, SYDNE CCC-SLP	3/13/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
22079	Fee-for-Service	1437137916	1437137916	1	1	LEONE, EDWARD W MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86668	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
22105	Fee-for-Service	1194913103	1194913103	1	2	LASERVUE EYE CENTER MEDICAL	3/4/2021	261QS0132X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	3540 MENDOCINO AVE	STE 100	SANTA ROSA	CA	95403	3639	49	06097	38.473938	-122.7258495	Sonoma County
22140	Fee-for-Service	1063560365	1063560365	1	1	LANDER, STEPHEN K LMFT	2/9/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	71687 HIGHWAY 111	SUITE 205	RANCHO MIRAGE	CA	92270	4515	33	06065	33.74279697	-116.4137932	Riverside County
22142	Fee-for-Service	1255892436	1255892436	1	1	LUCARELLI, KATHERINE M MD	5/5/2023	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	185918	None	None	0	In state provider	None	625 S FAIR OAKS AVE	227, 240, 280, 285	PASADENA	CA	91105	2613	19	06037	34.134894	-118.1504155	Los Angeles County
22196	Fee-for-Service	1720084163	1720084163	1	1	LIFELONG MEDICAL CARE	2/3/1997	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	WEST BERKELEY FAMILY	2031 6TH ST	None	BERKELEY	CA	94710	2006	01	06001	37.86709575	-122.2973759	Alameda County
22222	Fee-for-Service	1508851726	1508851726	1	1	LEE, KIL U MD	12/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36198	22	Pathology (M.D. only)	0	In state provider	None	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
22223	Fee-for-Service	1720495997	1720495997	1	1	LUBLINER, ERICA MD	3/4/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	141865	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
22232	Fee-for-Service	1578641148	1578641148	1	1	LEE, ANNIE W MD	9/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92385	05	Anesthesiology	0	In state provider	None	700 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
22235	Fee-for-Service	1457747180	1457747180	1	1	LEE, SUEGENE	7/27/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	172203	None	None	0	In state provider	None	1020 29TH ST	STE 680	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
22259	Fee-for-Service	1790288280	1790288280	1	1	LLEWELLYN, CHARLES M MD	6/2/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	186385	None	None	0	In state provider	None	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
22285	Fee-for-Service	1972135531	1972135531	1	1	LOPEZ-BRUMETT, LINDSEY N LMF	5/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	14350 CIVIC DR	SUITE 100	VICTORVILLE	CA	92392	2338	36	06071	34.51177135	-117.3236721	San Bernardino County
22330	Fee-for-Service	1881072296	1881072296	1	1	LEVINE, ANDREA R DO	10/11/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16529	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
22331	Fee-for-Service	1871149708	1871149708	1	1	LI, CATHERINE PT	9/17/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1085 W EL CAMINO REAL	None	SUNNYVALE	CA	94087	1030	43	06085	37.37270741	-122.0517412	Santa Clara County
22360	Fee-for-Service	1508886771	1508886771	1	1	LEE, KEE Y	10/31/1989	207L00000X	NA	Other	026	PHYSICIANS	59226	05	Anesthesiology	0	In state provider	None	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
22363	Fee-for-Service	1114973591	1114973591	1	1	LANZAT, MISHA DPM INC	1/1/1991	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3743 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1703	19	06037	34.02418646	-118.1927217	Los Angeles County
22388	Fee-for-Service	1831244318	1831244318	1	1	LOS ANGELES COUNTY CCS	9/27/1993	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	LONG BEACH MTU	2221 ARGONNE AVE	None	LONG BEACH	CA	90815	2527	19	06037	33.79673846	-118.1362298	Los Angeles County
22395	Fee-for-Service	1245313774	1245313774	1	1	LEE, BRIAN L MD	8/31/1995	207W00000X	NA	Ophthalmology	026	PHYSICIANS	80297	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
22399	Fee-for-Service	1184120347	1184120347	1	1	LOMONACO, JACOB	12/13/2023	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
22405	Fee-for-Service	1336572734	1336572734	1	1	LOUIE, LANA D A PROFESSIONAL	4/20/2015	208600000X	NA	General Surgery	026	PHYSICIANS	100603	02	General Surgery	0	In state provider	CORPORATION	18370 BURBANK BLVD	STE 607	TARZANA	CA	91356	2833	19	06037	34.17173059	-118.5331881	Los Angeles County
22424	Fee-for-Service	1891775607	1891775607	1	1	LAMAR, JAMES E II MD	1/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	137926	01	General Practice	0	In state provider	None	5575 RUFFIN ROAD	STE 100	SAN DIEGO	CA	92123	1380	37	06073	32.83605627	-117.1266464	San Diego County
22440	Fee-for-Service	1275653065	1275653065	1	1	LAWRENCE, SUSAN E MD	3/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	41677	41	Internal Medicine	0	In state provider	None	44758 ELM AVENUE	None	LANCASTER	CA	93534	3105	19	06037	34.69522745	-118.1415734	Los Angeles County
22451	Fee-for-Service	1568661841	1568661841	1	1	LEE, STEVEN C	4/12/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
22459	Fee-for-Service	1992174965	1992174965	1	1	LARA, JESSICA PSYD	7/18/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	350 E ST	STE 305	EUREKA	CA	95501	0378	12	06023	40.8030305	-124.1674522	Humboldt County
22480	Fee-for-Service	1225238454	1225238454	1	1	LIESKE, STEVEN P MD	7/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92577	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94153	2202	38	06075	37.76344756	-122.4581992	San Francisco County
22497	Fee-for-Service	1821318312	1821318312	1	1	LIN, YU-HSIANG MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130088	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365-B	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
22538	Fee-for-Service	1972571693	1972571693	1	1	LENNARD, WILLIAM T MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127215	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
22544	Fee-for-Service	1427208651	1427208651	1	1	LIN, KATHERINE Y DO	3/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10523	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
22546	Fee-for-Service	1902484132	1902484132	1	1	LICHTENFELD, DAVID MD	6/21/2024	207R00000X	NA	Other	026	PHYSICIANS	192446	41	Internal Medicine	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
22555	Fee-for-Service	1932668076	1932668076	1	1	LIU, LUCY S MD	10/21/2022	207P00000X	NA	Other	026	PHYSICIANS	179699	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
22602	Fee-for-Service	1184842007	1184842007	1	1	LIM, ANGELA W DO	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	11297	08	Family Practice	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
22628	Fee-for-Service	1275519092	1275519092	1	1	LEE, JENNIFER L MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	92721	83	Rheumatology	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
22683	Fee-for-Service	1124190459	1124190459	1	1	LAM, HAR HIU D MD	4/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86193	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
22684	Fee-for-Service	1184120347	1184120347	1	1	LOMONACO, JACOB	12/13/2023	207P00000X	NA	Other	026	PHYSICIANS	-	70	Clinic (mixed specialty)	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
22698	Fee-for-Service	1205926953	1205926953	1	1	LORD, KATHLEEN OT	10/14/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	25467 MEDICAL CENTER DR	100	MURRIETA	CA	92562	1501	33	06065	33.55711632	-117.1860368	Riverside County
22707	Fee-for-Service	1679063671	1679063671	1	1	LI, MICHAEL M MD	8/5/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
22718	Fee-for-Service	1669430955	1669430955	1	1	LORENZ, RANDALL G MD	7/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	31181	41	Internal Medicine	0	In state provider	None	525 WEST ACACIA STREET	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
22748	Fee-for-Service	1992260376	1992260376	1	1	LIFEPLUS PHARMACY INC.	4/10/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2764 ABORN RD	None	SAN JOSE	CA	95121	1204	43	06085	37.31364749	-121.7928998	Santa Clara County
22752	Fee-for-Service	1336382472	1336382472	1	1	LEE, PAUL S MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119027	30	Radiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
22781	Fee-for-Service	1821318312	1821318312	1	1	LIN, YU-HSIANG MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130088	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365-B	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
22789	Fee-for-Service	1689056301	1689056301	1	1	LUTHER, DANIEL MD	12/13/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
22790	Fee-for-Service	1902051675	1902051675	1	1	LE, HIEN T MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106045	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
22849	Fee-for-Service	1467808758	1467808758	1	1	LAL-NAVARRO, PRAKRITI P NP	3/11/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95011070	-	NOT APPLICABLE	0	In state provider	None	1349 AND 1343 W. MAIN ST	A & B	MERCED	CA	95340	4438	24	06047	37.30624009	-120.4963217	Merced County
22866	Fee-for-Service	1619984572	1619984572	1	1	LIN, YANN G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	315 MARTIN LUTHER KING J	None	TACOMA	WA	98405	4234	00	None	47.25960844	-122.4534238	Pierce County
22880	Fee-for-Service	1437760543	1437760543	1	1	LAMPL, NICHOLAS J	11/22/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
22881	Fee-for-Service	1992489595	1992489595	1	1	LOS ANGELES BEHAVIOR HEALTH	5/8/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	21540 PLUMMER ST	SUITE A	CHATSWORTH	CA	91311	4143	19	06037	34.24270353	-118.6001685	Los Angeles County
22884	Fee-for-Service	1245258144	1245258144	1	1	LINNE, STUART R MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	25407	41	Internal Medicine	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
22921	Fee-for-Service	1275519092	1275519092	1	1	LEE, JENNIFER L MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	92721	41	Internal Medicine	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
22926	Fee-for-Service	1154847788	1154847788	1	1	LAU, HANMAN PT	12/30/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
22951	Fee-for-Service	1124082466	1124082466	1	1	LIAO, CHUNG H MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	30981	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	14651 S BASCOM AVE	STE 102	LOS GATOS	CA	95032	2004	43	06085	37.25556684	-121.9504578	Santa Clara County
22970	Fee-for-Service	1053552893	1053552893	1	1	LAXPATI, MONISH J	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106370	None	None	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
23020	Fee-for-Service	1093809634	1093809634	1	1	LUH, JOIN Y MD	7/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99744	41	Internal Medicine	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
23040	Fee-for-Service	1598128183	1598128183	1	1	LEE, ALEXANDRIA MD	5/9/2019	207R00000X	NA	Other	026	PHYSICIANS	150735	41	Internal Medicine	0	In state provider	None	2336 SANTA MONICA BLVD	SUITE 304	SANTA MONICA	CA	90404	2067	19	06037	34.03136627	-118.4766854	Los Angeles County
23041	Fee-for-Service	1336382472	1336382472	1	1	LEE, PAUL S MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119027	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
23047	Fee-for-Service	1750640322	1750640322	1	1	LEVY, ERIC B MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149333	34	Urology and Urological Surgery	0	In state provider	None	3 MEDICAL PLAZA DRIVE	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
23064	Fee-for-Service	1952758005	1952758005	1	1	LAFORTUNE, MARIE-MICHELE MD	6/27/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	140297	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
23067	Fee-for-Service	1134200306	1134200306	1	1	LIN, JENNIFER MD	6/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87823	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
23082	Fee-for-Service	1396831210	1396831210	1	1	LE, CAM VAN MD	1/24/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42446	01	General Practice	0	In state provider	None	9341 BOLSA AVE	None	WESTMINSTER	CA	92683	5928	30	06059	33.74497046	-117.965907	Orange County
23105	Fee-for-Service	1851718902	1851718902	1	1	LADHANI, HUSAYN A MD	5/1/2024	2086S0127X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
23155	Fee-for-Service	1790761344	1790761344	1	1	LIU, HONG MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	64762	05	Anesthesiology	0	In state provider	None	7248 S LAND PARK DR	STE 105	SACRAMENTO	CA	95831	3662	34	06067	38.494602	-121.513743	Sacramento County
23164	Fee-for-Service	1568755429	1568755429	1	1	LIN, EUGENE MD	10/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130072	45	Nephrology (Renal-Kidney)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
23174	Fee-for-Service	1760541163	1760541163	1	1	LIBRA MEDICAL GROUP, INC.	11/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50204	41	Internal Medicine	0	In state provider	None	1410 MILLER DR	None	LOS ANGELES	CA	90069	1422	19	06037	34.09649013	-118.37655	Los Angeles County
23180	Fee-for-Service	1720022551	1720022551	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	717 MARSH ST	None	SAN LUIS OBISPO	CA	93401	3901	40	06079	35.27830358	-120.6633911	San Luis Obispo County
23184	Fee-for-Service	1518012533	1518012533	1	1	LIU, NANCY PSY	4/27/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
23193	Fee-for-Service	1750469375	1750469375	1	1	LEUNG, KENNETH L MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	30286	68	Hematology	0	In state provider	None	225 DICKINSON ST	# H212	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
23204	Fee-for-Service	1730429846	1730429846	1	1	LAMONT, CHRISTA M LMFT	3/27/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ONT COUNSELING	3576 ARLINGTON AVE STE 3	None	RIVERSIDE	CA	92506	3988	33	06065	33.94625192	-117.3913739	Riverside County
23241	Fee-for-Service	1104437391	1104437391	1	1	LIEM, CHRISTINA F CCC-SLP	8/20/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1895 ORANGE TREE LANE	STE 102	REDLANDS	CA	92374	0112	36	06071	34.06779452	-117.2169225	San Bernardino County
23253	Fee-for-Service	1386072163	1386072163	1	1	LEVINE, ELLYN MD INC	2/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	86297	41	Internal Medicine	0	In state provider	None	5358 JACKSON DR	STE 1	LA MESA	CA	91942	3040	37	06073	32.77670689	-117.0174595	San Diego County
23259	Fee-for-Service	1437593506	1437593506	1	1	LEE, ANDREW MD	7/23/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	159567	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
23262	Fee-for-Service	1457358756	1457358756	1	1	LOS PALOS MED ASSOC INC	12/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
23279	Fee-for-Service	1033373394	1033373394	1	1	LIBERTY AMBULANCE LLC	3/16/2009	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LIBERTY AMBULANCE LLC	14109 PONTLAVOY AVE	None	SANTA FE SPRINGS	CA	90670	4934	19	06037	33.90352979	-118.0493772	Los Angeles County
23283	Fee-for-Service	1225532047	1225532047	1	1	LIM, SOOBIN MD	3/12/2024	208200000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
23298	Fee-for-Service	1376586156	1376586156	2	1	LONGS DRUG STORE CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7850 TELEGRAPH RD	None	VENTURA	CA	93004	1503	56	06111	34.28137977	-119.1908978	Ventura County
23302	Fee-for-Service	1023288438	1023288438	1	1	LEE, MICHAEL B MD	10/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104206	13	Neurology (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
23341	Fee-for-Service	1730311226	1730311226	1	2	LEE, LILY F MD	3/1/2018	2086S0122X	NA	General Surgery	026	PHYSICIANS	87024	24	Plastic Surgery	0	In state provider	None	160 E ARTESIA ST	STE 120	POMONA	CA	91767	2900	19	06037	34.07556833	-117.7507835	Los Angeles County
23347	Fee-for-Service	1083612949	1083612949	1	1	LEUNG, YUK-YUEN M MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92169	34	Urology and Urological Surgery	0	In state provider	None	7014 N WHITNEY AVE	None	FRESNO	CA	93720	0155	10	06019	36.83834474	-119.7423213	Fresno County
23353	Fee-for-Service	1609819432	1609819432	2	1	LONGS DRUG STORES CA LLC	12/26/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6632 PACIFIC AVE	None	STOCKTON	CA	95207	3720	39	06077	38.01092228	-121.3201706	San Joaquin County
23361	Fee-for-Service	1154346542	1154346542	1	1	LE, NGUYET B MD	3/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	81603	01	General Practice	0	In state provider	None	1771 W ROMNEYA DR	STE E1	ANAHEIM	CA	92801	1817	30	06059	33.85067649	-117.9445635	Orange County
23391	Fee-for-Service	1851718902	1851718902	1	1	LADHANI, HUSAYN A MD	5/1/2024	2086S0127X	NA	General Surgery	026	PHYSICIANS	None	89	Surgery-Traumatic	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
23402	Fee-for-Service	1730199209	1730199209	1	1	LINEBARGER, ERIC J MD	5/1/1999	207W00000X	NA	Ophthalmology	026	PHYSICIANS	60535	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
23439	Fee-for-Service	1790761344	1790761344	1	1	LIU, HONG MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	64762	01	General Practice	0	In state provider	None	7248 S LAND PARK DR	STE 105	SACRAMENTO	CA	95831	3662	34	06067	38.494602	-121.513743	Sacramento County
23471	Fee-for-Service	1083643134	1083643134	1	1	LINDE, PAUL R MD	3/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	67682	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
23511	Fee-for-Service	1396756052	1396756052	1	1	LECHAU, LIEM MD	8/31/1993	207L00000X	NA	Other	026	PHYSICIANS	73558	05	Anesthesiology	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
23539	Fee-for-Service	1831201078	1831201078	1	1	LINDEN OPTOMETRY	12/1/1998	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	A PROFESSIONAL CORP	477 E COLORADO BLVD	None	PASADENA	CA	91101	2024	19	06037	34.14587948	-118.140561	Los Angeles County
23541	Fee-for-Service	1851358022	1851358022	1	1	LOFTIS, MICHELLE A MD	8/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	66222	40	Pediatrics	0	In state provider	None	15400 LOS GATOS BLVD	None	LOS GATOS	CA	95032	2502	43	06085	37.24572659	-121.957997	Santa Clara County
23550	Fee-for-Service	1457358756	1457358756	1	1	LOS PALOS MED ASSOC INC	11/10/1998	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
23561	Fee-for-Service	1801303078	1801303078	1	1	LEWIN, SHERYL L LMFT	8/14/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	145 WEST MAIN ST	#250	TUSTIN	CA	92780	4407	30	06059	33.7421135	-117.824643	Orange County
23567	Fee-for-Service	1124285572	1124285572	1	1	LUDDY, ALYSSA C MD	2/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122587	01	General Practice	0	In state provider	None	3801 HOWE STREET	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
23592	Fee-for-Service	1356307474	1356307474	1	1	LIMCABEBE, EMILY J MD	9/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88693	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
23603	Fee-for-Service	1770237737	1770237737	1	1	LIM, TRIXIE Z NP	8/9/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1800 WILSHIRE BLVD	None	LOS ANGELES	CA	90057	3602	19	06037	34.0565363	-118.2728437	Los Angeles County
23611	Fee-for-Service	1336590793	1336590793	1	1	LE, JULIE MD	3/30/2021	208600000X	NA	General Surgery	026	PHYSICIANS	171809	None	None	0	In state provider	None	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
23613	Fee-for-Service	1275547200	1275547200	1	1	LEUNG, EAMON W MD	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80342	18	Ophthalmology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
23617	Fee-for-Service	1700829975	1700829975	2	1	LONGS DRUG STORE CAL LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5040 LAGUNA BLVD	None	ELK GROVE	CA	95758	4150	34	06067	38.422206	-121.446702	Sacramento County
23622	Fee-for-Service	1265503171	1265503171	1	1	LI, LILIAN Y MD	9/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	33476	41	Internal Medicine	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
23650	Fee-for-Service	1215052725	1215052725	1	1	LEE, ELIZABETH M MD	11/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76904	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
23675	Fee-for-Service	1184194482	1184194482	1	1	LA CLINICA DE LA RAZA INC	12/31/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3451 E 12TH ST	None	OAKLAND	CA	94601	3463	01	06001	37.77571135	-122.2233908	Alameda County
23716	Fee-for-Service	1689208530	1689208530	1	1	LANE, EMILY MD	7/1/2024	390200000X	NA	Other	026	PHYSICIANS	192393	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
23742	Fee-for-Service	1376353052	1376353052	1	1	LEWALLEN, WYATT LMFT	2/24/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43585 MONTEREY AVE	SUITE 1	PALM DESERT	CA	92260	9342	33	06065	33.731946	-116.3912695	Riverside County
23759	Fee-for-Service	1912000829	1912000829	1	1	LEE, STEVEN M-H DO	10/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	8552	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
23761	Fee-for-Service	1336156470	1336156470	1	1	LOMA LINDA UNIVERSITY	1/16/1991	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	BEHAVIORAL MEDICINE CTR	1710 BARTON RD	None	REDLANDS	CA	92373	5304	36	06071	34.0483569	-117.2140061	San Bernardino County
23802	Fee-for-Service	1306356811	1306356811	1	1	LU, CHAN W	1/22/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
23834	Fee-for-Service	1588614572	1588614572	1	1	LISA RENO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PITTSBURGH EMERGENCY	1102 EAST CENTENNIAL	None	PITTSBURG	KS	66762	0000	00	None	37.3817127	-94.68489589	Crawford County
23837	Fee-for-Service	1457358756	1457358756	1	1	LOS PALOS MED ASSOC INC	12/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
23861	Fee-for-Service	1457832081	1457832081	1	1	LEVITT, AVI CNP	3/23/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8491 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90069	4218	19	06037	34.08988507	-118.3757716	Los Angeles County
23879	Fee-for-Service	1982814315	1982814315	1	1	LE BEAU, LAUREN G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
23922	Fee-for-Service	1801805163	1801805163	1	1	LIM, DEE B MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	39980	None	None	0	In state provider	None	9675 MONTE VISTA AVE	STE B	MONTCLAIR	CA	91763	2213	36	06071	34.079004	-117.6982135	San Bernardino County
23926	Fee-for-Service	1376983023	1376983023	2	1	LAPESARDE, KAREN	1/17/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	51127	None	None	0	In state provider	None	1418 MAIN ST	STE 210	SANTA MARIA	CA	93454	4833	42	06083	34.95286855	-120.4137315	Santa Barbara County
23941	Fee-for-Service	1316392657	1316392657	1	1	LINDSTROM, SORREN MD	9/19/2019	390200000X	NA	Other	026	PHYSICIANS	163728	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
23949	Fee-for-Service	1265526941	1265526941	1	1	LEFEVER, ERIC B MD	10/10/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	71804	05	Anesthesiology	0	In state provider	None	1801 HANOVER DR	STE F	DAVIS	CA	95616	1067	57	06113	38.55895232	-121.7567316	Yolo County
23976	Fee-for-Service	1316018211	1316018211	1	1	LEE, JACKSON K MD	10/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	41127	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
24050	Fee-for-Service	1881744423	1881744423	1	1	LAW, LISA S MD INC	4/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	61395	41	Internal Medicine	0	In state provider	LISA LAW, MD AMC	728 PACIFIC AVE	STE 302	SAN FRANCISCO	CA	94133	4489	38	06075	37.79687859	-122.4074282	San Francisco County
24083	Fee-for-Service	1306175039	1306175039	1	1	LAWRENCE, CHRISTOPHER E CRNA	5/15/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
24126	Fee-for-Service	1457358756	1457358756	1	1	LOS PALOS MED ASSOC INC	12/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
24151	Fee-for-Service	1619203510	1619203510	1	1	LUNDY, CONNOR T MD	12/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123906	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
24152	Fee-for-Service	1720016140	1720016140	1	1	LIEN, JONATHAN E MD	9/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92188	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
24161	Fee-for-Service	1942265533	1942265533	1	1	LOPEZ, MANUEL D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10201 GATEWAY BLVD W	STE 210	EL PASO	TX	79925	7647	00	None	31.75698888	-106.3517111	El Paso County
24165	Fee-for-Service	1861973067	1861973067	1	1	LOPEZ, BRANDIE M RCP	10/4/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
24200	Fee-for-Service	1679791909	1679791909	1	1	LIU, DEEDE Y MD	1/29/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	155845	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
24209	Fee-for-Service	1588050678	1588050678	1	1	LIM, JOEL V DO	3/5/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	13992	41	Internal Medicine	0	In state provider	None	450 E HUNTINGTON DR	None	ARCADIA	CA	91006	3748	19	06037	34.14015053	-118.0208745	Los Angeles County
24254	Fee-for-Service	1003196692	1003196692	1	1	LOS ANGELES PERINATAL	9/13/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES	529 E 10TH ST	None	LONG BEACH	CA	90813	4508	19	06037	33.77901046	-118.186047	Los Angeles County
24293	Fee-for-Service	1700013638	1700013638	1	1	LONG, BRYAN E MD	9/9/2022	2083P0500X	NA	Adult Primary Care	026	PHYSICIANS	151803	None	None	0	In state provider	None	5575 RUFFIN RD	STE 100	SAN DIEGO	CA	92123	1380	37	06073	32.83605627	-117.1266464	San Diego County
24308	Fee-for-Service	1437171626	1437171626	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1740 S VICTORIA AVE	None	VENTURA	CA	93003	6592	56	06111	34.25913074	-119.2093816	Ventura County
24383	Fee-for-Service	1467981720	1467981720	1	1	LEE, BRYAN S MD INC	6/8/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	136126	18	Ophthalmology	0	In state provider	None	762 ALTOS OAKS DR	STE 1	LOS ALTOS	CA	94024	5435	43	06085	37.35925198	-122.0937034	Santa Clara County
24396	Fee-for-Service	1376705418	1376705418	1	1	LAWANDY, SHOKRY N DO	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	10863	14	Neurological Surgery	0	In state provider	None	4860 Y STREET	MOB SUITE 308 SURGE	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
24413	Fee-for-Service	1457426462	1457426462	1	1	LIN, TANFEN OD	11/26/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
24418	Fee-for-Service	1083756308	1083756308	1	1	LOWSKY, ROBERT MD	9/5/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50659	68	Hematology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
24432	Fee-for-Service	1982703955	1982703955	1	1	LIM, ANNIE MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	41598	01	General Practice	0	In state provider	None	9209 COLIMA RD	STE 4200	WHITTIER	CA	90605	1827	19	06037	33.9505367	-118.0054552	Los Angeles County
24454	Fee-for-Service	1487633616	1487633616	1	1	LAMPHERE SULLIVAN, GEORGINA	10/8/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	I PHD	10832 LAUREL ST	STE 102	RANCHO CUCAMONGA	CA	91730	7688	36	06071	34.10486789	-117.5684863	San Bernardino County
24494	Fee-for-Service	1235609413	1235609413	1	1	LEO L FONG CORPORATION	5/17/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	D CENTER	1850 FLORAL AVE	None	SELMA	CA	93662	2871	10	06019	36.57623753	-119.609532	Fresno County
24495	Fee-for-Service	1972907715	1972907715	1	1	LEVIN, ANNA O PHD	2/23/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
24496	Fee-for-Service	1306034574	1306034574	1	1	LIN, PATTY MD	2/28/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	91142	18	Ophthalmology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
24497	Fee-for-Service	1447571815	1447571815	1	1	LEE, ALTHEA B LMFT	8/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	910 FLORIN ROAD	STE 200	SACRAMENTO	CA	95831	3501	34	06067	38.495781	-121.5256455	Sacramento County
24510	Fee-for-Service	1952349490	1952349490	1	1	LOS ANGELES EAR NOSE &	2/28/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	THROAT MEDICAL ASSOC	1245 WILSHIRE BLVD	STE 603	LOS ANGELES	CA	90017	4806	19	06037	34.05362775	-118.2661889	Los Angeles County
24515	Fee-for-Service	1992892756	1992892756	1	1	LINAWEAVER, ANN L LMFT	10/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	272 SIERRA MANOR ROAD	B1	MAMMOTH LAKES	CA	93546	6601	26	06051	37.64073357	-118.96489	Mono County
24525	Fee-for-Service	1922050186	1922050186	1	1	LATTHE, BHARAT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1125 CYPRESS STATION DR	STE B-4	HOUSTON	TX	77090	3055	00	None	30.0234945	-95.43876644	Harris County
24530	Fee-for-Service	1215045174	1215045174	1	1	LOSEK, JOSEPH D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	171 ASHLEY AVE	None	CHARLESTON	SC	29425	8908	00	None	32.78556	-79.9467075	Charleston County
24534	Fee-for-Service	1285896795	1285896795	1	1	LYNCH, NICHOLAS G MD	6/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126569	40	Pediatrics	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
24544	Fee-for-Service	1659461325	1659461325	1	1	LEVINE,JOEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	DENVER	CO	80045	0000	00	None	39.742182	-104.8408515	Adams County
24572	Fee-for-Service	1568406395	1568406395	2	1	LONGS DRUG STORES CA LLC	12/2/2008	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10 SHAW AVE	None	CLOVIS	CA	93612	3802	10	06019	36.80839051	-119.7087075	Fresno County
24586	Fee-for-Service	1881680791	1881680791	1	1	LERRO, DESIREE DO	11/30/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	11934	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
24592	Fee-for-Service	1881682714	1881682714	1	1	LOPEZ, JONATHAN D MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102015	78	Neoplastic Diseases/Oncology	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
24635	Fee-for-Service	1760481808	1760481808	1	1	LEE, ERIC C MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67823	83	Rheumatology	0	In state provider	None	548 N 13TH AVE	STE 204	UPLAND	CA	91786	4976	36	06071	34.10032426	-117.6334669	San Bernardino County
24645	Fee-for-Service	1023766185	1023766185	1	1	LUTHERAN SOCIAL SERVICES OF	5/26/2022	No Taxonomy Provided	NA	None	095	PRIVATE NON-PROFIT PROPRIETARY AGENCY	-	-	NOT APPLICABLE	0	In state provider	NORTHERN CALIFORNIA	4550 N PERSHING AVE	STE J	STOCKTON	CA	95207	6745	39	06077	37.98729745	-121.3211191	San Joaquin County
24699	Fee-for-Service	1659041671	1659041671	1	1	LAMPKIN, TAYLOR E CRNA	5/22/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
24700	Fee-for-Service	1447213632	1447213632	1	1	LIN, HUA L MD INC	2/26/1979	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	33475	10	Gastroenterology (M.D. only)	0	In state provider	None	2225 19TH ST	None	BAKERSFIELD	CA	93301	3608	15	06029	35.37622542	-119.0277065	Kern County
24720	Fee-for-Service	1982703955	1982703955	1	1	LIM, ANNIE MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	41598	40	Pediatrics	0	In state provider	None	9209 COLIMA RD	STE 4200	WHITTIER	CA	90605	1827	19	06037	33.9505367	-118.0054552	Los Angeles County
24736	Fee-for-Service	1427136076	1427136076	1	1	LAU, GENE C MD	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72183	01	General Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
24764	Fee-for-Service	1841207750	1841207750	1	1	LOMA LINDA UNIVERSITY	7/1/1980	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
24778	Fee-for-Service	1790791564	1790791564	1	1	LY, DAT Q MS	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	62801	05	Anesthesiology	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
24784	Fee-for-Service	1083868152	1083868152	1	1	LI, MAUREEN E MD	10/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99565	05	Anesthesiology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
24805	Fee-for-Service	1902851900	1902851900	1	1	LAGASSE, SUSAN	2/28/1992	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	12625 HIGH BLUFF DR	STE 206	SAN DIEGO	CA	92130	2053	37	06073	32.94734997	-117.2404952	San Diego County
24811	Fee-for-Service	1447502661	1447502661	1	1	LARSON, HANH H DO	10/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13073	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
24825	Fee-for-Service	1881655330	1881655330	1	1	LIBERTY MEDICAL, LLC	5/9/2024	3336C0003X	NA	Pharmacies	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	5249 NW 33RD AVE	None	FORT LAUDERDALE	FL	33309	6302	00	None	26.188668	-80.19131899	Broward County
24833	Fee-for-Service	1154423770	1154423770	1	1	LEE, MIAE CRNA	6/1/2001	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
24934	Fee-for-Service	1558685826	1558685826	1	1	LING, JENNIFER C MD	4/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	107246	77	Infectious Disease	0	In state provider	None	2100 WEBSTER ST	STE 400	SAN FRANCISCO	CA	94115	2378	38	06075	37.7904826	-122.4324477	San Francisco County
24940	Fee-for-Service	1598255879	1598255879	1	1	LAFLER, KATIE A LMFT	8/12/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
24945	Fee-for-Service	1811928625	1811928625	1	1	LIBERATORE, HOLLY	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1615 DELAWARE ST	None	LONGVIEW	WA	98632	0000	00	None	46.1309207	-122.9408931	Cowlitz County
24956	Fee-for-Service	1134177215	1134177215	1	1	LACY, MARK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 N BEAVER ST	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
24979	Fee-for-Service	1609114503	1609114503	1	1	LATSHA, MEGAN J CRNA	6/15/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
24989	Fee-for-Service	1447213632	1447213632	1	1	LIN, HUA L MD INC	2/26/1979	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	33475	41	Internal Medicine	0	In state provider	None	2225 19TH ST	None	BAKERSFIELD	CA	93301	3608	15	06029	35.37622542	-119.0277065	Kern County
25005	Fee-for-Service	1134158645	1134158645	1	1	LARSEN, LISA S PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3115 GLAD WAY	None	LANCASTER	CA	92536	6113	19	06037	34.68886274	-118.187193	Los Angeles County
25021	Fee-for-Service	1598795114	1598795114	1	1	LUU, NGHI K MD	5/25/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	50832	-	NOT APPLICABLE	0	In state provider	None	614 TULLY ROAD	None	SAN JOSE	CA	95111	1048	43	06085	37.30851705	-121.8465917	Santa Clara County
25028	Fee-for-Service	1710932579	1710932579	1	1	LING, BENJAMIN MD	2/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	105 W 8TH AVE	STE 200	SPOKANE	WA	99204	2318	00	None	47.647998	-117.413946	Spokane County
25042	Fee-for-Service	1811071566	1811071566	1	1	LAWVER, TIMOTHY I DO	4/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	10441	None	None	0	In state provider	None	10 WOODLAND ROAD	None	ST HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
25049	Fee-for-Service	1023339371	1023339371	1	1	LEE, LUNG C MD	11/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139429	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
25055	Fee-for-Service	1619028131	1619028131	1	1	LEE, JOHN K MD INC	11/3/2009	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	66137	41	Internal Medicine	0	In state provider	None	400 NORTH EUCLID STREET	None	FULLERTON	CA	92832	1625	30	06059	33.874011	-117.941981	Orange County
25069	Fee-for-Service	1124063482	1124063482	1	1	LEBOVITS, MARC J MD INC	7/24/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	None	2023 W VISTA WAY	STE J	VISTA	CA	92083	6030	37	06073	33.18569169	-117.2846332	San Diego County
25101	Fee-for-Service	1639213663	1639213663	1	1	LEE, CHRISTINA J MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	81728	41	Internal Medicine	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
25121	Fee-for-Service	1255316733	1255316733	1	1	LOOMIS, CARRIE A PT	3/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	577 EAST ELDER STREET	SUITE I	FALLBROOK	CA	92028	3079	37	06073	33.3801147	-117.2456536	San Diego County
25127	Fee-for-Service	1013998095	1013998095	1	1	LISA P. ZWERDLINGER, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	735 US HIGHWAY 24	None	LEADVILLE	CO	80461	3978	00	None	39.24020129	-106.3020882	Lake County
25131	Fee-for-Service	1215164645	1215164645	1	1	LAFOUNTAIN-RIVERA, MONALISA	1/5/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	A NP	77 CADILLAC DR	STE 230	SACRAMENTO	CA	95825	5453	34	06067	38.572551	-121.4181585	Sacramento County
25134	Fee-for-Service	1538519608	1538519608	1	1	LAMB, ASHLEY N DO	8/3/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	16149	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
25144	Fee-for-Service	1023129095	1023129095	1	1	LEE JR, RICHARD H MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	24722	18	Ophthalmology	0	In state provider	None	491 30TH ST	STE 201	OAKLAND	CA	94609	3235	01	06001	37.81935528	-122.2667902	Alameda County
25177	Fee-for-Service	1790780799	1790780799	1	1	LAURANCE, EDWARD P MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	41596	10	Gastroenterology (M.D. only)	0	In state provider	None	460 W SIERRA MADRE BLVD	None	SIERRA MADRE	CA	91024	2314	19	06037	34.16178952	-118.0623555	Los Angeles County
25185	Fee-for-Service	1639417181	1639417181	1	1	LAZAGA, JEROME K P MD	9/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136929	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
25254	Fee-for-Service	1750434445	1750434445	1	1	LARSEN, FRAN S MD	4/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	26650	08	Family Practice	0	In state provider	None	168 N BRENT ST	STE 502	VENTURA	CA	93003	2840	56	06111	34.27448266	-119.2572489	Ventura County
25269	Fee-for-Service	1235429572	1235429572	1	1	LIVINGSTON, JESSE G MD	3/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138774	01	General Practice	0	In state provider	None	2175 ROSALINE AVENUE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
25275	Fee-for-Service	1922292283	1922292283	1	1	LANGHORNE, SHERRI C DO	6/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9634	01	General Practice	0	In state provider	None	204 E BEACH STREET	None	WATSONVILLE	CA	95076	4809	44	06087	36.91224802	-121.7541363	Santa Cruz County
25294	Fee-for-Service	1376196634	1376196634	1	1	LIANG, ELDER PT	4/27/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
25311	Fee-for-Service	1861523052	1861523052	1	1	LUCERO, MARILOU C MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	31375	01	General Practice	0	In state provider	None	8301 FLORENCE AVE	STE 104	DOWNEY	CA	90240	3946	19	06037	33.95129816	-118.125377	Los Angeles County
25312	Fee-for-Service	1568801298	1568801298	1	1	LONG, KATIE J MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133257	40	Pediatrics	0	In state provider	None	5137 GOLDEN FOOTHILL PKY	SUITE 120	EL DORADO HILLS	CA	95762	5737	09	06017	38.63972246	-121.0689815	El Dorado County
25320	Fee-for-Service	1689036238	1689036238	1	1	LI, JONATHAN MD	3/7/2020	390200000X	NA	Other	026	PHYSICIANS	150828	18	Ophthalmology	0	In state provider	None	1001 POTRERO AVE	RM 4M31	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
25370	Fee-for-Service	1649664590	1649664590	1	1	LI, HUI HUI MD	8/12/2019	207R00000X	NA	Other	026	PHYSICIANS	162922	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
25402	Fee-for-Service	1720027337	1720027337	1	1	LINDQUIST, DEBORAH	8/20/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	1200 N. BEAVER STREET	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
25407	Fee-for-Service	1235239302	1235239302	1	1	LIM, PHILIP P MD	5/31/1990	207R00000X	NA	Other	026	PHYSICIANS	45973	01	General Practice	0	In state provider	None	9604 ARTESIA BLVD	STE 101	BELLFLOWER	CA	90706	8040	19	06037	33.87472842	-118.1288599	Los Angeles County
25419	Fee-for-Service	1619169414	1619169414	1	1	LITTLE LAKE CITY SD	4/11/2006	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	10515 S PIONEER BLVD	None	SANTA FE SPRINGS	CA	90670	3703	19	06037	33.93774723	-118.0821156	Los Angeles County
25441	Fee-for-Service	1477678001	1477678001	1	1	LU, YUE LAC	2/26/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	7220 ROSEMEAD BLVD	107B	SAN GABRIEL	CA	91775	1380	19	06037	34.128387	-118.073073	Los Angeles County
25446	Fee-for-Service	1710454640	1710454640	1	1	LOPEZ, EUGENE	5/9/2024	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
25466	Fee-for-Service	1790780799	1790780799	1	1	LAURANCE, EDWARD P MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	41596	40	Pediatrics	0	In state provider	None	460 W SIERRA MADRE BLVD	None	SIERRA MADRE	CA	91024	2314	19	06037	34.16178952	-118.0623555	Los Angeles County
25476	Fee-for-Service	1689742066	1689742066	1	1	LEE, CHRISTOPHER MD	4/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90814	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	1721	19	06037	34.06373445	-118.443537	Los Angeles County
25488	Fee-for-Service	1346585510	1346585510	1	1	LUKASIK, MARK K PHD	3/3/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
25519	Fee-for-Service	1396966586	1396966586	1	1	LEE, JUNE Y CA	2/8/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	LEE'S ACUPUNC & HERB CLN	1322 WEBSTER STREET	SUITE 1B	OAKLAND	CA	94612	2702	01	06001	37.8030918	-122.2689405	Alameda County
25550	Fee-for-Service	1245273010	1245273010	2	1	LONGS DRUG STORES CA LLC	8/17/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	380 E H ST	None	CHULA VISTA	CA	91910	7483	37	06073	32.63859	-117.0502155	San Diego County
25553	Fee-for-Service	1922097195	1922097195	1	1	LYNWOOD ALEXANDER JONES MD	3/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 BIESTERFIELD RD	STE 4011	ELK GROVE VLG	IL	60007	3372	00	None	42.00343981	-88.01660209	Cook County
25612	Fee-for-Service	1649541657	1649541657	1	1	LARDIZABAL, ANGELINE PT	9/10/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
25623	Fee-for-Service	1689352163	1689352163	1	1	LEE, JORDAN D PSYD	12/1/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
25642	Fee-for-Service	1851443071	1851443071	1	1	LATTIMORE, KIM M MD	11/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84435	02	General Surgery	0	In state provider	None	45 CASTRO ST	None	SAN FRANCISCO	CA	94114	1010	38	06075	37.76829732	-122.4357056	San Francisco County
25643	Fee-for-Service	1386977437	1386977437	1	1	LIN, Y GEORGE MD INC	9/27/2005	207R00000X	NA	Other	026	PHYSICIANS	61257	41	Internal Medicine	0	In state provider	None	13085 CENTRAL AVENUE	SUITE 6	CHINO	CA	91710	4184	36	06071	34.015761	-117.6891735	San Bernardino County
25650	Fee-for-Service	1962882811	1962882811	1	1	LAW, EMILY W MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145329	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
25657	Fee-for-Service	1841027679	1841027679	1	1	LEE, LIBBY K PT	11/25/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
25660	Fee-for-Service	1053495127	1053495127	1	1	LIN, DAVID C DPM	9/16/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
25692	Fee-for-Service	1578749990	1578749990	1	1	LYNN, MATHEW A MD	4/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141425	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
25694	Fee-for-Service	1235239302	1235239302	1	1	LIM, PHILIP P MD	5/31/1990	207R00000X	NA	Other	026	PHYSICIANS	45973	41	Internal Medicine	0	In state provider	None	9604 ARTESIA BLVD	STE 101	BELLFLOWER	CA	90706	8040	19	06037	33.87472842	-118.1288599	Los Angeles County
25712	Fee-for-Service	1457393308	1457393308	1	1	LE, HIEP V MD	1/31/1994	207RN0300X	NA	Nephrology	026	PHYSICIANS	51678	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
25714	Fee-for-Service	1699782599	1699782599	1	1	LOMA LINDA UNIVERSITY	6/1/1983	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
25816	Fee-for-Service	1598820706	1598820706	1	1	LODICO, DEREK N DO	12/12/2021	207L00000X	NA	Other	026	PHYSICIANS	10138	None	None	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	8580	30	06059	33.56008604	-117.6657795	Orange County
25834	Fee-for-Service	1235251117	1235251117	1	1	LANDEZA, TYSON C MD	8/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92168	25	Physical Medicine and Rehabilitation	0	In state provider	None	135 CARMEN LN	None	SANTA MARIA	CA	93458	7729	42	06083	34.92484952	-120.4374645	Santa Barbara County
25839	Fee-for-Service	1043509797	1043509797	1	1	LISBERG, AARON E MD	6/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131055	68	Hematology	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 130	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
25899	Fee-for-Service	1750778262	1750778262	1	1	LEE, JANELLE MD	9/10/2020	207P00000X	NA	Other	026	PHYSICIANS	144472	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
25922	Fee-for-Service	1780610675	1780610675	1	1	LUSZCZAK, MICHAEL H DO	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	6150	66	Emergency Medicine (Urgent Care)	0	In state provider	None	301 E 13TH ST	None	MERCED	CA	95340	6211	24	06047	37.29248035	-120.4730619	Merced County
25929	Fee-for-Service	1396824496	1396824496	1	1	LEVY, VICTOR MD	8/1/2023	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	158140	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
25993	Fee-for-Service	1215093752	1215093752	1	1	LIU, RENU C MD	6/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	105739	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
26007	Fee-for-Service	1013221936	1013221936	1	2	LUNDEN, NATHALIE I MD	11/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	3181 SW SAM JACKSON PARK	None	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
26020	Fee-for-Service	1780871186	1780871186	1	1	LIN, PETER T MD	12/5/2007	2084N0400X	NA	Neurology	026	PHYSICIANS	79891	13	Neurology (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
26027	Fee-for-Service	1811075567	1811075567	1	1	LIPSON, MARK H MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30796	40	Pediatrics	0	In state provider	None	PO BOX 696	None	DAVIS	CA	95617	0696	57	06113	0	0	None
26037	Fee-for-Service	1760583959	1760583959	1	2	LA, MY DO	10/17/2023	207L00000X	NA	Other	026	PHYSICIANS	20775	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
26061	Fee-for-Service	1568429660	1568429660	1	1	LEACH, RICHARD J MD INC	5/1/1995	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	31695	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2120 PROFESSIONAL DR	STE 135	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
26096	Fee-for-Service	1922068402	1922068402	1	1	LOS OLIVOS WOMENS MED	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CLINIC INC	15151 NATIONAL AVE	STE 1	LOS GATOS	CA	95032	2627	43	06085	37.24824144	-121.9505593	Santa Clara County
26104	Fee-for-Service	1205023215	1205023215	1	1	LEWIS, CHRISTINE R	8/8/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
26124	Fee-for-Service	1477847911	1477847911	1	1	LIAO, JESSICA MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135221	40	Pediatrics	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
26131	Fee-for-Service	1043509797	1043509797	1	1	LISBERG, AARON E MD	6/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131055	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 130	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
26141	Fee-for-Service	1588097604	1588097604	1	1	LUNDIN, KELLI L LMFT	1/8/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	STE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
26173	Fee-for-Service	1962468314	1962468314	1	1	LE, DAN C MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	76669	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
26176	Fee-for-Service	1265990188	1265990188	1	1	LOMAN, BRITTANY CRNA	1/13/2025	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	75 NIELSON	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
26195	Fee-for-Service	1083656193	1083656193	1	1	LEE, THEODORE J MD	4/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73722	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
26197	Fee-for-Service	1497246912	1497246912	1	1	LEE, HANNAH DO	5/29/2024	207ZP0102X	NA	Other	026	PHYSICIANS	17888	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
26212	Fee-for-Service	1922404250	1922404250	1	1	LLARENA, SHERYL LMFT	5/17/2022	251K00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
26239	Fee-for-Service	1679780647	1679780647	1	1	LEVY-PEART CHIROPRACTIC CORP	1/22/2020	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1225 SOUTH MAIN STREET	None	WILLITS	CA	95490	4305	23	06045	39.39950581	-123.3496147	Mendocino County
26248	Fee-for-Service	1427303809	1427303809	1	1	LOCASCIO, ELIZABETH DO	10/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11039	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25460 MEDICAL CENTER DR	STE 100	MURRIETA	CA	92562	5982	33	06065	33.5570278	-117.1862552	Riverside County
26250	Fee-for-Service	1710920541	1710920541	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1880 S PACIFIC COAST HWY	None	REDONDO BEACH	CA	90277	6117	19	06037	33.81617129	-118.3778243	Los Angeles County
26255	Fee-for-Service	1417143991	1417143991	1	1	LIU, ANNA C DO	10/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10116	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
26259	Fee-for-Service	1497009179	1497009179	1	1	LARSEN, JULIE L OT	1/9/2019	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
26262	Fee-for-Service	1861556581	1861556581	1	1	LESSER, REBECCA E CNM	5/19/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
26271	Fee-for-Service	1740564996	1740564996	2	1	LOZA, MICHAEL	6/27/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6089 N 1ST ST	104	FRESNO	CA	93710	5464	10	06019	36.82574354	-119.7724848	Fresno County
26294	Fee-for-Service	1891768479	1891768479	1	1	LIU, JUNECHIH MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77423	13	Neurology (M.D. only)	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
26296	Fee-for-Service	1285363846	1285363846	1	1	LIWAG, TARA ADRIENNE D NP	5/11/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
26315	Fee-for-Service	1740436039	1740436039	1	1	LIN, CHI-LING DO	2/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10346	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVENUE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
26320	Fee-for-Service	1861206617	1861206617	1	1	LEWIS, ERIC S PT	3/7/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	900 E WASHINGTON ST	STE 200	COLTON	CA	92324	4192	36	06071	34.04820662	-117.3128102	San Bernardino County
26326	Fee-for-Service	1275612632	1275612632	1	1	LEUNG, YING-YAN MD APC	4/30/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	43055	01	General Practice	0	In state provider	HACIENDA MEDC CLINIC INC	3038 S HACIENDA BLVD	None	HACIENDA HEIGHTS	CA	91745	5313	19	06037	33.98236418	-117.9727094	Los Angeles County
26341	Fee-for-Service	1780392688	1780392688	1	1	LARA, ROXANNE LCSW	12/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
26374	Fee-for-Service	1124362694	1124362694	1	1	LEE, SUSAN M LCSW	8/20/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
26381	Fee-for-Service	1366594855	1366594855	1	1	LEE, FA-CHYI MD	6/13/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	77104	68	Hematology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
26383	Fee-for-Service	1447511803	1447511803	1	1	LOPES, EURIDES I MD	7/22/2020	208M00000X	NA	Other	026	PHYSICIANS	131187	41	Internal Medicine	0	In state provider	None	3300 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.58243651	-124.135992	Humboldt County
26409	Fee-for-Service	1902853963	1902853963	1	1	LEE-HOANG, BETTY MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71523	05	Anesthesiology	0	In state provider	None	CLAY & BUCHANAN ST	None	SAN FRANCISCO	CA	94115	0000	38	06075	37.791126	-122.4309105	San Francisco County
26413	Fee-for-Service	1477847911	1477847911	1	1	LIAO, JESSICA MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135221	41	Internal Medicine	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
26447	Fee-for-Service	1831420488	1831420488	1	1	LEPAGE-SMITH, JESSICA LCSW	12/14/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5931 STANLEY AVE	# 1	CARMICHAEL	CA	95608	3846	34	06067	38.622978	-121.326966	Sacramento County
26474	Fee-for-Service	1790830131	1790830131	1	1	LIU, JANET LCSW	12/11/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
26492	Fee-for-Service	1497008528	1497008528	1	1	LOS ANGELES CHRISTIAN HEALTH	2/7/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	601 S SAN PEDRO STREET	None	LOS ANGELES	CA	90014	2415	19	06037	34.04193577	-118.24555	Los Angeles County
26498	Fee-for-Service	1114136934	1114136934	1	1	LIN, TOM K MD	1/3/2023	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	183143	None	None	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
26525	Fee-for-Service	1982868287	1982868287	1	1	LAU, DAVID L MD	8/21/2008	2086S0129X	NA	General Surgery	026	PHYSICIANS	104835	02	General Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
26572	Fee-for-Service	1942507983	1942507983	1	1	LOH, CINDY MD	11/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115951	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
26580	Fee-for-Service	1891768479	1891768479	1	1	LIU, JUNECHIH MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77423	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
26582	Fee-for-Service	1174758510	1174758510	1	1	LUONG, HAI T DO	10/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11055	25	Physical Medicine and Rehabilitation	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
26592	Fee-for-Service	1144562489	1144562489	1	1	LIU, ERIN C MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132798	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
26613	Fee-for-Service	1215267828	1215267828	1	1	LIANG, AMY CRNA	11/7/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
26626	Fee-for-Service	1518973502	1518973502	1	1	LEE, JONG C MD	10/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83310	08	Family Practice	0	In state provider	None	25775 MCBEAN PKWY	None	VALENCIA	CA	91355	3708	19	06037	34.40042013	-118.5511416	Los Angeles County
26636	Fee-for-Service	1124104633	1124104633	1	1	LUM, MICHAEL H MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74288	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
26642	Fee-for-Service	1588720742	1588720742	1	1	LE, CHRISTINE-THAO	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
26645	Fee-for-Service	1932105913	1932105913	1	1	LEE, STEPHEN MD	2/28/1982	174400000X	NA	Other	026	PHYSICIANS	21288	22	Pathology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
26671	Fee-for-Service	1447511803	1447511803	1	1	LOPES, EURIDES I MD	7/22/2020	208M00000X	NA	Other	026	PHYSICIANS	131187	77	Infectious Disease	0	In state provider	None	3300 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.58243651	-124.135992	Humboldt County
26679	Fee-for-Service	1811163926	1811163926	1	1	LE, THUY ANH T MD	3/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101295	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
26688	Fee-for-Service	1811315534	1811315534	1	1	LIN, GARY K MD	9/28/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	138730	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
26696	Fee-for-Service	1114093150	1114093150	1	1	LEVINGSTON, SONIA R MD	9/30/1996	174400000X	NA	Other	026	PHYSICIANS	60639	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
26700	Fee-for-Service	1437164712	1437164712	1	1	LEE, TAMMY B DO	8/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9151	05	Anesthesiology	0	In state provider	None	11632 BUTTERFIELD ST	None	LOMA LINDA	CA	92354	3956	36	06071	34.04245392	-117.2371028	San Bernardino County
26715	Fee-for-Service	1760534853	1760534853	1	1	LILJEQUIST, TRACY LMFT	11/4/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	617 VETERANS BLVD	STE 101	REDWOOD CITY	CA	94063	1496	41	06081	37.4924484	-122.2318516	San Mateo County
26719	Fee-for-Service	1114283322	1114283322	1	1	LARSSON, INGRID L MD	3/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130729	41	Internal Medicine	0	In state provider	None	12 CAMINO ENCINAS	None	ORINDA	CA	94563	3304	07	06013	37.87679015	-122.1800856	Contra Costa County
26738	Fee-for-Service	1518971241	1518971241	1	1	LOS ANGELES COUNTY	11/24/1986	261Q00000X	NA	Other	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	LONG BEACH COMPREHENSIVE	1333 CHESTNUT AVE	None	LONG BEACH	CA	90813	2944	19	06037	33.78354312	-118.1963702	Los Angeles County
26780	Fee-for-Service	1497008528	1497008528	1	1	LOS ANGELES CHRISTIAN HEALTH	2/7/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	601 S SAN PEDRO STREET	None	LOS ANGELES	CA	90014	2415	19	06037	34.04193577	-118.24555	Los Angeles County
26821	Fee-for-Service	1164491783	1164491783	1	1	LE, TIM ZUNG TRI DO	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7547	05	Anesthesiology	0	In state provider	None	2776 PACIFIC AVE	None	LONG BEACH	CA	90806	2613	19	06037	33.80692698	-118.1936915	Los Angeles County
26827	Fee-for-Service	1336524644	1336524644	1	1	LOVEALL, CHELSEA A	9/21/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
26838	Fee-for-Service	1376843672	1376843672	1	1	LAFONTAINE, TAMARA J LMFT	1/25/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	STE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
26872	Fee-for-Service	1750843868	1750843868	1	1	LUNNY, KATHRYN F MD	6/12/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	176496	36	Psychiatry	0	In state provider	None	101 THE CITY DR S	BLDG 53	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
26888	Fee-for-Service	1912954215	1912954215	1	1	LIEBERMAN, JEREMY A MD	7/1/1994	207L00000X	NA	Other	026	PHYSICIANS	62817	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
26895	Fee-for-Service	1649299959	1649299959	1	1	LAMBERT, JOSEPH D MD INC	1/30/1997	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	23768	40	Pediatrics	0	In state provider	None	1061 E MAIN ST	STE 201	GRASS VALLEY	CA	95945	5724	29	06057	39.22945852	-121.0502754	Nevada County
26913	Fee-for-Service	1518973502	1518973502	1	1	LEE, JONG C MD	10/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83310	41	Internal Medicine	0	In state provider	None	25775 MCBEAN PKWY	None	VALENCIA	CA	91355	3708	19	06037	34.40042013	-118.5511416	Los Angeles County
26916	Fee-for-Service	1235615543	1235615543	1	1	LEILI ZARBAKHSH INTEGRATED I	6/2/2022	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	TH	5005 CANYON CREST DR	None	RIVERSIDE	CA	92507	7721	33	06065	33.95957554	-117.3311659	Riverside County
26917	Fee-for-Service	1265430144	1265430144	1	1	LOPEZ, DANIEL MD	6/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52410	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
26921	Fee-for-Service	1740544493	1740544493	1	1	LE, THAI V MD	10/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156106	01	General Practice	0	In state provider	None	2 WEST FERN	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
26937	Fee-for-Service	1033731930	1033731930	1	1	LAKHANI, NAASIR MD	3/25/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
26964	Fee-for-Service	1861661258	1861661258	1	1	LIAMIDI, MICHELLE MD	7/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96419	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1441 CONSTITUTION BLVD	None	MONTEREY	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey
26987	Fee-for-Service	1699752295	1699752295	1	1	LOPEZ, ELDEN I MD	11/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49982	01	General Practice	0	In state provider	None	210 CANAL STREET	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
26988	Fee-for-Service	1932833928	1932833928	1	1	LOYA, RAVEN A CNP	9/6/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	19353 VICTORY BLVD	None	RESEDA	CA	91335	6302	19	06037	34.18659936	-118.5552114	Los Angeles County
26995	Fee-for-Service	1952797896	1952797896	1	1	LEE, CHRISTINE J MD	5/3/2021	208200000X	NA	General Surgery	026	PHYSICIANS	144390	None	None	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
27005	Fee-for-Service	1588891998	1588891998	1	1	LEE, EDWARD H MD	8/6/2018	207R00000X	NA	Other	026	PHYSICIANS	155199	39	Preventive (M.D. only)	0	In state provider	None	3000 Q STREET	4TH FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
27015	Fee-for-Service	1992264709	1992264709	1	1	LU, DEBORAH D MD	8/16/2022	207R00000X	NA	Other	026	PHYSICIANS	179848	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
27016	Fee-for-Service	1871588020	1871588020	1	1	LUU, BAO Q MD	6/14/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60328	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
27029	Fee-for-Service	1629505045	1629505045	1	1	LAU, KIMBLEY	5/20/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	20660	36	Psychiatry	0	In state provider	None	10802 COLLEGE PL	None	CERRITOS	CA	90703	1505	19	06037	33.88484554	-118.102932	Los Angeles County
27125	Fee-for-Service	1740607605	1740607605	1	1	LIN, JONATHAN K MD	5/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139569	04	Otology, Laryngology, Rhinology	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	0000	01	06001	37.8237837	-122.2590026	Alameda County
27142	Fee-for-Service	1447375951	1447375951	1	1	LAURIA, BEATRIZ R MD	12/1/1997	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	61439	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
27182	Fee-for-Service	1063725117	1063725117	1	1	LCS WESTMINSTER PARTNERSHIP	3/3/2011	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	2	Out of state provider	IV LLP	4555 E MAYO BLVD	None	PHOENIX	AZ	85050	6952	00	None	33.665463	-111.980673	Maricopa County
27205	Fee-for-Service	1235615543	1235615543	1	1	LEILI ZARBAKHSH INTEGRATED I	6/2/2022	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	TH	5005 CANYON CREST DR	None	RIVERSIDE	CA	92507	7721	33	06065	33.95957554	-117.3311659	Riverside County
27221	Fee-for-Service	1942456306	1942456306	1	1	LIU, GAILING LAC	3/2/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	650 W DUARTE ROAD	SUITE 203	ARCADIA	CA	91007	7640	19	06037	34.12621324	-118.0537434	Los Angeles County
27241	Fee-for-Service	1174539035	1174539035	1	1	LIN,HONG-DER MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	42964	02	General Surgery	0	In state provider	None	5565 GROSSMONT CENTER DR	STE 1	LA MESA	CA	91942	3000	37	06073	32.77978322	-117.0094766	San Diego County
27259	Fee-for-Service	1770047912	1770047912	1	1	LOJ HERITAGE INC	9/4/2019	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	1875 W REDONDO BEACH BLV	STE 100	GARDENA	CA	90247	3627	19	06037	33.8879044	-118.3111113	Los Angeles County
27280	Fee-for-Service	1508822248	1508822248	1	1	LUGOVOY, JUNE M MD	12/1/1995	207RN0300X	NA	Nephrology	026	PHYSICIANS	70977	45	Nephrology (Renal-Kidney)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
27286	Fee-for-Service	1083971162	1083971162	1	1	LEE, SAMUEL B MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116637	36	Psychiatry	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
27301	Fee-for-Service	1871588020	1871588020	1	1	LUU, BAO Q MD	6/14/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60328	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
27326	Fee-for-Service	1134207020	1134207020	1	1	LEY-HAN, HECTOR MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	80110	01	General Practice	0	In state provider	None	701 E CHANNEL ST	None	STOCKTON	CA	95202	2628	39	06077	37.95604528	-121.2821834	San Joaquin County
27333	Fee-for-Service	1205077666	1205077666	1	1	LEE, ANNIE D MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	110488	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
27337	Fee-for-Service	1255779120	1255779120	1	3	LANGLEY, LESLIE	6/18/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	22671	-	NOT APPLICABLE	0	In state provider	None	83385 ROSA AVENUE	None	THERMAL	CA	92274	9506	33	06065	33.64846105	-116.2093774	Riverside County
27379	Fee-for-Service	1447243191	1447243191	1	2	LICHTENSTEIN, RON MD	1/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77034	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2029 DIVISADERO ST	None	FRESNO	CA	93701	2013	10	06019	36.74332774	-119.7865097	Fresno County
27380	Fee-for-Service	1508024852	1508024852	1	1	LAVAF, AMIR MD	11/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115056	78	Neoplastic Diseases/Oncology	0	In state provider	None	1180 N INDIAN CANYON DR	STE E218	PALM SPRINGS	CA	92262	4885	33	06065	33.839505	-116.5455735	Riverside County
27418	Fee-for-Service	1710304910	1710304910	1	1	LAI, KAREN MD	10/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137616	36	Psychiatry	0	In state provider	None	2060 FAIRMONT DR	None	SAN LEANDRO	CA	94578	1001	01	06001	37.71083326	-122.1208841	Alameda County
27449	Fee-for-Service	1649289992	1649289992	1	1	LIN, SAM Y MD	3/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	64634	None	None	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
27454	Fee-for-Service	1336111210	1336111210	1	1	LAMONT EDWARD CAVANAGH MD	8/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1120 S UTICA AVE	None	TULSA	OK	74104	4012	00	None	36.14680804	-95.96713336	Tulsa County
27493	Fee-for-Service	1861624165	1861624165	1	1	LIM, AMY M MD	12/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108463	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
27505	Fee-for-Service	1821164864	1821164864	1	1	LOGALBO, FRED A MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	65032	30	Radiology	0	In state provider	None	FRESNO & R STREETS	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
27508	Fee-for-Service	1538338280	1538338280	1	1	LIN, CHI-YI MD	7/30/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1000 S. GARFIELD AVE	None	ALHAMBRA	CA	91801	4709	19	06037	34.084557	-118.123042	Los Angeles County
27512	Fee-for-Service	1356421408	1356421408	1	1	LEVY, RICHARD A MD	2/8/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	27656	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3580 CALIFORNIA ST	STE 3	SAN FRANCISCO	CA	94118	1725	38	06075	37.78648975	-122.452943	San Francisco County
27515	Fee-for-Service	1427652304	1427652304	1	1	LEE, DAVID C MD	2/1/2022	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	168381	None	None	0	In state provider	None	520 N MAIN ST	SUITE 120	SANTA ANA	CA	92701	4623	30	06059	33.749316	-117.868123	Orange County
27531	Fee-for-Service	1730701889	1730701889	1	1	LIANG, JULIE DO	10/20/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21262	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
27589	Fee-for-Service	1730357286	1730357286	1	1	LAMM, AVA M	3/6/2007	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	12398 CUSTER ST	None	YUCAIPA	CA	92399	4452	36	06071	34.02846967	-117.0322906	San Bernardino County
27598	Fee-for-Service	1396756938	1396756938	1	1	LAC USC MEDICAL CENTER	7/1/2000	282N00000X	NA	Hospitals	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	BUDGET FISCAL UNIT	1200 N STATE ST	None	LOS ANGELES	CA	90033	1083	19	06037	34.05855992	-118.209755	Los Angeles County
27622	Fee-for-Service	1376196865	1376196865	1	1	LAWSON, HILDA NJERI	11/1/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	37168 BRUTUS WAY	None	BEAUMONT	CA	92223	8059	33	06065	33.94572651	-117.016038	Riverside County
27623	Fee-for-Service	1104904283	1104904283	1	1	LIN, CHERRY	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62589	41	Internal Medicine	0	In state provider	None	5600 STONERIDGE MALL RD	None	PLEASANTON	CA	94588	2820	01	06001	37.6921981	-121.9276072	Alameda County
27625	Fee-for-Service	1639191737	1639191737	1	1	LEGMANN, MICHAEL D MD	11/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94915	22	Pathology (M.D. only)	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
27638	Fee-for-Service	1043835267	1043835267	1	1	LIND, EDWARD M PT	10/28/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9080 IRVINE CENTER DRIVE	None	IRVINE	CA	92618	4658	30	06059	33.63644038	-117.7392454	Orange County
27669	Fee-for-Service	1508024852	1508024852	1	1	LAVAF, AMIR MD	11/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115056	30	Radiology	0	In state provider	None	1180 N INDIAN CANYON DR	STE E218	PALM SPRINGS	CA	92262	4885	33	06065	33.839505	-116.5455735	Riverside County
27672	Fee-for-Service	1073361093	1073361093	1	1	LA PHARMACY, INC.	6/10/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	Y	1820 WESTWOOD BLVD	None	LOS ANGELES	CA	90025	4612	19	06037	34.04887011	-118.4359843	Los Angeles County
27688	Fee-for-Service	1184667917	1184667917	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8455 AUBURN FOLSOM RD	None	GRANITE BAY	CA	95746	9324	31	06061	38.744388	-121.1705725	Placer County
27690	Fee-for-Service	1790070159	1790070159	1	1	LANGE, JULIE A MD	9/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123253	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
27695	Fee-for-Service	1912922238	1912922238	1	1	LU, PO-HAONG PHD	10/6/2004	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	STE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
27731	Fee-for-Service	1730109992	1730109992	1	1	LEE, MOON O MD	1/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	92576	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
27736	Fee-for-Service	1528026267	1528026267	1	1	LONGVIEW MEDICAL CENTER LP	4/2/2017	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2901 N 4TH STREET	None	LONGVIEW	TX	75605	5128	00	None	32.5321109	-94.72889009	Gregg County
27741	Fee-for-Service	1548451776	1548451776	1	1	LINGAM, HIMA B MD	5/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102397	68	Hematology	0	In state provider	None	4500 BROCKTON AVE	#107	RIVERSIDE	CA	92501	4006	33	06065	33.97785263	-117.3836152	Riverside County
27744	Fee-for-Service	1750318127	1750318127	1	1	LAI, MICHAEL K MD	4/1/1999	174400000X	NA	Other	026	PHYSICIANS	37676	None	None	0	In state provider	None	116 S PALISADE DR	STE 1D	SANTA MARIA	CA	93454	8904	42	06083	34.9523869	-120.4120717	Santa Barbara County
27795	Fee-for-Service	1831406743	1831406743	1	1	LEMOR, MARCOS MD AMC	4/1/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	4036 WHITTIER BLVD	SUITE 202	LOS ANGELES	CA	90023	2561	19	06037	34.02390455	-118.1847825	Los Angeles County
27833	Fee-for-Service	1134603376	1134603376	1	1	LAHORI, MEGA MD	8/14/2023	390200000X	NA	Other	026	PHYSICIANS	183985	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
27854	Fee-for-Service	1083804306	1083804306	1	1	LOPEZ, ANGELA M MD	11/13/2008	207RH0003X	NA	Oncology	026	PHYSICIANS	87181	78	Neoplastic Diseases/Oncology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
27866	Fee-for-Service	1629308358	1629308358	1	1	LEE, JOHN H MD	7/20/2016	208600000X	NA	General Surgery	026	PHYSICIANS	101809	02	General Surgery	0	In state provider	None	20103 LAKE CHABOT ROAD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
27876	Fee-for-Service	1730357286	1730357286	1	1	LAMM, AVA M	3/9/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	12398 CUSTER ST	None	YUCAIPA	CA	92399	4452	36	06071	34.02846967	-117.0322906	San Bernardino County
27880	Fee-for-Service	1851625396	1851625396	1	1	LAKE ELSINORE CLINICA MEDICA	12/3/2009	193400000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	FAMILIAR	31739 RIVERSIDE DR	STE A1	LAKE ELSINORE	CA	92530	7818	33	06065	33.67696555	-117.373482	Riverside County
27883	Fee-for-Service	1396756938	1396756938	1	1	LAC USC MEDICAL CENTER	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	BUDGET FISCAL UNIT	1200 N STATE ST	None	LOS ANGELES	CA	90033	1083	19	06037	34.05855992	-118.209755	Los Angeles County
27911	Fee-for-Service	1376196865	1376196865	1	1	LAWSON, HILDA NJERI	11/1/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	37168 BRUTUS WAY	None	BEAUMONT	CA	92223	8059	33	06065	33.94572651	-117.016038	Riverside County
27927	Fee-for-Service	1477148450	1477148450	1	1	LUTE, BRITTANY M NP	1/10/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1310 STEWART DR	STE 301	ORANGE	CA	92868	3854	30	06059	33.78236048	-117.8664975	Orange County
27956	Fee-for-Service	1780876847	1780876847	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1970 YOSEMITE PKWY	None	MERCED	CA	95341	5214	24	06047	37.29517052	-120.452229	Merced County
27976	Fee-for-Service	1821589359	1821589359	1	1	LESYA G. TOMLINSON	10/14/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
27997	Fee-for-Service	1134353329	1134353329	1	1	LIN, MICHELLE P MD	9/9/2022	207P00000X	NA	Other	026	PHYSICIANS	181758	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
28022	Fee-for-Service	1528026267	1528026267	1	1	LONGVIEW MEDICAL CENTER LP	4/2/2017	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2901 N 4TH STREET	None	LONGVIEW	TX	75605	5128	00	None	32.5321109	-94.72889009	Gregg County
28024	Fee-for-Service	1396788121	1396788121	2	1	LONGS DRUG STORE CAL LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4405 1ST ST	None	LIVERMORE	CA	94551	4915	01	06001	37.69719821	-121.7435494	Alameda County
28031	Fee-for-Service	1548451776	1548451776	1	1	LINGAM, HIMA B MD	5/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102397	78	Neoplastic Diseases/Oncology	0	In state provider	None	4500 BROCKTON AVE	#107	RIVERSIDE	CA	92501	4006	33	06065	33.97785263	-117.3836152	Riverside County
28037	Fee-for-Service	1700050333	1700050333	1	1	LARSON, ILSE A MD	6/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103087	40	Pediatrics	0	In state provider	None	1001 POTRERO AVENUE	RM 6E	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
28040	Fee-for-Service	1346205127	1346205127	1	1	LILLEY, JOHN J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24559	41	Internal Medicine	0	In state provider	None	625 E GRAND AVE	None	ESCONDIDO	CA	92025	4402	37	06073	33.12475309	-117.0733326	San Diego County
28045	Fee-for-Service	1912656653	1912656653	1	1	LEW, RYAN W PT	4/21/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1561 ONTARIO	SUITE 101	CORONA	CA	92881	6662	33	06065	33.84257433	-117.5332788	Riverside County
28066	Fee-for-Service	1699119511	1699119511	1	1	LOMELI, DANICA K MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135832	01	General Practice	0	In state provider	None	1770 N ORANGE GROVE AVE	SUITE 101	POMONA	CA	91767	3027	19	06037	34.07637624	-117.7492622	Los Angeles County
28075	Fee-for-Service	1871585059	1871585059	1	1	LEWIS, WILLIAM S MD	11/30/1991	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	62557	04	Otology, Laryngology, Rhinology	0	In state provider	None	15861 WINCHESTER BLVD	None	LOS GATOS	CA	95030	3306	43	06085	37.23816199	-121.9770685	Santa Clara County
28078	Fee-for-Service	1619919495	1619919495	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 VENTURA BLVD	None	STUDIO CITY	CA	91604	2514	19	06037	34.14352473	-118.3955145	Los Angeles County
28083	Fee-for-Service	1225017551	1225017551	1	2	LIJUN W SAKAL MD	3/28/2003	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	PRACTICE MEDICAL CLINIC	14662 SKYWAY	None	MAGALIA	CA	95954	9356	04	06007	39.84131205	-121.5977266	Butte County
28099	Fee-for-Service	1275160020	1275160020	1	1	LEACHMAN, RYAN DO	6/20/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	21267	None	None	0	In state provider	None	1430 E MAIN ST	SUITE 201	SANTA MARIA	CA	93454	4809	42	06083	34.9528467	-120.4127301	Santa Barbara County
28102	Fee-for-Service	1487326880	1487326880	1	1	LOPEZ, GIOVANNI LMFT	12/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
28113	Fee-for-Service	1720648264	1720648264	1	1	LAZAR, DANIELA NP	10/24/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95011663	-	NOT APPLICABLE	0	In state provider	None	8330 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4619	19	06037	34.221609	-118.5360405	Los Angeles County
28114	Fee-for-Service	1336227008	1336227008	1	1	LEE, KENNETH K MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	27759	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
28124	Fee-for-Service	1285659276	1285659276	1	1	LIN, ERIC I DO	2/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	7966	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
28139	Fee-for-Service	1528087129	1528087129	1	1	LEE, ELIZABERH W	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72583	02	General Surgery	0	In state provider	None	612 W DUARTE RD	STE 602	ARCADIA	CA	91007	9241	19	06037	34.12647805	-118.051994	Los Angeles County
28140	Fee-for-Service	1083804306	1083804306	1	1	LOPEZ, ANGELA M MD	11/13/2008	207RH0003X	NA	Oncology	026	PHYSICIANS	87181	68	Hematology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
28168	Fee-for-Service	1851625396	1851625396	1	1	LAKE ELSINORE CLINICA MEDICA	12/3/2009	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	FAMILIAR	31739 RIVERSIDE DR	STE A1	LAKE ELSINORE	CA	92530	7818	33	06065	33.67696555	-117.373482	Riverside County
28201	Fee-for-Service	1356725816	1356725816	1	1	LOS ANGELES OPHTHALMOLOGY	9/28/2016	261QS0132X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	MEDICAL GROUP INC	323 N PRAIRIE AVE	SUITE 201	INGLEWOOD	CA	90301	4500	19	06037	33.966333	-118.3439975	Los Angeles County
28209	Fee-for-Service	1174914303	1174914303	1	1	LOUIE, TERESA H NP	5/18/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	2043	33	06065	33.904782	-117.469323	Riverside County
28222	Fee-for-Service	1306481551	1306481551	1	1	LIN, LILI PT	11/16/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
28241	Fee-for-Service	1528144334	1528144334	1	1	LOBO, SARITA A MD	12/29/2009	207R00000X	NA	Other	026	PHYSICIANS	53810	41	Internal Medicine	0	In state provider	None	2025 SOQUEL AVENUE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
28267	Fee-for-Service	1821031667	1821031667	2	1	LONGS DRUG STORE CAL LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	365 E WASHINGTON ST	None	PETALUMA	CA	94952	3168	49	06097	38.23772286	-122.6363752	Sonoma County
28272	Fee-for-Service	1760689525	1760689525	1	1	LEE, CASSANDRA A MD	9/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109362	None	None	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
28284	Fee-for-Service	1518147636	1518147636	1	1	LOYDS LIBERTY HOMES INC	3/2/2007	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1733 AUGUSTA LN	None	ATWATER	CA	95301	4903	24	06047	37.34694665	-120.5787258	Merced County
28293	Fee-for-Service	1891873790	1891873790	1	1	LEVY, AARON M MD	5/3/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68797	01	General Practice	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
28305	Fee-for-Service	1598296469	1598296469	1	1	LEE, MATTHEW C MD	10/8/2024	207RX0202X	NA	Oncology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
28326	Fee-for-Service	1346205127	1346205127	1	1	LILLEY, JOHN J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24559	45	Nephrology (Renal-Kidney)	0	In state provider	None	625 E GRAND AVE	None	ESCONDIDO	CA	92025	4402	37	06073	33.12475309	-117.0733326	San Diego County
28330	Fee-for-Service	1144085606	1144085606	1	1	LEVELSMD LLC	7/8/2024	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	16236 SAN DIEGUITO RD	STE 5-11	RANCHO SANTA FE	CA	92091	9802	37	06073	32.99560461	-117.1930695	San Diego County
28369	Fee-for-Service	1508802992	1508802992	1	1	LIN-HURTUBISE, KEVIN M MD	12/10/2020	208600000X	NA	General Surgery	026	PHYSICIANS	88017	None	None	0	In state provider	None	1325 E CHURCH STREET	SUITE 204	SANTA MARIA	CA	93454	5915	42	06083	34.95209265	-120.4147348	Santa Barbara County
28372	Fee-for-Service	1225017551	1225017551	1	2	LIJUN W SAKAL MD	3/28/2003	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	PRACTICE MEDICAL CLINIC	14662 SKYWAY	None	MAGALIA	CA	95954	9356	04	06007	39.84131205	-121.5977266	Butte County
28384	Fee-for-Service	1396907432	1396907432	1	1	LEE, DUSTIN J DO	11/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10484	02	General Surgery	0	In state provider	None	941 S ATLANTIC BLVD	SUITE 101	MONTEREY PARK	CA	91754	4722	19	06037	34.04918291	-118.1391218	Los Angeles County
28400	Fee-for-Service	1528142643	1528142643	2	1	LA CRESCENTA PHARMACY INC	5/30/2017	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2764 FOOTHILL BLVD	None	LA CRESCENTA	CA	91214	3517	19	06037	34.22362444	-118.239099	Los Angeles County
28421	Fee-for-Service	1871805721	1871805721	1	1	LEE, YUN S MD	11/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119950	07	Dermatology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
28435	Fee-for-Service	1932357118	1932357118	1	1	LUNCEFORD, NICOLE L DO	1/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13030	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
28475	Fee-for-Service	1295892883	1295892883	1	1	LAB-SERV INC	2/21/1997	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	15944 COLORADO AVE	None	PARAMOUNT	CA	90723	5008	19	06037	33.88805107	-118.1613698	Los Angeles County
28485	Fee-for-Service	1104027630	1104027630	1	1	LEBASCHI, AMIR DPM	3/20/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2220 E FRUIT STREET	STE 214	SANTA ANA	CA	92701	4459	30	06059	33.75277851	-117.8354745	Orange County
28541	Fee-for-Service	1184234601	1184234601	1	1	LEWIS, AMELIA LCSW	12/20/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
28544	Fee-for-Service	1528056900	1528056900	1	1	LAU, FRANCIS W MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91625	05	Anesthesiology	0	In state provider	None	6815 NOBLE AVE	None	VAN NUYS	CA	91405	3796	19	06037	34.19440435	-118.461871	Los Angeles County
28549	Fee-for-Service	1013159086	1013159086	1	1	LAURA E CUDZILO-KELSEY MD	3/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
28561	Fee-for-Service	1184608085	1184608085	1	1	LIEBIG, ROBERT J MD	11/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	52684	30	Radiology	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
28578	Fee-for-Service	1285712042	1285712042	1	1	LAHEY, JAMES	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	63558	41	Internal Medicine	0	In state provider	None	200 STEIN PLAZA RM 1-340	None	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
28582	Fee-for-Service	1023271350	1023271350	1	1	LEVY, GALLIA G MD PHD	1/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92297	68	Hematology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
28589	Fee-for-Service	1598296469	1598296469	1	1	LEE, MATTHEW C MD	10/8/2024	207RX0202X	NA	Oncology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
28607	Fee-for-Service	1598227316	1598227316	1	1	LEWIS, LENORA MD	4/9/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	2121 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2302	19	06037	34.02980528	-118.4786605	Los Angeles County
28609	Fee-for-Service	1598756090	1598756090	1	1	LIEBERMAN, PAN J MD	11/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77902	08	Family Practice	0	In state provider	None	11420 WARNER AVE	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
28626	Fee-for-Service	1598877557	1598877557	1	1	LIM, YENNY S MD	2/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	60516	41	Internal Medicine	0	In state provider	None	145 THUNDER DR	None	VISTA	CA	92083	6010	37	06073	33.18535652	-117.288201	San Diego County
28644	Fee-for-Service	1508953555	1508953555	1	1	LARSEN,STEVEN A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	OHSU	3181 SW SAM JACKSON PARK	RD	PORTLAND	OR	97239	3098	00	None	45.49936609	-122.6856232	Multnomah County
28645	Fee-for-Service	1831133271	1831133271	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3950 W POINT LOMA BLVD	None	SAN DIEGO	CA	92110	5601	37	06073	32.75444473	-117.2217206	San Diego County
28654	Fee-for-Service	1609898899	1609898899	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1885 W 11TH AVE	None	TRACY	CA	95376	3727	39	06077	37.73943749	-121.45212	San Joaquin County
28672	Fee-for-Service	1154631869	1154631869	1	1	LAM, FRANCES K LAC	11/22/2022	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
28706	Fee-for-Service	1205929635	1205929635	1	1	LING, CARSON H MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90819	05	Anesthesiology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
28715	Fee-for-Service	1306898887	1306898887	1	1	LIU, CHARLES C MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65777	30	Radiology	0	In state provider	None	3921 WARING RD	STE A	OCEANSIDE	CA	92056	4456	37	06073	33.18776771	-117.2893136	San Diego County
28716	Fee-for-Service	1437446648	1437446648	1	1	LOWENSTEIN, HAYDEN M E MD	12/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122670	41	Internal Medicine	0	In state provider	None	8635 W 3RD STREET	None	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
28734	Fee-for-Service	1417624271	1417624271	1	1	LECTURE, EMILY G AU	11/10/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	761 BROADWAY	None	EL CAJON	CA	92021	4631	37	06073	32.8076427	-116.9524762	San Diego County
28759	Fee-for-Service	1912961913	1912961913	2	1	LUU, LOI MD	4/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56092	01	General Practice	0	In state provider	None	14501 MAGNOLIA ST	STE 108	WESTMINSTER	CA	92683	5542	30	06059	33.75188963	-117.9723601	Orange County
28762	Fee-for-Service	1750458691	1750458691	1	1	LU, HELEN H MD	1/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	64631	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
28783	Fee-for-Service	1689917544	1689917544	1	1	LIN, SONIA S MD	8/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133312	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
28787	Fee-for-Service	1134949142	1134949142	1	1	LUCAS, ALANA M NP	11/20/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	27720 JEFFERSON	SUITE 200	TEMECULA	CA	92590	2610	33	06065	33.51188961	-117.1586219	Riverside County
28852	Fee-for-Service	1245256346	1245256346	1	1	LEE, EMILY K MD	3/31/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	74137	None	None	0	In state provider	None	1001 POTRERO AVE	RM 7M	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
28892	Fee-for-Service	1295949923	1295949923	1	1	LYNCH, LISA CRNA	4/30/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	75 NIELSON	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
28898	Fee-for-Service	1952459273	1952459273	1	1	LEMON GROVE ELEM SD	1/1/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	8025 LINCOLN ST	None	LEMON GROVE	CA	91945	2515	37	06073	32.7382347	-117.026155	San Diego County
28915	Fee-for-Service	1396315909	1396315909	1	1	LASTRA MARTIN, YANISET D CRN	3/1/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	A	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
28936	Fee-for-Service	1467514265	1467514265	1	1	LU, KENNETH L MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	62592	18	Ophthalmology	0	In state provider	None	622 W DUARTE RD	STE 101	ARCADIA	CA	91007	9266	19	06037	34.12645266	-118.0521552	Los Angeles County
28937	Fee-for-Service	1891773834	1891773834	1	1	LUZA, ANTONIO ZAMBOANGA PA	10/5/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	10062	-	NOT APPLICABLE	0	In state provider	None	7240 E SOUTHGATE DRIVE	SUITE G	SACRAMENTO	CA	95823	2627	34	06067	38.494359	-121.438377	Sacramento County
28939	Fee-for-Service	1639405970	1639405970	1	1	LEE, JENNIFER J	1/30/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
29020	Fee-for-Service	1568612463	1568612463	1	1	LIVINGSTON, CHRISTY LMFT	2/11/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	132 MILL ST	STE 210	HEALDSBURG	CA	95448	4462	49	06097	38.60873636	-122.8682221	Sonoma County
29036	Fee-for-Service	1023166063	1023166063	1	1	LIN, GINA MD	12/5/2007	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	97173	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
29051	Fee-for-Service	1245841766	1245841766	1	1	LOS ANGELES CENTERS FOR ALCO	4/2/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	305 S. CENTRAL AVE.	None	LOS ANGELES	CA	90013	1709	19	06037	34.04598286	-118.239632	Los Angeles County
29098	Fee-for-Service	1245306836	1245306836	1	1	LIN, IAN Y MD	12/5/2019	207R00000X	NA	Other	026	PHYSICIANS	54669	41	Internal Medicine	0	In state provider	None	417 N SAN MATEO DR	None	SAN MATEO	CA	94401	2417	41	06081	37.57262728	-122.3330639	San Mateo County
29127	Fee-for-Service	1134835820	1134835820	1	1	LONG BEACH HEALTHCARE LLC	3/1/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3232 EAST ARTESIA BLVD	None	LONG BEACH	CA	90805	2811	19	06037	33.87461606	-118.1549882	Los Angeles County
29138	Fee-for-Service	1730766239	1730766239	1	1	LAVIN, ARYE M MD	1/23/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	26585 W AGOURA ROAD	330	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
29142	Fee-for-Service	1407878150	1407878150	1	1	LOS ANGELES COUNTY	12/1/1977	282N00000X	NA	Hospitals	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	HARBOR-UCLA MEDICAL CTR	1000 W CARSON ST	# L4	TORRANCE	CA	90502	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
29169	Fee-for-Service	1780812602	1780812602	1	1	LIN, RUTH J MD	2/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	73229	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
29181	Fee-for-Service	1508352717	1508352717	1	1	LEE, AMELIA	3/2/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
29183	Fee-for-Service	1952459273	1952459273	1	1	LEMON GROVE ELEM SD	4/21/1999	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	8025 LINCOLN ST	None	LEMON GROVE	CA	91945	2515	37	06073	32.7382347	-117.026155	San Diego County
29187	Fee-for-Service	1962011148	1962011148	1	1	LARA, EMILY PSYD	10/7/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
29201	Fee-for-Service	1336152578	1336152578	1	1	LOS ANGELES CO	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ANTELOPE VALLEY HLTH CTR	335 E AVENUE K6	STE B	LANCASTER	CA	93535	4645	19	06037	34.6694985	-118.125468	Los Angeles County
29217	Fee-for-Service	1043437379	1043437379	1	1	LOS ALAMITOS COLORECTAL	11/16/2018	208C00000X	NA	General Surgery	026	PHYSICIANS	38275	None	None	0	In state provider	SURGICAL	10931 CHERRY ST	STE 200	LOS ALAMITOS	CA	90720	2496	30	06059	33.803811	-118.0679885	Orange County
29222	Fee-for-Service	1548298532	1548298532	1	4	LOS ANGELES LGBT CENTER	1/22/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1602 IVAR AVE	None	LOS ANGELES	CA	90028	6351	19	06037	34.100136	-118.328133	Los Angeles County
29233	Fee-for-Service	1356702690	1356702690	1	1	LEUNG, PABLO MD	11/14/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	170106	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
29236	Fee-for-Service	1952536468	1952536468	1	1	LAI, TAMMY T MD	9/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102434	41	Internal Medicine	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
29291	Fee-for-Service	1124243431	1124243431	1	1	LOTLIKAR, SIDDHESH R MD	1/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151100	41	Internal Medicine	0	In state provider	None	1000 TRANCAS STREET	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
29293	Fee-for-Service	1497939193	1497939193	1	1	LOS ANGELES COUNTY CCS	9/7/2007	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	WIDNEY MTU	2302 S GRAMERCY PL	None	LOS ANGELES	CA	90018	1323	19	06037	34.035948	-118.313292	Los Angeles County
29296	Fee-for-Service	1164612131	1164612131	1	1	LEE, NATHAN R CPO	4/4/2007	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2328 N BATAVIA ST	STE 115	ORANGE	CA	92865	2026	30	06059	33.82696636	-117.8621073	Orange County
29306	Fee-for-Service	1780718387	1780718387	1	1	LONGWORTH, MAUREEN P MD	10/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	42549	08	Family Practice	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
29308	Fee-for-Service	1457468514	1457468514	1	1	LEE, SALLY S DO INC	9/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8088	61	Unknown	0	In state provider	SAN DEIGO EYE PHYSICIANS	6760 UNIVERSITY AVE	STE 130	SAN DIEGO	CA	92115	5827	37	06073	32.75527746	-117.0513203	San Diego County
29319	Fee-for-Service	1740381029	1740381029	1	1	LIU, JIBANG MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77965	41	Internal Medicine	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
29324	Fee-for-Service	1700048634	1700048634	1	1	LUKE, JANIENE MD	10/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115128	07	Dermatology	0	In state provider	None	11370 ANDERSON ST	STE 2600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
29333	Fee-for-Service	1679712947	1679712947	1	1	LEE KIM, CINDY MD	4/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	109891	01	General Practice	0	In state provider	None	14591 NEWPORT AVE	SUITE 206	TUSTIN	CA	92780	6027	30	06059	33.7317307	-117.8285651	Orange County
29428	Fee-for-Service	1316200660	1316200660	1	1	LIOU, BRYAN Y MD	7/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113344	13	Neurology (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
29435	Fee-for-Service	1760469639	1760469639	1	1	LAURIE LOMASNEY, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2160 S 1ST AVE	None	MAYWOOD	IL	60153	3328	00	None	41.86025379	-87.83381752	Cook County
29446	Fee-for-Service	1417071325	1417071325	1	1	LEONARD, LEAH INGRAM LMFT	5/28/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	R	818 N MOUNTAIN AVE	SUITE 219	UPLAND	CA	91786	3669	36	06071	34.10424442	-117.6701797	San Bernardino County
29488	Fee-for-Service	1336152578	1336152578	1	1	LOS ANGELES CO	7/1/2000	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ANTELOPE VALLEY HLTH CTR	335 E AVENUE K6	STE B	LANCASTER	CA	93535	4645	19	06037	34.6694985	-118.125468	Los Angeles County
29508	Fee-for-Service	1548298532	1548298532	1	4	LOS ANGELES LGBT CENTER	1/22/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1602 IVAR AVE	None	LOS ANGELES	CA	90028	6351	19	06037	34.100136	-118.328133	Los Angeles County
29519	Fee-for-Service	1043398837	1043398837	1	1	LAMBERTI, JUDITH A MD	10/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	46579	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
29569	Fee-for-Service	1407893001	1407893001	1	1	LIEM, CALEB MD	1/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	22689	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
29579	Fee-for-Service	1124243431	1124243431	1	1	LOTLIKAR, SIDDHESH R MD	1/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151100	45	Nephrology (Renal-Kidney)	0	In state provider	None	1000 TRANCAS STREET	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
29584	Fee-for-Service	1174729610	1174729610	1	1	LOWRY, KELLY J	8/6/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2225 BUCHANAN RD	SUITE C	ANTIOCH	CA	94509	4209	07	06013	37.99862519	-121.8375728	Contra Costa County
29594	Fee-for-Service	1457468514	1457468514	1	1	LEE, SALLY S DO INC	9/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8088	15	Obstetrics (D.O. only)	0	In state provider	SAN DEIGO EYE PHYSICIANS	6760 UNIVERSITY AVE	STE 130	SAN DIEGO	CA	92115	5827	37	06073	32.75527746	-117.0513203	San Diego County
29596	Fee-for-Service	1144398421	1144398421	1	1	LIN, GEORGE C DO	9/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10358	25	Physical Medicine and Rehabilitation	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
29609	Fee-for-Service	1790343887	1790343887	1	1	LE, CHRISTOPHER DO	6/5/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	21164	36	Psychiatry	0	In state provider	None	16465 SIERRA LAKES PKWY	SUITE 140	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
29613	Fee-for-Service	1699139196	1699139196	1	1	LANDEFELD, KEVIN R MD	4/27/2022	207P00000X	NA	Other	026	PHYSICIANS	176253	None	None	0	In state provider	None	1223 16TH STREET 3RD FLO	SUITE 3400 POD D	SANTA MONICA	CA	90404	1279	19	06037	34.02773198	-118.4862675	Los Angeles County
29620	Fee-for-Service	1548533631	1548533631	1	1	LE, NICOLE V OD	4/9/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	363 SOUTH A ST	None	OXNARD	CA	93030	5804	56	06111	34.1991684	-119.1786033	Ventura County
29626	Fee-for-Service	1619590700	1619590700	1	1	LUTCHANSKY, CAMERON C LMFT	10/7/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
29628	Fee-for-Service	1568842706	1568842706	1	1	LIN, HSIN-YING NP	1/27/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
29638	Fee-for-Service	1053330761	1053330761	1	1	LAYMAN, ANDREW F LCSW	3/1/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
29655	Fee-for-Service	1356800254	1356800254	1	1	LAM, TINA	8/12/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
29715	Fee-for-Service	1366433245	1366433245	1	1	LLOYD, RYAN T DC	6/24/2020	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	19270 SONOMA HIGHWAY 12	None	SONOMA	CA	95476	5414	49	06097	38.29871411	-122.4751509	Sonoma County
29751	Fee-for-Service	1861450348	1861450348	1	1	LUCCHESI, GARY M MD	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83924	None	None	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
29755	Fee-for-Service	1346508207	1346508207	1	1	LIANG, RANDY C DO	5/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13232	41	Internal Medicine	0	In state provider	None	751 SOUTH BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
29775	Fee-for-Service	1316970387	1316970387	1	1	LOVETT, CRAIG H MD INC	1/6/1993	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	54754	20	Orthopedic Surgery	0	In state provider	None	585 STANISLAUS ST	STE A	ANGELS CAMP	CA	95221	0610	05	06009	38.07613275	-120.5503492	Calaveras County
29794	Fee-for-Service	1750565891	1750565891	1	1	LIEBERMAN, DAVID M MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	101911	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	751 BASCOM AVENUE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
29867	Fee-for-Service	1568909315	1568909315	1	1	LE, MARY T	11/27/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
29883	Fee-for-Service	1457468514	1457468514	1	1	LEE, SALLY S DO INC	9/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8088	18	Ophthalmology	0	In state provider	SAN DEIGO EYE PHYSICIANS	6760 UNIVERSITY AVE	STE 130	SAN DIEGO	CA	92115	5827	37	06073	32.75527746	-117.0513203	San Diego County
29961	Fee-for-Service	1023157310	1023157310	1	1	LASSEN CO OFFICE OF ED	5/18/1999	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	472-013 JOHNSTONVILLE RD	None	SUSANVILLE	CA	96130	8752	18	06035	40.37621678	-120.5808212	Lassen County
29962	Fee-for-Service	1891772299	1891772299	1	1	LINDELL, KRISTEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
29988	Fee-for-Service	1548881154	1548881154	1	1	LUCIO, AMY J LMFT	12/7/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2035 E BALL RD	STE 100A, 100P	ANAHEIM	CA	92806	5158	30	06059	33.81812448	-117.8880075	Orange County
29993	Fee-for-Service	1548748494	1548748494	1	1	LAZOS, JESSICA LMFT	4/29/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	G	78401 HWY 111	U	LA QUINTA	CA	92253	2066	33	06065	33.71562752	-116.2964232	Riverside County
29997	Fee-for-Service	1225328107	1225328107	1	1	LIN, KEVIN OUYI MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122083	41	Internal Medicine	0	In state provider	None	3687 MT. DIABLO BLVD.	SUITE 200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
30005	Fee-for-Service	1558457556	1558457556	1	1	LEE, BRIAN M MD	11/3/2008	207RN0300X	NA	Nephrology	026	PHYSICIANS	86438	41	Internal Medicine	0	In state provider	None	5471 LA PALMA AVE	STE 105	LA PALMA	CA	90623	1773	30	06059	33.84643649	-118.0377675	Orange County
30014	Fee-for-Service	1114555059	1114555059	1	1	LEVINE, EMMA H MD	7/20/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	187636	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
30053	Fee-for-Service	1144806811	1144806811	1	1	LONG, ANDREW W MD	4/23/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
30079	Fee-for-Service	1063839371	1063839371	1	1	LEHIL, MANDEEP S MD	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
30086	Fee-for-Service	1194814343	1194814343	1	1	LE, PHILLIP D MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66633	01	General Practice	0	In state provider	None	8781 VAN NUYS BLVD	None	VAN NUYS	CA	91402	2406	19	06037	34.22960628	-118.4502708	Los Angeles County
30101	Fee-for-Service	1003865841	1003865841	1	1	LEE, CHAI SUE MD	8/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74722	07	Dermatology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
30110	Fee-for-Service	1982685327	1982685327	1	1	LEE, JOHN S MD	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	33764	18	Ophthalmology	0	In state provider	None	9675 BRIGHTON WAY	STE 390	BEVERLY HILLS	CA	90210	5134	19	06037	34.06763711	-118.4052901	Los Angeles County
30191	Fee-for-Service	1558868281	1558868281	1	1	LARSON, LINDSAY NP	9/28/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	30	06059	33.74496	-117.818857	Orange County
30194	Fee-for-Service	1548682958	1548682958	1	1	LIU, MARGARET P MD INC	4/21/2014	207W00000X	NA	Ophthalmology	026	PHYSICIANS	119575	None	None	0	In state provider	None	711 VAN NESS AVE	SUITE 310	SAN FRANCISCO	CA	94102	3285	38	06075	37.78218473	-122.4208156	San Francisco County
30212	Fee-for-Service	1285673202	1285673202	1	1	LIDDICOAT, REBECCA V MD	7/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92299	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
30235	Fee-for-Service	1659657245	1659657245	1	1	LINARES, ROSALIA C LMFT	7/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7365 CARNELIAN ST	STE 202	RANCHO CUCAMONGA	CA	91730	1100	36	06071	34.12038413	-117.6160525	San Bernardino County
30243	Fee-for-Service	1457398505	1457398505	1	1	LOMA LINDA UNIVERSITY	12/25/1987	207ZC0500X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	PATHOLOGY MEDICAL GROUP	11370 ANDERSON ST	STE 2960	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
30265	Fee-for-Service	1083076673	1083076673	1	1	LIEU, MICHELLE-THAO MD	6/16/2020	207L00000X	NA	Other	026	PHYSICIANS	155084	05	Anesthesiology	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
30272	Fee-for-Service	1902814346	1902814346	1	1	LI, JIAYI MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76039	10	Gastroenterology (M.D. only)	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
30286	Fee-for-Service	1649426990	1649426990	1	2	LULU L. CHEN, MD INC	12/2/2024	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7143 SEVILLE AVE	None	HUNTINGTON PARK	CA	90255	4905	19	06037	33.97427787	-118.2224599	Los Angeles County
30294	Fee-for-Service	1134302193	1134302193	1	1	LLOREN ELLAINE ABIGAIL DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
30311	Fee-for-Service	1033747324	1033747324	1	1	LAMBA, SIMARJEET MD	7/11/2023	207R00000X	NA	Other	026	PHYSICIANS	182882	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
30321	Fee-for-Service	1376827758	1376827758	1	1	LA ARC HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5652 VINELAND AVENUE	SUITE 202B	NORTH HOLLYWOOD	CA	91601	2061	19	06037	34.17374219	-118.3702596	Los Angeles County
30351	Fee-for-Service	1669050118	1669050118	1	1	LOVE, ASMA MD	6/5/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
30358	Fee-for-Service	1992748727	1992748727	2	1	LONGS DRUG STORE CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	19783 RINALDI ST	None	PORTER RANCH	CA	91326	4143	19	06037	34.2748738	-118.5645605	Los Angeles County
30374	Fee-for-Service	1194814343	1194814343	1	1	LE, PHILLIP D MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66633	08	Family Practice	0	In state provider	None	8781 VAN NUYS BLVD	None	VAN NUYS	CA	91402	2406	19	06037	34.22960628	-118.4502708	Los Angeles County
30401	Fee-for-Service	1356372973	1356372973	1	1	LANDRES, RICHARD T MD	12/2/1987	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	21484	10	Gastroenterology (M.D. only)	0	In state provider	DEPT OF MEDICINE	225 DICKINSON ST	# CD58	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
30436	Fee-for-Service	1366530875	1366530875	2	1	LYONGA, DORIS E MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	32526	78	Neoplastic Diseases/Oncology	0	In state provider	None	575 E HARDY ST	STE 321	INGLEWOOD	CA	90301	4036	19	06037	33.94909392	-118.3477665	Los Angeles County
30446	Fee-for-Service	1992717045	1992717045	1	1	LEE,CAROLINE MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61488	41	Internal Medicine	0	In state provider	None	5901 W OLYMPIC BLVD	STE 202	LOS ANGELES	CA	90036	4663	19	06037	34.05764121	-118.3603115	Los Angeles County
30461	Fee-for-Service	1871671412	1871671412	1	1	LOVETT, KARLA K MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75632	08	Family Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
30522	Fee-for-Service	1134328198	1134328198	1	1	LEE, PRISTINE W MD	8/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101615	07	Dermatology	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
30530	Fee-for-Service	1003942491	1003942491	1	1	LOME, STEVEN M DO	10/12/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	18311	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
30545	Fee-for-Service	1821206335	1821206335	1	1	LI, YANYAN MD	11/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107139	08	Family Practice	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
30546	Fee-for-Service	1740634591	1740634591	1	1	LEE, GLORIA MD	7/23/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	153569	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
30572	Fee-for-Service	1871823237	1871823237	1	1	LEE, KAO Y NP	6/23/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
30574	Fee-for-Service	1649426990	1649426990	1	2	LULU L. CHEN, MD INC	12/2/2024	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	7143 SEVILLE AVE	None	HUNTINGTON PARK	CA	90255	4905	19	06037	33.97427787	-118.2224599	Los Angeles County
30600	Fee-for-Service	1700923042	1700923042	1	1	LEE, SARAH J MD	8/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102564	45	Nephrology (Renal-Kidney)	0	In state provider	None	1310 W STEWART DRIVE	STE 607	ORANGE	CA	92868	3857	30	06059	33.78236048	-117.8664975	Orange County
30604	Fee-for-Service	1619043858	1619043858	1	1	LAIRD, SWEETMD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	EMERG PHYS PROF ASSN	4401 GARTH ROAD	None	BAYTOWN	TX	77521	0000	00	None	29.76910842	-94.97759843	Harris County
30607	Fee-for-Service	1376827758	1376827758	1	1	LA ARC HOSPICE INC	8/22/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5652 VINELAND AVENUE	SUITE 202B	NORTH HOLLYWOOD	CA	91601	2061	19	06037	34.17374219	-118.3702596	Los Angeles County
30614	Fee-for-Service	1053341784	1053341784	1	1	LIMVARAPUSS, CHAINARONG MD	12/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	80619	78	Neoplastic Diseases/Oncology	0	In state provider	None	100 HOSPITAL DR	STE 103	VALLEJO	CA	94589	2580	48	06095	38.13100118	-122.2403008	Solano County
30616	Fee-for-Service	1609816917	1609816917	2	1	LEE, CHE-CHERNG MD	12/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	37292	41	Internal Medicine	0	In state provider	None	7136 PACIFIC BLVD	STE 225	HUNTINGTON PARK	CA	90255	4767	19	06037	33.97474083	-118.2251149	Los Angeles County
30626	Fee-for-Service	1033430939	1033430939	1	1	LO, AMY A MD	11/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	22	Pathology (M.D. only)	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
30685	Fee-for-Service	1225318827	1225318827	1	1	LAM, KHOA V MD	4/12/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	184864	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
30714	Fee-for-Service	1588665178	1588665178	1	1	LEE, TONY T MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84674	78	Neoplastic Diseases/Oncology	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
30715	Fee-for-Service	1477782852	1477782852	1	1	LANDEROS, VERONICA C	2/28/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
30723	Fee-for-Service	1366530875	1366530875	2	1	LYONGA, DORIS E MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	32526	68	Hematology	0	In state provider	None	575 E HARDY ST	STE 321	INGLEWOOD	CA	90301	4036	19	06037	33.94909392	-118.3477665	Los Angeles County
30725	Fee-for-Service	1740770007	1740770007	1	1	LI, DAISY DO	11/8/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17788	08	Family Practice	0	In state provider	None	1525 N EL DORADO ST	STE 1	STOCKTON	CA	95204	5932	39	06077	37.96821044	-121.2941422	San Joaquin County
30729	Fee-for-Service	1194933945	1194933945	1	1	LONG, ALAN E MD	8/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	54509	01	General Practice	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
30737	Fee-for-Service	1407982697	1407982697	1	1	LINCOLN INTERNAL MEDICINE	6/25/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	A MEDICAL CORPORATION	801 STERLING PARKWAY	STE 120	LINCOLN	CA	95648	7327	31	06061	38.870694	-121.293657	Placer County
30749	Fee-for-Service	1871671412	1871671412	1	1	LOVETT, KARLA K MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75632	38	Geriatrics	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
30777	Fee-for-Service	1336306166	1336306166	1	1	LAW, DAVID S MD	2/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110846	41	Internal Medicine	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
30778	Fee-for-Service	1548298532	1548298532	1	3	LOS ANGELES LGBT CENTER	1/22/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2313 W MARTIN LUTHER KIN	None	LOS ANGELES	CA	90008	2724	19	06037	34.01084047	-118.318977	Los Angeles County
30779	Fee-for-Service	1992070064	1992070064	1	1	LPMI LONG BEACH PC	9/13/2013	2085R0202X	NA	Mammography/MRI Provider	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2708 WILLOW ST	None	SIGNAL HILL	CA	90755	2217	19	06037	33.80432955	-118.1594295	Los Angeles County
30780	Fee-for-Service	1851601074	1851601074	1	1	LAM, RANDY S	1/26/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	TURE	3100 COOLIDGE AVE	None	OAKLAND	CA	94602	2765	01	06001	37.79260502	-122.2141111	Alameda County
30807	Fee-for-Service	1770946543	1770946543	1	1	LUNDSTROM, JILL M MD	9/9/2019	390200000X	NA	Other	026	PHYSICIANS	162159	40	Pediatrics	0	In state provider	None	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	37	06073	32.90618683	-117.1814064	San Diego County
30819	Fee-for-Service	1255652400	1255652400	1	1	LEE, ALAN H MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135830	20	Orthopedic Surgery	0	In state provider	None	1700 PRAIRIE CITY RD	None	FOLSOM	CA	95630	9594	34	06067	38.652012	-121.166901	Sacramento County
30835	Fee-for-Service	1851593990	1851593990	1	1	LUCAS CAMPBELL	11/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	390 E LONGVIEW ST	None	FAYETTEVILLE	AR	72703	4618	00	None	36.111726	-94.1517135	Washington County
30867	Fee-for-Service	1942388673	1942388673	1	1	LUI, FOR SHING MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	56342	13	Neurology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
30872	Fee-for-Service	1043086119	1043086119	1	1	LOS ANGELES VISION INSTITUTE	3/6/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	8635 W 3RD ST	360W	LOS ANGELES	CA	90048	6149	19	06037	34.07361928	-118.3803143	Los Angeles County
30887	Fee-for-Service	1598975674	1598975674	1	1	LOPEZ-URIBE, DANIEL MD	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100160	08	Family Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
30902	Fee-for-Service	1053341784	1053341784	1	1	LIMVARAPUSS, CHAINARONG MD	12/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	80619	41	Internal Medicine	0	In state provider	None	100 HOSPITAL DR	STE 103	VALLEJO	CA	94589	2580	48	06095	38.13100118	-122.2403008	Solano County
30914	Fee-for-Service	1508014747	1508014747	1	1	LEE, GINA MD	2/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	91925	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
30933	Fee-for-Service	1811000318	1811000318	1	1	LEONARD BERNARD	3/18/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1700 S TAMIAMI TRL	None	SARASOTA	FL	34239	3509	00	None	27.31818165	-82.52981128	Sarasota County
30955	Fee-for-Service	1861440869	1861440869	1	1	LOW, NORMAN D MD	7/7/2017	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	44706	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W COOLIDGE AVE	None	MODESTO	CA	95350	4447	50	06099	37.66550267	-120.9951522	Stanislaus County
30971	Fee-for-Service	1194187914	1194187914	1	1	LII, THERESA R MD	7/30/2021	207L00000X	NA	Other	026	PHYSICIANS	150347	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
30991	Fee-for-Service	1013352897	1013352897	1	1	LEE, YOUN KYUNG MD	7/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	133202	30	Radiology	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
31002	Fee-for-Service	1104908656	1104908656	1	1	LEVIN, LARRY M LCSW	1/24/2011	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1660 HUMBOLDT RD	STE 3	CHICO	CA	95928	9199	04	06007	39.73657225	-121.811656	Butte County
31012	Fee-for-Service	1366530875	1366530875	2	1	LYONGA, DORIS E MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	32526	41	Internal Medicine	0	In state provider	None	575 E HARDY ST	STE 321	INGLEWOOD	CA	90301	4036	19	06037	33.94909392	-118.3477665	Los Angeles County
31044	Fee-for-Service	1992187959	1992187959	1	1	LAUW, STEPHANIE MD	2/28/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	146034	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
31049	Fee-for-Service	1437354289	1437354289	1	1	LLOYD, BRENDAN M MD	8/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116891	07	Dermatology	0	In state provider	None	2501 E CHAPMAN AVE	STE 301	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
31065	Fee-for-Service	1548298532	1548298532	1	3	LOS ANGELES LGBT CENTER	1/22/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2313 W MARTIN LUTHER KIN	None	LOS ANGELES	CA	90008	2724	19	06037	34.01084047	-118.318977	Los Angeles County
31099	Fee-for-Service	1720642192	1720642192	1	1	LORRAINE IBOLD LCSW	12/5/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	COUNSELING	505 N TUSTINE AVE	SUITE 134	SANTA ANA	CA	92705	3712	30	06059	33.74962094	-117.8341227	Orange County
31153	Fee-for-Service	1053601401	1053601401	1	1	LIU, STANLEY Y MD	7/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122495	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
31158	Fee-for-Service	1043086119	1043086119	1	1	LOS ANGELES VISION INSTITUTE	3/6/2025	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8635 W 3RD ST	360W	LOS ANGELES	CA	90048	6149	19	06037	34.07361928	-118.3803143	Los Angeles County
31180	Fee-for-Service	1932475035	1932475035	1	1	LANDMAN, GERI O MD	8/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137095	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
31191	Fee-for-Service	1053341784	1053341784	1	1	LIMVARAPUSS, CHAINARONG MD	12/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	80619	68	Hematology	0	In state provider	None	100 HOSPITAL DR	STE 103	VALLEJO	CA	94589	2580	48	06095	38.13100118	-122.2403008	Solano County
31230	Fee-for-Service	1760864961	1760864961	1	1	LIN, ANDREW Q MD	8/18/2022	208G00000X	NA	General Surgery	026	PHYSICIANS	176225	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
31259	Fee-for-Service	1326667213	1326667213	1	1	LARBAH, AMINA R MD	7/21/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	185037	None	None	0	In state provider	None	955 W IMPERIAL HWY	SUITE 110	BREA	CA	92821	3812	30	06059	33.91745451	-117.9133065	Orange County
31275	Fee-for-Service	1891738068	1891738068	2	1	LONGS DRUG STORES CA LLC	12/8/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	727 S GLENDORA AVE	None	WEST COVINA	CA	91790	3707	19	06037	34.06223761	-117.9311758	Los Angeles County
31333	Fee-for-Service	1538111026	1538111026	1	1	LEE, HESTER H MD	5/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90953	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
31334	Fee-for-Service	1316488265	1316488265	1	1	LAI, TIFFANNY OD INC	11/2/2017	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	125 E ANAHEIM ST	UNIT O	WILMINGTON	CA	90744	4590	19	06037	33.78005575	-118.2615103	Los Angeles County
31336	Fee-for-Service	1043816705	1043816705	1	1	LAM, ANTHEA W	5/2/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
31340	Fee-for-Service	1144372947	1144372947	1	1	LA COUR, MARIE L MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55395	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
31375	Fee-for-Service	1528211679	1528211679	1	1	LIU, SAMUEL MD INC	6/12/2009	207RN0300X	NA	Nephrology	026	PHYSICIANS	74056	13	Neurology (M.D. only)	0	In state provider	None	210 BONITA AVE.	SUITE 140	POMONA	CA	91767	1866	19	06037	34.09639602	-117.750267	Los Angeles County
31382	Fee-for-Service	1518038371	1518038371	1	1	LAMBERTI, JOHN J JR MD	8/12/1988	208600000X	NA	General Surgery	026	PHYSICIANS	19503	33	Thoracic Surgery	0	In state provider	INC	3020 CHILDRENS WAY	MC 5078	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
31386	Fee-for-Service	1851803431	1851803431	1	1	LAKEWOOD RESIDENTIAL CARELLC	11/20/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	12045 LAKEWOOD BLVD	None	DOWNEY	CA	90242	2635	19	06037	33.92591718	-118.1312397	Los Angeles County
31443	Fee-for-Service	1053601401	1053601401	1	1	LIU, STANLEY Y MD	7/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122495	84	Surgery-Head and Neck	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
31447	Fee-for-Service	1578524468	1578524468	1	2	LINDSEY, ROBERT O MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	77792	30	Radiology	0	In state provider	None	11420 WARNER AVENUE	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
31527	Fee-for-Service	1609169788	1609169788	1	1	LEE, MATTHEW B MD	10/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137693	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
31532	Fee-for-Service	1114423670	1114423670	1	1	LE, FRANCESCA MD	8/20/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	173876	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
31537	Fee-for-Service	1407145170	1407145170	1	1	LIU, PEONY MD	5/2/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	123332	40	Pediatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
31590	Fee-for-Service	1992082895	1992082895	1	1	LEE, PORTIA LAC	12/16/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
31600	Fee-for-Service	1457428351	1457428351	1	1	LIN, CHAO-MING C MD	7/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66705	38	Geriatrics	0	In state provider	None	2621 S BRISTOL ST	STE 203	SANTA ANA	CA	92704	5700	30	06059	33.711876	-117.885371	Orange County
31633	Fee-for-Service	1255828802	1255828802	1	1	LE, VINH MD	2/26/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173398	08	Family Practice	0	In state provider	None	34675 YUCAIPA BLVD	SUITER 102	YUCAIPA	CA	92399	4155	36	06071	34.03384452	-117.048195	San Bernardino County
31664	Fee-for-Service	1528211679	1528211679	1	1	LIU, SAMUEL MD INC	6/12/2009	207RN0300X	NA	Nephrology	026	PHYSICIANS	74056	41	Internal Medicine	0	In state provider	None	210 BONITA AVE.	SUITE 140	POMONA	CA	91767	1866	19	06037	34.09639602	-117.750267	Los Angeles County
31665	Fee-for-Service	1225070253	1225070253	1	1	LAWRENCE, TRACY N MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73510	None	None	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
31669	Fee-for-Service	1710032370	1710032370	1	1	LOTYSCH, MATTHEW J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39962	02	General Surgery	0	In state provider	None	151 N SAN VICENTE BLVD	STE 208	BEVERLY HILLS	CA	90211	2323	19	06037	34.06838129	-118.3748976	Los Angeles County
31670	Fee-for-Service	1518038371	1518038371	1	1	LAMBERTI, JOHN J JR MD	8/12/1988	208600000X	NA	General Surgery	026	PHYSICIANS	19503	06	Cardiovascular Disease (M.D. only)	0	In state provider	INC	3020 CHILDRENS WAY	MC 5078	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
31698	Fee-for-Service	1568489383	1568489383	1	1	LASH, BHRETT A MD	2/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	76274	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
31705	Fee-for-Service	1992877427	1992877427	1	1	LEE, STEVEN K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53712	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 S HOBART BLVD	SUITE 301	LOS ANGELES	CA	90020	3693	19	06037	34.0687961	-118.3053621	Los Angeles County
31731	Fee-for-Service	1053601401	1053601401	1	1	LIU, STANLEY Y MD	7/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122495	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
31747	Fee-for-Service	1568486033	1568486033	1	1	LAC MARTIN LUTHER KING	6/3/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	12021 S WILMINGTON AVE	None	LOS ANGELES	CA	90052	3019	19	06037	33.922863	-118.2431655	Los Angeles County
31750	Fee-for-Service	1235217886	1235217886	1	1	LIM, CHARLES K MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78313	20	Orthopedic Surgery	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
31763	Fee-for-Service	1457504375	1457504375	1	1	LOPEZ, ALMA A MD	4/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101560	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
31773	Fee-for-Service	1013042498	1013042498	1	1	LO, HELEN L NP	9/12/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15272 SUMMIT AVE	None	FONTANA	CA	92336	0231	36	06071	34.152624	-117.4724415	San Bernardino County
31789	Fee-for-Service	1376734780	1376734780	1	2	LIEN, LI-CHANG MD	4/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109215	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
31791	Fee-for-Service	1417113119	1417113119	1	1	LEVIN, AMY L MD	4/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	6850 N DURANGO DR	STE 204	LAS VEGAS	NV	89149	4596	00	None	36.285876	-115.285266	Clark County
31831	Fee-for-Service	1982995650	1982995650	1	1	LEE, THOMAS D MD	6/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	124424	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
31833	Fee-for-Service	1023634516	1023634516	1	1	LONG, CHRISTOPHER MD	7/22/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	182745	18	Ophthalmology	0	In state provider	None	4560 E CESAR E CHAVEZ	None	LOS ANGELES	CA	90022	1117	19	06037	34.04057653	-118.167318	Los Angeles County
31847	Fee-for-Service	1487663761	1487663761	1	1	LEVIN, DAVID L MD	12/27/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	74098	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
31848	Fee-for-Service	1568458834	1568458834	1	1	LAUFER, PABLO MARCELO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3200 SW 60TH CT	STE 206	MIAMI	FL	33155	4070	00	None	25.74153817	-80.29306992	Miami-Dade County
31862	Fee-for-Service	1902840739	1902840739	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1282 COAST VILLAGE RD	None	SANTA BARBARA	CA	93108	2719	42	06083	34.42157149	-119.6407395	Santa Barbara County
31881	Fee-for-Service	1568495307	1568495307	1	1	LOPRESTI, JOHNATHAN MD	2/28/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	48153	01	General Practice	0	In state provider	None	2025 ZONAL AVE	None	LOS ANGELES	CA	90089	0264	19	06037	34.05998665	-118.2058023	Los Angeles County
31883	Fee-for-Service	1083627749	1083627749	1	1	LOS ANGELES COUNTY	4/28/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	ROYBAL FAMILY PLANNING	245 S FETTERLY AVE	None	LOS ANGELES	CA	90022	1605	19	06037	34.03404953	-118.1609476	Los Angeles County
31886	Fee-for-Service	1093846438	1093846438	1	1	LOULAN, AMY M LMFT	11/4/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4987 GOLDEN FOOTHILL PKW	100	EL DORADO HILLS	CA	95762	9364	09	06017	38.63795293	-121.0685958	El Dorado County
31888	Fee-for-Service	1457428351	1457428351	1	1	LIN, CHAO-MING C MD	7/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66705	08	Family Practice	0	In state provider	None	2621 S BRISTOL ST	STE 203	SANTA ANA	CA	92704	5700	30	06059	33.711876	-117.885371	Orange County
31909	Fee-for-Service	1669874657	1669874657	1	1	LEE, AMY C PSYD	4/27/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
31931	Fee-for-Service	1750571212	1750571212	1	1	LILIENSTEIN, DAVID A MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	100009	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
31943	Fee-for-Service	1972861268	1972861268	1	1	LAI, CHRISTY Y MD	10/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127468	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
31946	Fee-for-Service	1558756270	1558756270	1	1	LAGO HERNANDEZ, CARLOS A MD	6/24/2019	208M00000X	NA	Other	026	PHYSICIANS	146029	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
31956	Fee-for-Service	1710032370	1710032370	1	1	LOTYSCH, MATTHEW J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39962	30	Radiology	0	In state provider	None	151 N SAN VICENTE BLVD	STE 208	BEVERLY HILLS	CA	90211	2323	19	06037	34.06838129	-118.3748976	Los Angeles County
31960	Fee-for-Service	1861641573	1861641573	1	1	LOPEZ MAGANA, NORMA LCSW	1/10/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1000 TOWN CENTER DR	STE 206	OXNARD	CA	93036	9997	56	06111	34.242487	-119.1824169	Ventura County
31979	Fee-for-Service	1740830306	1740830306	1	1	LEIB, HANNAH E LCSW	5/29/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
32020	Fee-for-Service	1962806000	1962806000	1	1	LOVINGS, TRIVAN M LCSW	3/4/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
32031	Fee-for-Service	1568488526	1568488526	1	1	LU, MIN J MD	11/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130396	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
32033	Fee-for-Service	1164843108	1164843108	1	1	LAI, JINPING MD	4/27/2020	207ZP0101X	NA	Other	026	PHYSICIANS	119223	22	Pathology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
32037	Fee-for-Service	1649696501	1649696501	1	1	LEE, IRENE M	8/7/2014	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	217 W CERRITOS AVE	None	ANAHEIM	CA	92805	6549	30	06059	33.81058193	-117.9065445	Orange County
32052	Fee-for-Service	1457504375	1457504375	1	1	LOPEZ, ALMA A MD	4/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101560	01	General Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
32093	Fee-for-Service	1154839645	1154839645	1	1	LUONG, TONG NP	9/20/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3113	30	06059	33.80318353	-118.0666665	Orange County
32107	Fee-for-Service	1497085666	1497085666	1	1	LO, EMILY PT	5/24/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
32111	Fee-for-Service	1861657033	1861657033	1	1	LORENTZ, WILLIAM C MD	5/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109139	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
32136	Fee-for-Service	1366592602	1366592602	1	1	L M CALDWELL PHARMACIST	12/22/1977	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	235 W PUEBLO ST	None	SANTA BARBARA	CA	93105	3892	42	06083	34.43059905	-119.7218351	Santa Barbara County
32156	Fee-for-Service	1225725435	1225725435	1	1	LOTUSFLOWERLLC	4/19/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
32158	Fee-for-Service	1881048072	1881048072	1	1	LEI, LEI MD	6/15/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	168230	None	None	0	In state provider	None	15503 VENTURA BLVD	240, 340, 350	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
32193	Fee-for-Service	1760666945	1760666945	1	1	LIANG, NI-CHENG MD	3/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98510	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
32200	Fee-for-Service	1740584101	1740584101	1	1	LAMBDIN, CRAIG B MFT	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	15406	-	NOT APPLICABLE	0	In state provider	None	5870 ARLINGTON AVENUE	None	RIVERSIDE	CA	92504	2037	33	06065	33.94592702	-117.4313099	Riverside County
32236	Fee-for-Service	1134207798	1134207798	1	1	LANDSDORF, ADAM J MD	4/7/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71265	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
32329	Fee-for-Service	1790160182	1790160182	1	1	LEWIS, GRAYSON J	6/30/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
32333	Fee-for-Service	1568488526	1568488526	1	1	LU, MIN J MD	11/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130396	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
32343	Fee-for-Service	1891011599	1891011599	1	1	LA MAESTRA FAMILY CLINIC INC	10/5/2010	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	7967 BROADWAY	None	LEMON GROVE	CA	91945	1809	37	06073	32.74269062	-117.0268984	San Diego County
32346	Fee-for-Service	1710906094	1710906094	1	1	LEE, ROGER M MD	6/15/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75104	None	None	0	In state provider	None	200 MED PLAZA STE 365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
32351	Fee-for-Service	1669161543	1669161543	1	1	LAUREN CAMACHO INTEGRATIVE C	1/5/2024	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1211 CENTER COURT DR	106	COVINA	CA	91724	3627	19	06037	34.07347496	-117.8653457	Los Angeles County
32363	Fee-for-Service	1871526590	1871526590	1	1	LEMMEL, DAVID F MD	3/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108587	66	Emergency Medicine (Urgent Care)	0	In state provider	None	508 E HICKORY AVE	None	LOMPOC	CA	93436	7318	42	06083	34.63568383	-120.4522776	Santa Barbara County
32367	Fee-for-Service	1144360850	1144360850	1	1	LE, CAROLYN N T OD	1/26/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
32383	Fee-for-Service	1477902120	1477902120	1	1	LOZANO, CHRISTIAN LMFT	11/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15200 HESPERIAN BLVD	STE 202	SAN LEANDRO	CA	94578	3927	01	06001	37.69863049	-122.1299049	Alameda County
32401	Fee-for-Service	1962561563	1962561563	1	1	LAWRENCE, MICHAEL A MD	4/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	60482	34	Urology and Urological Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
32438	Fee-for-Service	1134528904	1134528904	1	1	LOS ANGELES REHABILITATION	10/11/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	340 S ALVARADO ST	None	LOS ANGELES	CA	90057	2915	19	06037	34.06185191	-118.2733673	Los Angeles County
32484	Fee-for-Service	1134489594	1134489594	1	1	LE, WILLIAM T MD	1/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141124	01	General Practice	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
32486	Fee-for-Service	1548748353	1548748353	1	1	LEONE-ALDRICH, MICHAEL S LMF	5/9/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
32489	Fee-for-Service	1578625364	1578625364	1	1	LAWRENCE, PATRICK B MD	11/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	20149	15	Obstetrics (D.O. only)	0	In state provider	None	1061 E VERNON	#F	LOS ANGELES	CA	90241	3600	19	06037	34.0039535	-118.256877	Los Angeles County
32501	Fee-for-Service	1619031051	1619031051	1	1	LITTLE, DANIEL J MD	1/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	72337	08	Family Practice	0	In state provider	None	4770 W HERNDON AVE	None	FRESNO	CA	93722	8401	10	06019	36.83717984	-119.8778388	Fresno County
32507	Fee-for-Service	1881080786	1881080786	1	1	LU, CHRISTINE MD	8/15/2020	2084N0008X	NA	Neurology	026	PHYSICIANS	157927	13	Neurology (M.D. only)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
32532	Fee-for-Service	1437251931	1437251931	1	1	LUNDINE, MARK L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6979 REDANSA DR	None	ROCKFORD	IL	61108	0000	00	None	42.25401939	-88.98180577	Winnebago County
32538	Fee-for-Service	1790942076	1790942076	1	1	LAW, JEREMY P MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105931	08	Family Practice	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
32620	Fee-for-Service	1336406974	1336406974	1	1	LEVITT, DANIELLE L MD	7/11/2019	207PP0204X	NA	Other	026	PHYSICIANS	160815	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
32627	Fee-for-Service	1467599183	1467599183	1	1	LEWIS, ANNA K MD	4/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54693	41	Internal Medicine	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
32631	Fee-for-Service	1891011599	1891011599	1	1	LA MAESTRA FAMILY CLINIC INC	10/5/2010	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	7967 BROADWAY	None	LEMON GROVE	CA	91945	1809	37	06073	32.74269062	-117.0268984	San Diego County
32635	Fee-for-Service	1669161543	1669161543	1	1	LAUREN CAMACHO INTEGRATIVE C	1/5/2024	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1211 CENTER COURT DR	106	COVINA	CA	91724	3627	19	06037	34.07347496	-117.8653457	Los Angeles County
32638	Fee-for-Service	1649651647	1649651647	1	1	LOEB, GABRIEL MD	6/9/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	154997	45	Nephrology (Renal-Kidney)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
32658	Fee-for-Service	1003216441	1003216441	1	1	LEU, SARAH B MD	11/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124139	40	Pediatrics	0	In state provider	None	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda County
32664	Fee-for-Service	1346284353	1346284353	1	1	LI, GANG MD	7/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	74725	25	Physical Medicine and Rehabilitation	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
32672	Fee-for-Service	1992799654	1992799654	1	1	LEWIS, JEFFREY D MD	5/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	1707 W CHARLESTON BLVD	STE 160	LAS VEGAS	NV	89102	2354	00	None	36.15879353	-115.1643015	Clark County
32687	Fee-for-Service	1881248540	1881248540	1	1	LEE, MARCUS J NP	9/9/2019	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	600 N GARFIELD AVE	SUITE 111	MONTEREY PARK	CA	91754	1166	19	06037	34.06820797	-118.1228835	Los Angeles County
32694	Fee-for-Service	1275085722	1275085722	1	1	LUM, SHANNON R LMFT	1/22/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	55 SHAW AVE	STE 115	CLOVIS	CA	93612	3819	10	06019	36.80859553	-119.708505	Fresno County
32698	Fee-for-Service	1427330497	1427330497	1	1	LEE, DAVID H L MD	2/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118160	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
32737	Fee-for-Service	1306852538	1306852538	1	1	LEE, HYE O DO	5/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8550	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
32740	Fee-for-Service	1306805189	1306805189	1	1	LAINE, JONATHAN E MD	1/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	63676	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10121 PINE AVENUE	None	TRUCKEE	CA	96161	4856	29	06057	39.3245308	-120.2013097	Nevada County
32745	Fee-for-Service	1659344943	1659344943	1	1	LAI, YIN H MD	12/1/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36531	08	Family Practice	0	In state provider	None	1060 E FOOTHILL BLVD	STE 203	UPLAND	CA	91786	4070	36	06071	34.1070235	-117.6371235	San Bernardino County
32746	Fee-for-Service	1801463773	1801463773	1	1	LE, VY N OD	1/11/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 WILSHIRE BLVD.	SUITE 1275	LOS ANGELES	CA	90025	7143	19	06037	34.04370122	-118.4678993	Los Angeles County
32784	Fee-for-Service	1588696660	1588696660	1	1	LETENDRE, SCOTT L MD	6/1/1998	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	63591	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
32785	Fee-for-Service	1578625364	1578625364	1	1	LAWRENCE, PATRICK B MD	11/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	20149	08	Family Practice	0	In state provider	None	1061 E VERNON	#F	LOS ANGELES	CA	90241	3600	19	06037	34.0039535	-118.256877	Los Angeles County
32789	Fee-for-Service	1083965735	1083965735	1	1	LANDRY, BEVERLY J NP	4/16/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
32802	Fee-for-Service	1548298532	1548298532	1	2	LOS ANGELES LGBT CENTER	1/22/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3055 WILSHIRE BLVD	STE 360	LOS ANGELES	CA	90010	1108	19	06037	34.06185807	-118.2880358	Los Angeles County
32814	Fee-for-Service	1831355965	1831355965	1	1	LEMANE, PAULA D	3/22/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
32826	Fee-for-Service	1427332030	1427332030	1	2	LOVE, NANCY D MD	10/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118444	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	SUITE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
32862	Fee-for-Service	1407816820	1407816820	1	1	LE, KHOI M MD	3/31/1989	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	68849	41	Internal Medicine	0	In state provider	None	257 CASTRO ST	None	SAN FRANCISCO	CA	94114	1527	38	06075	37.76474225	-122.4353607	San Francisco County
32880	Fee-for-Service	1780308395	1780308395	1	1	LTC PHARMACY INC	12/7/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	19562 VENTURA BLVD	STE 218	TARZANA	CA	91356	6069	19	06037	34.17276463	-118.5593281	Los Angeles County
32888	Fee-for-Service	1619436458	1619436458	1	1	LOLA EMERGENCY PHYSICIANS LL	11/4/2019	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	2	Out of state provider	C	360 S LOLA LN	None	PAHRUMP	NV	89048	0884	00	None	36.214524	-116.025615	Nye County
32909	Fee-for-Service	1801871801	1801871801	1	1	LINK, LAUREEN K OD	9/5/2011	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3241 CHURN CREEK RD	None	REDDING	CA	96002	2516	45	06089	40.560309	-122.3530415	Shasta County
32910	Fee-for-Service	1023465879	1023465879	1	1	LAM, RAYMOND MD	7/21/2020	390200000X	NA	Other	026	PHYSICIANS	154231	41	Internal Medicine	0	In state provider	None	845 JACKSON ST	None	SAN FRANCISCO	CA	94133	4851	38	06075	37.79571919	-122.4089166	San Francisco County
32917	Fee-for-Service	1508502444	1508502444	1	1	LENAHAN, CAMERON DO	1/20/2025	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	23562	01	General Practice	0	In state provider	None	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	37	06073	32.8384953	-116.9677746	San Diego County
32918	Fee-for-Service	1467599183	1467599183	1	1	LEWIS, ANNA K MD	4/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54693	01	General Practice	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
32927	Fee-for-Service	1891011599	1891011599	1	1	LA MAESTRA FAMILY CLINIC INC	10/5/2010	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	7967 BROADWAY	None	LEMON GROVE	CA	91945	1809	37	06073	32.74269062	-117.0268984	San Diego County
32937	Fee-for-Service	1164193918	1164193918	1	1	LAURI, MARISOL OD	10/16/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
32954	Fee-for-Service	1346284353	1346284353	1	1	LI, GANG MD	7/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	74725	01	General Practice	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
32962	Fee-for-Service	1992799654	1992799654	1	1	LEWIS, JEFFREY D MD	5/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	1707 W CHARLESTON BLVD	STE 160	LAS VEGAS	NV	89102	2354	00	None	36.15879353	-115.1643015	Clark County
33000	Fee-for-Service	1558465799	1558465799	1	1	LE, BRUCE N DO	7/9/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7965	20	Orthopedic Surgery	0	In state provider	None	325 S WILLIS ST	None	VISALIA	CA	93291	6105	54	06107	36.327717	-119.2981005	Tulare County
33016	Fee-for-Service	1386758746	1386758746	1	1	LUNA, JAMES D MD	4/23/1981	207P00000X	NA	Other	026	PHYSICIANS	34413	66	Emergency Medicine (Urgent Care)	0	In state provider	None	100 CONGRESS STREET	None	PASADENA	CA	91105	0000	19	06037	34.13395172	-118.1534955	Los Angeles County
33028	Fee-for-Service	1952677445	1952677445	1	1	LAM, FRANCIS MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126870	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
33054	Fee-for-Service	1871751107	1871751107	1	1	LEE, KATRINA L MD	12/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	104714	05	Anesthesiology	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
33067	Fee-for-Service	1932454360	1932454360	1	1	LIGHTHOUSE HOSPICE CARE INC	1/17/2024	251G00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	10535 FOOTHILL BLVD	STE 408	RANCHO CUCAMONGA	CA	91730	3829	36	06071	34.10636254	-117.5751945	San Bernardino County
33073	Fee-for-Service	1588696660	1588696660	1	1	LETENDRE, SCOTT L MD	6/1/1998	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	63591	77	Infectious Disease	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
33088	Fee-for-Service	1548298532	1548298532	1	2	LOS ANGELES LGBT CENTER	1/22/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3055 WILSHIRE BLVD	STE 360	LOS ANGELES	CA	90010	1108	19	06037	34.06185807	-118.2880358	Los Angeles County
33105	Fee-for-Service	1033198288	1033198288	1	1	LAM, GIANG N MD	1/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93687	08	Family Practice	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4423	50	06099	37.666863	-120.9962775	Stanislaus County
33131	Fee-for-Service	1316915622	1316915622	1	1	LUBBEN, JOHN MD	5/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	66896	05	Anesthesiology	0	In state provider	None	2900 EUREKA WAY	None	REDDING	CA	96001	0220	45	06089	40.58549966	-122.4167649	Shasta County
33153	Fee-for-Service	1407816820	1407816820	1	1	LE, KHOI M MD	3/31/1989	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	68849	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	257 CASTRO ST	None	SAN FRANCISCO	CA	94114	1527	38	06075	37.76474225	-122.4353607	San Francisco County
33160	Fee-for-Service	1700073962	1700073962	1	1	LOEFFLER, ALLISON MELANIE MD	10/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116680	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
33173	Fee-for-Service	1700111382	1700111382	1	1	LIKHTEROV, ILYA MD	6/4/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	117132	04	Otology, Laryngology, Rhinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
33174	Fee-for-Service	1205883121	1205883121	1	1	LOHTIA, MEENA S MD	8/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93125	08	Family Practice	0	In state provider	None	205 BON AIR RD	None	GREENBRAE	CA	94904	2486	21	06041	37.94602449	-122.5372642	Marin County
33191	Fee-for-Service	1396184685	1396184685	1	1	LEE-WANG, CANDICE J MD	12/31/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144571	08	Family Practice	0	In state provider	None	264 N HIGHLAND SPRINGS A	STE 5A	BANNING	CA	92220	3083	33	06065	33.93063	-116.946864	Riverside County
33195	Fee-for-Service	1134570575	1134570575	1	1	LEE, YEONSEUNG MD	11/22/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	161903	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
33198	Fee-for-Service	1053816181	1053816181	1	1	LI, KIM M	3/18/2024	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
33228	Fee-for-Service	1598846743	1598846743	1	1	LODHIA, ANANT K MD	8/15/1991	207R00000X	NA	Other	026	PHYSICIANS	35942	41	Internal Medicine	0	In state provider	None	5250 ELVAS AVE	None	SACRAMENTO	CA	95819	2332	34	06067	38.57614224	-121.4350326	Sacramento County
33256	Fee-for-Service	1821175811	1821175811	1	1	LEE, MYUNG H MD	12/31/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45901	08	Family Practice	0	In state provider	VICTORIA MEDICAL CLINIC	14614 VICTORY BLVD	None	VAN NUYS	CA	91411	1621	19	06037	34.18663148	-118.451421	Los Angeles County
33311	Fee-for-Service	1588996557	1588996557	1	1	LAM, GARY K DPM	4/27/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1655 N MT VERNON AVE	STE B1	SAN BERNARDINO	CA	92411	1427	36	06071	34.129539	-117.3137845	San Bernardino County
33347	Fee-for-Service	1568406908	1568406908	2	1	LONGS DRUG STORES CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6668 ALHAMBRA AVE	None	MARTINEZ	CA	94553	6105	07	06013	37.95913478	-122.0936569	Contra Costa County
33354	Fee-for-Service	1700109501	1700109501	1	1	LEE, GRANT E MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112249	18	Ophthalmology	0	In state provider	None	17833 COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	1729	19	06037	33.99017251	-117.9153748	Los Angeles County
33400	Fee-for-Service	1154882017	1154882017	1	1	LEDYARD, KATHRYN S MD	8/28/2023	207R00000X	NA	Other	026	PHYSICIANS	179157	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
33417	Fee-for-Service	1598982522	1598982522	1	1	LIU, YEN-FU J MD	6/22/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	97572	40	Pediatrics	0	In state provider	None	3250 SEPULVEDA BLVD	None	TORRANCE	CA	90505	2719	19	06037	33.82491629	-118.3437278	Los Angeles County
33474	Fee-for-Service	1366003170	1366003170	1	1	LINCOLN, VADIM MD	3/28/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	182477	None	None	0	In state provider	None	1300 AVENIDA VISTA HERMO	150	SAN CLEMENTE	CA	92673	6315	30	06059	33.45766933	-117.5920941	Orange County
33547	Fee-for-Service	1093141590	1093141590	1	1	LUZNY, THOMAS J NP	8/14/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	2	Out of state provider	None	500 W THOMAS RD	STE 500	PHOENIX	AZ	85013	4220	00	None	33.481485	-112.080816	Maricopa County
33548	Fee-for-Service	1386419786	1386419786	1	1	LISA E.S. VEAL, O.D., A PROF	6/12/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	15336 DEVONSHIRE ST	STE 4	MISSION HILLS	CA	91345	2763	19	06037	34.25726849	-118.4664285	Los Angeles County
33567	Fee-for-Service	1033257027	1033257027	1	1	LEE, VENNY V MD	4/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
33595	Fee-for-Service	1871056036	1871056036	1	1	LAIRD, EMMA C PT	6/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
33610	Fee-for-Service	1124125232	1124125232	1	1	LEE, DIANA D MD	8/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85417	41	Internal Medicine	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
33613	Fee-for-Service	1609829142	1609829142	1	1	LE, MINH V MD	12/6/2007	207P00000X	NA	Other	026	PHYSICIANS	80722	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
33642	Fee-for-Service	1619912615	1619912615	1	1	LEBBY, TOM I MD	6/18/1990	207P00000X	NA	Other	026	PHYSICIANS	68850	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
33645	Fee-for-Service	1164602215	1164602215	1	1	LISA BRIGGS FNP	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	EMERGENCY ROOM ASSOCIATE	1601 W ST MARY'S RD	None	TUCSON	AZ	85745	0000	00	None	32.228199	-111.0000825	Pima County
33662	Fee-for-Service	1922041706	1922041706	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3749 AVOCADO BLVD	None	LA MESA	CA	91941	7301	37	06073	32.74756131	-116.9620699	San Diego County
33664	Fee-for-Service	1184363780	1184363780	1	1	LEE, CARMEN OT	12/30/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7313 WHITTIER AVE	None	WHITTIER	CA	90602	1132	19	06037	33.975027	-118.043219	Los Angeles County
33686	Fee-for-Service	1912551151	1912551151	1	1	LIVELY-ENDICOTT, HANNAH MD	10/12/2023	207PP0204X	NA	Other	026	PHYSICIANS	178376	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
33688	Fee-for-Service	1750878997	1750878997	1	1	LOEB, CHARLES A MD	4/4/2023	208800000X	NA	Other	026	PHYSICIANS	165921	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
33737	Fee-for-Service	1215310958	1215310958	1	1	LINSENMEYER-ACKLIN, ANGELA D	11/30/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
33745	Fee-for-Service	1730195686	1730195686	1	1	LIU, PAUL T MD	3/11/2008	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	67740	38	Geriatrics	0	In state provider	None	2233 HUNTINGTON DR	STE 10	SAN MARINO	CA	91108	2655	19	06037	34.12214824	-118.1058479	Los Angeles County
33769	Fee-for-Service	1760809941	1760809941	1	2	LAPE, ALEXANDRA A	5/6/2025	No Taxonomy Provided	NA	None	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	4677 VALLEY EAST BLVD.	SUITE 2	ARCATA	CA	95521	4630	12	06023	40.90085428	-124.0816212	Humboldt County
33770	Fee-for-Service	1487818548	1487818548	1	1	LABORATORY CORP OF AMERICA	6/9/2009	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	50 E HAMILTON AVENUE	STE 180	CAMPBELL	CA	95008	0251	43	06085	37.29415254	-121.948758	Santa Clara County
33775	Fee-for-Service	1902519762	1902519762	1	1	LARES, CHRISTINA BIRTH DOUL	2/7/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
33803	Fee-for-Service	1992052195	1992052195	1	1	LUMBA, ANGELA K MD	2/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	107633	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
33804	Fee-for-Service	1679968630	1679968630	1	1	LONG, ADRIENNE H MD	5/12/2022	2080P0207X	NA	Hematology	026	PHYSICIANS	161307	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
33819	Fee-for-Service	1093468308	1093468308	1	1	LOPEZ, PAULINE M CCC-SLP	10/8/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
33821	Fee-for-Service	1164120671	1164120671	1	1	LEE, RYAN CRNA	6/21/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
33863	Fee-for-Service	1184865594	1184865594	1	1	LAI, KENNY C MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120425	30	Radiology	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
33899	Fee-for-Service	1033122601	1033122601	1	1	LAM, MICHAEL C MD	7/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62691	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
33901	Fee-for-Service	1902467806	1902467806	1	1	LIN, EDWIN	9/11/2024	207L00000X	NA	Other	026	PHYSICIANS	179242	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
33912	Fee-for-Service	1073579421	1073579421	1	1	LIN, ALBERT Y MD	2/28/1996	207RH0003X	NA	Oncology	026	PHYSICIANS	45974	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
33930	Fee-for-Service	1982865267	1982865267	1	1	LEE, STEVEN S MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107778	None	None	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
33934	Fee-for-Service	1619912615	1619912615	1	1	LEBBY, TOM I MD	6/18/1990	207P00000X	NA	Other	026	PHYSICIANS	68850	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
33965	Fee-for-Service	1922543750	1922543750	1	1	LIN, SOPHIE MD	7/5/2024	2086X0206X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
33972	Fee-for-Service	1730640194	1730640194	1	1	LI, XIAOLONG PSYD	2/8/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
33999	Fee-for-Service	1851427025	1851427025	1	1	LEVY, RONALD MD	1/1/1982	207RH0003X	NA	Oncology	026	PHYSICIANS	21994	01	General Practice	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
34004	Fee-for-Service	1003980442	1003980442	1	1	LEVINE, MICHAEL S MD AMC	2/28/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	100 UCLA MEDICAL PLZ	STE 723	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
34032	Fee-for-Service	1730195686	1730195686	1	1	LIU, PAUL T MD	3/11/2008	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	67740	41	Internal Medicine	0	In state provider	None	2233 HUNTINGTON DR	STE 10	SAN MARINO	CA	91108	2655	19	06037	34.12214824	-118.1058479	Los Angeles County
34037	Fee-for-Service	1073507976	1073507976	1	1	LIEBSCHER, BRANDY PSYD	8/22/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	163 2ND STREET	None	WOODLAND	CA	95695	3316	57	06113	38.68060768	-121.7718082	Yolo County
34080	Fee-for-Service	1053309005	1053309005	1	1	LLANES, BENJAMIN P OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9580 BLACK MOUNTAIN RD	STE J	SAN DIEGO	CA	92126	4522	37	06073	32.89737833	-117.1233582	San Diego County
34093	Fee-for-Service	1992052195	1992052195	1	1	LUMBA, ANGELA K MD	2/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	107633	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
34157	Fee-for-Service	1265884811	1265884811	1	1	LOPEZ, KATHRYN	6/15/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1648 DRUMMOND LN	None	LINCOLN	CA	95648	2935	31	06061	38.87900946	-121.312215	Placer County
34203	Fee-for-Service	1073579421	1073579421	1	1	LIN, ALBERT Y MD	2/28/1996	207RH0003X	NA	Oncology	026	PHYSICIANS	45974	78	Neoplastic Diseases/Oncology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
34207	Fee-for-Service	1831799204	1831799204	1	1	LIFEPRO HOME HEALTH CARE INC	11/21/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	221 E GLENOAKS BLVD	STE 222B	GLENDALE	CA	91207	2085	19	06037	34.15856042	-118.253151	Los Angeles County
34233	Fee-for-Service	1770526931	1770526931	1	1	LE, DZUNG T	5/31/1990	207ZP0105X	NA	Other	026	PHYSICIANS	71291	22	Pathology (M.D. only)	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
34236	Fee-for-Service	1437178274	1437178274	1	1	LA, DAN MD	5/3/2018	207RR0500X	NA	Other	026	PHYSICIANS	84795	83	Rheumatology	0	In state provider	None	6673 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2706	19	06037	34.24711056	-118.2779523	Los Angeles County
34239	Fee-for-Service	1851824940	1851824940	1	1	LI, YONGCHAO MD	5/31/2022	207ZP0105X	NA	Other	026	PHYSICIANS	172044	None	None	0	In state provider	None	FRESNO AND R STREETS	2823 FRESNO STREET	FRESNO	CA	93721	1324	10	06019	36.741663	-119.7841005	Fresno County
34259	Fee-for-Service	1659496313	1659496313	1	1	LUCASH, RYAN E PHD	10/30/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
34292	Fee-for-Service	1003980442	1003980442	1	1	LEVINE, MICHAEL S MD AMC	2/28/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	100 UCLA MEDICAL PLZ	STE 723	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
34300	Fee-for-Service	1649566019	1649566019	1	1	LEE, CYNTHIA L MD	2/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132144	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
34301	Fee-for-Service	1548316144	1548316144	1	1	LU, LINH K MD	8/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101453	07	Dermatology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
34384	Fee-for-Service	1558529214	1558529214	1	1	LEE, NATHAN C DPM	4/28/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
34423	Fee-for-Service	1114111283	1114111283	1	1	LIU, PAUL Y MD	1/8/2008	207R00000X	NA	Other	026	PHYSICIANS	95248	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
34446	Fee-for-Service	1366466443	1366466443	1	1	LEVITT, MARTIN MD	1/1/1982	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	40300	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
34471	Fee-for-Service	1912014481	1912014481	1	1	LIN, JULIE C	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78926	05	Anesthesiology	0	In state provider	None	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	37	06073	33.14066871	-117.156095	San Diego County
34472	Fee-for-Service	1508811837	1508811837	1	1	LEE, JASON S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 NE 13TH ST	None	OKLAHOMA CITY	OK	73104	5004	00	None	35.480961	-97.5013965	Oklahoma County
34500	Fee-for-Service	1043276496	1043276496	1	1	LIN, JOANNA MD	4/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88899	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
34501	Fee-for-Service	1003035841	1003035841	1	1	LEVY, MARC D MD	8/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79214	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
34524	Fee-for-Service	1447439450	1447439450	1	1	LEE, ALICE D MD	9/15/2010	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	89710	04	Otology, Laryngology, Rhinology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
34551	Fee-for-Service	1699296459	1699296459	1	1	LAW, ADRIENNE M DO	4/19/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19074	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
34572	Fee-for-Service	1588040489	1588040489	1	1	LUONG, VINCENT H DO	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13642	01	General Practice	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
34666	Fee-for-Service	1659692879	1659692879	1	1	LEHMANN, BENJAMIN DO	8/24/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23150	30	Radiology	0	In state provider	None	8933 ACTIVITY RD	None	SAN DIEGO	CA	92126	4427	37	06073	32.89637448	-117.133497	San Diego County
34668	Fee-for-Service	1013147107	1013147107	1	1	LULE, ENOCH B MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145705	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
34704	Fee-for-Service	1912328485	1912328485	1	1	LOYAL HOSPICE CARE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	9608 VAN NUYS BLVD	SUITE 207-B	PANORAMA CITY	CA	91402	1000	19	06037	34.24485892	-118.4502135	Los Angeles County
34743	Fee-for-Service	1659935344	1659935344	1	1	LOYOLA, KEVIN C MD	7/16/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	177083	13	Neurology (M.D. only)	0	In state provider	None	11370 ANDERSON ST	STE B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
34764	Fee-for-Service	1912014481	1912014481	1	1	LIN, JULIE C	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78926	40	Pediatrics	0	In state provider	None	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	37	06073	33.14066871	-117.156095	San Diego County
34771	Fee-for-Service	1659880946	1659880946	1	4	LIGHTHOUSE COUNSELING AND FA	8/14/2020	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	MILY RESOURCE CENTER	735 SUNRISE AVE	110	ROSEVILLE	CA	95661	4596	31	06061	38.73334248	-121.2720172	Placer County
34781	Fee-for-Service	1548623671	1548623671	1	1	LONGWELL, BENJAMIN DO	8/11/2021	207L00000X	NA	Other	026	PHYSICIANS	18376	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
34787	Fee-for-Service	1841232717	1841232717	1	1	LAI, MAI K MD	3/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90320	None	None	0	In state provider	None	47111 MONROE STREET	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
34795	Fee-for-Service	1104489897	1104489897	1	1	LOPEZ, SANTIAGO MD	9/12/2023	207P00000X	NA	Other	026	PHYSICIANS	184318	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
34819	Fee-for-Service	1235897331	1235897331	1	1	LGDM	1/27/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 S CENTRAL AVE	101A	GLENDALE	CA	91204	4375	19	06037	34.13654729	-118.2578243	Los Angeles County
34866	Fee-for-Service	1750034674	1750034674	1	1	LITTLE TOWN, LLC	8/2/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	40125 10TH ST W	STE U	PALMDALE	CA	93551	3035	19	06037	34.6122493	-118.1477991	Los Angeles County
34882	Fee-for-Service	1992854384	1992854384	1	1	LEE, PHOEBUS P CRNA	10/26/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
34890	Fee-for-Service	1760688345	1760688345	1	1	LANAUSSE, YVETTE LCSW	1/5/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
34914	Fee-for-Service	1578566246	1578566246	1	1	LOPEZ, LORENZO MD	10/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	62591	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	722 MEDICAL CENTER DR E	STE 101	CLOVIS	CA	93611	6810	10	06019	36.84107334	-119.6587409	Fresno County
34925	Fee-for-Service	1649278243	1649278243	1	1	LIU, FRANK S MD	1/2/1979	207L00000X	NA	Other	026	PHYSICIANS	31216	05	Anesthesiology	0	In state provider	None	11601 SANTA MONICA BLVD	None	LOS ANGELES	CA	90025	2907	19	06037	34.04458879	-118.4542015	Los Angeles County
34945	Fee-for-Service	1124706221	1124706221	1	1	LOS ANGELES COUNTY ADDICTION	4/29/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	TREATMENT CENTER, INC.	20630 CHATSWORTH ST	None	CHATSWORTH	CA	91311	1631	19	06037	34.26447565	-118.5830859	Los Angeles County
34946	Fee-for-Service	1164452546	1164452546	1	1	LIEM, WIEKE H MD	5/27/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	70387	07	Dermatology	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
34960	Fee-for-Service	1811945611	1811945611	1	1	LE, HOE H MD INC	8/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	43614	08	Family Practice	0	In state provider	None	10201 MISSION GORGE RD	STE 0	SANTEE	CA	92071	3027	37	06073	32.83844552	-116.9759925	San Diego County
34964	Fee-for-Service	1780677732	1780677732	1	1	LIPSCOMB, DIANE C MD	5/1/2002	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
34991	Fee-for-Service	1912328485	1912328485	1	1	LOYAL HOSPICE CARE, INC	4/25/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	9608 VAN NUYS BLVD	SUITE 207-B	PANORAMA CITY	CA	91402	1000	19	06037	34.24485892	-118.4502135	Los Angeles County
35005	Fee-for-Service	1629230917	1629230917	1	1	LLOYD, ADRIANA V PSYD	4/15/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
35016	Fee-for-Service	1770042897	1770042897	1	1	LIVNAT, ITAMAR MD	6/5/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	180711	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
35026	Fee-for-Service	1245214261	1245214261	1	1	LU, ZHI-WEN MD INC	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	56421	41	Internal Medicine	0	In state provider	None	412 W CARROLL AVE	STE 104	GLENDORA	CA	91741	4704	19	06037	34.13415622	-117.8702547	Los Angeles County
35048	Fee-for-Service	1912014481	1912014481	1	1	LIN, JULIE C	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78926	66	Emergency Medicine (Urgent Care)	0	In state provider	None	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	37	06073	33.14066871	-117.156095	San Diego County
35059	Fee-for-Service	1548203862	1548203862	2	1	LONGS DRUG STORES CA, LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	46445 MISSION BLVD	None	FREMONT	CA	94539	7909	01	06001	37.49187801	-121.9271172	Alameda County
35069	Fee-for-Service	1356658611	1356658611	1	1	LOVATO FAMILY OPTOMETRIC	2/14/2011	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	4566 FLORENCE AVE	STE 6	CUDAHY	CA	90201	4347	19	06037	33.97004595	-118.1858787	Los Angeles County
35072	Fee-for-Service	1447225156	1447225156	1	1	LIN, TINA MD	7/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95441	14	Neurological Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
35089	Fee-for-Service	1124047063	1124047063	1	1	LEIBOWITZ, MATTHEW R MD	6/1/1998	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	82313	77	Infectious Disease	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
35100	Fee-for-Service	1063916310	1063916310	1	1	LESTER, CATHERINE LCSW	9/4/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
35126	Fee-for-Service	1457747248	1457747248	1	1	LIVINGSTON-ROSANOFF, DEVON	10/16/2023	208600000X	NA	General Surgery	026	PHYSICIANS	188267	None	None	0	In state provider	MD	6121 N THESTA ST	202	FRESNO	CA	93710	8603	10	06019	36.82493955	-119.783139	Fresno County
35154	Fee-for-Service	1710925904	1710925904	1	1	LIU, XIUSHI S MD	8/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109894	41	Internal Medicine	0	In state provider	None	220 S 1ST ST	None	ALHAMBRA	CA	91801	3893	19	06037	34.09192598	-118.1259775	Los Angeles County
35178	Fee-for-Service	1144312141	1144312141	1	1	LASTUFKA, FRANCIS J	12/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	61232	08	Family Practice	0	In state provider	None	25 N 14TH ST	STE 1060	SAN JOSE	CA	95112	6209	43	06085	37.34293357	-121.8775187	Santa Clara County
35182	Fee-for-Service	1407268618	1407268618	1	1	LAWC DERMATOLOGY	12/8/2014	207N00000X	NA	Dermatology	026	PHYSICIANS	116156	07	Dermatology	0	In state provider	None	8221 ROCHESTER AVE	SUITE 130	RANCHO CUCAMONGA	CA	91730	0721	36	06071	34.104249	-117.5430105	San Bernardino County
35187	Fee-for-Service	1477631570	1477631570	1	1	LUTZ, JENNIFER A MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	69389	40	Pediatrics	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
35192	Fee-for-Service	1407948862	1407948862	1	1	LATCH, LLOYD E DC	11/1/1975	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	A CHIROPRACTIC CORP	1237 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	5506	38	06075	37.78713385	-122.4218515	San Francisco County
35216	Fee-for-Service	1770696528	1770696528	1	1	LOZA, JULIO A DO	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7721	41	Internal Medicine	0	In state provider	None	850 S ATLANTIC BLVD	STE 101	MONTEREY PARK	CA	91754	4727	19	06037	34.05097684	-118.1379979	Los Angeles County
35217	Fee-for-Service	1194803098	1194803098	1	1	LAND, MARY C MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67642	40	Pediatrics	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
35252	Fee-for-Service	1780677732	1780677732	1	1	LIPSCOMB, DIANE C MD	5/1/2002	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
35286	Fee-for-Service	1972514503	1972514503	1	1	LONG BEACH MEMORIAL MEDICAL	10/2/1992	3336H0001X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	HOME CARE PHARMACY	450 E SPRING ST	STE 11	LONG BEACH	CA	90806	1625	19	06037	33.8099218	-118.1872346	Los Angeles County
35302	Fee-for-Service	1821418302	1821418302	1	1	LE, THUY-TIEN B MD	1/27/2020	207R00000X	NA	Other	026	PHYSICIANS	156410	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
35340	Fee-for-Service	1760559819	1760559819	1	1	LE, THANG T MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74522	41	Internal Medicine	0	In state provider	ATTN MGA OFFICE	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
35363	Fee-for-Service	1528264371	1528264371	1	1	LARES, EDUARDO	7/1/2010	163WG0000X	NA	Other	026	PHYSICIANS	107364	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1798 NORTH GAREY AVENUE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
35369	Fee-for-Service	1396278529	1396278529	1	1	LI, LINGSHENG MD	6/14/2022	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	170356	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
35415	Fee-for-Service	1235828062	1235828062	1	1	LANG, COLIN PT	12/20/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1922 HACIENDA DR	None	VISTA	CA	92081	0000	37	06073	33.1855682	-117.2834788	San Diego County
35423	Fee-for-Service	1922150267	1922150267	1	1	LII, SHYH-MINE MD	6/30/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	48765	08	Family Practice	0	In state provider	None	3859 ROSEMEAD BLVD	None	ROSEMEAD	CA	91770	1976	19	06037	34.07830627	-118.0732309	Los Angeles County
35443	Fee-for-Service	1356532600	1356532600	1	1	LE, PHUONG	4/1/2010	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	HORIZON OPTOMETRIC GROUP	9600 BOLSA AVE	STE C & H	WESTMINSTER	CA	92683	5949	30	06059	33.74479453	-117.9619155	Orange County
35460	Fee-for-Service	1881680320	1881680320	1	1	LALAMA, VICTOR HD DC	1/1/1979	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	8601 WHEELER AVE	None	FONTANA	CA	92335	3854	36	06071	34.09732414	-117.4346278	San Bernardino County
35475	Fee-for-Service	1184651820	1184651820	1	1	LUE, TOM F MD	12/31/1993	208800000X	NA	Other	026	PHYSICIANS	33382	34	Urology and Urological Surgery	0	In state provider	U C S F	400 PARNASSUS AVE	STE A610	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
35481	Fee-for-Service	1093839649	1093839649	1	1	LAURA MARIE STURGIS PH.D.	10/30/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2851 E MANOA RD	STE 1-203	HONOLULU	HI	96822	1858	00	None	21.30954846	-157.8107196	Honolulu County
35507	Fee-for-Service	1770696528	1770696528	1	1	LOZA, JULIO A DO	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7721	01	General Practice	0	In state provider	None	850 S ATLANTIC BLVD	STE 101	MONTEREY PARK	CA	91754	4727	19	06037	34.05097684	-118.1379979	Los Angeles County
35514	Fee-for-Service	1164471918	1164471918	1	1	LIU, FU-TONG MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	70628	None	None	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
35518	Fee-for-Service	1477697001	1477697001	1	1	LONGSERRE, LINDA L LMFT	9/24/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1000 FREMONT AVE	STE 202	SOUTH PASADENA	CA	91030	3225	19	06037	34.11448921	-118.1530905	Los Angeles County
35539	Fee-for-Service	1821679317	1821679317	1	1	L&L DIAGNOSTICS LLC	10/3/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	908 N CITRUS AVE	None	COVINA	CA	91722	2737	19	06037	34.0962229	-117.8901388	Los Angeles County
35561	Fee-for-Service	1083611230	1083611230	1	1	LEVER, BARBARA M MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	47875	41	Internal Medicine	0	In state provider	None	19066 MAGNOLIA ST	None	HUNTINGTON BEACH	CA	92646	2232	30	06059	33.68568661	-117.9714001	Orange County
35586	Fee-for-Service	1326643883	1326643883	1	1	LOUIE, WENDY K NP	2/3/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
35599	Fee-for-Service	1376997072	1376997072	1	1	LEE, SAMUEL MD	7/14/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	155614	36	Psychiatry	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
35620	Fee-for-Service	1679766042	1679766042	1	1	LOU, YENMAY S MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85454	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
35626	Fee-for-Service	1912327875	1912327875	1	1	LEONG, JASON H MD	10/19/2021	207L00000X	NA	Other	026	PHYSICIANS	137598	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
35627	Fee-for-Service	1790878759	1790878759	1	1	LEVIN, VICTOR A MD	4/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	22392	13	Neurology (M.D. only)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
35628	Fee-for-Service	1902830359	1902830359	1	1	LUM, GORDON S JR MD	7/20/1988	207P00000X	NA	Other	026	PHYSICIANS	55623	01	General Practice	0	In state provider	None	1034 35TH ST	None	SACRAMENTO	CA	95816	5302	34	06067	38.570868	-121.460373	Sacramento County
35629	Fee-for-Service	1144409616	1144409616	1	1	LARNER, ALLAN I MD INC	2/24/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	28596	08	Family Practice	0	In state provider	None	921 S BEACON ST	None	SAN PEDRO	CA	90731	3740	19	06037	33.73553795	-118.2805075	Los Angeles County
35640	Fee-for-Service	1396735346	1396735346	1	1	LAWRENCE E LONG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1700 E 19TH ST	None	THE DALLES	OR	97058	3317	00	None	45.58806554	-121.164498	Wasco County
35642	Fee-for-Service	1033153028	1033153028	1	1	LANDOVITZ, RAPHAEL J MD	9/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96826	None	None	0	In state provider	None	1399 ROXBURY DR	STE 100	LOS ANGELES	CA	90035	4709	19	06037	34.05424495	-118.4023816	Los Angeles County
35689	Fee-for-Service	1114363827	1114363827	1	1	LATTING, JOHN W MD	1/15/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	168540	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
35697	Fee-for-Service	1164696753	1164696753	1	1	LI, YAN	5/7/2008	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1135 E ROUTE 66	#111	GLENDORA	CA	91740	3778	19	06037	34.12888853	-117.845127	Los Angeles County
35698	Fee-for-Service	1245813146	1245813146	1	1	LOPEZ, AMY E	5/9/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2530 ATLANTIC AVE	STE D	LONG BEACH	CA	90806	2741	19	06037	33.803172	-118.185004	Los Angeles County
35706	Fee-for-Service	1063404762	1063404762	1	1	LEHMAN, AUDRA B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77708	08	Family Practice	0	In state provider	None	1301 SOUTHPOINT BLVD	None	PETALUMA	CA	94954	6858	49	06097	38.26109022	-122.6476782	Sonoma County
35709	Fee-for-Service	1922150267	1922150267	1	1	LII, SHYH-MINE MD	6/30/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	48765	01	General Practice	0	In state provider	None	3859 ROSEMEAD BLVD	None	ROSEMEAD	CA	91770	1976	19	06037	34.07830627	-118.0732309	Los Angeles County
35713	Fee-for-Service	1679589816	1679589816	1	1	LIN, JUI KUANG MD	3/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	31805	None	None	0	In state provider	PO BOX 2156	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
35722	Fee-for-Service	1851068233	1851068233	1	1	LUBNA ISHO DO INC	8/26/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	250 W BONITA AVE	SUITE 150	POMONA	CA	91767	1863	19	06037	34.09664881	-117.751261	Los Angeles County
35746	Fee-for-Service	1326012154	1326012154	1	1	LEE, JONATHAN K MD	2/9/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	69750	25	Physical Medicine and Rehabilitation	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
35794	Fee-for-Service	1710478227	1710478227	1	1	LIOU, SHERRY MD	3/20/2023	207L00000X	NA	Other	026	PHYSICIANS	166558	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
35807	Fee-for-Service	1144210980	1144210980	1	1	LEE, LUANN OD	8/25/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7075 N SHARON AVE	None	FRESNO	CA	93720	3329	10	06019	36.83882737	-119.7590708	Fresno County
35813	Fee-for-Service	1821296609	1821296609	1	1	LOU, SHIRLEY D	5/25/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	75036 GERALD FORD DRIVE	None	PALM DESERT	CA	92211	2080	33	06065	33.78158473	-116.353994	Riverside County
35841	Fee-for-Service	1528416435	1528416435	1	1	LOPEZ, CYNTHIA CNP	8/20/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	491 E ALESSANDRO BLVD	None	RIVERSIDE	CA	92508	6071	33	06065	33.91628714	-117.3230954	Riverside County
35886	Fee-for-Service	1861832768	1861832768	1	1	LEE, JENNIFER W MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149457	18	Ophthalmology	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	9687	07	06013	37.94947636	-121.7752571	Contra Costa County
35895	Fee-for-Service	1073623278	1073623278	1	1	LAL, MUNISH MD INC	4/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85179	05	Anesthesiology	0	In state provider	PROFESSIONAL CORPORATION	274 COHASSET RD	STE 110	CHICO	CA	95926	2236	04	06007	39.75169866	-121.851622	Butte County
35921	Fee-for-Service	1194115188	1194115188	1	1	LARGENT, JAMES S LCSW	3/5/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2558 ROOSEVELT ST	304	CARLSBAD	CA	92008	1672	37	06073	33.1647304	-117.3513763	San Diego County
35924	Fee-for-Service	1972046423	1972046423	2	1	LYNN, BRIAN W PHD	6/19/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8695 EL CERRO CIR	None	FOUNTAIN VALLEY	CA	92708	5008	30	06059	33.70179837	-117.9769542	Orange County
35943	Fee-for-Service	1255374047	1255374047	2	1	LONGS DRUG STORES CALIFO	4/23/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	783 RIO DEL MAR BLVD	STE 3	APTOS	CA	95003	4700	44	06087	36.97397481	-121.8882196	Santa Cruz County
35955	Fee-for-Service	1346573094	1346573094	1	1	LUO, CANDACE LAC	4/21/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
35981	Fee-for-Service	1033278668	1033278668	1	1	LOZAR,DAVID C MD	11/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	72253	08	Family Practice	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
35990	Fee-for-Service	1770632655	1770632655	2	1	LIMAS PROFESSIONAL PHARMACY	11/7/2017	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	INC	2097 HARRISON AVE	None	EUREKA	CA	95501	3211	12	06023	40.78845	-124.1396025	Humboldt County
35991	Fee-for-Service	1588029953	1588029953	1	1	LINKOVA, ANASTASSIA	8/8/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	721402	-	NOT APPLICABLE	0	In state provider	None	4838 LAUREL CANYON BLVD	None	NORTH HOLLYWOOD	CA	91607	3717	19	06037	34.158726	-118.3964605	Los Angeles County
36000	Fee-for-Service	1871536664	1871536664	2	1	LONGS DRUG STORES CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	906 E ST	None	MARYSVILLE	CA	95901	5329	58	06115	39.14475017	-121.5912604	Yuba County
36119	Fee-for-Service	1669546164	1669546164	1	1	LIM, TREVOR D MD	1/3/2022	2085R0001X	NA	Other	026	PHYSICIANS	87508	None	None	0	In state provider	None	44151 15TH ST W	101	LANCASTER	CA	93534	4079	19	06037	34.68551775	-118.1568686	Los Angeles County
36121	Fee-for-Service	1952461774	1952461774	1	1	LOS REYES CLINICA MEDICA	2/16/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC	2715 SANTA ANA ST	None	SOUTH GATE	CA	90280	2021	19	06037	33.96465909	-118.2217216	Los Angeles County
36144	Fee-for-Service	1073557260	1073557260	1	1	LUND, LUCAS Z DO	3/6/2025	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	23047	41	Internal Medicine	0	In state provider	None	5765 GREENBACK LN	None	SACRAMENTO	CA	95841	2013	34	06067	38.681622	-121.327848	Sacramento County
36202	Fee-for-Service	1508252180	1508252180	1	1	LE, MINH MD	4/26/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	145535	None	None	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
36249	Fee-for-Service	1366937484	1366937484	1	1	LESTER, MELISSA MD	9/11/2023	207LP3000X	NA	Other	026	PHYSICIANS	188208	None	None	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
36252	Fee-for-Service	1619946779	1619946779	1	1	LE, ANH-DAO V MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81117	07	Dermatology	0	In state provider	None	160 E ARTESIA ST	STE 310	POMONA	CA	91767	2922	19	06037	34.07556833	-117.7507835	Los Angeles County
36271	Fee-for-Service	1487712022	1487712022	2	1	LINCARE INC	10/14/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	13455 MALAKI RD	SUITE 6F	APPLE VALLEY	CA	92308	2200	36	06071	34.495956	-117.1770505	San Bernardino County
36295	Fee-for-Service	1538229638	1538229638	1	3	LYON, DAVID H MD	5/13/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	43180	-	NOT APPLICABLE	0	In state provider	None	823 E ORANGEBURG AVE	None	MODESTO	CA	95350	4619	50	06099	37.66364047	-120.98268	Stanislaus County
36319	Fee-for-Service	1194897132	1194897132	1	1	LIEBOWITZ, ELLEN B OD	9/9/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	421 PIONEER AVE	STE B	WOODLAND	CA	95776	4948	57	06113	38.6759259	-121.7468988	Yolo County
36345	Fee-for-Service	1427004621	1427004621	1	1	LIEBERMAN, RONALD E MD	7/2/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83884	66	Emergency Medicine (Urgent Care)	0	In state provider	None	616 WITMER ST	None	LOS ANGELES	CA	90017	2308	19	06037	34.0549933	-118.2658354	Los Angeles County
36351	Fee-for-Service	1508925165	1508925165	1	1	LIN, CHRISTOPHER C MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67398	05	Anesthesiology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
36372	Fee-for-Service	1417714940	1417714940	1	1	LENCIONI, AMIE NP	5/1/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
36388	Fee-for-Service	1508944166	1508944166	1	1	LAKSHMANAN, ALAMELU M MD	12/4/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	56435	41	Internal Medicine	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
36390	Fee-for-Service	1104896372	1104896372	1	1	LIM, EDWARD L OD	9/3/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2109 FOREST AVE	None	CHICO	CA	95928	7680	04	06007	39.721518	-121.8015025	Butte County
36391	Fee-for-Service	1982647228	1982647228	1	1	LESLIE K TOMEK M.D.	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1720 UNIVERSITY DR S	None	FARGO	ND	58103	4940	00	None	46.853136	-96.797421	Cass County
36394	Fee-for-Service	1568738854	1568738854	1	1	LAZORWITZ, AARON M MD	1/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
36408	Fee-for-Service	1760550651	1760550651	1	1	LAWSIN, LOREDO M MD	2/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136766	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
36409	Fee-for-Service	1952461774	1952461774	1	1	LOS REYES CLINICA MEDICA	2/16/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	2715 SANTA ANA ST	None	SOUTH GATE	CA	90280	2021	19	06037	33.96465909	-118.2217216	Los Angeles County
36476	Fee-for-Service	1881288272	1881288272	1	1	LAM, WHITNEY NP	4/19/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
36478	Fee-for-Service	1285963124	1285963124	1	1	LALEZARZADEH, FARIBORZ DO	3/22/2010	208600000X	NA	General Surgery	026	PHYSICIANS	8309	02	General Surgery	0	In state provider	INC	399 E HIGHLAND	#319	SAN BERNARDINO	CA	92404	3858	36	06071	34.1358627	-117.2757898	San Bernardino County
36484	Fee-for-Service	1801327481	1801327481	1	1	LUONG, ALBERT MD	11/12/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	191820	36	Psychiatry	0	In state provider	None	100 PINE ST	STE 1250	SAN FRANCISCO	CA	94111	5235	38	06075	37.79237874	-122.3989278	San Francisco County
36497	Fee-for-Service	1043251143	1043251143	1	2	LEE, CAROL H MD	5/31/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	68496	-	NOT APPLICABLE	0	In state provider	None	1841 E MAIN ST	None	BARSTOW	CA	92311	3234	36	06071	34.8901829	-116.9978731	San Bernardino County
36517	Fee-for-Service	1821146606	1821146606	1	1	LO, SIANG LIAN	5/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6730	01	General Practice	0	In state provider	None	17821 PIONEER BLVD	None	ARTESIA	CA	90701	3901	19	06037	33.8691791	-118.0823685	Los Angeles County
36591	Fee-for-Service	1649458795	1649458795	1	1	LY, STACY D MD	1/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102438	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
36606	Fee-for-Service	1407022106	1407022106	1	1	LARIVIERE, LORI L MD	3/27/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	146660	-	NOT APPLICABLE	0	In state provider	None	560 COHASSET ROAD	STE 165	CHICO	CA	95926	2460	04	06007	39.7519137	-121.8477606	Butte County
36607	Fee-for-Service	1265632558	1265632558	1	1	LONGINO, CYNTHIA N MFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	78627	-	NOT APPLICABLE	0	In state provider	None	15305 RAYEN STREET	None	NORTH HILLS	CA	91343	5117	19	06037	34.23191048	-118.4657625	Los Angeles County
36643	Fee-for-Service	1689827057	1689827057	1	1	LEWIS, REBECCA L	10/2/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1450 SAN PABLO ST	STE 5901	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
36646	Fee-for-Service	1487090213	1487090213	1	1	LE, MARK B MD	8/19/2019	2085R0204X	NA	Other	026	PHYSICIANS	160384	30	Radiology	0	In state provider	None	4640 ADMIRALTY WAY	STE 102	MARINA DEL REY	CA	90292	6629	19	06037	33.98120707	-118.4409729	Los Angeles County
36662	Fee-for-Service	1174621353	1174621353	1	1	LE THANG Q MD INC	8/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	71456	05	Anesthesiology	0	In state provider	None	7901 WALKER ST	None	LA PALMA	CA	90623	1722	30	06059	33.84755382	-118.0373024	Orange County
36663	Fee-for-Service	1053132407	1053132407	1	1	LUU, THEO OT	1/28/2025	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
36668	Fee-for-Service	1548314313	1548314313	1	1	LEE, THOMAS K MD	10/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106146	22	Pathology (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
36669	Fee-for-Service	1801255500	1801255500	1	1	LEMUS, BIANCA LPCC	11/15/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
36701	Fee-for-Service	1912008582	1912008582	1	1	LA VASCULAR AND ENDOVASCULAR	11/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	64485	02	General Surgery	0	In state provider	SURGERY - AMC	201 S BUENA VISTA	STE #325	BURBANK	CA	91505	4569	19	06037	34.15978726	-118.3289164	Los Angeles County
36715	Fee-for-Service	1316105554	1316105554	1	1	LAI, EN M DO	10/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	6144	01	General Practice	0	In state provider	None	616 N GARFIELD AVE	STE 300	MONTEREY PARK	CA	91754	1101	19	06037	34.06916465	-118.1229039	Los Angeles County
36718	Fee-for-Service	1851984165	1851984165	1	1	LEONARDO, PAOLO PT	2/12/2024	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	16025 GALE AVE	STE B7	CITY OF INDUSTRY	CA	91745	1633	19	06037	34.00908153	-117.9571941	Los Angeles County
36735	Fee-for-Service	1013979269	1013979269	1	1	LOWY, JAMES A MD	8/13/1971	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21122	08	Family Practice	0	In state provider	None	500 DOYLE PARK DR	STE G04	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
36758	Fee-for-Service	1144336181	1144336181	1	2	LA CLINICA DE LA RAZA	4/1/1992	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	SAN ANTONIO NEIGHBORHOOD	1030 E 14TH ST	None	OAKLAND	CA	94606	3730	01	06001	37.79174716	-122.2492125	Alameda County
36776	Fee-for-Service	1669828265	1669828265	1	1	LAW, TIMOTHY MD	11/20/2023	207ZP0102X	NA	Other	026	PHYSICIANS	154026	None	None	0	In state provider	None	20001 S RANCHO WAY	None	COMPTON	CA	90220	6318	19	06037	33.8498073	-118.2223737	Los Angeles County
36806	Fee-for-Service	1578584694	1578584694	1	1	LEE, HONG-LING MD	8/1/1984	174400000X	NA	Other	026	PHYSICIANS	34719	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	603 E LATHAM AVE	# 1	HEMET	CA	92543	4342	33	06065	33.74933852	-116.96598	Riverside County
36808	Fee-for-Service	1275536799	1275536799	1	1	LAFAYETTE GENERAL	4/26/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	1214 COOLIDGE BLVD	None	LAFAYETTE	LA	70503	2621	00	None	30.20240927	-92.01862646	Lafayette Parish
36834	Fee-for-Service	1629585930	1629585930	1	1	LEOSHKO, JULIA CRNA	11/6/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
36848	Fee-for-Service	1871981498	1871981498	1	1	LOFTON, ALLISON CRNA	9/5/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
36882	Fee-for-Service	1588792915	1588792915	1	1	LEE, LAURE M MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	84542	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
36905	Fee-for-Service	1770656753	1770656753	1	1	LOCK, WILLIAM S MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69314	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
36933	Fee-for-Service	1033177449	1033177449	1	1	LONG, KATHLEEN L MD	12/4/1986	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	23162	40	Pediatrics	0	In state provider	None	1235 OSOS ST	None	SAN LUIS OBISPO	CA	93401	3600	40	06079	35.27979518	-120.6596361	San Luis Obispo County
36983	Fee-for-Service	1194725267	1194725267	1	1	LINCOLN, LAWRENCE J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5697 E. GRANT ROAD	None	TUCSON	AZ	85721	2211	00	None	32.25080208	-110.8710774	Pima County
36999	Fee-for-Service	1396930038	1396930038	1	1	LAI, JASON S MD INC	12/29/2008	208800000X	NA	Other	026	PHYSICIANS	86130	34	Urology and Urological Surgery	0	In state provider	None	8135 S PAINTER AVE	STE 304	WHITTIER	CA	90602	3102	19	06037	33.965829	-118.032738	Los Angeles County
37015	Fee-for-Service	1144857038	1144857038	1	1	LI, ALEX MD	7/27/2023	208M00000X	NA	Other	026	PHYSICIANS	186235	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
37029	Fee-for-Service	1275691875	1275691875	1	1	LAURO, PATRICK OD	1/31/1988	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3530 ATLANTIC AVE	STE 106	LONG BEACH	CA	90807	4569	19	06037	33.820875	-118.1850035	Los Angeles County
37048	Fee-for-Service	1790103695	1790103695	1	1	LIFE TREE HOSPICE INC	4/27/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	17779 VENTURA BLVD	STE 202	ENCINO	CA	91316	3717	19	06037	34.16283238	-118.5199399	Los Angeles County
37053	Fee-for-Service	1487972261	1487972261	1	1	LO, AILEEN K Y MD	9/25/2018	2083P0901X	NA	Adult Primary Care	026	PHYSICIANS	132421	01	General Practice	0	In state provider	None	150 E HOLT BLVD	None	ONTARIO	CA	91761	1613	36	06071	34.063164	-117.6502275	San Bernardino County
37082	Fee-for-Service	1730412024	1730412024	1	1	LAWRENCE, GENE C MD INC	1/1/1979	193400000X	NA	Other	026	PHYSICIANS	29177	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	ONE HOAG DR	None	NEWPORT BEACH	CA	92658	6100	30	06059	33.62421676	-117.9309656	Orange County
37084	Fee-for-Service	1528473642	1528473642	1	1	LEE, BRITTANY V LCSW	10/29/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
37092	Fee-for-Service	1578584694	1578584694	1	1	LEE, HONG-LING MD	8/1/1984	174400000X	NA	Other	026	PHYSICIANS	34719	41	Internal Medicine	0	In state provider	None	603 E LATHAM AVE	# 1	HEMET	CA	92543	4342	33	06065	33.74933852	-116.96598	Riverside County
37094	Fee-for-Service	1346833019	1346833019	1	1	LANGDALE, BRINN E LMFT	2/19/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2131 CAPITOL AVE	SUITE 206	SACRAMENTO	CA	95816	5755	34	06067	38.573073	-121.4788005	Sacramento County
37096	Fee-for-Service	1275536799	1275536799	1	1	LAFAYETTE GENERAL	4/26/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	1214 COOLIDGE BLVD	None	LAFAYETTE	LA	70503	2621	00	None	30.20240927	-92.01862646	Lafayette Parish
37103	Fee-for-Service	1689890758	1689890758	1	1	LIFELINE TREATMENT SERVICES	11/6/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	10429 INTERNATIONAL BLVD	None	OAKLAND	CA	94603	3221	01	06001	37.73941567	-122.1668635	Alameda County
37108	Fee-for-Service	1619491115	1619491115	1	1	LOPEZ, BRENDA	11/5/2024	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
37121	Fee-for-Service	1366603045	1366603045	1	1	LOUGHLAND, MACKENZIE E MD	1/8/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	2825 EAST BARNETT ROAD	None	MEDFORD	OR	97504	8383	00	None	42.31650147	-122.8306005	Jackson County
37140	Fee-for-Service	1225895162	1225895162	1	1	LA COMFORT RIDE LLC	5/13/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1087 PARK CIRCLE DR	None	TORRANCE	CA	90502	2817	19	06037	33.81459417	-118.2930372	Los Angeles County
37163	Fee-for-Service	1912043001	1912043001	1	1	LIANG, XINGJIE LAC	5/3/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
37169	Fee-for-Service	1396787107	1396787107	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2224 PATTERSON RD	None	RIVERBANK	CA	95367	9647	50	06099	37.73262247	-120.957552	Stanislaus County
37175	Fee-for-Service	1811424682	1811424682	1	1	LEE, DARRICK B DO	8/21/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16700	08	Family Practice	0	In state provider	None	1250 LA VENTA DRIVE	100, 101A, 105, 207, 211	WESTLAKE VILLAGE	CA	91361	3774	19	06037	34.14827603	-118.8227637	Ventura County
37195	Fee-for-Service	1922337518	1922337518	1	1	LOVETT, NICOLE M	9/14/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
37197	Fee-for-Service	1659455251	1659455251	1	1	LAM, DIANA MD	8/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	45411	41	Internal Medicine	0	In state provider	None	2350 IRVING ST	None	SAN FRANCISCO	CA	94122	1621	38	06075	37.76332206	-122.4832473	San Francisco County
37229	Fee-for-Service	1700386539	1700386539	1	1	LEWIS, LISA LMFT	2/18/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	446 S MARENGO AVE	SUITE A	PASADENA	CA	91101	3113	19	06037	34.138512	-118.1458425	Los Angeles County
37247	Fee-for-Service	1700115722	1700115722	1	2	LOS NINOS CHILDRENS MEDICAL	2/1/2001	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	CLINIC APC	1150 N. HACIENDA BLVD.	None	LA PUENTE	CA	91744	1663	19	06037	34.04113831	-117.9494747	Los Angeles County
37257	Fee-for-Service	1194081729	1194081729	1	1	LERNER, DAVID R DO	8/26/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	16568	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
37258	Fee-for-Service	1407210529	1407210529	1	1	LAU, IGNATIUS H MD	9/27/2021	2086S0129X	NA	General Surgery	026	PHYSICIANS	171825	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
37259	Fee-for-Service	1336559038	1336559038	1	1	LALEZARI, SHAHRZAD DO	12/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14349	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
37273	Fee-for-Service	1831273960	1831273960	1	1	LIN, NANCY J PHD	1/29/2016	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4025 CAMINO DEL RIO S	STE 300	SAN DIEGO	CA	92108	4107	37	06073	32.77795434	-117.1076906	San Diego County
37320	Fee-for-Service	1447603394	1447603394	1	1	LY, KELLY M OD	4/9/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1721 WESTWIND DR	STE B	BAKERSFIELD	CA	93301	3026	15	06029	35.37519935	-119.0425415	Kern County
37335	Fee-for-Service	1790103695	1790103695	1	1	LIFE TREE HOSPICE INC	4/27/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	17779 VENTURA BLVD	STE 202	ENCINO	CA	91316	3717	19	06037	34.16283238	-118.5199399	Los Angeles County
37351	Fee-for-Service	1841667904	1841667904	1	1	LOGAN, EMILY G PT	2/28/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3760 CONVOY STREET	100	SAN DIEGO	CA	92111	3743	37	06073	32.81197521	-117.1531278	San Diego County
37357	Fee-for-Service	1790722692	1790722692	1	1	LUNDIN, DAVID A MD	7/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95443	01	General Practice	0	In state provider	None	160 E ARTESIA ST	STE 360	POMONA	CA	91767	2927	19	06037	34.07556833	-117.7507835	Los Angeles County
37375	Fee-for-Service	1104854025	1104854025	1	1	LUJAN, JASON P M D	4/1/1999	207L00000X	NA	Other	026	PHYSICIANS	61322	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
37385	Fee-for-Service	1912910647	1912910647	1	1	LEMUS, LUCILLE L MD	9/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	43514	07	Dermatology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
37405	Fee-for-Service	1508378597	1508378597	1	1	LINEBACK, DAVID L	3/23/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
37408	Fee-for-Service	1891335717	1891335717	1	1	LOMPOC HOSPITALIST GROUP PC	5/13/2020	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1515 EAST OCEAN AVE.	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
37431	Fee-for-Service	1770644262	1770644262	1	1	LINDSAY GARDENSIDENCE OPCO	5/7/1996	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	1011 W TULARE RD	None	LINDSAY	CA	93247	1471	54	06107	36.21057523	-119.106241	Tulare County
37432	Fee-for-Service	1902047228	1902047228	1	1	LANGEVIN, JEAN-PHILIPPE MD	10/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	90703	14	Neurological Surgery	0	In state provider	None	300 MEDICAL PLAZA	STE 200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
37438	Fee-for-Service	1215390620	1215390620	1	1	LAI, ADRIAN C MD	12/5/2019	207RA0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	151841	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
37456	Fee-for-Service	1598726895	1598726895	1	1	LIM, ROMEO N MD	11/12/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53960	08	Family Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
37457	Fee-for-Service	1679892871	1679892871	1	1	LEWIS, SARAH C MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125919	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
37481	Fee-for-Service	1841232659	1841232659	2	1	LONGS DRUG STORES CA LLC	12/26/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	311 S MOUNTAIN AVE	None	UPLAND	CA	91786	7032	36	06071	34.090461	-117.6701655	San Bernardino County
37508	Fee-for-Service	1285605501	1285605501	1	1	LURIE, MICHAEL K MD	8/21/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	44637	02	General Surgery	0	In state provider	None	950 CASS ST	None	MONTEREY	CA	93940	4546	27	06053	36.59271384	-121.8962446	Monterey County
37519	Fee-for-Service	1528007366	1528007366	1	1	LAWSON, KEVIN J MD	2/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	76331	20	Orthopedic Surgery	0	In state provider	None	25455 BARTON RD	None	LOMA LINDA	CA	92354	3312	36	06071	34.04805253	-117.249534	San Bernardino County
37523	Fee-for-Service	1205369709	1205369709	1	1	LINDQUIST, BRITTA E MD	7/29/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	160340	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
37536	Fee-for-Service	1245382431	1245382431	1	1	LEE, DOUGLAS F OD	10/16/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
37540	Fee-for-Service	1629192307	1629192307	1	1	LIVINGSTON UNION SD	3/30/1998	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	922 B ST	None	LIVINGSTON	CA	95334	1150	24	06047	37.38591077	-120.7292229	Merced County
37545	Fee-for-Service	1780609750	1780609750	1	1	LEVY, LAWRENCE A MD	1/1/1982	174400000X	NA	Other	026	PHYSICIANS	23281	41	Internal Medicine	0	In state provider	None	1000 S ELISEO DR	STE 101	GREENBRAE	CA	94904	2150	21	06041	37.94348559	-122.5335273	Marin County
37546	Fee-for-Service	1306473442	1306473442	1	1	LEVAN, SOPHIA MD	9/13/2024	207R00000X	NA	Other	026	PHYSICIANS	176460	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
37568	Fee-for-Service	1578927539	1578927539	1	1	LING, JOHNNY MD	6/10/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171311	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
37569	Fee-for-Service	1407458995	1407458995	1	1	LAKESIDE HOME HEALTH INC	10/10/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4119 W BURBANK BLVD	STE 143	BURBANK	CA	91505	2122	19	06037	34.1730175	-118.3553514	Los Angeles County
37581	Fee-for-Service	1376645861	1376645861	1	1	LIU, RAYMOND MD	7/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81007	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
37586	Fee-for-Service	1346560125	1346560125	1	1	LARSON, KATHRYN D	7/18/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
37588	Fee-for-Service	1952609257	1952609257	1	1	LIN, TINA C MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119294	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
37617	Fee-for-Service	1881058097	1881058097	1	1	LIVINGSTON, JOSEPHINE L MD	6/1/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7500 HOSPITAL DRIVE	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
37621	Fee-for-Service	1760514939	1760514939	1	2	LEE, SHANNON LMFT	3/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3111 LOS FELIZ BLVD	SUITE 106	LOS ANGELES	CA	90039	1599	19	06037	34.12432566	-118.2669792	Los Angeles County
37632	Fee-for-Service	1043891187	1043891187	1	1	LEE, SALLEY S DO	8/28/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22262	08	Family Practice	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
37647	Fee-for-Service	1154515393	1154515393	1	1	LOUBRIEL,MITZI Z MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67558	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
37665	Fee-for-Service	1336182666	1336182666	2	1	LONGS DRUG STORES CA LLC	12/22/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1405 FOXWORTHY AVE	None	SAN JOSE	CA	95118	1119	43	06085	37.27495177	-121.8918538	Santa Clara County
37667	Fee-for-Service	1629157375	1629157375	1	1	LEE, WAI-KIN R MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62586	45	Nephrology (Renal-Kidney)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
37682	Fee-for-Service	1831220961	1831220961	1	1	LABAY, ABIGAIL M	3/24/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
37713	Fee-for-Service	1639602675	1639602675	1	1	LEE, ELAINE D MD	10/15/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159629	08	Family Practice	0	In state provider	None	901 CAMPUS DR.	None	DALY CITY	CA	94015	4900	41	06081	37.66535778	-122.4763793	San Mateo County
37718	Fee-for-Service	1083863690	1083863690	1	1	LI, KEVIN K MD	1/1/2011	207L00000X	NA	Other	026	PHYSICIANS	100695	05	Anesthesiology	0	In state provider	None	21530 S PIONEER BLVD	None	HAWAIIAN GARDENS	CA	90716	2608	19	06037	33.83358457	-118.0817796	Los Angeles County
37729	Fee-for-Service	1174697783	1174697783	1	1	LEKANDER, GARY M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	85799	None	None	0	In state provider	None	1375 UNIVERSITY AVENUE	None	HEALDSBURG	CA	95448	3382	49	06097	38.6272407	-122.8638253	Sonoma County
37735	Fee-for-Service	1811133473	1811133473	1	1	LANNUM, SARAH J MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105754	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
37742	Fee-for-Service	1518977735	1518977735	1	1	LIEU, BINH C MD	6/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75402	08	Family Practice	0	In state provider	None	2201 MISSION AVE	None	OCEANSIDE	CA	92054	2328	37	06073	33.20742226	-117.3612486	San Diego County
37750	Fee-for-Service	1992005102	1992005102	1	1	LAO, XIN L MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116027	08	Family Practice	0	In state provider	None	1555 SHAW AVE	None	CLOVIS	CA	93611	4096	10	06019	36.80870008	-119.687617	Fresno County
37751	Fee-for-Service	1356446819	1356446819	1	1	LIN, DAVID W MD	6/5/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	54643	41	Internal Medicine	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
37782	Fee-for-Service	1447337399	1447337399	1	1	LERNER, ALFRED M MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	42903	01	General Practice	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
37794	Fee-for-Service	1285605501	1285605501	1	1	LURIE, MICHAEL K MD	8/21/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	44637	66	Emergency Medicine (Urgent Care)	0	In state provider	None	950 CASS ST	None	MONTEREY	CA	93940	4546	27	06053	36.59271384	-121.8962446	Monterey County
37802	Fee-for-Service	1801974514	1801974514	1	1	LAURENSON, KIMBERLY E MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66220	08	Family Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
37820	Fee-for-Service	1972503233	1972503233	1	1	LA JOLLA ORTHOPAEDIC SURGERY	5/2/2016	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	4120 LA JOLLA VILLAGE DR	None	LA JOLLA	CA	92037	1406	37	06073	32.87194345	-117.2173414	San Diego County
37825	Fee-for-Service	1649389990	1649389990	2	1	LARABEE, TODD M MD	8/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
37829	Fee-for-Service	1073808010	1073808010	1	1	LU, YUXIN MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118926	22	Pathology (M.D. only)	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
37834	Fee-for-Service	1881682656	1881682656	1	1	LIVNAT, GUY S MD	5/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80455	41	Internal Medicine	0	In state provider	None	1350 S ELISEO DR	STE 300	GREENBRAE	CA	94904	2011	21	06041	37.94490653	-122.537021	Marin County
37884	Fee-for-Service	1952478802	1952478802	1	1	LEIFER, TIMOTHY R DO	9/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7778	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
37910	Fee-for-Service	1952729931	1952729931	1	1	LEE, JERRY C MD	10/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148877	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
37947	Fee-for-Service	1063616118	1063616118	1	1	LATIMER, JOEL D LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
37997	Fee-for-Service	1083903850	1083903850	1	1	LI, CONG J MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122081	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
38030	Fee-for-Service	1922167634	1922167634	1	1	LEE, JEANETTE H MD	12/31/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	81588	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
38040	Fee-for-Service	1356446819	1356446819	1	1	LIN, DAVID W MD	6/5/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	54643	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
38064	Fee-for-Service	1013238930	1013238930	1	1	LEE, JUSTIN S H H MD	6/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119852	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
38092	Fee-for-Service	1265493936	1265493936	1	1	LISCOMB, JESSE R JR MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	36753	01	General Practice	0	In state provider	None	250 E HANFORD ARMONA RD	None	LEMOORE	CA	93245	2141	16	06031	36.31347649	-119.7771345	Kings County
38095	Fee-for-Service	1972897478	1972897478	1	1	LOHARUKA, GARIMA DO	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	11972	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 DOYLE PARK DR	STE G-06	SANTA ROSA	CA	95405	4558	49	06097	38.44332	-122.6985255	Sonoma County
38098	Fee-for-Service	1194702563	1194702563	1	1	LEE, JAE K MD	4/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79627	41	Internal Medicine	0	In state provider	None	26732 CROWN VALLEY PKWY	STE 131	MISSION VIEJO	CA	92691	8533	30	06059	33.56347704	-117.66546	Orange County
38113	Fee-for-Service	1245301407	1245301407	1	1	LO, KENSON MD	2/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	87635	40	Pediatrics	0	In state provider	None	30212 TOMAS	SUITE 220	RANCHO SANTA MARG	CA	92688	2174	30	06059	33.63747366	-117.6029402	Orange County
38125	Fee-for-Service	1881682656	1881682656	1	1	LIVNAT, GUY S MD	5/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80455	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1350 S ELISEO DR	STE 300	GREENBRAE	CA	94904	2011	21	06041	37.94490653	-122.537021	Marin County
38162	Fee-for-Service	1285051219	1285051219	1	1	LAND, MEGAN E MD	10/7/2021	2080P0203X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
38169	Fee-for-Service	1245288059	1245288059	1	1	LADABAUM, URI MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	75684	10	Gastroenterology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
38170	Fee-for-Service	1538168372	1538168372	2	1	LIFENET, INC.	6/15/2019	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	1102 W. 32ND ST.	None	JOPLIN	MO	64804	3503	00	None	37.05416859	-94.52742582	Newton County
38181	Fee-for-Service	1457684938	1457684938	1	1	LASSEN, ELIZABETH W PHD	1/30/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PRKWAY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
38198	Fee-for-Service	1396817110	1396817110	1	1	LEUNG, FLORENCE K MD	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	76008	08	Family Practice	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
38200	Fee-for-Service	1114963873	1114963873	1	1	LIN, SHOU-I MD	1/31/1979	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	33667	40	Pediatrics	0	In state provider	None	75 W MARCH LN	STE G	STOCKTON	CA	95207	5729	39	06077	37.99559064	-121.3067448	San Joaquin County
38202	Fee-for-Service	1669859443	1669859443	1	1	LANE, RICHARD A MD	6/10/2020	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	160001	13	Neurology (M.D. only)	0	In state provider	None	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	37	06073	33.12288368	-117.3058276	San Diego County
38209	Fee-for-Service	1689647331	1689647331	1	1	LYON, JAMES W MD	5/31/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	36265	30	Radiology	0	In state provider	None	340 4TH AVE	STE 15	CHULA VISTA	CA	91910	3813	37	06073	32.63831293	-117.0833536	San Diego County
38222	Fee-for-Service	1033140843	1033140843	1	1	LY, BINH T MD	9/1/1999	207P00000X	NA	Other	026	PHYSICIANS	61597	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
38231	Fee-for-Service	1700288586	1700288586	1	1	LUI, KIMBERLY NP	12/17/2018	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
38241	Fee-for-Service	1770019416	1770019416	1	1	LAI, EVERETT MD	6/9/2022	208M00000X	NA	Other	026	PHYSICIANS	159713	None	None	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
38247	Fee-for-Service	1275533473	1275533473	1	1	LINDBERG, CAROL A MD	4/1/1998	2084P0800X	NA	Psychiatry	026	PHYSICIANS	21592	36	Psychiatry	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
38290	Fee-for-Service	1306949326	1306949326	1	1	LE, MAI-TRAM MD	6/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92143	08	Family Practice	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
38314	Fee-for-Service	1255510426	1255510426	1	1	LIPTON, SARAH S M MD	7/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	102597	25	Physical Medicine and Rehabilitation	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
38320	Fee-for-Service	1659880946	1659880946	1	6	LIGHTHOUSE COUNSELING AND FA	9/30/2021	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	MILY RESOURCE CENTER	11990 HERITAGE OAK PLACE	SUITE 4B	AUBURN	CA	95603	2405	31	06061	38.941389	-121.0988205	Placer County
38364	Fee-for-Service	1790863884	1790863884	1	1	LIU, SAMUEL K MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	64755	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
38380	Fee-for-Service	1265493936	1265493936	1	1	LISCOMB, JESSE R JR MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	36753	08	Family Practice	0	In state provider	None	250 E HANFORD ARMONA RD	None	LEMOORE	CA	93245	2141	16	06031	36.31347649	-119.7771345	Kings County
38393	Fee-for-Service	1912699802	1912699802	1	1	LIFETREAT NURSING CORPORATIO	7/18/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	LNESS CENTER	1341 HISTORICAL PLAZA WA	None	MANTECA	CA	95336	5064	39	06077	37.79628766	-121.1964812	San Joaquin County
38436	Fee-for-Service	1497911804	1497911804	1	1	LUGO, BRIAN A MD	7/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	87704	02	General Surgery	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
38460	Fee-for-Service	1386715209	1386715209	1	1	LEVY, GERALD MD	6/30/1995	207RR0500X	NA	Other	026	PHYSICIANS	45061	83	Rheumatology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
38468	Fee-for-Service	1427191949	1427191949	1	1	LOVE, SHERRI PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5150 E CANDLEWOOD SREET	SUITE 4B	LAKEWOOD	CA	90712	1900	19	06037	33.85362254	-118.1326815	Los Angeles County
38503	Fee-for-Service	1598329302	1598329302	1	1	LA VERA HOSPICE INC	10/7/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10700 BURBANK BLVD	SUITE 1	NORTH HOLLYWOOD	CA	91601	2513	19	06037	34.17211552	-118.363959	Los Angeles County
38525	Fee-for-Service	1437680378	1437680378	1	1	LA CHARITE, JAIME M MD MPH	4/10/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	172122	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
38537	Fee-for-Service	1588753750	1588753750	1	1	LEE, JULIE A DO	11/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8856	30	Radiology	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
38547	Fee-for-Service	1508841537	1508841537	1	1	LINK, DANIEL P MD	1/16/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	18653	30	Radiology	0	In state provider	UCD PROF SVCS GROUP	2233 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.555946	-121.45743	Sacramento County
38553	Fee-for-Service	1497711832	1497711832	1	1	LIAO, YAPING J MD	8/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69593	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
38568	Fee-for-Service	1629297924	1629297924	1	2	LIND, MEREDITH N MD	4/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	04	Otology, Laryngology, Rhinology	2	Out of state provider	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
38629	Fee-for-Service	1023107380	1023107380	1	1	LIM, WILLIAM S MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99969	18	Ophthalmology	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
38640	Fee-for-Service	1720472376	1720472376	1	1	LAO, KATHY MD	10/4/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16364	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
38643	Fee-for-Service	1013061555	1013061555	1	1	LACEY, ANNA LCSW	3/17/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1242 PARK ST	SUITE C	ALAMEDA	CA	94501	5500	01	06001	37.76187672	-122.2447503	Alameda County
38681	Fee-for-Service	1033636261	1033636261	1	1	LEARY, SARAH	2/9/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK DR	STE 1000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
38686	Fee-for-Service	1932668084	1932668084	1	1	LIOU, DENG-YUAN D	7/23/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	184769	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
38703	Fee-for-Service	1881082824	1881082824	1	1	LEUNG, EDWIN HO CHUN PT	12/4/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1902 ROYALTY DRIVE	SUITE 220	POMONA	CA	91767	3056	19	06037	34.07791925	-117.746146	Los Angeles County
38721	Fee-for-Service	1760588834	1760588834	1	1	LIU, QUANJING MD	2/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106228	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
38723	Fee-for-Service	1750602694	1750602694	1	1	LIN, JOHN MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128544	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
38744	Fee-for-Service	1306221890	1306221890	1	1	LAM, ANNA	8/19/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10737 CAMINO RUIZ	SUITE 100	SAN DIEGO	CA	92126	2370	37	06073	32.91416051	-117.1437943	San Diego County
38749	Fee-for-Service	1356056253	1356056253	1	1	LOW, MICHELLE J CLD	2/9/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	55	06109	0	0	None
38764	Fee-for-Service	1558322347	1558322347	1	1	LEW, EVA Y MC	7/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	71857	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
38768	Fee-for-Service	1992960892	1992960892	1	1	LOW, RENEE PHD	3/16/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2800 L STREET	SUITE 340	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
38774	Fee-for-Service	1528612322	1528612322	1	1	LEON, ANGELA C	2/2/2022	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	25880 TOURNAMENT RD	SUITE 109	VALENCIA	CA	91355	2384	19	06037	34.39184204	-118.5626441	Los Angeles County
38790	Fee-for-Service	1598329302	1598329302	1	1	LA VERA HOSPICE INC	10/7/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10700 BURBANK BLVD	SUITE 1	NORTH HOLLYWOOD	CA	91601	2513	19	06037	34.17211552	-118.363959	Los Angeles County
38807	Fee-for-Service	1720205917	1720205917	1	1	LAI, JERRY MD	4/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134763	18	Ophthalmology	0	In state provider	None	323 N MATHILDA AVE	None	SUNNYVALE	CA	94085	4207	43	06085	37.38565917	-122.0317807	Santa Clara County
38812	Fee-for-Service	1437680378	1437680378	1	1	LA CHARITE, JAIME M MD MPH	4/10/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	172122	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
38813	Fee-for-Service	1881884682	1881884682	1	1	LAZO, MARIA ANNA C PSYD	5/12/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
38817	Fee-for-Service	1427302256	1427302256	1	1	LEE, MICHAEL K MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123756	24	Plastic Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	BLDG 55	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
38835	Fee-for-Service	1508841537	1508841537	1	1	LINK, DANIEL P MD	1/16/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	18653	01	General Practice	0	In state provider	UCD PROF SVCS GROUP	2233 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.555946	-121.45743	Sacramento County
38837	Fee-for-Service	1821165820	1821165820	1	1	LE, TUYEN T MD	2/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	56152	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
38841	Fee-for-Service	1407987183	1407987183	1	1	LIZARRAGA, ROSA M LMFT	5/10/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2716 S VERMONT AVE	UNIT 9	LOS ANGELES	CA	90007	2671	19	06037	34.029891	-118.2915225	Los Angeles County
38910	Fee-for-Service	1669536942	1669536942	1	1	LATA, BETHANY P	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
38916	Fee-for-Service	1992221113	1992221113	1	1	LLOVIDO, JESSICA D NP	12/5/2017	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
38956	Fee-for-Service	1962418186	1962418186	1	1	LEE, PATRICIA W MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85768	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	930 E FOOTHILL BLVD	STE 2	UPLAND	CA	91786	4051	36	06071	34.10687051	-117.6387075	San Bernardino County
38980	Fee-for-Service	1679720700	1679720700	1	1	LIVELY, HARRY R MD INC	4/21/2009	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	56294	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	119 S LOCUST STREET	SUITE B	VISALIA	CA	93291	0000	54	06107	36.329382	-119.2937355	Tulare County
38988	Fee-for-Service	1326476177	1326476177	1	1	LANCASTER INVESTMENT COMPANY	4/8/2014	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA LLC	1525 7TH AVE	None	OAKLAND	CA	94606	2919	01	06001	37.7952273	-122.2508805	Alameda County
39016	Fee-for-Service	1205940756	1205940756	1	1	LASRY, JASON MD	9/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
39066	Fee-for-Service	1407048697	1407048697	1	1	LISA LAFOREST M.D.	2/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 CHICAGO AVE	None	MINNEAPOLIS	MN	55404	4518	00	None	44.95666589	-93.26255996	Hennepin County
39087	Fee-for-Service	1518351683	1518351683	1	1	LOUIE, JUSTIN MD	2/27/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	144124	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
39116	Fee-for-Service	1558445536	1558445536	1	1	LAKES, DAVID M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	22953	01	General Practice	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
39120	Fee-for-Service	1891009601	1891009601	1	1	LANG, CHRISTINA E DO	12/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13309	41	Internal Medicine	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4404	50	06099	37.66508443	-120.9962589	Stanislaus County
39121	Fee-for-Service	1538101357	1538101357	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1155 W HENDERSON AVE	None	PORTERVILLE	CA	93257	1452	54	06107	36.08038552	-119.0428605	Tulare County
39173	Fee-for-Service	1639674567	1639674567	1	1	LUONG, JACKY DO	8/25/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18985	None	None	0	In state provider	None	5575 W LAS POSITAS BLVD	SUITE 130	PLEASANTON	CA	94588	5800	01	06001	37.69214859	-121.8796532	Alameda County
39220	Fee-for-Service	1356558191	1356558191	1	1	LIVINGSTON, LORI A MD	5/31/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92445	40	Pediatrics	0	In state provider	None	2921 REDONDO AVE	None	LONG BEACH	CA	90806	2415	19	06037	33.808185	-118.1513675	Los Angeles County
39240	Fee-for-Service	1609197250	1609197250	1	1	LITTLEJOHN, JAMES E MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136653	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
39266	Fee-for-Service	1679720700	1679720700	1	1	LIVELY, HARRY R MD INC	4/21/2009	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	56294	41	Internal Medicine	0	In state provider	None	119 S LOCUST STREET	SUITE B	VISALIA	CA	93291	0000	54	06107	36.329382	-119.2937355	Tulare County
39290	Fee-for-Service	1467787440	1467787440	1	1	LE, NHA T MD	9/17/2021	207R00000X	NA	Other	026	PHYSICIANS	173814	None	None	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
39297	Fee-for-Service	1548519366	1548519366	1	1	LIU, JANIE F DO	12/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12485	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
39327	Fee-for-Service	1851925754	1851925754	1	1	LINTON, DEBORAH E CNP	3/21/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	434 S SAN VINCENTE BLVD	STE 100	LOS ANGELES	CA	90048	4108	19	06037	34.07053591	-118.375828	Los Angeles County
39368	Fee-for-Service	1265686612	1265686612	1	1	LEISEROWITZ, GINA S LMFT	6/17/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	69844 CA HIGHWAY 111	SUITE H	RANCHO MIRAGE	CA	92270	2849	33	06065	33.76988393	-116.4463473	Riverside County
39372	Fee-for-Service	1164749578	1164749578	1	1	LABELLE, JASPER C MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120347	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
39377	Fee-for-Service	1376517599	1376517599	1	1	LEES, JOEL A MD	1/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	67637	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
39406	Fee-for-Service	1629146683	1629146683	1	1	LOWE, STANLEY OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	228 E 3RD AVE	None	SAN MATEO	CA	94401	4015	41	06081	37.56531339	-122.3226082	San Mateo County
39435	Fee-for-Service	1245612753	1245612753	1	1	LOCKWOOD, JOSEPH D MD	7/5/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	185702	None	None	0	In state provider	None	101 CITY DR S	STE 313	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
39453	Fee-for-Service	1205878030	1205878030	2	1	LONGS DRUG STORES CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 S CLOVERDALE BLVD	None	CLOVERDALE	CA	95425	4413	49	06097	38.78536768	-123.013678	Sonoma County
39483	Fee-for-Service	1992902126	1992902126	1	1	LITT, JONATHAN S MD	9/25/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	100602	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
39520	Fee-for-Service	1831650571	1831650571	1	1	LINFIELD, REBECCA MD	4/22/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	177495	77	Infectious Disease	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
39559	Fee-for-Service	1649689381	1649689381	1	1	LEE, ERIN MD	8/21/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	153346	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
39567	Fee-for-Service	1659467215	1659467215	1	1	LEE, SANDRA D MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86568	08	Family Practice	0	In state provider	None	125 N LINCOLN ST	None	DIXON	CA	95620	3258	48	06095	38.44614779	-121.8364229	Solano County
39572	Fee-for-Service	1104015486	1104015486	1	1	LI, HO-YIN A MD INC	2/29/2008	207L00000X	NA	Other	026	PHYSICIANS	50572	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
39576	Fee-for-Service	1467500264	1467500264	1	1	LOFTY, AMIR N MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	84675	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
39649	Fee-for-Service	1932219292	1932219292	1	1	LIETMAN, THOMAS M MD	12/31/1995	207W00000X	NA	Ophthalmology	026	PHYSICIANS	80168	18	Ophthalmology	0	In state provider	None	95 KIRKHAM AVE	None	SAN FRANCISCO	CA	94143	0001	38	06075	37.7605845	-122.4605768	San Francisco County
39653	Fee-for-Service	1255027546	1255027546	1	1	LUKE W. DEITZ M.D., A PROFES	9/5/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	None	None	0	In state provider	None	6101 W CENTINELA AVE	STE 170	CULVER CITY	CA	90230	6350	19	06037	33.98156541	-118.3957895	Los Angeles County
39682	Fee-for-Service	1740316405	1740316405	1	1	LOPEZ, XIMENA MD	10/9/2023	2080P0205X	NA	Endocrinology	026	PHYSICIANS	191415	None	None	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
39711	Fee-for-Service	1235154600	1235154600	1	1	LIM, CHIN S MD	4/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85495	05	Anesthesiology	0	In state provider	None	9212 MIRA ESTE CT	STE 204	SAN DIEGO	CA	92126	6337	37	06073	32.88927901	-117.1482338	San Diego County
39728	Fee-for-Service	1558520718	1558520718	1	1	LOEWEN, KIMBERLY C PHD	8/2/2011	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
39735	Fee-for-Service	1225375017	1225375017	1	1	LIN, ANGELA H	11/12/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	217 W CERRITOS AVE	None	ANAHEIM	CA	92805	6549	30	06059	33.81058193	-117.9065445	Orange County
39739	Fee-for-Service	1497183354	1497183354	1	1	LEEDS, KATHRYN G	7/16/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
39752	Fee-for-Service	1407350036	1407350036	1	1	LOVRO, LUKE R MD	9/1/2024	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	165701	20	Orthopedic Surgery	0	In state provider	None	862 MEINECKE AVE	STE 100	SAN LUIS OBISPO	CA	93405	3701	40	06079	35.29243951	-120.668652	San Luis Obispo County
39769	Fee-for-Service	1982742862	1982742862	1	1	LINK, MICHAEL P MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	30861	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
39779	Fee-for-Service	1376698522	1376698522	1	1	LAKE DISTRICT HOSP	1/1/1993	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	700 S J ST	None	LAKEVIEW	OR	97630	1623	00	None	42.181335	-120.351489	Lake County
39783	Fee-for-Service	1972939684	1972939684	1	1	LONG, VERONICA Y	1/23/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK RD	None	CONTRA COSTA	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa
39808	Fee-for-Service	1912004664	1912004664	1	1	LEE, MIMI C MD	9/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76994	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
39812	Fee-for-Service	1831650571	1831650571	1	1	LINFIELD, REBECCA MD	4/22/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	177495	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
39843	Fee-for-Service	1467652198	1467652198	1	1	LYNCH, CAROL A	12/28/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
39844	Fee-for-Service	1760041826	1760041826	1	1	LI, XI MD	11/15/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	182098	13	Neurology (M.D. only)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
39881	Fee-for-Service	1952505141	1952505141	1	1	LEA ALHILALI MD	10/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	4409	00	None	33.480864	-112.0795155	Maricopa County
39928	Fee-for-Service	1962009613	1962009613	1	1	LOGUERCIO, LINDSAY MARGARET	10/20/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4 MARAVILLA CT	None	CAMPBELL	CA	95008	1847	43	06085	37.28740732	-121.9592045	Santa Clara County
39972	Fee-for-Service	1396864872	1396864872	1	1	LIN, JAMES M MD	7/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102814	None	None	0	In state provider	None	1133 EAST STANLEY BLVD	STE 207	LIVERMORE	CA	94550	4246	01	06001	37.67914693	-121.7810206	Alameda County
40019	Fee-for-Service	1750383071	1750383071	1	1	L & A CARE CORPORATION	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5000 OVERLAND AVE	SUITE 101	CULVER CITY	CA	90230	4995	19	06037	34.00638832	-118.3954405	Los Angeles County
40054	Fee-for-Service	1558849182	1558849182	1	1	LU, LU RCP	8/16/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
40055	Fee-for-Service	1083866719	1083866719	1	1	LEE, LILLIAN C MD	10/21/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	68663	18	Ophthalmology	0	In state provider	None	15725 POMERADO RD	STE 102	POWAY	CA	92064	2068	37	06073	33.00037882	-117.0580735	San Diego County
40064	Fee-for-Service	1376698522	1376698522	1	1	LAKE DISTRICT HOSP	1/1/1993	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	700 S J ST	None	LAKEVIEW	OR	97630	1623	00	None	42.181335	-120.351489	Lake County
40074	Fee-for-Service	1265587190	1265587190	1	1	LEV, DANIEL PHD	9/11/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
40123	Fee-for-Service	1265539712	1265539712	1	1	LUDMIR, JAIME MD	7/1/1984	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	35195	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2810 S BRISTOL ST	None	SANTA ANA	CA	92704	6204	30	06059	33.709428	-117.8854685	Orange County
40150	Fee-for-Service	1083826879	1083826879	1	1	LEE, CHRISTOPHER C T MD	8/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95243	None	None	0	In state provider	None	3012 SUMMIT ST	None	OAKLAND	CA	94609	3480	01	06001	37.81947101	-122.264516	Alameda County
40216	Fee-for-Service	1831511856	1831511856	1	1	LITTLE, KEVIN T NP	12/3/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	546706	-	NOT APPLICABLE	0	In state provider	None	1466 LINCOLN AVE	None	SAN RAFAEL	CA	94901	2021	21	06041	37.98004532	-122.5221262	Marin County
40219	Fee-for-Service	1962009613	1962009613	1	1	LOGUERCIO, LINDSAY MARGARET	10/20/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4 MARAVILLA CT	None	CAMPBELL	CA	95008	1847	43	06085	37.28740732	-121.9592045	Santa Clara County
40238	Fee-for-Service	1144418039	1144418039	1	1	LEE, PAULA C NP	9/26/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
40243	Fee-for-Service	1275730988	1275730988	1	1	LUO, TINA H MD	12/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113043	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
40309	Fee-for-Service	1750383071	1750383071	1	1	L & A CARE CORPORATION	6/26/1998	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5000 OVERLAND AVE	SUITE 101	CULVER CITY	CA	90230	4995	19	06037	34.00638832	-118.3954405	Los Angeles County
40322	Fee-for-Service	1336482298	1336482298	1	1	LAU, VICTORIA K DO	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14147	01	General Practice	0	In state provider	None	18406 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.2206967	-118.5342638	Los Angeles County
40349	Fee-for-Service	1013625748	1013625748	1	1	LIN, WILLIE OT	5/8/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5350 OLIVE ST	None	MONTCLAIR	CA	91763	1639	36	06071	34.09054746	-117.6886395	San Bernardino County
40398	Fee-for-Service	1699303701	1699303701	1	1	LEVIN, MORDECHAI A MD	9/1/2023	207R00000X	NA	Other	026	PHYSICIANS	184798	None	None	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
40408	Fee-for-Service	1700374592	1700374592	1	1	LIU, KANG-NING	10/11/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173946	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
40411	Fee-for-Service	1043847882	1043847882	1	1	LAI, HOBART DO	7/20/2023	207R00000X	NA	Other	026	PHYSICIANS	21447	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
40440	Fee-for-Service	1528191095	1528191095	1	1	LIU, LINDA G MD	1/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109368	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
40459	Fee-for-Service	1750598967	1750598967	1	2	LAMB, MELINDA N MD	3/2/2018	208600000X	NA	General Surgery	026	PHYSICIANS	126175	02	General Surgery	0	In state provider	None	275 VICTORIA ST	STE 2L	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
40462	Fee-for-Service	1386977346	1386977346	1	2	LOMELI, OSVALDO LCSW	5/12/2022	1041S0200X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	120 BIRMINGHAM DRIVE	240A	CARDIFF BY THE SE	CA	92007	1757	37	06073	33.02310224	-117.2826142	San Diego County
40474	Fee-for-Service	1073202206	1073202206	1	1	LISETH SALES FAMILY THERAPY	6/19/2023	251S00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	610 14TH ST	None	MODESTO	CA	95354	2505	50	06099	37.63980073	-120.9921241	Stanislaus County
40504	Fee-for-Service	1679703243	1679703243	1	1	LEUNG, AMY MD	11/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103797	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
40513	Fee-for-Service	1134205651	1134205651	1	1	LEE, ESTHER MD	12/20/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	54667	41	Internal Medicine	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
40534	Fee-for-Service	1902848732	1902848732	2	1	LONGS DRUG STORE CA, INC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3220 S. WHITE RD.	None	SAN JOSE	CA	95148	4050	43	06085	37.31517102	-121.7923163	Santa Clara County
40543	Fee-for-Service	1730536954	1730536954	1	1	LONGBOTTOM, JENNA B	1/6/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
40629	Fee-for-Service	1639926827	1639926827	1	1	LEE, SABRINA E OT	8/12/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
40649	Fee-for-Service	1295998052	1295998052	1	1	LERNER, KEREN MD	8/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116638	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	99 N LA CIENEGA BLVD	None	BEVERLY HILLS	CA	90211	2222	19	06037	34.06736471	-118.3763201	Los Angeles County
40670	Fee-for-Service	1144319211	1144319211	1	1	LITTLE, PAUL M JR MD	9/22/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	53673	-	NOT APPLICABLE	0	In state provider	None	1560 CAPALINA RD	None	SAN MARCOS	CA	92069	1288	37	06073	33.15089345	-117.1946501	San Diego County
40700	Fee-for-Service	1992863096	1992863096	1	1	LA CLINICA DE LA RAZA INC	8/21/2007	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	GREAT BEGINNINGS	210 HOSPITAL DR	None	VALLEJO	CA	94589	2517	48	06095	38.13109785	-122.238998	Solano County
40729	Fee-for-Service	1861526246	1861526246	1	1	LEYVA NGUYEN, ANNA I LMFT	4/21/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	104487	-	NOT APPLICABLE	0	In state provider	None	2425 ENBORG LANE	None	SAN JOSE	CA	95128	2648	43	06085	37.31105733	-121.937923	Santa Clara County
40755	Fee-for-Service	1740414119	1740414119	1	1	LEUCHT, PHILIPP MD	4/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117710	20	Orthopedic Surgery	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
40768	Fee-for-Service	1740269794	1740269794	1	1	LONGLEY,GAY DEBORAH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	333 N SMITH AVE	None	ST PAUL	MN	55101	1421	00	None	44.94251219	-93.1074995	Ramsey County
40797	Fee-for-Service	1316079122	1316079122	1	1	LUM, MELISSA A MD	2/1/2003	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	68119	40	Pediatrics	0	In state provider	None	14600 SHERMAN WAY	STE 300	VAN NUYS	CA	91405	2272	19	06037	34.20025916	-118.4500763	Los Angeles County
40799	Fee-for-Service	1700064383	1700064383	1	1	LACHMAN, LARRY K PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7590 FAY AVE	SUITE 507	LA JOLLA	CA	92037	4872	37	06073	32.8418488	-117.2743025	San Diego County
40801	Fee-for-Service	1043346208	1043346208	1	1	LIMON, KIMEL A PSYD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	21143 HAWTHORNE BLVD	STE 460	TORRANCE	CA	90503	4615	19	06037	33.83897075	-118.353872	Los Angeles County
40833	Fee-for-Service	1356476196	1356476196	1	1	LAIR, BRIAN J DO	8/23/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	6422	08	Family Practice	0	In state provider	None	2580 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14842672	-122.2180085	Tehama County
40840	Fee-for-Service	1760905186	1760905186	1	1	LUTHRA, ANKITA MD	1/3/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	176145	None	None	0	In state provider	None	1062 K ST	None	TULARE	CA	93274	6422	54	06107	36.19548226	-119.3433058	Tulare County
40857	Fee-for-Service	1033631676	1033631676	1	1	LAO, NINA C	11/3/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
40861	Fee-for-Service	1336162874	1336162874	1	1	LEGACY GOOD SAMARITAN	5/1/2001	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSP & MED CTR	1015 NW 22ND AVE	None	PORTLAND	OR	97210	3025	00	None	45.53024175	-122.6966202	Multnomah County
40907	Fee-for-Service	1730473885	1730473885	1	1	LARSON, KIMBERLY A MD	5/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148236	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
40929	Fee-for-Service	1104163989	1104163989	1	1	LINDSAY JOY FREDRICKSEN NP	3/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	701 PARK AVE	None	MINNEAPOLIS	MN	55415	1623	00	None	44.97241797	-93.26300044	Hennepin County
40937	Fee-for-Service	1265493217	1265493217	1	1	LUNAT, MOOSA M MD	1/1/1979	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	32534	40	Pediatrics	0	In state provider	None	1191 E YOSEMITE AVE	STE B	MANTECA	CA	95336	5011	39	06077	37.79751749	-121.1988375	San Joaquin County
40961	Fee-for-Service	1457026858	1457026858	1	1	LAYE, KERSTIN LMFT	10/11/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4000 MAGNOLIA BLVD	A	BURBANK	CA	91505	2827	19	06037	34.16705225	-118.3493748	Los Angeles County
40990	Fee-for-Service	1588427116	1588427116	1	1	LOUISE DOULA & FAMILY HEALTH	2/7/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	43	06085	0	0	None
41038	Fee-for-Service	1689170920	1689170920	1	1	LIU, MING Z MD	3/26/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	166167	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
41076	Fee-for-Service	1689617904	1689617904	1	1	LO, KUANG-CHIH DO	3/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	6260	08	Family Practice	0	In state provider	None	954 SACRAMENTO AVE	None	WEST SACRAMENTO	CA	95605	1904	57	06113	38.58935106	-121.5252207	Yolo County
41082	Fee-for-Service	1346885985	1346885985	1	1	LAFRADEZ, CAROL OD	2/4/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1850 N RIVERSIDE AVE	SUITE 100	RIALTO	CA	92376	8071	36	06071	34.132905	-117.3704675	San Bernardino County
41100	Fee-for-Service	1871071910	1871071910	1	1	LA LANDE, DENISE M LCSW	3/15/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41593 WINCHESTER RD	215	TEMECULA	CA	92590	4860	33	06065	33.52030169	-117.1659061	Riverside County
41104	Fee-for-Service	1609238237	1609238237	1	1	LEE, HANNAH MD	8/22/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	162703	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
41125	Fee-for-Service	1033497367	1033497367	1	2	LONGSTROTH, DAVID E MD	11/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117824	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
41136	Fee-for-Service	1053403097	1053403097	1	1	LEUNG, TINA W MD	9/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71215	08	Family Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
41148	Fee-for-Service	1336162874	1336162874	1	1	LEGACY GOOD SAMARITAN	5/1/2001	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSP & MED CTR	1015 NW 22ND AVE	None	PORTLAND	OR	97210	3025	00	None	45.53024175	-122.6966202	Multnomah County
41161	Fee-for-Service	1235360793	1235360793	1	1	LIU, HOWARD H W MD	11/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130089	01	General Practice	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
41166	Fee-for-Service	1134162290	1134162290	1	1	LOPEZ, MARIA G MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68740	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
41189	Fee-for-Service	1639190028	1639190028	1	1	LEE, ROLAND R MD	1/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	57800	30	Radiology	0	In state provider	None	330 LEWIS ST	None	SAN DIEGO	CA	92103	2108	37	06073	32.75187491	-117.1617402	San Diego County
41226	Fee-for-Service	1912481573	1912481573	1	1	LEBLANC, CHEYENNE N AU	10/27/2021	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
41234	Fee-for-Service	1790184471	1790184471	1	1	LAPOINTE, ROXANNE L NP	8/25/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1335 N WATERMAN AVENUE	None	SAN BERNARDINO	CA	92404	5385	36	06071	34.124274	-117.2787625	San Bernardino County
41239	Fee-for-Service	1619283777	1619283777	1	1	LONGORIA, TERESA C MD	4/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120717	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92863	4091	30	06059	33.78674051	-117.8888713	Orange County
41273	Fee-for-Service	1639428238	1639428238	1	1	LO, VICTOR P MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138993	14	Neurological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
41287	Fee-for-Service	1740338722	1740338722	1	1	LEE, JEFFREY A MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	55127	14	Neurological Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
41303	Fee-for-Service	1336190016	1336190016	1	1	LIPTON, GLENN M MD	7/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87103	05	Anesthesiology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
41312	Fee-for-Service	1770608499	1770608499	1	1	LI, EDWARD N MD	10/20/2009	2086S0129X	NA	General Surgery	026	PHYSICIANS	108991	01	General Practice	0	In state provider	None	8631 W 3RD ST	None	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
41319	Fee-for-Service	1841586849	1841586849	1	1	LUU, NANCY OD	7/20/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	865 B STREET	None	HAYWARD	CA	94541	5107	01	06001	37.67179004	-122.084486	Alameda County
41322	Fee-for-Service	1629598206	1629598206	1	1	LUNG, MEGAN L DO	8/5/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16706	08	Family Practice	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
41325	Fee-for-Service	1124171897	1124171897	1	1	LUBECK, LAURIE LMFT	8/20/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	610 D ST	SUITE A	SAN RAFAEL	CA	94901	3708	21	06041	37.97030652	-122.5324786	Marin County
41330	Fee-for-Service	1588610828	1588610828	2	1	LIND, STUART E MD	1/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	22	Pathology (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
41335	Fee-for-Service	1780754713	1780754713	1	1	LIS, ROBERT J DO	12/11/2002	207L00000X	NA	Other	026	PHYSICIANS	6953	05	Anesthesiology	0	In state provider	None	1150 N INDIAN AVE	None	PALM SPRINGS	CA	92262	4872	33	06065	33.90825494	-116.545378	Riverside County
41343	Fee-for-Service	1639386295	1639386295	1	1	LE, SANG V MD	10/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	100744	20	Orthopedic Surgery	0	In state provider	None	400 N PEPPER AVENUE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
41356	Fee-for-Service	1821162413	1821162413	1	1	LI, YAN	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67768	78	Neoplastic Diseases/Oncology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
41362	Fee-for-Service	1003821406	1003821406	1	1	LONGIA, HARMINDER S MD	11/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92314	41	Internal Medicine	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
41369	Fee-for-Service	1922441963	1922441963	1	1	LOPEZ, MATHEW J MD	11/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138193	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
41404	Fee-for-Service	1336596592	1336596592	1	1	LEE, WILLIAM MD	6/30/2020	207L00000X	NA	Other	026	PHYSICIANS	168626	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
41405	Fee-for-Service	1336353721	1336353721	1	1	LA MAESTRA FAMILY CLINIC	2/4/1999	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1609	37	06073	32.750523	-117.100927	San Diego County
41416	Fee-for-Service	1093277345	1093277345	1	1	LOPEZ FLORES, FLOR D MD	7/26/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180438	None	None	0	In state provider	None	700 17TH ST	None	MODESTO	CA	95354	1209	50	06099	37.64283069	-120.9903982	Stanislaus County
41417	Fee-for-Service	1326447756	1326447756	1	1	LEMBO, BRYAN S MD	6/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129384	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
41433	Fee-for-Service	1497926042	1497926042	1	1	LEADLEY, MELANIE N DO	2/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12929	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
41495	Fee-for-Service	1427029198	1427029198	1	1	LERMAN, BENJAMIN S MD	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65066	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
41497	Fee-for-Service	1154424240	1154424240	1	1	LANE, ROGER I MD	3/1/1999	207R00000X	NA	Other	026	PHYSICIANS	75236	41	Internal Medicine	0	In state provider	None	2030 VIBORG RD	None	SOLVANG	CA	93463	2220	42	06083	34.60247248	-120.1271535	Santa Barbara County
41532	Fee-for-Service	1184790230	1184790230	1	1	LINN, DIANA J LMFT	8/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	110 GATEWAY DR	210 AND 230	LINCOLN	CA	95648	3306	31	06061	38.88433725	-121.2931529	Placer County
41566	Fee-for-Service	1821503228	1821503228	1	1	LA, JULIAN D PT	4/1/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
41571	Fee-for-Service	1124670989	1124670989	1	1	LEE, MICHELLE M MD	4/28/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	192583	13	Neurology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
41573	Fee-for-Service	1477707701	1477707701	1	1	LATHROP URGENT CARE INC	3/12/2009	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	15810 S HARLAN ROAD	STE A	LATHROP	CA	95330	8719	39	06077	37.81877638	-121.292417	San Joaquin County
41588	Fee-for-Service	1265497770	1265497770	1	1	LEE, CHRISTINE K MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68173	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	365 HAWTHORNE AVE	STE 301	OAKLAND	CA	94609	3113	01	06001	37.82079728	-122.2633226	Alameda County
41617	Fee-for-Service	1124195409	1124195409	1	1	LE, NGOC-LAN T DO	8/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9709	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
41628	Fee-for-Service	1538117403	1538117403	1	1	LEVIN, MORRIS MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131784	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
41657	Fee-for-Service	1922141951	1922141951	1	1	LAFAYETTE, RICHARD A MD	12/31/1989	207RN0300X	NA	Nephrology	026	PHYSICIANS	62856	01	General Practice	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
41694	Fee-for-Service	1336353721	1336353721	1	1	LA MAESTRA FAMILY CLINIC	2/9/1999	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1609	37	06073	32.750523	-117.100927	San Diego County
41701	Fee-for-Service	1073586145	1073586145	1	1	LEE, PAMELA MD	8/31/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	74612	40	Pediatrics	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
41702	Fee-for-Service	1467554873	1467554873	1	1	LOMPOC HEALTHCARE DISTRICT	8/20/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	LOMPOC HEALTHCARE	508 EAST HICKORY AVE	None	LOMPOC	CA	93436	7337	42	06083	34.63568383	-120.4522776	Santa Barbara County
41704	Fee-for-Service	1982664892	1982664892	1	1	LI, HONG MD	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62242	22	Pathology (M.D. only)	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
41709	Fee-for-Service	1861831695	1861831695	1	1	LEHNHOF, BRIAN S DO	6/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
41731	Fee-for-Service	1487751947	1487751947	1	1	LAX, DANIELA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
41758	Fee-for-Service	1366480188	1366480188	1	1	LE, TIM T DO	5/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5595	08	Family Practice	0	In state provider	None	5475 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02627053	-117.684846	San Bernardino County
41785	Fee-for-Service	1093797557	1093797557	1	1	LAI, DONALD M MD	1/31/1987	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	54833	41	Internal Medicine	0	In state provider	None	2222 EAST ST	STE 260	CONCORD	CA	94520	2074	07	06013	37.98125538	-122.0329375	Contra Costa County
41792	Fee-for-Service	1174996342	1174996342	1	1	LAM, DAVID M DO	8/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14340	41	Internal Medicine	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 100	LOS ANGELES	CA	90033	2488	19	06037	34.05112725	-118.2173921	Los Angeles County
41801	Fee-for-Service	1225392178	1225392178	1	1	LEE, BRIAN H MD	6/24/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	153953	30	Radiology	0	In state provider	None	612 W. DUARTE ROAD	SUITE 101	ARCADIA	CA	91007	7602	19	06037	34.12647805	-118.051994	Los Angeles County
41820	Fee-for-Service	1861057556	1861057556	1	1	LOI, MICHAEL T DO	10/9/2024	207R00000X	NA	Other	026	PHYSICIANS	22634	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
41829	Fee-for-Service	1194136473	1194136473	1	1	LOUVET, DANIEL G MD	8/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133026	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
41838	Fee-for-Service	1023448222	1023448222	1	1	LOBO, MICHELLE V LMFT	2/23/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
41852	Fee-for-Service	1114196185	1114196185	1	1	LORENZ, GIOVANNI DO	11/2/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	10535	None	None	0	In state provider	None	12602 AMARGOSA RD	STE F	VICTORVILLE	CA	92392	7640	36	06071	34.47936072	-117.3397257	San Bernardino County
41865	Fee-for-Service	1881771723	1881771723	1	1	LEVIN, DAVID K MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38833	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
41873	Fee-for-Service	1639139595	1639139595	1	1	LYONS, WILLIAM J MD	7/1/1994	174400000X	NA	Other	026	PHYSICIANS	17266	41	Internal Medicine	0	In state provider	A PROF CORP	2653 ELM AVE	STE 300	LONG BEACH	CA	90806	1636	19	06037	33.805512	-118.188348	Los Angeles County
41877	Fee-for-Service	1356600175	1356600175	1	1	LIN, LEAH M MD	5/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112256	30	Radiology	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
41879	Fee-for-Service	1487021382	1487021382	1	1	LUONG, VINCENT	1/25/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
41886	Fee-for-Service	1164683876	1164683876	1	1	LIN, ELINOR Y MD	5/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110043	13	Neurology (M.D. only)	0	In state provider	None	1045 ATLANTIC AVENUE	SUITE 719	LONG BEACH	CA	90813	3412	19	06037	33.780267	-118.1850795	Los Angeles County
41978	Fee-for-Service	1386842268	1386842268	1	1	LE-CARLSON, MINOU MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99427	10	Gastroenterology (M.D. only)	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
41998	Fee-for-Service	1477620383	1477620383	1	1	LAIRD, PETER A MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82189	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
42010	Fee-for-Service	1861836660	1861836660	1	1	LEONARD MACIAS, MICHAEL A MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147268	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
42027	Fee-for-Service	1356804033	1356804033	1	1	LAKIREDDY, JAYAKALA DO	11/4/2024	207P00000X	NA	Other	026	PHYSICIANS	20383	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
42031	Fee-for-Service	1740707264	1740707264	1	1	LEE, DANIEL J PT	5/17/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
42046	Fee-for-Service	1821573981	1821573981	1	1	LEUGUE, PEGGY T NP	1/24/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43939 N 15TH ST WEST	None	LANCASTER	CA	93534	4756	19	06037	34.6810297	-118.1569157	Los Angeles County
42068	Fee-for-Service	1265937932	1265937932	1	1	LI, CHRISTINA F MD	7/23/2021	208M00000X	NA	Other	026	PHYSICIANS	166016	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
42076	Fee-for-Service	1093797557	1093797557	1	1	LAI, DONALD M MD	1/31/1987	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	54833	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2222 EAST ST	STE 260	CONCORD	CA	94520	2074	07	06013	37.98125538	-122.0329375	Contra Costa County
42126	Fee-for-Service	1336182120	1336182120	2	1	LONGS DRUG STORE CA, INC	11/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9285 ELK GROVE BLVD	None	ELK GROVE	CA	95624	2101	34	06067	38.409381	-121.353759	Sacramento County
42136	Fee-for-Service	1558316984	1558316984	1	1	LA PHYSIATRISTS PROFESSIONAL	4/6/2010	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	CORPORATION	1245 WILSHIRE BLVD	STE 403	LOS ANGELES	CA	90017	2395	19	06037	34.05362775	-118.2661889	Los Angeles County
42159	Fee-for-Service	1538578307	1538578307	1	1	LAFORTEZA, JOZELLE B NP	11/8/2018	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
42197	Fee-for-Service	1437712627	1437712627	1	1	LEDESMA, HAZEL C NP	12/7/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
42237	Fee-for-Service	1326577727	1326577727	1	1	LEE, WILLIAM A DO	8/2/2019	207P00000X	NA	Other	026	PHYSICIANS	17217	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
42248	Fee-for-Service	1750499877	1750499877	1	1	LIM, PHILIP P MD INC	5/31/1990	207R00000X	NA	Other	026	PHYSICIANS	45973	41	Internal Medicine	0	In state provider	None	9604 ARTESIA BLVD	STE 101	BELLFLOWER	CA	90706	8040	19	06037	33.87472842	-118.1288599	Los Angeles County
42267	Fee-for-Service	1386842268	1386842268	1	1	LE-CARLSON, MINOU MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99427	40	Pediatrics	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
42328	Fee-for-Service	1881057578	1881057578	1	1	LOPEZ, ANTHONY F LPCC	3/18/2022	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
42335	Fee-for-Service	1114097151	1114097151	1	1	LANE, BARTON MD	5/20/1987	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23477	30	Radiology	0	In state provider	None	STANFORD UNIV MEDICAL CT	None	STANFORD	CA	94305	0000	43	06085	37.43249119	-122.1738152	Santa Clara County
42381	Fee-for-Service	1174671036	1174671036	1	1	LIU, MICHELE A MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	67006	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
42399	Fee-for-Service	1790152718	1790152718	1	1	LOPEZ SALAS, MARTHA LMFT	9/9/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
42411	Fee-for-Service	1639148562	1639148562	1	1	LASZIK,ZOLTAN G MD	9/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52350	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
42428	Fee-for-Service	1194782706	1194782706	1	1	LAL, INDU M MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152313	40	Pediatrics	0	In state provider	None	2415 W VINE ST	STE 100	LODI	CA	95242	3525	39	06077	38.1228953	-121.3052826	San Joaquin County
42447	Fee-for-Service	1417942939	1417942939	1	1	LANG, FRANK J JR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	80837	01	General Practice	0	In state provider	None	3733 SAN DIMAS STREET	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
42510	Fee-for-Service	1497181895	1497181895	1	1	LIN, JENNIFER C	5/18/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
42533	Fee-for-Service	1750499877	1750499877	1	1	LIM, PHILIP P MD INC	5/31/1990	207R00000X	NA	Other	026	PHYSICIANS	45973	01	General Practice	0	In state provider	None	9604 ARTESIA BLVD	STE 101	BELLFLOWER	CA	90706	8040	19	06037	33.87472842	-118.1288599	Los Angeles County
42563	Fee-for-Service	1588689368	1588689368	1	1	LINDA IRELAND MD	3/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4300 BARTLETT ST	None	HOMER	AK	99603	7000	00	None	59.65210843	-151.5501715	Kenai Peninsula Borough
42567	Fee-for-Service	1245395789	1245395789	1	1	LIU, MANUEL S CRNA	9/21/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
42608	Fee-for-Service	1457855322	1457855322	1	1	LOS ANGELES NEUROSCIENCES, I	8/10/2018	2084N0402X	NA	Neurology	026	PHYSICIANS	130877	13	Neurology (M.D. only)	0	In state provider	NC.	23823 VALENCIA BLVD	115	VALENCIA	CA	91355	9509	19	06037	34.41347743	-118.5523087	Los Angeles County
42630	Fee-for-Service	1386673218	1386673218	1	1	LUBARSKY, DAVID A MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	158778	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
42692	Fee-for-Service	1922099159	1922099159	2	1	L I C PROSTHETICS AND	8/20/2012	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ORTHOTICS	321 E. CENTER ST.	None	ANAHEIM	CA	92805	3263	30	06059	33.83609467	-117.9108676	Orange County
42723	Fee-for-Service	1952642720	1952642720	1	1	LELAND, SHAREEN E MFT	9/21/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	31652	-	NOT APPLICABLE	0	In state provider	None	1816 SCENIC AVE	None	BERKELEY	CA	94709	1324	01	06001	37.87558576	-122.2622904	Alameda County
42756	Fee-for-Service	1619964038	1619964038	1	1	LUKAC, JAN S MD INC	4/6/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	32888	None	None	0	In state provider	None	410 WEST CENTRAL AVENUE	SUITE 109	BREA	CA	92821	3009	30	06059	33.93194416	-117.9031642	Orange County
42810	Fee-for-Service	1861614265	1861614265	1	1	LOYDS LIBERTY HOMES INC	7/1/1991	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	FELAND	6249 N FELAND AVE	None	FRESNO	CA	93711	1621	10	06019	36.82719	-119.848969	Fresno County
42822	Fee-for-Service	1174641112	1174641112	1	1	LEVENFELD, RACHEL E LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
42826	Fee-for-Service	1164711487	1164711487	1	1	LAMEKA, KATARZYNA MD	10/30/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	185862	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
42862	Fee-for-Service	1477720316	1477720316	1	1	LEE, GREGORY E PT	3/9/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
42881	Fee-for-Service	1598992984	1598992984	1	1	LEE, LAUREN K MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117247	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
42903	Fee-for-Service	1487926424	1487926424	1	1	LIM ACUPUNCTURE & HERBS	4/29/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	CLINIC INC	3600 W OLYMPIC BLVD	STE 5	LOS ANGELES	CA	90019	2035	19	06037	34.05279992	-118.3179316	Los Angeles County
42904	Fee-for-Service	1326138355	1326138355	1	1	LEIBOLD, SCOTT H DPM	12/25/2015	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2107 PICKWICK DR	None	CAMARILLO	CA	93010	6427	56	06111	34.22230046	-119.041623	Ventura County
42916	Fee-for-Service	1710262001	1710262001	1	1	LEGEND HOME HEALTH INC	12/20/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3510 TORRANCE BLVD	STE 111	TORRANCE	CA	90503	4814	19	06037	33.83756756	-118.3469036	Los Angeles County
42956	Fee-for-Service	1912174301	1912174301	1	1	LAU, CATHERINE Y MD	6/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108356	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
42965	Fee-for-Service	1558597054	1558597054	1	1	LIU MAY M MD	7/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135428	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
43016	Fee-for-Service	1043390172	1043390172	1	1	LANE, JOHN S III MD	10/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81602	02	General Surgery	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
43017	Fee-for-Service	1023572583	1023572583	1	1	LOPEZ, MYRA D LCSW	6/1/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
43052	Fee-for-Service	1487685939	1487685939	1	1	LEE, JOUNG H DPM	7/15/2008	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
43053	Fee-for-Service	1649222951	1649222951	1	1	LESSMAN-KEANE, DEBORAH A	4/17/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	1660 E ROSEVILLE PKWY	BLDG C	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
43062	Fee-for-Service	1386110732	1386110732	1	1	LA CLINICA DE LOS ANGELES ME	5/23/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	01	General Practice	0	In state provider	DICAL GROUP APC	1021 W MARTIN LUTHER KIN	None	LOS ANGELES	CA	90037	1816	19	06037	34.01089347	-118.292526	Los Angeles County
43067	Fee-for-Service	1063586675	1063586675	1	1	LIESKOVSKY, YEEYIE E MD	2/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78233	78	Neoplastic Diseases/Oncology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
43082	Fee-for-Service	1932341690	1932341690	1	1	LE, SANG N MD	7/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124050	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
43095	Fee-for-Service	1770066722	1770066722	1	1	LEE, KATELYNN RCP	3/27/2024	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
43104	Fee-for-Service	1043865504	1043865504	1	1	LARSON, MARIA MARGARIDA G PT	9/12/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
43170	Fee-for-Service	1124656780	1124656780	1	1	LEE-YUEN, MICHELLE MD	9/15/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	186749	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
43171	Fee-for-Service	1780763417	1780763417	1	1	LEE, DONALD D MD	11/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75520	05	Anesthesiology	0	In state provider	THE PERMANENTE MED GRP	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
43207	Fee-for-Service	1588731301	1588731301	1	1	LEE, SONDRA B MD	5/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71268	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
43213	Fee-for-Service	1013656446	1013656446	1	1	LATUNO, EMMA C	8/6/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 PIO PICO DR	STE 105	CARLSBAD	CA	92008	1951	37	06073	33.16162799	-117.3408476	San Diego County
43215	Fee-for-Service	1245710961	1245710961	1	1	LEDDON, KRISTINA PT	8/31/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4318 SPYRES WAY	None	MODESTO	CA	95356	9259	50	06099	37.70194177	-120.9988293	Stanislaus County
43231	Fee-for-Service	1922779404	1922779404	1	1	LEE, SAM K OD	2/5/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
43254	Fee-for-Service	1649610312	1649610312	1	1	LE, STEPHANIE P DO	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12311	08	Family Practice	0	In state provider	None	1693 FLANNIGAN DR	SUITE 100	SAN JOSE	CA	95121	1683	43	06085	37.31874246	-121.8234636	Santa Clara County
43255	Fee-for-Service	1528211679	1528211679	1	2	LIU, SAMUEL MD INC	11/14/2014	207RN0300X	NA	Nephrology	026	PHYSICIANS	74056	41	Internal Medicine	0	In state provider	None	11480 BROOKSHIRE AVE	SUITE 105	DOWNEY	CA	90241	5024	19	06037	33.93622932	-118.1311752	Los Angeles County
43259	Fee-for-Service	1114206729	1114206729	1	1	LE, THANH P LCSW	5/11/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
43265	Fee-for-Service	1235244146	1235244146	1	1	LUU, MICHAEL C DO	3/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	7354	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2920 SONOMA BLVD	STE C	VALLEJO	CA	94590	3879	48	06095	38.11333463	-122.2546213	Solano County
43287	Fee-for-Service	1699855858	1699855858	1	1	LUDERER, ULRIKE MD	4/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85505	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
43320	Fee-for-Service	1407852486	1407852486	1	1	LEACH, CHRISTOPHER L MD	9/14/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	158842	01	General Practice	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
43326	Fee-for-Service	1366544082	1366544082	1	1	LIT, YIMING Z MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79552	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
43355	Fee-for-Service	1063586675	1063586675	1	1	LIESKOVSKY, YEEYIE E MD	2/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78233	30	Radiology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
43373	Fee-for-Service	1467401273	1467401273	1	1	LANNAN, ROBIN L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3680 NW SAMARITAN DR	None	CORVALLIS	OR	97330	3737	00	None	44.60268509	-123.2548681	Benton County
43390	Fee-for-Service	1760894661	1760894661	1	1	LU, TIMOTHY MD	11/8/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	168299	None	None	0	In state provider	None	1306 MARICOPA HIGHWAY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
43410	Fee-for-Service	1245396902	1245396902	1	1	LOMPOC UNIF SCHOOL DIST	3/10/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	1301 N A ST	None	LOMPOC	CA	93436	3516	42	06083	34.65870843	-120.4489031	Santa Barbara County
43472	Fee-for-Service	1740213214	1740213214	1	1	LUH, GEORGE Y MD	11/2/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78325	30	Radiology	0	In state provider	None	25455 BARTON RD	STE 107B	LOMA LINDA	CA	92354	3139	36	06071	34.04805253	-117.249534	San Bernardino County
43484	Fee-for-Service	1174711444	1174711444	1	1	LAMBOURNE, LINDSEY A MD	11/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101353	40	Pediatrics	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95661	2912	31	06061	38.74730831	-121.2613758	Placer County
43513	Fee-for-Service	1336161348	1336161348	1	1	LE, VIET K P MD	12/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	73490	05	Anesthesiology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
43532	Fee-for-Service	1962778597	1962778597	1	1	LUM, ZACHARY C DO	7/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	13186	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
43541	Fee-for-Service	1528211679	1528211679	1	2	LIU, SAMUEL MD INC	11/14/2014	207RN0300X	NA	Nephrology	026	PHYSICIANS	74056	45	Nephrology (Renal-Kidney)	0	In state provider	None	11480 BROOKSHIRE AVE	SUITE 105	DOWNEY	CA	90241	5024	19	06037	33.93622932	-118.1311752	Los Angeles County
43544	Fee-for-Service	1619001351	1619001351	1	1	LUU, TUAN V MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66707	41	Internal Medicine	0	In state provider	None	1731 N FRESNO ST	None	FRESNO	CA	93703	3031	10	06019	36.766485	-119.7815575	Fresno County
43559	Fee-for-Service	1164592580	1164592580	1	1	LAI, DANNY K LAC	12/11/2024	111N00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	237 W 7TH ST	None	OXNARD	CA	93030	7131	56	06111	34.19508266	-119.1795067	Ventura County
43570	Fee-for-Service	1811007164	1811007164	1	1	LO, EDMUND MD INC	9/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	123 N GARFIELD AVE	STE A	ALHAMBRA	CA	91801	3564	19	06037	34.09636542	-118.127778	Los Angeles County
43603	Fee-for-Service	1104855501	1104855501	1	1	LANDES, PATRICK J. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1102 SAINT MARYS RD	None	JUNCTION CITY	KS	66441	4139	00	None	39.0135326	-96.85014563	Geary County
43614	Fee-for-Service	1366544082	1366544082	1	1	LIT, YIMING Z MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79552	45	Nephrology (Renal-Kidney)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
43616	Fee-for-Service	1154383495	1154383495	1	1	LOWE, MERLIN C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
43618	Fee-for-Service	1821105321	1821105321	1	1	LEE, CHING G MD	3/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	61762	41	Internal Medicine	0	In state provider	None	3010 W ORANGE AVE	STE 507	ANAHEIM	CA	92804	3174	30	06059	33.82472315	-117.994133	Orange County
43629	Fee-for-Service	1043059686	1043059686	1	1	LANTRIP, KEATON	7/17/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
43639	Fee-for-Service	1942526686	1942526686	1	1	LAI, JEFFREY C MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113395	08	Family Practice	0	In state provider	None	MCMF 450 E SPRING STREET	STE 1	LONG BEACH	CA	90806	1625	19	06037	33.8099218	-118.1872346	Los Angeles County
43649	Fee-for-Service	1023202884	1023202884	1	1	LAKHARDT, KELLYN A LMFT	7/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
43656	Fee-for-Service	1336182104	1336182104	2	1	LONGS DRUG STORE CA LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	949 11TH ST	None	LAKEPORT	CA	95453	4119	17	06033	39.04900052	-122.923242	Lake County
43698	Fee-for-Service	1245396902	1245396902	1	1	LOMPOC UNIF SCHOOL DIST	7/1/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1301 N A ST	None	LOMPOC	CA	93436	3516	42	06083	34.65870843	-120.4489031	Santa Barbara County
43721	Fee-for-Service	1861080236	1861080236	2	1	LTC AMERICA LLC	3/28/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3403 WATT AVE	None	SACRAMENTO	CA	95821	3612	34	06067	38.627181	-121.383855	Sacramento County
43726	Fee-for-Service	1558446518	1558446518	1	1	LARSON, ROSEANN LCSW	6/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
43773	Fee-for-Service	1437358884	1437358884	1	1	LIN, ANNE Y MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117077	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 214	LOS ANGELES	CA	90095	8344	19	06037	34.06527974	-118.4462792	Los Angeles County
43777	Fee-for-Service	1639442429	1639442429	1	1	LI, XIN MD	10/30/2021	207RX0202X	NA	Oncology	026	PHYSICIANS	134896	None	None	0	In state provider	None	20101 LAKE CHABOT RD	3RD FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
43784	Fee-for-Service	1629312210	1629312210	1	1	LAU, ALICIA E OD	5/25/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
43816	Fee-for-Service	1619912078	1619912078	1	1	LOBATZ, MICHAEL A MD	12/19/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	38353	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3907 WARING RD	None	OCEANSIDE	CA	92056	4454	37	06073	33.18780783	-117.2918439	San Diego County
43818	Fee-for-Service	1336904515	1336904515	1	1	LARIOS, EDITH LCSW	5/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
43832	Fee-for-Service	1649333436	1649333436	1	1	LEFRINGHOUSE, JASON R MD	2/8/2022	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	155536	None	None	0	In state provider	None	1180 N INDIAN CANYON DR	SUITE E218	PALM SPRINGS	CA	92262	4800	33	06065	33.839505	-116.5455735	Riverside County
43834	Fee-for-Service	1770775835	1770775835	1	1	LIN, MATTHEW Y MD	8/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96948	02	General Surgery	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
43836	Fee-for-Service	1518169333	1518169333	1	1	LEE, JOHN J MD	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100297	05	Anesthesiology	0	In state provider	JOHN J LEE APC	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
43847	Fee-for-Service	1689070088	1689070088	1	1	LOPEZ, OSCAR A MD	11/24/2014	193400000X	NA	Other	026	PHYSICIANS	108837	None	None	0	In state provider	None	207 WEST LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
43926	Fee-for-Service	1104936673	1104936673	1	1	LEVINE, ADIN MD	8/2/2002	207P00000X	NA	Other	026	PHYSICIANS	58301	01	General Practice	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
43934	Fee-for-Service	1245243484	1245243484	1	1	LIE, ARIADNE G MD	6/28/2022	207R00000X	NA	Other	026	PHYSICIANS	175923	None	None	0	In state provider	None	5800 HOLLIS ST	None	EMERYVILLE	CA	94608	2016	01	06001	37.84043576	-122.2894291	Alameda County
43948	Fee-for-Service	1952999740	1952999740	1	1	LOHR, MARISSA H NP	4/14/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
44002	Fee-for-Service	1992320998	1992320998	1	1	LEE, JONATHAN Y PA	7/17/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	57923	-	NOT APPLICABLE	0	In state provider	None	161 N DATE ST	None	ESCONDIDO	CA	92025	3405	37	06073	33.12662288	-117.070312	San Diego County
44006	Fee-for-Service	1669414512	1669414512	1	1	LEUNG, ALEX S Y MD	2/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88871	41	Internal Medicine	0	In state provider	None	433 W BASTANCHURY ROAD	None	FULLERTON	CA	92835	3404	30	06059	33.89344341	-117.9338865	Orange County
44010	Fee-for-Service	1942692454	1942692454	1	1	LIAO, COREY W LAC	2/28/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	630 W DUARTE RD	204	ARCADIA	CA	91007	9205	19	06037	34.12627293	-118.0533506	Los Angeles County
44028	Fee-for-Service	1992733943	1992733943	1	1	LEE, MICHAEL S MD	7/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91019	66	Emergency Medicine (Urgent Care)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
44052	Fee-for-Service	1851537351	1851537351	1	1	LEON, SAMUEL O MD INC	7/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	73337	08	Family Practice	0	In state provider	None	560 W GRANGEVILLE BLVD	STE C	HANFORD	CA	93230	2866	16	06031	36.34270548	-119.653191	Kings County
44054	Fee-for-Service	1437358884	1437358884	1	1	LIN, ANNE Y MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117077	01	General Practice	0	In state provider	None	200 MEDICAL PLAZA	STE 214	LOS ANGELES	CA	90095	8344	19	06037	34.06527974	-118.4462792	Los Angeles County
44077	Fee-for-Service	1528159092	1528159092	1	1	LIEBERMAN, MARC MD	2/1/1985	207RR0500X	NA	Other	026	PHYSICIANS	33154	41	Internal Medicine	0	In state provider	None	224 SAN JOSE ST	None	SALINAS	CA	93901	3931	27	06053	36.65846024	-121.64729	Monterey County
44102	Fee-for-Service	1619912078	1619912078	1	1	LOBATZ, MICHAEL A MD	12/19/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	38353	13	Neurology (M.D. only)	0	In state provider	None	3907 WARING RD	None	OCEANSIDE	CA	92056	4454	37	06073	33.18780783	-117.2918439	San Diego County
44110	Fee-for-Service	1235490988	1235490988	1	1	LIAO, HAINI MD	8/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143026	38	Geriatrics	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6367	43	06085	37.36797679	-122.0297112	Santa Clara County
44121	Fee-for-Service	1639437809	1639437809	1	1	LAFREE, ANDREW T MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122523	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
44128	Fee-for-Service	1962784504	1962784504	1	1	LESLIE RASCH NP-C	11/7/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	544 S 400 E	None	ST GEORGE	UT	84770	3705	00	None	37.09902122	-113.5748483	Washington County
44129	Fee-for-Service	1710065305	1710065305	1	1	LIN, CAL K MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	60723	41	Internal Medicine	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
44151	Fee-for-Service	1356390843	1356390843	1	1	LOPATA, SCOTT D MD	5/14/1999	207P00000X	NA	Other	026	PHYSICIANS	68419	None	None	0	In state provider	None	3828 DELMAS TER	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
44159	Fee-for-Service	1891717203	1891717203	1	1	LICHTMACHER, JONATHAN E MD	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	77655	36	Psychiatry	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
44165	Fee-for-Service	1841428364	1841428364	1	1	LIEBERMAN, ROBERT MD	10/30/2024	2085R0204X	NA	Other	026	PHYSICIANS	114877	30	Radiology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
44169	Fee-for-Service	1497191738	1497191738	1	1	LE, DUONG L MD	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133090	41	Internal Medicine	0	In state provider	None	275 W HERNDON AVE	None	CLOVIS	CA	93612	0204	10	06019	36.83766747	-119.715174	Fresno County
44180	Fee-for-Service	1346699709	1346699709	1	1	LUCILE SALTER PACKARD	1/23/2018	3336C0002X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	ROOM 166	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
44210	Fee-for-Service	1467529206	1467529206	1	1	LEE, DIANA J OD	9/12/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2295 S VINEYARD	BUILDING A	ONTARIO	CA	91761	7925	36	06071	34.031889	-117.608112	San Bernardino County
44215	Fee-for-Service	1104936673	1104936673	1	1	LEVINE, ADIN MD	8/2/2002	207P00000X	NA	Other	026	PHYSICIANS	58301	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
44259	Fee-for-Service	1710482674	1710482674	1	1	LE, ANH P MD	6/4/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	167130	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
44288	Fee-for-Service	1760560338	1760560338	1	1	LUDHER, DIMPLE MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93919	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
44307	Fee-for-Service	1053346858	1053346858	1	1	LEE, JAY H MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63111	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1140 W LA VETA AVE	STE 640	ORANGE	CA	92868	4228	30	06059	33.7802984	-117.8651669	Orange County
44316	Fee-for-Service	1811531361	1811531361	1	1	LLOYD, DEBRA L NP	2/3/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95013936	-	NOT APPLICABLE	0	In state provider	None	120 BIRMINGHAM DRIVE	240A	CARDIFF BY THE SE	CA	92007	1757	37	06073	33.02310224	-117.2826142	San Diego County
44321	Fee-for-Service	1760864664	1760864664	1	1	LEE, JENNIFER G MD	2/1/2022	207P00000X	NA	Other	026	PHYSICIANS	144869	None	None	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
44365	Fee-for-Service	1528159092	1528159092	1	1	LIEBERMAN, MARC MD	2/1/1985	207RR0500X	NA	Other	026	PHYSICIANS	33154	83	Rheumatology	0	In state provider	None	224 SAN JOSE ST	None	SALINAS	CA	93901	3931	27	06053	36.65846024	-121.64729	Monterey County
44375	Fee-for-Service	1124470042	1124470042	1	1	LEONE, DANIELLE OD	9/7/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	27830 BRADLEY RD	None	SUN CITY	CA	92586	2201	33	06065	33.71615891	-117.1906431	Riverside County
44382	Fee-for-Service	1598182578	1598182578	1	1	LEVA, NATALIA MD	8/23/2021	208800000X	NA	Other	026	PHYSICIANS	138019	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
44413	Fee-for-Service	1154346468	1154346468	1	1	LI, ERIC C MD	10/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	76566	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
44443	Fee-for-Service	1053305177	1053305177	1	1	LENZ, KELLY A MD	6/21/2000	207L00000X	NA	Other	026	PHYSICIANS	76818	01	General Practice	0	In state provider	None	400 E MAIN ST	# 200	STOCKTON	CA	95202	3000	39	06077	37.95344497	-121.2852303	San Joaquin County
44459	Fee-for-Service	1194899419	1194899419	1	1	LEE, ARTHUR C MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	40110	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
44479	Fee-for-Service	1558748210	1558748210	1	1	LIN, CLIFFORD W	3/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	2	Out of state provider	None	3181 SW SAM JACKSON PARK	RD	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
44482	Fee-for-Service	1538261805	1538261805	1	1	LEE, STEPHEN M MD	1/25/2005	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	40530	10	Gastroenterology (M.D. only)	0	In state provider	None	27206 CALAROGA AVE	STE 212	HAYWARD	CA	94545	4300	01	06001	37.632357	-122.0868765	Alameda County
44486	Fee-for-Service	1962438044	1962438044	1	1	LOVETT, STUART M MD	12/8/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	40757	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3001 COLBY ST	# 3625	BERKELEY	CA	94705	2039	01	06001	37.85496934	-122.2575642	Alameda County
44507	Fee-for-Service	1780743435	1780743435	1	1	LOW, SAVINA QUAN MD	1/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77538	18	Ophthalmology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
44560	Fee-for-Service	1770661589	1770661589	1	1	LEE, JON G MD	1/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	78741	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
44579	Fee-for-Service	1730541616	1730541616	1	1	LE CLAIR, MARIE MD	8/27/2020	207L00000X	NA	Other	026	PHYSICIANS	151800	05	Anesthesiology	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
44590	Fee-for-Service	1275089518	1275089518	1	1	LOTAN, EYAL	6/2/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
44598	Fee-for-Service	1053346858	1053346858	1	1	LEE, JAY H MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63111	01	General Practice	0	In state provider	None	1140 W LA VETA AVE	STE 640	ORANGE	CA	92868	4228	30	06059	33.7802984	-117.8651669	Orange County
44649	Fee-for-Service	1215383583	1215383583	1	1	LIAO, JAMES H DO	9/18/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15977	08	Family Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
44667	Fee-for-Service	1447348370	1447348370	1	1	LEVINE, MICHAEL D MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97381	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
44703	Fee-for-Service	1356684211	1356684211	1	1	LIU, ANDREW B DO	10/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
44705	Fee-for-Service	1780627042	1780627042	2	1	LONGS DRUG STORES CA LLC	11/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5500 GROSSMONT CENTER DR	BLDG P	LA MESA	CA	91942	3016	37	06073	32.7793549	-117.0091108	San Diego County
44741	Fee-for-Service	1023235926	1023235926	1	1	LANG, L KHADIJAH MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66503	01	General Practice	0	In state provider	None	4361 S WESTERN AVE	None	LOS ANGELES	CA	90062	1651	19	06037	34.004313	-118.308959	Los Angeles County
44755	Fee-for-Service	1235784844	1235784844	1	1	LIN, DAVID PT	7/4/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
44767	Fee-for-Service	1366500647	1366500647	1	1	LONDON, JAMES T MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	23448	20	Orthopedic Surgery	0	In state provider	None	1360 W 6TH ST	STE 305	SAN PEDRO	CA	90732	3577	19	06037	33.73886546	-118.3075065	Los Angeles County
44771	Fee-for-Service	1518026814	1518026814	1	1	LEE, JOHN W MD	11/1/2000	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	54810	30	Radiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
44774	Fee-for-Service	1962438044	1962438044	1	1	LOVETT, STUART M MD	12/8/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	40757	01	General Practice	0	In state provider	None	3001 COLBY ST	# 3625	BERKELEY	CA	94705	2039	01	06001	37.85496934	-122.2575642	Alameda County
44775	Fee-for-Service	1538458724	1538458724	1	1	LAU, KENNETH K MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122425	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
44805	Fee-for-Service	1033163019	1033163019	1	1	LOS ROBLES HOSPITAL	1/1/1994	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	& MEDICAL CENTER	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1899	56	06111	34.2064445	-118.8824085	Ventura County
44810	Fee-for-Service	1144615659	1144615659	1	1	LENHART-PENDERGRASS, PATRICI	8/1/2022	2080P0214X	NA	Pulmonology	026	PHYSICIANS	179331	None	None	0	In state provider	A M MD	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
44858	Fee-for-Service	1942315387	1942315387	1	1	LIN, GRACE A MD	3/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90866	41	Internal Medicine	0	In state provider	None	1001 PORTRERO AVE	RM 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
44863	Fee-for-Service	1376079707	1376079707	1	1	LEE, SWAN MD	11/16/2022	208M00000X	NA	Other	026	PHYSICIANS	178141	None	None	0	In state provider	None	800 N TUSTIN AVENUE	SUITE A	SANTA ANA	CA	92705	5001	30	06059	33.752241	-117.8342255	Orange County
44903	Fee-for-Service	1528648284	1528648284	1	1	LOPEZ, DIANA H NP	9/5/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
44935	Fee-for-Service	1215383583	1215383583	1	1	LIAO, JAMES H DO	9/18/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15977	66	Emergency Medicine (Urgent Care)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
44964	Fee-for-Service	1316395726	1316395726	1	1	LOUIS, MATTHEW D MD	2/26/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	154573	08	Family Practice	0	In state provider	None	555 TACHEVAH DR	SUITE 2E-107	PALM SPRINGS	CA	92262	5752	33	06065	33.83753681	-116.5424435	Riverside County
45032	Fee-for-Service	1942248141	1942248141	1	1	LAI,CONRAD N MD	12/1/2000	207P00000X	NA	Other	026	PHYSICIANS	66219	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
45061	Fee-for-Service	1659788438	1659788438	1	1	LUCEY, CATHERINE S LMFT	5/8/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
45072	Fee-for-Service	1326303538	1326303538	1	1	LIM, BERNICE MD	10/7/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
45079	Fee-for-Service	1679600449	1679600449	1	1	LOSE, KOY S LMFT	10/22/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	51187	-	NOT APPLICABLE	0	In state provider	None	2934 N FRESNO ST	None	FRESNO	CA	93703	1123	10	06019	36.777735	-119.7815105	Fresno County
45112	Fee-for-Service	1912074402	1912074402	1	1	LING, DUYEN KHANH LE MD	9/30/1995	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	72979	30	Radiology	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
45121	Fee-for-Service	1861472300	1861472300	1	1	LAM, DING SUN MD INC	3/31/1980	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	32527	40	Pediatrics	0	In state provider	None	600 N GARFIELD AVE	STE 101	MONTEREY PARK	CA	91754	1167	19	06037	34.06820797	-118.1228835	Los Angeles County
45123	Fee-for-Service	1154322360	1154322360	1	1	LEPORE, MARK F MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75021	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
45135	Fee-for-Service	1033134572	1033134572	1	1	LITTLE, SUSAN J MD	8/31/1991	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	70574	77	Infectious Disease	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
45161	Fee-for-Service	1639452758	1639452758	1	1	LIAO, VICTORIA PSYD	4/19/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
45182	Fee-for-Service	1508599820	1508599820	1	1	LY, AARON PT	12/13/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 S LAS POSAS RD	STE 254	SAN MARCOS	CA	92078	2475	37	06073	33.14138594	-117.1924065	San Diego County
45192	Fee-for-Service	1700433943	1700433943	1	1	LAPALMA, DORIAN M MD	1/5/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	182658	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
45206	Fee-for-Service	1235428475	1235428475	1	1	LEE, JOANNA S MD	7/29/2022	2086X0206X	NA	General Surgery	026	PHYSICIANS	176275	None	None	0	In state provider	None	1480 64TH ST	STE 100, 125, 175	EMERYVILLE	CA	94608	2038	01	06001	37.84431239	-122.2926758	Alameda County
45242	Fee-for-Service	1457445249	1457445249	1	1	LEE, CAROLINE J MD	1/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86899	40	Pediatrics	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
45244	Fee-for-Service	1154748374	1154748374	1	1	LIAO, TIFFANY W MD	10/4/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	138614	40	Pediatrics	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
45259	Fee-for-Service	1962442012	1962442012	1	1	LONG BEACH MEMORIAL	3/1/1982	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
45336	Fee-for-Service	1659483550	1659483550	1	1	LAM, MAGGIE M K MD	12/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99562	22	Pathology (M.D. only)	0	In state provider	None	2450 ASHBY AVENUE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
45339	Fee-for-Service	1104320274	1104320274	1	1	LI, CHRISTOPHER MD	10/6/2023	208800000X	NA	Other	026	PHYSICIANS	185276	None	None	0	In state provider	None	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
45370	Fee-for-Service	1407875982	1407875982	1	1	LIEM,KIEM D MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	53159	78	Neoplastic Diseases/Oncology	0	In state provider	None	1043 ELM AVE	STE 104	LONG BEACH	CA	90813	3244	19	06037	33.779655	-118.1880065	Los Angeles County
45371	Fee-for-Service	1457393357	1457393357	1	1	LAUREN K WILLIS	3/23/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2835 FORT MISSOULA RD	BUILDING 3	MISSOULA	MT	59804	7423	00	None	46.846044	-114.0489675	Missoula County
45384	Fee-for-Service	1821090887	1821090887	1	1	LINDBLAD, DONALD E MD	6/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	14482	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
45386	Fee-for-Service	1598988057	1598988057	1	1	LEE, ARNOLD W MD	8/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114106	07	Dermatology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
45392	Fee-for-Service	1265576219	1265576219	2	1	LEE, JUNG SUN	8/8/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3663 W 6TH ST	STE 102	LOS ANGELES	CA	90020	3026	19	06037	34.06360557	-118.30199	Los Angeles County
45410	Fee-for-Service	1518917814	1518917814	1	1	LOARIE, DONALD J MD	4/28/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	29816	05	Anesthesiology	0	In state provider	None	1375 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3382	49	06097	38.627145	-122.863779	Sonoma County
45434	Fee-for-Service	1316068992	1316068992	1	1	LINDQUIST, MICHELE D	12/16/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6670 ALTON PARKWAY	None	IRVINE	CA	92618	3734	30	06059	33.65837833	-117.7727118	Orange County
45437	Fee-for-Service	1871755017	1871755017	1	1	LOO, JON W MD	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123551	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
45457	Fee-for-Service	1235650672	1235650672	1	1	LOPEZ, LEEZETT A CRNA	10/18/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
45510	Fee-for-Service	1902034887	1902034887	1	1	LIN, BONNIE	3/7/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	888 S HILL RD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
45512	Fee-for-Service	1467465641	1467465641	1	1	LOS ANGELES COUNTY	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MID VALLEY COMP HLTH CTR	7515 VAN NUYS BLVD	None	VAN NUYS	CA	91405	1949	19	06037	34.207344	-118.4487995	Los Angeles County
45514	Fee-for-Service	1427497262	1427497262	1	1	LEVERONI-CALVI, MATTEO MD	7/10/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168281	08	Family Practice	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
45515	Fee-for-Service	1225181829	1225181829	1	1	LEE, MUN Y J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	22220	01	General Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
45546	Fee-for-Service	1962442012	1962442012	1	1	LONG BEACH MEMORIAL	3/1/1982	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
45547	Fee-for-Service	1972797116	1972797116	1	1	LUBER, KARL M MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	62495	34	Urology and Urological Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
45566	Fee-for-Service	1912232224	1912232224	1	1	LIU, ANTHONY C MD	4/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	104903	18	Ophthalmology	0	In state provider	None	910 MAPLE STREET	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
45582	Fee-for-Service	1588241566	1588241566	1	1	LEON, BRIANNA MD	3/3/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	18370 BURBANK BLVD	STE 307	TARZANA	CA	91356	2804	19	06037	34.17173059	-118.5331881	Los Angeles County
45588	Fee-for-Service	1104041995	1104041995	1	1	LOZANO, DAVID MD	9/20/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54737	01	General Practice	0	In state provider	None	402 E HOLT BLVD	None	ONTARIO	CA	91761	1618	36	06071	34.063029	-117.6468075	San Bernardino County
45608	Fee-for-Service	1114345006	1114345006	1	1	LAW, JASON MD	1/31/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	148326	45	Nephrology (Renal-Kidney)	0	In state provider	None	2222 EAST STREET	STE 305	CONCORD	CA	94520	2066	07	06013	37.98125538	-122.0329375	Contra Costa County
45657	Fee-for-Service	1407875982	1407875982	1	1	LIEM,KIEM D MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	53159	68	Hematology	0	In state provider	None	1043 ELM AVE	STE 104	LONG BEACH	CA	90813	3244	19	06037	33.779655	-118.1880065	Los Angeles County
45673	Fee-for-Service	1124259569	1124259569	1	1	LIN, STEVEN W MD	10/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109541	07	Dermatology	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
45716	Fee-for-Service	1609095637	1609095637	1	1	LIN, SHIN MD	10/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107288	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
45719	Fee-for-Service	1669657748	1669657748	1	1	LONG, JENNIFER L MD	5/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93108	04	Otology, Laryngology, Rhinology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
45721	Fee-for-Service	1700021276	1700021276	1	1	LIPPERT, SUZANNE C MD	6/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98511	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
45739	Fee-for-Service	1477978534	1477978534	1	1	LEIVA SALINAS, CARLOS MD	2/2/2023	2085N0700X	NA	MRI Provider	026	PHYSICIANS	154586	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
45752	Fee-for-Service	1720080369	1720080369	1	1	LOVERIDGE,BRAIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5475 S 500 E	None	OGDEN	UT	84405	6905	00	None	41.16449014	-111.9686412	Weber County
45781	Fee-for-Service	1164956264	1164956264	1	1	LEININGER, DANIEL T DO	6/10/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	16789	None	None	0	In state provider	None	8851 CENTER DR	STE 505	LA MESA	CA	91942	3032	37	06073	32.78189749	-117.0075062	San Diego County
45782	Fee-for-Service	1558386045	1558386045	1	1	LEE-VALKOV, PAULA MD	2/7/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	90476	None	None	0	In state provider	None	1306 MARICOPA HIGHWAY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
45801	Fee-for-Service	1467465641	1467465641	1	1	LOS ANGELES COUNTY	7/1/2000	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MID VALLEY COMP HLTH CTR	7515 VAN NUYS BLVD	None	VAN NUYS	CA	91405	1949	19	06037	34.207344	-118.4487995	Los Angeles County
45803	Fee-for-Service	1104868918	1104868918	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2000 MOUNTAIN BLVD	None	OAKLAND	CA	94611	2807	01	06001	37.82723019	-122.2099391	Alameda County
45809	Fee-for-Service	1346255924	1346255924	1	4	LADENHEIM, ERIC D MD INC	2/22/2012	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	6145 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.82545273	-119.7831405	Fresno County
45828	Fee-for-Service	1033173588	1033173588	2	1	LEE, JAMES MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	45399	05	Anesthesiology	0	In state provider	None	12832 GARDEN GROVE BLVD	STE 230	GARDEN GROVE	CA	92843	2033	30	06059	33.77433247	-117.908712	Orange County
45835	Fee-for-Service	1972797116	1972797116	1	1	LUBER, KARL M MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	62495	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
45862	Fee-for-Service	1790315778	1790315778	1	1	LUNA HOSPICE INC	12/8/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8374 TOPANGA CANYON BLVD	STE 212	CANOGA PARK	CA	91304	2344	19	06037	34.222113	-118.605974	Los Angeles County
45872	Fee-for-Service	1750894630	1750894630	1	1	LE, HUONG H D OD	12/28/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	33758 YUCAIPA BLVD	None	YUCAIPA	CA	92399	2243	36	06071	34.03407872	-117.0672458	San Bernardino County
45893	Fee-for-Service	1225407976	1225407976	1	1	LEBRUN, RACHEL D NP	1/8/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
45895	Fee-for-Service	1114345006	1114345006	1	1	LAW, JASON MD	1/31/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	148326	41	Internal Medicine	0	In state provider	None	2222 EAST STREET	STE 305	CONCORD	CA	94520	2066	07	06013	37.98125538	-122.0329375	Contra Costa County
45899	Fee-for-Service	1306854526	1306854526	1	1	LIM, YIN MIN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49034	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2485 HOSPITAL DR	STE 261	MOUNTAIN VIEW	CA	94040	4103	43	06085	37.368918	-122.081761	Santa Clara County
45902	Fee-for-Service	1215213798	1215213798	1	1	LEE, CYNTHIA N CNP	1/13/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8731 W PICO BLVD	None	LOS ANGELES	CA	90035	2205	19	06037	34.05456946	-118.3824636	Los Angeles County
45907	Fee-for-Service	1255467296	1255467296	1	1	LUTZ, LYNN B OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	868 GRAVENSTEIN HWY N	None	SEBASTOPOL	CA	95472	2810	49	06097	38.40946337	-122.8405126	Sonoma County
45910	Fee-for-Service	1982617692	1982617692	1	1	LOS ANGELES COUNTY	6/18/2013	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	ROYBAL COMPREHENSIVE HLT	245 S FETTERLY AVE	None	LOS ANGELES	CA	90022	1605	19	06037	34.03404953	-118.1609476	Los Angeles County
45916	Fee-for-Service	1710075536	1710075536	1	1	LEVIN, EDWARD I MD	1/19/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	62168	34	Urology and Urological Surgery	0	In state provider	None	2450 MARTIN RD	None	FAIRFIELD	CA	94534	1018	48	06095	38.27452597	-122.0510438	Solano County
45929	Fee-for-Service	1508002742	1508002742	1	1	LARREW, MATTHEW D DO	11/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12880	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2309 ANTONIO AVE	None	CAMARILLO	CA	93010	1414	56	06111	34.24435917	-119.0191975	Ventura County
45957	Fee-for-Service	1528287281	1528287281	1	1	LAMBERSON, MARK D	6/8/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	100 JACKSON ST	None	RED BLUFF	CA	96080	3954	52	06103	40.17030473	-122.2378182	Tehama County
45961	Fee-for-Service	1063445815	1063445815	1	1	LEWIS, RENEE F LMFT	2/16/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27307 STATE HWY 189	SUITE 102	BLUE JAY	CA	92317	0102	36	06071	34.24736419	-117.2074501	San Bernardino County
46002	Fee-for-Service	1609095637	1609095637	1	1	LIN, SHIN MD	10/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107288	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
46029	Fee-for-Service	1427085745	1427085745	1	1	LEVIN, GORDON L MD	1/1/1979	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	17837	20	Orthopedic Surgery	0	In state provider	None	14901 NATIONAL AVE	STE 101	LOS GATOS	CA	95032	2637	43	06085	37.25216405	-121.9516011	Santa Clara County
46090	Fee-for-Service	1679935597	1679935597	1	1	LEIVA, DANIEL DO	9/13/2023	207P00000X	NA	Other	026	PHYSICIANS	20603	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
46095	Fee-for-Service	1346255924	1346255924	1	4	LADENHEIM, ERIC D MD INC	2/22/2012	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	6145 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.82545273	-119.7831405	Fresno County
46103	Fee-for-Service	1699905141	1699905141	1	1	LAMBROSE, SUSAN D LMFT	1/31/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4645 VIA VISTOSA	None	SANTA BARBARA	CA	93110	2333	42	06083	34.42917448	-119.7822497	Santa Barbara County
46118	Fee-for-Service	1386844868	1386844868	1	1	LEVINE, REED L MD	2/21/2018	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	94916	13	Neurology (M.D. only)	0	In state provider	None	1017 S FAIR OAKS AVE	None	PASADENA	CA	91105	2621	19	06037	34.12830178	-118.1503497	Los Angeles County
46119	Fee-for-Service	1447264668	1447264668	1	1	LAU, STEVEN C MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	51826	None	None	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
46134	Fee-for-Service	1750549176	1750549176	1	1	LEBARES, CARTER K MD	5/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117421	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
46147	Fee-for-Service	1811341647	1811341647	1	1	LINDSAY-MCGINN, FORREST MD	10/8/2021	207P00000X	NA	Other	026	PHYSICIANS	172721	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
46150	Fee-for-Service	1790315778	1790315778	1	1	LUNA HOSPICE INC	12/8/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8374 TOPANGA CANYON BLVD	STE 212	CANOGA PARK	CA	91304	2344	19	06037	34.222113	-118.605974	Los Angeles County
46153	Fee-for-Service	1710029772	1710029772	1	1	LIM, SUNG J DO	10/24/2017	207P00000X	NA	Other	026	PHYSICIANS	9670	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
46167	Fee-for-Service	1952763799	1952763799	1	1	LEE RODRIGUEZ, CHRISTIAN A M	2/19/2019	207R00000X	NA	Other	026	PHYSICIANS	150818	41	Internal Medicine	0	In state provider	D	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
46173	Fee-for-Service	1891873519	1891873519	1	1	LEPLER, YEVGENIY A MD	10/20/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82675	36	Psychiatry	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
46198	Fee-for-Service	1689916520	1689916520	1	1	LANDIG, MARK E L OD	12/24/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 STEIN PLAZA	SUITE 1-340	LOS ANGELES	CA	90095	0001	19	06037	34.06489065	-118.4443287	Los Angeles County
46200	Fee-for-Service	1982617692	1982617692	1	1	LOS ANGELES COUNTY	7/1/2000	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ROYBAL COMPREHENSIVE HLT	245 S FETTERLY AVE	None	LOS ANGELES	CA	90022	1605	19	06037	34.03404953	-118.1609476	Los Angeles County
46206	Fee-for-Service	1710075536	1710075536	1	1	LEVIN, EDWARD I MD	1/19/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	62168	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 MARTIN RD	None	FAIRFIELD	CA	94534	1018	48	06095	38.27452597	-122.0510438	Solano County
46214	Fee-for-Service	1942294202	1942294202	1	1	LOMAS, HARRY IV MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148885	30	Radiology	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
46255	Fee-for-Service	1407114606	1407114606	1	1	LEARNED, NICOLE L MD	4/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130347	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
46304	Fee-for-Service	1659422707	1659422707	1	1	LEE, LARRY J LCSW	1/28/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94410	3109	38	06075	37.78096053	-122.4637512	San Francisco County
46333	Fee-for-Service	1598895161	1598895161	1	1	LATHAN, MARGARETTE LMFT	8/30/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28100 BOUQUET CANYON RD.	SUITE 218	SANTA CLARITA	CA	91350	2009	19	06037	34.45052733	-118.497654	Los Angeles County
46376	Fee-for-Service	1356579916	1356579916	1	1	LEVIN, JESSE A MD	6/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113653	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
46402	Fee-for-Service	1275822793	1275822793	1	1	LANGELIER, CHARLES R MD	10/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	124890	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
46406	Fee-for-Service	1811004559	1811004559	1	2	LUM, PAULA J MD	10/16/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	53476	-	NOT APPLICABLE	0	In state provider	None	1001 POTRERO AVE	BLDG 80, 6TH FLOOR	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
46418	Fee-for-Service	1043611700	1043611700	1	1	LE-NGUYEN, HOANG LMFT	10/30/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
46420	Fee-for-Service	1831547736	1831547736	1	1	LOGGINS, GARY P JR	11/2/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
46449	Fee-for-Service	1164548541	1164548541	1	1	LIEN, SUSAN F MD	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127608	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
46453	Fee-for-Service	1285933838	1285933838	1	1	LAROSE, LISA D MD	10/20/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	174916	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
46488	Fee-for-Service	1982617692	1982617692	1	1	LOS ANGELES COUNTY	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ROYBAL COMPREHENSIVE HLT	245 S FETTERLY AVE	None	LOS ANGELES	CA	90022	1605	19	06037	34.03404953	-118.1609476	Los Angeles County
46510	Fee-for-Service	1114926672	1114926672	1	1	LEE, EDWARD S MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	62692	84	Surgery-Head and Neck	0	In state provider	None	1401 N TUSTIN AVE	STE 130	SANTA ANA	CA	92705	8675	30	06059	33.757254	-117.8341425	Orange County
46527	Fee-for-Service	1366658726	1366658726	1	1	LOYD'S LIBERTY HOMES	1/17/1995	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	NORTH KNOLL	6062 N KNOLL AVE	None	FRESNO	CA	93711	6512	10	06019	36.823896	-119.860101	Fresno County
46529	Fee-for-Service	1407083348	1407083348	1	1	LEE, JOHN J MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141816	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
46579	Fee-for-Service	1275104499	1275104499	1	1	LOGAN, STEPHANIE LCSW	10/25/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
46590	Fee-for-Service	1952338501	1952338501	1	1	LEWIS, MARIA F MD	9/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88691	08	Family Practice	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
46592	Fee-for-Service	1164735551	1164735551	1	1	LIGHTMAN, NICOLE S CP	3/16/2023	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	23 CORPORATE PLAZA DR	STE 150	NEWPORT BEACH	CA	92660	7908	30	06059	33.6090297	-117.8748261	Orange County
46604	Fee-for-Service	1477170561	1477170561	1	1	LOVE AND PEACE HOSPICE INC	4/27/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	22048 SHERMAN WAY	SUITE 202	CANOGA PARK	CA	91303	1894	19	06037	34.20099048	-118.60776	Los Angeles County
46627	Fee-for-Service	1588756704	1588756704	1	1	LANG, JOHN A PHD	9/18/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
46654	Fee-for-Service	1225600422	1225600422	1	1	LANE, DANAE J OT	10/18/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	556 N 1ST ST	SUITE 201	SAN JOSE	CA	95112	5300	43	06085	37.34591974	-121.8977166	Santa Clara County
46666	Fee-for-Service	1730604364	1730604364	1	1	LEE, WENNY H CNP	2/10/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
46676	Fee-for-Service	1053495051	1053495051	1	1	LOWELL, ROBERT ANDREW MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74960	41	Internal Medicine	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
46694	Fee-for-Service	1063801207	1063801207	1	1	LIMOGES, NATALIE DO	6/29/2022	207T00000X	NA	General Surgery	026	PHYSICIANS	19824	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
46702	Fee-for-Service	1124014741	1124014741	1	1	LEE, MIN-WEI C MD	6/14/2013	207N00000X	NA	Dermatology	026	PHYSICIANS	80164	None	None	0	In state provider	IONAL CORP	370 N WIGET LN	SUITE 125	WALNUT CREEK	CA	94598	2451	07	06013	37.92948925	-122.0275099	Contra Costa County
46734	Fee-for-Service	1316997810	1316997810	1	1	LEE, JOSEPHINE MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69592	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
46735	Fee-for-Service	1851355309	1851355309	1	2	LEE, EILEEN S OD	11/6/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	388 9TH STREET	SUITE 157	OAKLAND	CA	94607	4290	01	06001	37.80019425	-122.2715222	Alameda County
46736	Fee-for-Service	1770886483	1770886483	1	1	LUNNEY, KEVIN M MD	9/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114959	None	None	0	In state provider	None	400 WEST MINERAL KING BL	None	VISALIA	CA	93291	6263	54	06107	36.327888	-119.294919	Tulare County
46737	Fee-for-Service	1568487593	1568487593	1	1	LENAHAN, JOHN E MD INC	1/11/1996	207L00000X	NA	Other	026	PHYSICIANS	28143	05	Anesthesiology	0	In state provider	None	16795 LARK AVE	STE 230	LOS GATOS	CA	95032	7650	43	06085	37.25302151	-121.966891	Santa Clara County
46778	Fee-for-Service	1649208794	1649208794	1	1	LILLICH, CARLEEN F LPCC	1/19/2021	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5871 PINE AVE	SUITE 230	CHINO HILLS	CA	91709	6545	36	06071	33.94767013	-117.6754339	San Bernardino County
46794	Fee-for-Service	1114926672	1114926672	1	1	LEE, EDWARD S MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	62692	04	Otology, Laryngology, Rhinology	0	In state provider	None	1401 N TUSTIN AVE	STE 130	SANTA ANA	CA	92705	8675	30	06059	33.757254	-117.8341425	Orange County
46798	Fee-for-Service	1780615641	1780615641	1	1	LUONG, JEAN	1/31/1990	207R00000X	NA	Other	026	PHYSICIANS	48809	41	Internal Medicine	0	In state provider	None	295 OCONNOR DR	None	SAN JOSE	CA	95128	1624	43	06085	37.32556245	-121.9398958	Santa Clara County
46801	Fee-for-Service	1043453228	1043453228	1	1	LEWIS, JASON	2/10/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	191933	08	Family Practice	0	In state provider	None	3535 TORRANCE BLVD	STE 13	TORRANCE	CA	90503	4815	19	06037	33.83761551	-118.348227	Los Angeles County
46802	Fee-for-Service	1174979660	1174979660	1	1	LICHTENSTEIN, SHIRI Z PSYD	6/30/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
46816	Fee-for-Service	1497857999	1497857999	1	1	LESSNER, MARK M MD	10/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	33868	40	Pediatrics	0	In state provider	None	2415 W VINE ST	STE 100	LODI	CA	95242	3731	39	06077	38.1228953	-121.3052826	San Joaquin County
46862	Fee-for-Service	1972104925	1972104925	1	1	LEE, ANDREW S PT	2/23/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
46873	Fee-for-Service	1366594459	1366594459	1	1	LEE, HELEN S OD	1/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
46877	Fee-for-Service	1922288745	1922288745	1	1	LI, PETER MD	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109365	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
46880	Fee-for-Service	1760707210	1760707210	1	1	LEHNERT SCHUCHARDT, ELEANOR	8/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156946	35	Pediatric Cardiology (M.D. only)	0	In state provider	L MD	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
46892	Fee-for-Service	1477170561	1477170561	1	1	LOVE AND PEACE HOSPICE INC	4/27/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	22048 SHERMAN WAY	SUITE 202	CANOGA PARK	CA	91303	1894	19	06037	34.20099048	-118.60776	Los Angeles County
46983	Fee-for-Service	1548525157	1548525157	1	1	LI, SONGQIAN MD	9/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136726	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
46986	Fee-for-Service	1891996724	1891996724	1	1	LIU, SASHA LMFT	8/22/2018	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39825 PASEO PADER PKWY	STE B	FREMONT	CA	94538	3031	01	06001	37.54749452	-121.9695757	Alameda County
47010	Fee-for-Service	1346828159	1346828159	1	1	LINS, JEREMY MD	9/9/2024	207P00000X	NA	Other	026	PHYSICIANS	192402	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
47027	Fee-for-Service	1568487593	1568487593	1	1	LENAHAN, JOHN E MD INC	1/11/1996	207L00000X	NA	Other	026	PHYSICIANS	28143	01	General Practice	0	In state provider	None	16795 LARK AVE	STE 230	LOS GATOS	CA	95032	7650	43	06085	37.25302151	-121.966891	Santa Clara County
47093	Fee-for-Service	1912941683	1912941683	1	1	LUGO, GUSTAVO A MD	10/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	57240	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
47138	Fee-for-Service	1902338650	1902338650	1	1	LANDSMAN, ASHLEY N MD	6/15/2020	390200000X	NA	Other	026	PHYSICIANS	157017	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
47146	Fee-for-Service	1578641726	1578641726	1	1	LEE, MARTHA MFT	6/23/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	32 MAIN STREET	None	SUTTER CREEK	CA	95685	4231	03	06005	38.39271966	-120.8028632	Amador County
47168	Fee-for-Service	1760707210	1760707210	1	1	LEHNERT SCHUCHARDT, ELEANOR	8/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156946	40	Pediatrics	0	In state provider	L MD	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
47189	Fee-for-Service	1497737738	1497737738	1	1	LOPEZ, ENRIQUE PHD	5/5/2006	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
47192	Fee-for-Service	1265493936	1265493936	1	2	LISCOMB, JESSE R JR MD	11/30/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	36753	-	NOT APPLICABLE	0	In state provider	None	95C W HANFORD-ARMONA RD	None	LEMOORE	CA	93245	5270	16	06031	36.3133857	-119.7822987	Kings County
47206	Fee-for-Service	1114038338	1114038338	1	1	LEPKOWSKI, HEMLATA K MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50838	30	Radiology	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 103	GARDEN GROVE	CA	92843	1915	30	06059	33.77450141	-117.9123364	Orange County
47219	Fee-for-Service	1669470860	1669470860	1	1	LEVINE, MARTIN D MD INC	5/31/1995	2084N0400X	NA	Neurology	026	PHYSICIANS	21066	13	Neurology (M.D. only)	0	In state provider	None	16311 VENTURA BLVD	STE 680	ENCINO	CA	91436	4321	19	06037	34.15706864	-118.4885978	Los Angeles County
47260	Fee-for-Service	1437192606	1437192606	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10 BAYHILL SHOPPING CNT	None	SAN BRUNO	CA	94066	2953	41	06081	37.62675744	-122.4250498	San Mateo County
47312	Fee-for-Service	1679597215	1679597215	1	1	LORD, JANET MD	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	597 CENTER AVE	SUITE 150	MARTINEZ	CA	94553	4674	07	06013	37.99276685	-122.1187185	Contra Costa County
47321	Fee-for-Service	1770788713	1770788713	1	1	LEE, PAUL C MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	77461	18	Ophthalmology	0	In state provider	CA CNTR FOR REFRACT SURG	3130 W OLYMPIC BLVD	STE 250	LOS ANGELES	CA	90006	2491	19	06037	34.05258529	-118.3039795	Los Angeles County
47333	Fee-for-Service	1275762387	1275762387	1	1	LE, THUAN H MD	7/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130547	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
47350	Fee-for-Service	1649584194	1649584194	1	1	LI, WING Y OD	10/28/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
47379	Fee-for-Service	1912941683	1912941683	1	1	LUGO, GUSTAVO A MD	10/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	57240	01	General Practice	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
47398	Fee-for-Service	1700945441	1700945441	1	1	LATTANZI, IRINA MD	8/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78923	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
47419	Fee-for-Service	1487282067	1487282067	1	1	LAPIERRE, SARAH MD	7/29/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
47446	Fee-for-Service	1538216783	1538216783	1	1	LA HABRA CITY SD	7/1/1994	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	500 N WALNUT ST	None	LA HABRA	CA	90631	3769	30	06059	33.93604639	-117.9505008	Orange County
47461	Fee-for-Service	1255980843	1255980843	1	1	LA DIRECT HOME HEALTH CARE	11/27/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	3959 FOOTHILL BLVD	STE 301	GLENDALE	CA	91214	1664	19	06037	34.24025956	-118.2658392	Los Angeles County
47466	Fee-for-Service	1154365666	1154365666	1	1	LAVERNE, ROBERT G MD	1/2/1982	207L00000X	NA	Other	026	PHYSICIANS	35834	None	None	0	In state provider	None	1399 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	2884	07	06013	37.91095214	-122.0468144	Contra Costa County
47477	Fee-for-Service	1205881026	1205881026	1	1	LOMA LINDA UNIVERSITY	12/25/1987	207ZC0500X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	PATHOLOGY MEDICAL GROUP	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
47504	Fee-for-Service	1538329990	1538329990	1	1	LI, ERIN L NP	9/25/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
47562	Fee-for-Service	1447678941	1447678941	1	1	LE, CRYSTAL P MD MPH	3/26/2018	390200000X	NA	Other	026	PHYSICIANS	154634	18	Ophthalmology	0	In state provider	None	1001 POTRERO AVE	RM 4M31	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
47583	Fee-for-Service	1437160637	1437160637	1	1	LOS ANGELES LGBT CENTER	6/1/2003	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1625 N SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	19	06037	34.100523	-118.3324855	Los Angeles County
47631	Fee-for-Service	1649590258	1649590258	1	2	LU, ELAINE I MD	1/3/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	113541	-	NOT APPLICABLE	0	In state provider	None	86 SOUTH 14TH STREET	None	SAN JOSE	CA	95112	2015	43	06085	37.34109735	-121.8760463	Santa Clara County
47681	Fee-for-Service	1720075096	1720075096	1	1	LIN WANG, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	17198 ST LUKES WAY	STE 510	THE WOODLANDS	TX	77384	8016	00	None	30.20499907	-95.45947645	Montgomery County
47692	Fee-for-Service	1598870768	1598870768	1	1	LINTON, SHANNON M MD	6/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99568	05	Anesthesiology	0	In state provider	None	700 MT RANCH RD	None	SAN ANDREAS	CA	95249	0000	05	06009	38.18960347	-120.6719165	Calaveras County
47699	Fee-for-Service	1114940640	1114940640	1	1	LEON, ZONIA A MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	72043	40	Pediatrics	0	In state provider	None	14901 RINALDI ST	STE 330	MISSION HILLS	CA	91345	1250	19	06037	34.27903452	-118.457433	Los Angeles County
47710	Fee-for-Service	1881875433	1881875433	1	1	LEVINE, PHILLIP MD	8/1/1996	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	35171	41	Internal Medicine	0	In state provider	None	8631 W 3RD ST	STE 815E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
47735	Fee-for-Service	1821044082	1821044082	1	1	LIN, STEVEN T MD	12/31/1995	207PE0004X	NA	Other	026	PHYSICIANS	79843	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16200 SAND CANYON AVE	None	IRVINE	CA	92618	3714	30	06059	33.6617581	-117.7736362	Orange County
47757	Fee-for-Service	1134757941	1134757941	1	1	LEE, DANIEL J MD	4/11/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
47772	Fee-for-Service	1275995490	1275995490	1	1	LI, CATHLEEN Y DO	1/29/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14494	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
47797	Fee-for-Service	1174602965	1174602965	1	1	LEE, FRANK MD	10/20/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71170	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
47850	Fee-for-Service	1124269949	1124269949	1	1	LU, JANE H LMFT	11/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2600 MISSION ST	STE 201	SAN MARINO	CA	91008	1676	19	06037	34.11610632	-118.1375175	Los Angeles County
47851	Fee-for-Service	1427096957	1427096957	1	1	LOPES, ANA S MD	2/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101559	08	Family Practice	0	In state provider	None	27924 SECO CANYON RD	None	SANTA CLARITA	CA	91350	3870	19	06037	34.4588501	-118.5343405	Los Angeles County
47877	Fee-for-Service	1932231503	1932231503	1	1	LOPEZ, NICHOLAS R MD	5/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100996	None	None	0	In state provider	None	300 HOSPITAL DRIVE	None	VALLEJO	CA	94589	2517	48	06095	38.13070051	-122.237307	Solano County
47885	Fee-for-Service	1457602807	1457602807	1	1	LAU, WILMONDSON LMFT	1/20/2025	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
47894	Fee-for-Service	1639265143	1639265143	1	1	LEE, JAE W MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32086	01	General Practice	0	In state provider	None	3670 WILSHIRE BLVD	STE 410	LOS ANGELES	CA	90010	2702	19	06037	34.06169447	-118.3057335	Los Angeles County
47921	Fee-for-Service	1104073709	1104073709	1	1	LARSEN, GREGORY S DO	10/19/2010	207P00000X	NA	Other	026	PHYSICIANS	10521	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
47930	Fee-for-Service	1265917595	1265917595	1	1	LANNY RUDNER, M.D., P.C.	4/10/2019	207XX0004X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	T & ANKLE SPECIALISTS	99 N LA CIENEGA BLVD	SUITE 304	BEVERLY HILLS	CA	90211	2286	19	06037	34.06736471	-118.3763201	Los Angeles County
47949	Fee-for-Service	1306871199	1306871199	1	1	LU, DAVID B MD	2/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	77795	None	None	0	In state provider	None	26816 VISTA TER	None	LAKE FOREST	CA	92630	8115	30	06059	33.6649298	-117.6631024	Orange County
47953	Fee-for-Service	1255307724	1255307724	1	1	LAYA, JOSEPH W OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ADVAN EYE CARE OPT	1751 HARTNELL AVE	STE 1	REDDING	CA	96002	0748	45	06089	40.56370348	-122.3388585	Shasta County
47957	Fee-for-Service	1437660081	1437660081	1	1	LUX DERM AESTHETICS	4/2/2018	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	38920 TRADE CENTER DR	None	PALMDALE	CA	93551	3715	19	06037	34.58884303	-118.1430688	Los Angeles County
47959	Fee-for-Service	1669435509	1669435509	1	1	LILLO, OSCAR OD	4/11/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1801 E. TAHQUITZ CANYON	200 & 201	PALM SPRINGS	CA	92262	7123	33	06065	33.82303451	-116.5265775	Riverside County
47969	Fee-for-Service	1285614693	1285614693	1	1	LEE, THOMAS W MD INC	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	25725	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	930 E FOOTHILL BLVD	STE 2	UPLAND	CA	91786	4051	36	06071	34.10687051	-117.6387075	San Bernardino County
47980	Fee-for-Service	1295145951	1295145951	1	1	LOPEZ, JASON J MD	2/1/2019	207P00000X	NA	Other	026	PHYSICIANS	155935	66	Emergency Medicine (Urgent Care)	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
48000	Fee-for-Service	1881875433	1881875433	1	1	LEVINE, PHILLIP MD	8/1/1996	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	35171	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8631 W 3RD ST	STE 815E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
48029	Fee-for-Service	1518205020	1518205020	1	1	LANG, SHENGHUA MD	6/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135688	41	Internal Medicine	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
48030	Fee-for-Service	1316179252	1316179252	1	1	LI, JAMES S OD	1/6/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
48037	Fee-for-Service	1437419777	1437419777	1	1	LE, MARGEAUX C MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136955	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
48062	Fee-for-Service	1174881346	1174881346	1	1	LEE-KIM, CHRISTINE Y DO	4/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	11915	03	Allergy	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
48067	Fee-for-Service	1235609413	1235609413	1	2	LEO L FONG CORPORATION	7/1/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	D CENTER	5448 W DE LAS ROBLES	None	VISALIA	CA	93291	5322	54	06107	36.328311	-119.3517315	Tulare County
48076	Fee-for-Service	1144398132	1144398132	1	1	LOWE, SUSAN-MARIE	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
48087	Fee-for-Service	1265937742	1265937742	1	1	LANTOS, EMMA	10/7/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	176641	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
48121	Fee-for-Service	1285774414	1285774414	1	1	LEINER, HELENA E MD	12/31/1995	207R00000X	NA	Other	026	PHYSICIANS	40915	41	Internal Medicine	0	In state provider	None	1860 ALCATRAZ AVE	None	BERKELEY	CA	94703	2715	01	06001	37.84890801	-122.2698934	Alameda County
48135	Fee-for-Service	1558302570	1558302570	1	1	LEE MEMORIAL HEALTH SYS	3/1/1998	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2776 CLEVELAND AVE	None	FORT MYERS	FL	33901	5864	00	None	26.628237	-81.873945	Lee County
48153	Fee-for-Service	1487009171	1487009171	1	1	LEMONS, KATRINIA R NP	6/19/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
48154	Fee-for-Service	1205148277	1205148277	1	1	LEI, PENG MD	4/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129179	18	Ophthalmology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
48208	Fee-for-Service	1962530618	1962530618	1	1	LIPKIN, DANIELLE R LMFT	9/17/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
48218	Fee-for-Service	1629154745	1629154745	1	1	LEWIS, KENNETH D MD	3/1/2000	207L00000X	NA	Other	026	PHYSICIANS	48449	05	Anesthesiology	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
48239	Fee-for-Service	1881118321	1881118321	1	1	LIEM, SOPHIA C DO	6/18/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2031 W ALAMEDA AVE	300	BURBANK	CA	91506	2960	19	06037	34.15972797	-118.3237055	Los Angeles County
48245	Fee-for-Service	1437660081	1437660081	1	1	LUX DERM AESTHETICS	4/2/2018	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	38920 TRADE CENTER DR	None	PALMDALE	CA	93551	3715	19	06037	34.58884303	-118.1430688	Los Angeles County
48260	Fee-for-Service	1356609317	1356609317	1	1	LANA J MCGILL M.D.	3/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 S COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
48289	Fee-for-Service	1760520837	1760520837	1	1	LINDEN UNIFIED SD	5/3/2004	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	18527 E MAIN ST	None	LINDEN	CA	95236	9584	39	06077	0	0	None
48293	Fee-for-Service	1952335002	1952335002	1	1	LABOWE, MARK L MD	2/8/2015	2086S0122X	NA	General Surgery	026	PHYSICIANS	52484	24	Plastic Surgery	0	In state provider	None	100 UCLA MEDICAL PLZ	STE 747	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
48296	Fee-for-Service	1871743542	1871743542	1	1	LE, JENNIFER NP	9/27/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
48351	Fee-for-Service	1174881346	1174881346	1	1	LEE-KIM, CHRISTINE Y DO	4/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	11915	41	Internal Medicine	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
48408	Fee-for-Service	1285774414	1285774414	1	1	LEINER, HELENA E MD	12/31/1995	207R00000X	NA	Other	026	PHYSICIANS	40915	08	Family Practice	0	In state provider	None	1860 ALCATRAZ AVE	None	BERKELEY	CA	94703	2715	01	06001	37.84890801	-122.2698934	Alameda County
48421	Fee-for-Service	1558302570	1558302570	1	1	LEE MEMORIAL HEALTH SYS	3/27/2018	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2776 CLEVELAND AVE	None	FORT MYERS	FL	33901	5864	00	None	26.628237	-81.873945	Lee County
48455	Fee-for-Service	1992882534	1992882534	1	1	LITTLE SIS. OF THE POOR	4/12/2006	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	SIS. MARG. MCCARTHY	2100 S. WESTERN AVE	None	SAN PEDRO	CA	90732	4331	19	06037	33.72553551	-118.3112798	Los Angeles County
48464	Fee-for-Service	1790742856	1790742856	1	1	LO, ABRAHAM J JR MD	10/26/1994	174400000X	NA	Other	026	PHYSICIANS	53654	01	General Practice	0	In state provider	None	1100 N PALM CANYON DR	STE 210	PALM SPRINGS	CA	92262	4426	33	06065	33.838182	-116.546744	Riverside County
48486	Fee-for-Service	1194380683	1194380683	1	1	LUECK, BETHANY MD	4/21/2023	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	184928	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
48503	Fee-for-Service	1821593146	1821593146	1	1	LISENBEE, SARAH C PSYD	10/10/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
48522	Fee-for-Service	1831586015	1831586015	1	1	LIOU, VICTOR D MD	5/5/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	185134	None	None	0	In state provider	None	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
48529	Fee-for-Service	1053368084	1053368084	1	1	LUH, STEVEN MD	8/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	82994	01	General Practice	0	In state provider	None	27871 MEDICAL CENTER RD	SUITE 200	MISSION VIEJO	CA	92691	6406	30	06059	33.558534	-117.6641255	Orange County
48536	Fee-for-Service	1487673034	1487673034	1	1	LI, STEVEN T MD	4/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	72097	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
48541	Fee-for-Service	1043707714	1043707714	1	1	LIN, KEVIN MD	9/3/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	186465	04	Otology, Laryngology, Rhinology	0	In state provider	None	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
48554	Fee-for-Service	1831156827	1831156827	1	1	LEHMANN, CORRINE E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
48556	Fee-for-Service	1124081112	1124081112	1	1	LEWIS, WILLIAM BECK MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86559	18	Ophthalmology	0	In state provider	None	2961 SUMMIT ST	STE 1	OAKLAND	CA	94609	3482	01	06001	37.81865235	-122.2647856	Alameda County
48560	Fee-for-Service	1366633554	1366633554	1	1	LEBA, THU-BA MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121441	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
48573	Fee-for-Service	1760520837	1760520837	1	1	LINDEN UNIFIED SD	2/13/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	18527 E MAIN ST	None	LINDEN	CA	95236	9584	39	06077	0	0	None
48580	Fee-for-Service	1184205122	1184205122	1	1	LMD SAN DIEGO PHARMACY, INC.	2/28/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	330 S MAGNOLIA AVE	STE. 102	EL CAJON	CA	92020	5221	37	06073	32.79218212	-116.9623617	San Diego County
48591	Fee-for-Service	1104336254	1104336254	1	1	LIU-KU, SHANNON B MD	9/10/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	149635	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
48608	Fee-for-Service	1235572934	1235572934	1	1	LIU, YIN MD	6/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138661	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
48636	Fee-for-Service	1528224235	1528224235	1	1	LAHIJANI, SHEILA C MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137837	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
48670	Fee-for-Service	1811382138	1811382138	1	1	LARA, MARTHA L MD	7/8/2020	207L00000X	NA	Other	026	PHYSICIANS	146445	None	None	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
48695	Fee-for-Service	1639334378	1639334378	1	1	LIM, SHI YUN MD	7/12/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	153471	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
48697	Fee-for-Service	1285774414	1285774414	1	1	LEINER, HELENA E MD	12/31/1995	207R00000X	NA	Other	026	PHYSICIANS	40915	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1860 ALCATRAZ AVE	None	BERKELEY	CA	94703	2715	01	06001	37.84890801	-122.2698934	Alameda County
48806	Fee-for-Service	1700536398	1700536398	1	1	LEWIS, JOSEPH MD	6/12/2024	207P00000X	NA	Other	026	PHYSICIANS	187739	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
48828	Fee-for-Service	1639422272	1639422272	1	2	LYNN L ROCKWELL	2/8/2015	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	215 OAKVALE AVENUE	None	OROVILLE	CA	95966	2056	04	06007	39.49847607	-121.4928969	Butte County
48851	Fee-for-Service	1821036500	1821036500	1	1	LISK, JEROME P MD	10/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	88331	13	Neurology (M.D. only)	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
48895	Fee-for-Service	1235572934	1235572934	1	1	LIU, YIN MD	6/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138661	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
48923	Fee-for-Service	1528224235	1528224235	1	1	LAHIJANI, SHEILA C MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137837	36	Psychiatry	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
48932	Fee-for-Service	1447767678	1447767678	1	1	LING, LESLIE CNM	8/4/2022	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
48937	Fee-for-Service	1508430968	1508430968	1	1	LIM, ALEX E MD	4/3/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1211 W. LA PALMA AVE.	SUITE 404	ANAHEIM	CA	92801	2806	30	06059	33.84718298	-117.933758	Orange County
48940	Fee-for-Service	1083658439	1083658439	2	1	LONGS DRUG STORES CA LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1041 EL MONTE AVE	None	MOUNTAIN VIEW	CA	94040	2320	43	06085	37.39002228	-122.0959287	Santa Clara County
48984	Fee-for-Service	1104923663	1104923663	1	1	LEE, JONG H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV MED CTR	1501 N CAMPBELL	None	TUCSON	AZ	85724	0000	00	None	32.240493	-110.9460825	Pima County
48987	Fee-for-Service	1598121667	1598121667	1	1	LENFORD, LANCE R PSYD	11/9/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10601 CIVIC CENTER DR	STE 100 A-D	RANCHO CUCAMONGA	CA	91730	3878	36	06071	34.1023554	-117.5735696	San Bernardino County
49010	Fee-for-Service	1780250431	1780250431	1	1	LEE, DEANNA H PT	6/10/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	585 SATURN	STE A	SAN DIEGO	CA	92154	4721	37	06073	32.586336	-117.088506	San Diego County
49040	Fee-for-Service	1295861409	1295861409	1	1	LANGER, ANNETTE M MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60219	13	Neurology (M.D. only)	0	In state provider	None	2680 HANOVER ST	# 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
49073	Fee-for-Service	1467133694	1467133694	1	1	LIN, BRIAN CRNA	12/7/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
49106	Fee-for-Service	1477991859	1477991859	1	1	LOW, MICHAEL S MD	8/1/2017	207P00000X	NA	Other	026	PHYSICIANS	149679	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 EAST 4TH STREET	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
49110	Fee-for-Service	1316271802	1316271802	1	1	LAM, FRED C MD	2/29/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
49116	Fee-for-Service	1659774461	1659774461	1	1	LIVELY, KATHERINE M LMFT	3/2/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
49141	Fee-for-Service	1174653992	1174653992	1	1	LO, MARGARET S MD	9/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95854	08	Family Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
49183	Fee-for-Service	1710098074	1710098074	1	1	LOPEZ, JAVIER E MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79848	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
49185	Fee-for-Service	1801945167	1801945167	1	1	LEE, MICHAEL L MD	2/28/1984	207R00000X	NA	Other	026	PHYSICIANS	39187	41	Internal Medicine	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
49188	Fee-for-Service	1073053179	1073053179	1	1	LEBLANC, SHANNON K NP	4/19/2018	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
49192	Fee-for-Service	1760061519	1760061519	1	1	LIBRERO, DAPHNE LEN PT	2/23/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
49223	Fee-for-Service	1316238850	1316238850	1	1	LJUBENKOV, PETER A MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124893	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
49240	Fee-for-Service	1811931645	1811931645	2	1	LONGS DRUG STORE CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6910 ALMADEN EXPY	None	SAN JOSE	CA	95120	3201	43	06085	37.21031335	-121.8469142	Santa Clara County
49278	Fee-for-Service	1366113508	1366113508	1	1	LIM, CAITRYN A NP	3/17/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
49299	Fee-for-Service	1033461124	1033461124	1	1	LAI, MEI F W	6/12/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
49300	Fee-for-Service	1881216679	1881216679	1	1	LA COUNTY OF EDU	2/6/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	9300 IMPERIAL HWY	None	DOWNEY	CA	90242	0000	19	06037	33.91693053	-118.129077	Los Angeles County
49306	Fee-for-Service	1831658186	1831658186	1	1	LEUNG, KRYSTLE M MD	4/15/2025	207RP1001X	NA	Pulmonology	026	PHYSICIANS	176254	41	Internal Medicine	0	In state provider	None	420 BROADWAY STREET	None	REDWOOD CITY	CA	94063	3132	41	06081	37.48517644	-122.2022111	San Mateo County
49323	Fee-for-Service	1790834877	1790834877	1	1	LITVIN, CHESTER PHD	2/1/2001	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	421 E ANGELENO AVE	STE 105	BURBANK	CA	91501	2286	19	06037	34.18278568	-118.3048911	Los Angeles County
49339	Fee-for-Service	1740306489	1740306489	1	1	LOERA, MEGAN LCSW	10/17/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
49354	Fee-for-Service	1215356233	1215356233	1	1	LIN, YUXUAN MD	10/18/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	161056	30	Radiology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
49361	Fee-for-Service	1427493758	1427493758	1	1	LEWIS, LAUREN M	7/23/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2930 IMPERIAL HWY	310	LOS ANGELES	CA	90303	3112	19	06037	33.93087352	-118.32534	Los Angeles
49404	Fee-for-Service	1730256637	1730256637	1	1	LIBAW, EVAN MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50215	07	Dermatology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
49407	Fee-for-Service	1730541764	1730541764	1	1	LEVINE, ZACHARY MD	4/12/2022	207P00000X	NA	Other	026	PHYSICIANS	174692	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
49413	Fee-for-Service	1790216075	1790216075	1	1	LEVIN, ANA A MD	8/18/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158162	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
49447	Fee-for-Service	1487488631	1487488631	1	1	LALA, RACHEL M NP	1/17/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3700 SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
49472	Fee-for-Service	1174781124	1174781124	1	1	LEE, HANNHA PSYD	8/29/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	12501 IMPERIAL HWY	STE 400	NORWALK	CA	90650	1419	19	06037	33.91723852	-118.065834	Los Angeles County
49494	Fee-for-Service	1245378173	1245378173	1	1	LO, SEE S MD	9/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97696	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2155 IRON POINT ROAD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
49539	Fee-for-Service	1871700898	1871700898	1	1	LAURA K HOWELL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CHILDREND HOSPITAL MD	3333 BURNET AVE	None	CINCINNATI	OH	45229	0000	00	None	39.14105892	-84.50040782	Hamilton County
49549	Fee-for-Service	1437315298	1437315298	1	1	LORENZ, EILEEN MD	4/16/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	191709	30	Radiology	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
49594	Fee-for-Service	1720001977	1720001977	1	1	LUMKONG, GERARD A MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	80036	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2201 MISSION AVE	None	OCEANSIDE	CA	92054	2328	37	06073	33.20742226	-117.3612486	San Diego County
49595	Fee-for-Service	1831658186	1831658186	1	1	LEUNG, KRYSTLE M MD	4/15/2025	207RP1001X	NA	Pulmonology	026	PHYSICIANS	176254	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	420 BROADWAY STREET	None	REDWOOD CITY	CA	94063	3132	41	06081	37.48517644	-122.2022111	San Mateo County
49596	Fee-for-Service	1598763674	1598763674	1	1	LAFONT, ROBERT A OD	5/7/2007	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7960 ORANGETHORPE AVE	None	BUENA PARK	CA	90621	3437	30	06059	33.85899466	-117.9941923	Orange County
49660	Fee-for-Service	1073562294	1073562294	1	1	LAWTON, MICHAEL T MD	9/30/1996	207T00000X	NA	General Surgery	026	PHYSICIANS	62104	14	Neurological Surgery	0	In state provider	None	533 PARNASSUS AVE	STE U126	SAN FRANCISCO	CA	94143	2208	38	06075	37.76304484	-122.4592904	San Francisco County
49705	Fee-for-Service	1760838536	1760838536	1	1	LAKHANPAL, SURYA K MD	6/2/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168504	08	Family Practice	0	In state provider	None	2333 FOOTHILL BLVD	None	LA VERNE	CA	91750	3027	19	06037	34.11220804	-117.7613999	Los Angeles County
49717	Fee-for-Service	1992807267	1992807267	2	1	LEE, PEN H MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	44281	41	Internal Medicine	0	In state provider	None	600 N GARFIELD AVE	STE 110	MONTEREY PARK	CA	91754	1168	19	06037	34.06820797	-118.1228835	Los Angeles County
49724	Fee-for-Service	1558519231	1558519231	1	1	LESLEY WOOD	9/8/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1003 WILLOW CREEK RD	None	PRESCOTT	AZ	86301	1641	00	None	34.558992	-112.481901	Yavapai County
49778	Fee-for-Service	1508163270	1508163270	1	1	LIM, JEFFREY	10/3/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
49791	Fee-for-Service	1316915622	1316915622	1	2	LUBBEN, JOHN MD	9/21/2011	207L00000X	NA	Other	026	PHYSICIANS	66896	05	Anesthesiology	0	In state provider	None	2888 EUREKA WAY	STE 200	REDDING	CA	96001	0210	45	06089	40.58556034	-122.4159705	Shasta County
49817	Fee-for-Service	1740236967	1740236967	1	1	LUNSFORD, LEIF E MD	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87825	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 BROOKLYN AVE	None	LOS ANGELES	CA	90033	2462	19	06037	34.040502	-118.191954	Los Angeles County
49843	Fee-for-Service	1740382423	1740382423	1	1	LEVIN, JEFFREY S LCSW	8/21/2006	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	700 E ST	STE 206	SAN RAFAEL	CA	94901	2756	21	06041	37.97112293	-122.533553	Marin County
49881	Fee-for-Service	1720001977	1720001977	1	1	LUMKONG, GERARD A MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	80036	08	Family Practice	0	In state provider	None	2201 MISSION AVE	None	OCEANSIDE	CA	92054	2328	37	06073	33.20742226	-117.3612486	San Diego County
49895	Fee-for-Service	1609880723	1609880723	1	1	LIEN, JAMIE G MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90818	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
49915	Fee-for-Service	1639658636	1639658636	1	1	LOWE, CYNTHIA LCSW	11/27/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16800 DEVONSHIRE ST	212	GRANADA HILLS	CA	91344	7403	19	06037	34.25745651	-118.4982159	Los Angeles County
49939	Fee-for-Service	1619191269	1619191269	1	1	LIN, SOPHIA D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	525 E 68TH ST	None	NEW YORK	NY	10065	4870	00	None	40.764357	-73.9545075	New York County
49964	Fee-for-Service	1992013866	1992013866	1	2	LANCASTER, ALLISON T LMFT	4/26/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
50037	Fee-for-Service	1518943265	1518943265	1	1	LEE, EUGENE S MD	6/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78144	02	General Surgery	0	In state provider	None	221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	0000	34	06067	38.54846605	-121.4544709	Sacramento County
50048	Fee-for-Service	1689844979	1689844979	1	1	LA ENDOCRINE CARE INC	2/13/2008	207RE0101X	NA	Endocrinology	026	PHYSICIANS	66198	67	Endocrinology	0	In state provider	None	3621 MARTIN LUTHER KING	STE 1	LYNWOOD	CA	90262	0000	19	06037	33.93082719	-118.2024698	Los Angeles County
50061	Fee-for-Service	1033227640	1033227640	1	1	LEVIN, IAN A MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	43357	30	Radiology	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
50076	Fee-for-Service	1013944313	1013944313	1	1	LLANES, MARIA L S MD	7/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80090	36	Psychiatry	0	In state provider	None	933 S SUNSET AVE	STE 105	WEST COVINA	CA	91790	3410	19	06037	34.06428275	-117.9432037	Los Angeles County
50084	Fee-for-Service	1275969271	1275969271	1	1	LIN, EMILY M OD	7/15/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	61 SERRA WAY	STE 128	MILPITAS	CA	95035	8519	43	06085	37.42799329	-121.907974	Santa Clara County
50091	Fee-for-Service	1871641837	1871641837	1	1	LOUNSBURY, BARBARA J MD	3/31/1989	2080P0006X	NA	Psychiatry	026	PHYSICIANS	42688	40	Pediatrics	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
50107	Fee-for-Service	1336496710	1336496710	1	1	LICEA, EMILIO PSYD	12/4/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
50113	Fee-for-Service	1013338755	1013338755	1	1	LARA, GREGORY G MD INC	2/12/2014	207L00000X	NA	Other	026	PHYSICIANS	69087	05	Anesthesiology	0	In state provider	None	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
50140	Fee-for-Service	1013904911	1013904911	1	1	LEGOME, MILTON E MD	1/1/1979	174400000X	NA	Other	026	PHYSICIANS	23153	20	Orthopedic Surgery	0	In state provider	None	1310 W STEWART DR	STE 510	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
50150	Fee-for-Service	1528380011	1528380011	1	1	LEE, CHRISTOPHER H MD	7/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	96476	30	Radiology	0	In state provider	None	3700 E SOUTH STREET	None	LAKEWOOD	CA	90712	1419	19	06037	33.8601747	-118.148313	Los Angeles County
50154	Fee-for-Service	1336414853	1336414853	1	1	LIM, STEPHANIE MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124214	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
50158	Fee-for-Service	1659670719	1659670719	1	1	LEE, GRACE T LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1263 E ARQUES AVE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
50182	Fee-for-Service	1144759176	1144759176	1	1	LION, PAUL L MD	8/4/2021	207L00000X	NA	Other	026	PHYSICIANS	172066	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
50203	Fee-for-Service	1447461637	1447461637	1	1	LARSON, SUSAN P MD	5/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115679	41	Internal Medicine	0	In state provider	None	7601 STONERIDGE DRIVE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
50242	Fee-for-Service	1144417007	1144417007	1	1	LEUNG, MAN-KIT MD	8/18/2009	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	87983	04	Otology, Laryngology, Rhinology	0	In state provider	None	728 PACIFIC AVENUE	STE 308	SAN FRANCISCO	CA	94133	4449	38	06075	37.79687859	-122.4074282	San Francisco County
50246	Fee-for-Service	1720240781	1720240781	1	1	LEARNED, JAMES R MD	12/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144527	20	Orthopedic Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
50258	Fee-for-Service	1669578050	1669578050	1	1	LOWE, LISA G MD	8/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91326	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
50274	Fee-for-Service	1013339860	1013339860	1	1	LI, WEI MD A MEDICAL	1/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	105970	None	None	0	In state provider	CORPORATION	438 W LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
50312	Fee-for-Service	1578570487	1578570487	1	1	LOMA LINDA UNIV MED CTR	7/18/1995	282N00000X	NA	Hospitals	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	ADULT DAY HEALTH SVS	11406 LOMA LINDA DR	None	LOMA LINDA	CA	92354	3711	36	06071	34.04642588	-117.2480303	San Bernardino County
50321	Fee-for-Service	1396795514	1396795514	1	1	LICUANAN, JESSE MD	6/24/2012	174400000X	NA	Other	026	PHYSICIANS	87633	41	Internal Medicine	0	In state provider	None	3300 E SOUTH ST	STE 209	LONG BEACH	CA	90805	4549	19	06037	33.86018093	-118.1537163	Los Angeles County
50335	Fee-for-Service	1689844979	1689844979	1	1	LA ENDOCRINE CARE INC	2/13/2008	207RE0101X	NA	Endocrinology	026	PHYSICIANS	66198	41	Internal Medicine	0	In state provider	None	3621 MARTIN LUTHER KING	STE 1	LYNWOOD	CA	90262	0000	19	06037	33.93082719	-118.2024698	Los Angeles County
50340	Fee-for-Service	1407896335	1407896335	1	1	LIAO, TERESA H MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50522	05	Anesthesiology	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
50361	Fee-for-Service	1124089701	1124089701	1	1	LOPEZ, RAUL MD	1/31/1993	207P00000X	NA	Other	026	PHYSICIANS	73384	None	None	0	In state provider	None	15151 JANINE DR	None	WHITTIER	CA	90605	1803	19	06037	33.94969305	-118.0035917	Los Angeles County
50364	Fee-for-Service	1922001593	1922001593	1	1	LASHER, DONALD R OD	12/1/1999	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	225 S MAIN ST	None	LAKEPORT	CA	95453	5018	17	06033	39.0408909	-122.9152513	Lake County
50407	Fee-for-Service	1356741672	1356741672	1	1	LEWELLEN, TRACY L PHD	10/7/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
50411	Fee-for-Service	1487016960	1487016960	1	1	LO, TRACIE MD	6/6/2021	207L00000X	NA	Other	026	PHYSICIANS	153939	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
50425	Fee-for-Service	1871980722	1871980722	1	1	LAUREL AVENUE LLC	4/5/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1618 LAUREL AVENUE	None	REDLANDS	CA	92373	4838	36	06071	34.03845885	-117.2032115	San Bernardino County
50434	Fee-for-Service	1689632614	1689632614	1	1	LEMIRE, GUY G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31562	33	Thoracic Surgery	0	In state provider	None	5122 KATELLA AVE	STE 110	LOS ALAMITOS	CA	90720	2818	30	06059	33.80290311	-118.0433422	Orange County
50470	Fee-for-Service	1083820633	1083820633	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2050 CLUB CENTER DR	None	SACRAMENTO	CA	95835	1324	34	06067	38.670327	-121.506237	Sacramento County
50484	Fee-for-Service	1013084037	1013084037	1	1	LOLACHI, CHRISTOPHER M	6/14/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	83126	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	ATTN MGA OFFICE	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
50508	Fee-for-Service	1477516805	1477516805	1	1	LETNER, CRAIG S MD	6/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74369	30	Radiology	0	In state provider	None	1702 ESPLANADE	None	CHICO	CA	95926	3315	04	06007	39.74458257	-121.8503103	Butte County
50519	Fee-for-Service	1972861813	1972861813	1	1	LILAGAN, CRISTINA D C MD	10/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135525	40	Pediatrics	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
50529	Fee-for-Service	1144417007	1144417007	1	1	LEUNG, MAN-KIT MD	8/18/2009	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	87983	84	Surgery-Head and Neck	0	In state provider	None	728 PACIFIC AVENUE	STE 308	SAN FRANCISCO	CA	94133	4449	38	06075	37.79687859	-122.4074282	San Francisco County
50546	Fee-for-Service	1104908193	1104908193	1	1	LIN, BRYANT Y MD	11/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95766	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
50549	Fee-for-Service	1023096013	1023096013	1	1	LOIS, IRIS F MD	5/1/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	37935	40	Pediatrics	0	In state provider	None	6405 DAY ST	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
50588	Fee-for-Service	1356096200	1356096200	1	1	LENNAN, YAHSEMIN LMFT	2/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
50611	Fee-for-Service	1124628029	1124628029	1	1	LIFETIME HOME HEALTH CARE	12/15/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	11350 VENTURA BLVD	UNIT 201	STUDIO CITY	CA	91604	3140	19	06037	34.14014506	-118.3774984	Los Angeles County
50667	Fee-for-Service	1720433626	1720433626	1	1	LEE, JUN W MD	9/26/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	177944	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
50687	Fee-for-Service	1396887956	1396887956	1	1	LOLMAUGH, ADAM LMFT	3/3/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
50720	Fee-for-Service	1689632614	1689632614	1	1	LEMIRE, GUY G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31562	02	General Surgery	0	In state provider	None	5122 KATELLA AVE	STE 110	LOS ALAMITOS	CA	90720	2818	30	06059	33.80290311	-118.0433422	Orange County
50721	Fee-for-Service	1215305180	1215305180	1	1	LOLLIS, AARON J LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
50746	Fee-for-Service	1952324311	1952324311	1	1	LINGAM, DIWAKAR V MD	7/23/2020	207R00000X	NA	Other	026	PHYSICIANS	163708	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2 MEDICAL PLAZA DR	STE 175	ROSEVILLE	CA	95661	3049	31	06061	38.76507948	-121.2477476	Placer County
50751	Fee-for-Service	1376918938	1376918938	1	1	LEV, CECILIA P MD	12/22/2015	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2121 SANTA MONICA	None	SANTA MONICA	CA	90404	2303	19	06037	34.02980528	-118.4786605	Los Angeles County
50752	Fee-for-Service	1619056926	1619056926	1	1	LA CLINICA DE LA RAZA	1/10/2007	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	TIGER HEALTH CLINIC	4610 FOOTHILL BLVD	None	OAKLAND	CA	94601	4618	01	06001	37.77396591	-122.2102146	Alameda County
50755	Fee-for-Service	1245638840	1245638840	1	1	LAU, JOSHUA PT	5/1/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18 RANCHO CAMINO DR	STE 201	POMONA	CA	91766	7010	19	06037	34.0273637	-117.760137	Los Angeles County
50762	Fee-for-Service	1740297795	1740297795	1	1	LEMKE, DON	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
50772	Fee-for-Service	1013084037	1013084037	1	1	LOLACHI, CHRISTOPHER M	6/14/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	83126	84	Surgery-Head and Neck	0	In state provider	ATTN MGA OFFICE	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
50776	Fee-for-Service	1760456529	1760456529	1	1	LEWIS, BEVERLY MD	1/11/2013	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	42697	01	General Practice	0	In state provider	None	2675 E SLAUSON AVENUE	None	HUNTINGTON PARK	CA	90255	2996	19	06037	33.9892055	-118.2228885	Los Angeles County
50778	Fee-for-Service	1437237013	1437237013	1	1	LEE, KIMBERLY L MD	4/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89769	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
50787	Fee-for-Service	1598818858	1598818858	1	1	LECKIE, ROBERT G MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86763	30	Radiology	0	In state provider	NORTH STAR IMAGING	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
50794	Fee-for-Service	1023314309	1023314309	1	1	LANE, NATHANIEL G MD	9/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
50796	Fee-for-Service	1184938359	1184938359	1	1	LUGO, BRIAN A MD INC	10/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	87704	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
50804	Fee-for-Service	1922371384	1922371384	1	1	LIEN, JENNIE H NP	2/5/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26357 MCBEAN PKWAY	None	VALENCIA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
50853	Fee-for-Service	1114907995	1114907995	1	1	LAVALLE, PETER L MD	6/10/2021	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	17435	-	NOT APPLICABLE	0	In state provider	None	135 CARMEN LANE	None	SANTA MARIA	CA	93454	4607	42	06083	34.92484952	-120.4374645	Santa Barbara County
50881	Fee-for-Service	1962427310	1962427310	1	1	LONERGAN, JOSEPH T MD	7/31/1995	207R00000X	NA	Other	026	PHYSICIANS	55815	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
50913	Fee-for-Service	1740467083	1740467083	1	2	LEAH FARINAS SURGICAL SERV	8/22/2017	174400000X	NA	Other	026	PHYSICIANS	None	02	General Surgery	0	In state provider	SERVICES INC	6386 ALVARADO COURT	SUITE 330	SAN DIEGO	CA	92120	5240	37	06073	32.77666838	-117.0614255	San Diego County
50916	Fee-for-Service	1861521296	1861521296	1	1	LOPEZ MANUEL MO	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	141 S A ST	STE 100	OXNARD	CA	93030	5358	56	06111	34.202169	-119.1785765	Ventura County
50917	Fee-for-Service	1063455830	1063455830	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	27750 SANTA MARGARITA PW	None	MISSION VIEJO	CA	92691	6653	30	06059	33.65172392	-117.6449852	Orange County
50923	Fee-for-Service	1629295100	1629295100	1	1	LACSON, JENNIFER A OD	2/7/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1502 W COVINA PKWY	None	WEST COVINA	CA	91790	2703	19	06037	34.06975232	-117.9394512	Los Angeles County
50947	Fee-for-Service	1649407792	1649407792	1	1	LABORATORY SERVICES COOPERAT	8/18/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	IVE	723B NE RIDDELL RD	None	BREMERTON	WA	98310	3030	00	None	47.60679748	-122.636017	Kitsap County
50949	Fee-for-Service	1972064681	1972064681	1	1	LOUIE, TAWNY A DO	8/4/2023	390200000X	NA	Other	026	PHYSICIANS	20240	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
50963	Fee-for-Service	1528478989	1528478989	1	1	LIEN, DONNA M MD	7/30/2019	207L00000X	NA	Other	026	PHYSICIANS	139729	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
50967	Fee-for-Service	1881638229	1881638229	2	1	LONGS DRUG STORES CA LLC	11/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	175 41ST ST.	None	OAKLAND	CA	94611	5206	01	06001	37.82680148	-122.2530107	Alameda County
50968	Fee-for-Service	1013458454	1013458454	1	1	LIESSE, KELLY MD	7/16/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	172837	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
50971	Fee-for-Service	1083262307	1083262307	1	1	LAMPHERE, KRISTA L CCC-SLP	8/3/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41689 ENTERPRISE CR. NO.	SUITE 118	TEMECULA	CA	92590	5630	33	06065	33.51953516	-117.1693891	Riverside County
50973	Fee-for-Service	1881894889	1881894889	1	1	LEONG, JENNIFER MD	10/21/2019	2084P0804X	NA	Psychiatry	026	PHYSICIANS	150127	36	Psychiatry	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
50979	Fee-for-Service	1851704605	1851704605	1	1	LEE, HANG T NP	3/13/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	250 SOUTH G STREET	None	SAN BERNARDINO	CA	92410	3320	36	06071	34.09693522	-117.2986838	San Bernardino County
50986	Fee-for-Service	1093747545	1093747545	1	1	LINDSTROM, TOMAS K MD	1/31/1984	207L00000X	NA	Other	026	PHYSICIANS	41103	05	Anesthesiology	0	In state provider	None	11375 ANDERSON ST	None	LOMA LINDA	CA	92354	3407	36	06071	34.046865	-117.2610915	San Bernardino County
51009	Fee-for-Service	1689632614	1689632614	1	1	LEMIRE, GUY G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31562	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5122 KATELLA AVE	STE 110	LOS ALAMITOS	CA	90720	2818	30	06059	33.80290311	-118.0433422	Orange County
51039	Fee-for-Service	1619056926	1619056926	1	1	LA CLINICA DE LA RAZA	6/2/2006	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	TIGER HEALTH CLINIC	4610 FOOTHILL BLVD	None	OAKLAND	CA	94601	4618	01	06001	37.77396591	-122.2102146	Alameda County
51048	Fee-for-Service	1871867093	1871867093	1	1	LEE, DAVID J MD	12/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117367	20	Orthopedic Surgery	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
51059	Fee-for-Service	1013084037	1013084037	1	1	LOLACHI, CHRISTOPHER M	6/14/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	83126	04	Otology, Laryngology, Rhinology	0	In state provider	ATTN MGA OFFICE	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
51064	Fee-for-Service	1760456529	1760456529	1	1	LEWIS, BEVERLY MD	1/11/2013	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	42697	07	Dermatology	0	In state provider	None	2675 E SLAUSON AVENUE	None	HUNTINGTON PARK	CA	90255	2996	19	06037	33.9892055	-118.2228885	Los Angeles County
51108	Fee-for-Service	1235692310	1235692310	1	1	LOWE, CHRISTIAN MD	8/7/2024	363LX0001X	NA	Nurse Practitioner	026	PHYSICIANS	183201	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
51125	Fee-for-Service	1194883546	1194883546	1	1	LARA, NATHALIE MD	1/17/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	161934	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
51126	Fee-for-Service	1427785609	1427785609	1	1	LAVARO, CATHERINE R NP	11/4/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
51130	Fee-for-Service	1255475703	1255475703	1	1	LIVSHITS, ZHANNA MD	9/30/2019	207P00000X	NA	Other	026	PHYSICIANS	162019	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
51136	Fee-for-Service	1538425145	1538425145	1	1	LEE, RYAN H MD	5/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129178	25	Physical Medicine and Rehabilitation	0	In state provider	None	43112 15TH ST WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
51142	Fee-for-Service	1114907995	1114907995	1	1	LAVALLE, PETER L MD	6/10/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	17435	None	None	0	In state provider	None	135 CARMEN LANE	None	SANTA MARIA	CA	93454	4607	42	06083	34.92484952	-120.4374645	Santa Barbara County
51183	Fee-for-Service	1881081206	1881081206	1	1	LEE, YOUNG LAC	6/1/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	99 LONG CT	104	THOUSAND OAKS	CA	91360	6066	56	06111	34.17738252	-118.8666576	Ventura County
51246	Fee-for-Service	1497243125	1497243125	1	1	LI, SHAWN X MD	6/24/2024	1835C0206X	NA	None	026	PHYSICIANS	173925	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
51250	Fee-for-Service	1750872768	1750872768	1	1	LANGWORTHY, MATTHEW	12/4/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11750 SORRENTO VALLEY	STE 130	SAN DIEGO	CA	92121	1019	37	06073	32.91461387	-117.2343576	San Diego County
51251	Fee-for-Service	1528478989	1528478989	1	1	LIEN, DONNA M MD	7/30/2019	207L00000X	NA	Other	026	PHYSICIANS	139729	05	Anesthesiology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
51267	Fee-for-Service	1326366121	1326366121	1	1	LISKE, MICHELLE A MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79986	41	Internal Medicine	0	In state provider	None	3405 KENYON ST	STE 411	SAN DIEGO	CA	92110	5007	37	06073	32.74866031	-117.2135544	San Diego County
51270	Fee-for-Service	1225077464	1225077464	1	1	LESLIE COHEN	8/26/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	915 HIGHLAND BLVD	None	BOZEMAN	MT	59715	6902	00	None	45.669708	-111.020157	Gallatin County
51284	Fee-for-Service	1932636396	1932636396	1	1	LI, ANGIE MD	1/28/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	160715	None	None	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
51325	Fee-for-Service	1578660692	1578660692	1	1	LABRIOLA, MARK JOSEPH MD	5/31/1987	207R00000X	NA	Other	026	PHYSICIANS	63458	41	Internal Medicine	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
51329	Fee-for-Service	1619056926	1619056926	1	1	LA CLINICA DE LA RAZA	6/2/2006	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	TIGER HEALTH CLINIC	4610 FOOTHILL BLVD	None	OAKLAND	CA	94601	4618	01	06001	37.77396591	-122.2102146	Alameda County
51351	Fee-for-Service	1841852365	1841852365	1	1	LEE, DONALD MD	12/9/2023	207L00000X	NA	Other	026	PHYSICIANS	182204	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
51362	Fee-for-Service	1427578624	1427578624	1	1	LEAL, REBECCA N LMFT	9/17/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
51394	Fee-for-Service	1275997579	1275997579	1	1	LEAZENBY, JUSTIN M PSYD	1/22/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	800 SERENO DRIVE	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
51398	Fee-for-Service	1275162810	1275162810	1	1	LE, JOHN DO	11/20/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21263	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
51399	Fee-for-Service	1700854585	1700854585	1	1	LING, GOW-NAN MD	1/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	40117	08	Family Practice	0	In state provider	None	801 W VALLEY BLVD	STE 206	ALHAMBRA	CA	91803	3257	19	06037	34.07808133	-118.1319851	Los Angeles County
51421	Fee-for-Service	1487632261	1487632261	1	1	LAU, JAMES N MD	6/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95115	02	General Surgery	0	In state provider	DR BANUELOS	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
51461	Fee-for-Service	1285926055	1285926055	1	1	LEE, CHUL J CA	8/17/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3000 W 6TH ST	STE 203	LOS ANGELES	CA	90020	1564	19	06037	34.06369155	-118.2874502	Los Angeles County
51489	Fee-for-Service	1497354039	1497354039	1	1	LIFE TOUCH HOSPICE	2/19/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	9778 KATELLA AVE	STE 205	ANAHEIM	CA	92804	6447	30	06059	33.80288252	-117.9628155	Orange County
51506	Fee-for-Service	1801864970	1801864970	1	1	LANTHIEZ, PIERRE MD	7/16/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	45059	30	Radiology	0	In state provider	None	FRESNO AND R ST	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
51518	Fee-for-Service	1437454543	1437454543	1	1	LAKTINEH, SOLOMON MD	5/3/2011	193200000X	NA	Other	026	PHYSICIANS	50421	40	Pediatrics	0	In state provider	None	780 ATLANTIC AVE	None	LONG BEACH	CA	90813	4565	19	06037	33.776325	-118.1850235	Los Angeles County
51532	Fee-for-Service	1467805739	1467805739	1	1	LUU, THAN MD INC	8/15/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	101119	01	General Practice	0	In state provider	None	709 N HILL STREET	SUITE 18	LOS ANGELES	CA	90012	2352	19	06037	34.06103994	-118.2404034	Los Angeles County
51535	Fee-for-Service	1497243125	1497243125	1	1	LI, SHAWN X MD	6/24/2024	1835C0206X	NA	None	026	PHYSICIANS	173925	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
51563	Fee-for-Service	1750037123	1750037123	1	1	LEYVA, ANA C LMFT	1/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SANTA BARBARA	5290 OVERPASS RD	209	SANTA BARBARA	CA	93105	3791	42	06083	34.43960012	-119.8079098	Santa Barbara County
51573	Fee-for-Service	1023417649	1023417649	1	1	LIN, SITHU MD	5/3/2023	208M00000X	NA	Other	026	PHYSICIANS	143411	None	None	0	In state provider	None	11100 WARNER AVENUE	SUITE 218	FOUNTAIN VALLEY	CA	92708	7515	30	06059	33.716291	-117.9355051	Orange County
51580	Fee-for-Service	1225105034	1225105034	1	1	LOOS, WILLIAM C MD	1/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	38444	20	Orthopedic Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
51602	Fee-for-Service	1013047208	1013047208	1	1	LAWSON, D'ANN DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	25 E ARRELLAGA ST	None	SANTA BARBARA	CA	93101	2501	42	06083	34.42785486	-119.7088153	Santa Barbara County
51609	Fee-for-Service	1679679450	1679679450	1	1	LIVAS, BERNARDO C MD SC	3/1/2013	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	2	Out of state provider	None	9462 W LAWRENCE CT	None	SCHILLER PARK	IL	60176	1552	00	None	41.96534661	-87.86465212	Cook County
51639	Fee-for-Service	1295985299	1295985299	1	1	LILIT ARZUMANYAN INC	4/8/2009	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7341 FOOTHILL BLVD	STE 101	TUJUNGA	CA	91042	2720	19	06037	34.25065577	-118.2919464	Los Angeles County
51641	Fee-for-Service	1073775425	1073775425	1	1	LOENING, ANDREAS M MD	7/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109175	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
51665	Fee-for-Service	1093276099	1093276099	1	1	LAM, YAN NP	2/7/2021	363LN0005X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
51678	Fee-for-Service	1023180833	1023180833	1	1	LU,XING JIAN MD	5/17/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74526	41	Internal Medicine	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
51690	Fee-for-Service	1730178724	1730178724	1	1	LEONARD, CHERYL NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	44444 20TH ST WEST	None	LANCASTER	CA	93534	2714	19	06037	34.69063406	-118.1656452	Los Angeles County
51719	Fee-for-Service	1497175558	1497175558	1	1	LAFIAN, HAIG J DO	8/29/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	14476	None	None	0	In state provider	None	660 W BROADWAY	None	GLENDALE	CA	91204	1008	19	06037	34.14675547	-118.269153	Los Angeles County
51743	Fee-for-Service	1164467866	1164467866	1	1	LUTZER, ELISA M MD	10/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94203	36	Psychiatry	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
51757	Fee-for-Service	1134376080	1134376080	1	1	LADSON, SHELESTE V MD	4/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114245	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
51776	Fee-for-Service	1497354039	1497354039	1	1	LIFE TOUCH HOSPICE	2/19/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	9778 KATELLA AVE	STE 205	ANAHEIM	CA	92804	6447	30	06059	33.80288252	-117.9628155	Orange County
51784	Fee-for-Service	1922442383	1922442383	1	1	LIU, JESSICA T MD	12/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143835	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
51809	Fee-for-Service	1861478463	1861478463	1	1	LERTVARANURAK, VARAVOOT	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71768	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
51813	Fee-for-Service	1508066945	1508066945	1	1	LAKKIS, CLAIR L MD	3/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107773	41	Internal Medicine	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91328	4105	19	06037	34.22073847	-118.532988	Los Angeles County
51815	Fee-for-Service	1710938808	1710938808	1	1	LUECK, KRISTIN L MD	1/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78651	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
51816	Fee-for-Service	1053485748	1053485748	1	1	LEVY, VIVIAN MD	7/1/2000	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	72051	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
51819	Fee-for-Service	1922260504	1922260504	1	1	LIU, YANG MD	1/31/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	191888	None	None	0	In state provider	None	505 E ROMIE LN	A	SALINAS	CA	93901	4031	27	06053	36.65998191	-121.6461895	Monterey County
51838	Fee-for-Service	1336276450	1336276450	1	1	LIEN, CONWAY MD	4/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76635	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
51843	Fee-for-Service	1417989922	1417989922	2	1	LONGS DRUG STORES CA LLC	12/26/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	102 N SAN GABRIEL BLVD	None	SAN GABRIEL	CA	91775	2427	19	06037	34.103799	-118.090994	Los Angeles County
51851	Fee-for-Service	1629410519	1629410519	1	1	LUONG, ELI MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131189	05	Anesthesiology	0	In state provider	None	531 W COLLEGE STREET	None	LOS ANGELES	CA	90012	2315	19	06037	34.0645892	-118.2391033	Los Angeles County
51859	Fee-for-Service	1518697838	1518697838	1	1	LEE, CAMELLIA Y OD	6/24/2023	390200000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	388 9TH STREET	SUITE 157	OAKLAND	CA	94607	4290	01	06001	37.80019425	-122.2715222	Alameda County
51860	Fee-for-Service	1578504379	1578504379	1	1	LEISURE, MARKETA K MD	8/6/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	158744	40	Pediatrics	0	In state provider	None	5030 J STREET	301	SACRAMENTO	CA	95819	3800	34	06067	38.566359	-121.442094	Sacramento County
51862	Fee-for-Service	1427192574	1427192574	1	1	LAZENBY, DARLENE Y LVN	8/17/2002	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4974 N FRESNO ST	None	FRESNO	CA	93726	0317	10	06019	36.807813	-119.781352	Fresno County
51872	Fee-for-Service	1396842704	1396842704	1	1	LE, THUAN PHUOC MD	2/8/2015	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	60874	77	Infectious Disease	0	In state provider	None	36243 INLAND VALLEY DR	STE 40	WILDOMAR	CA	92595	9547	33	06065	33.591528	-117.2393325	Riverside County
51874	Fee-for-Service	1144864679	1144864679	1	1	LOPEZ, JAYMIE	6/9/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
51875	Fee-for-Service	1457392193	1457392193	1	1	LEVIN, JOHN MD	8/29/1988	207P00000X	NA	Other	026	PHYSICIANS	38638	None	None	0	In state provider	None	9309 BEVERLY CREST DR	None	BEVERLY HILLS	CA	90210	2503	19	06037	34.09830154	-118.401476	Los Angeles County
51883	Fee-for-Service	1124076435	1124076435	1	1	LALIOTIS, ARISTOTELIS MD	6/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	54580	41	Internal Medicine	0	In state provider	INC	4282 GENESEE AVE	STE 102	SAN DIEGO	CA	92117	4986	37	06073	32.82092667	-117.1828683	San Diego County
51887	Fee-for-Service	1497386544	1497386544	1	1	LOPAPA, FABIANA E NP	2/2/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
51894	Fee-for-Service	1568856763	1568856763	1	1	LARSEN, TYLER B MD	4/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146511	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
51927	Fee-for-Service	1902850498	1902850498	1	1	LATTANZA, LISA L MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85464	20	Orthopedic Surgery	0	In state provider	None	1595 QUINTARA STREET	None	SAN FRANCISCO	CA	94116	1273	38	06075	37.74829578	-122.4824422	San Francisco County
51935	Fee-for-Service	1780098962	1780098962	1	1	LE, TRAM Q OD	1/25/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2101 STONE BLVD	STE 150	WEST SACRAMENTO	CA	95691	4054	57	06113	38.56318049	-121.5379228	Yolo County
51975	Fee-for-Service	1164453890	1164453890	1	1	LUCERO, ETHEL CINDY R	10/26/2005	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	25	Physical Medicine and Rehabilitation	0	In state provider	ABLE PHYSICAL THERAPY	14624 SHERMAN WAY	STE 201	VAN NUYS	CA	91405	2287	19	06037	34.20078354	-118.450843	Los Angeles County
51986	Fee-for-Service	1861684201	1861684201	1	1	LEE, ROBERT S MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	97379	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3771 KATELLA AVE.	STE 300	LOS ALAMITOS	CA	90720	3108	30	06059	33.80319153	-118.067274	Orange County
52028	Fee-for-Service	1326111832	1326111832	1	1	LEVINSKY, DEBRA A MD	8/22/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	37684	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	895 MORAGA RD	STE 11	LAFAYETTE	CA	94549	5039	07	06013	37.88677178	-122.1180216	Contra Costa County
52060	Fee-for-Service	1558703363	1558703363	1	1	LARSON, KRISZTINA I MD	1/15/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	158003	41	Internal Medicine	0	In state provider	None	11550 INDIAN HILLS RD	SUITE 330	MISSION HILLS	CA	91345	1203	19	06037	34.28024575	-118.4588775	Los Angeles County
52082	Fee-for-Service	1679663165	1679663165	1	1	LOWERY, CURTIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	SLOT 783	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
52089	Fee-for-Service	1316980675	1316980675	2	1	LONGS DRUG STORE CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	929 SIERRA ST	None	KINGSBURG	CA	93631	1512	10	06019	36.51801347	-119.5576965	Fresno County
52122	Fee-for-Service	1205888922	1205888922	1	1	LOPEZ, MARIA C S MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	77794	08	Family Practice	0	In state provider	None	5823 YORK BLVD	SUITE 1	LOS ANGELES	CA	90042	2634	19	06037	34.11850913	-118.1915335	Los Angeles County
52148	Fee-for-Service	1679676779	1679676779	1	1	LIU & WANG MEDICAL CORP	7/1/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	18395 COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	2749	19	06037	33.9884853	-117.9044348	Los Angeles County
52150	Fee-for-Service	1649426735	1649426735	1	1	LEE, NANCY M OD	12/8/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 E HERNDON	SUITE 401	FRESNO	CA	93720	3326	10	06019	36.83744648	-119.7646425	Fresno County
52152	Fee-for-Service	1427192574	1427192574	1	1	LAZENBY, DARLENE Y LVN	7/15/2004	164X00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4974 N FRESNO ST	None	FRESNO	CA	93726	0317	10	06019	36.807813	-119.781352	Fresno County
52158	Fee-for-Service	1396842704	1396842704	1	1	LE, THUAN PHUOC MD	2/8/2015	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	60874	40	Pediatrics	0	In state provider	None	36243 INLAND VALLEY DR	STE 40	WILDOMAR	CA	92595	9547	33	06065	33.591528	-117.2393325	Riverside County
52171	Fee-for-Service	1124076435	1124076435	1	1	LALIOTIS, ARISTOTELIS MD	6/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	54580	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	4282 GENESEE AVE	STE 102	SAN DIEGO	CA	92117	4986	37	06073	32.82092667	-117.1828683	San Diego County
52217	Fee-for-Service	1942250717	1942250717	1	1	LOMBARDI, WILLIAM L MD	3/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53147	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
52245	Fee-for-Service	1841575636	1841575636	1	1	LAVERTY, MELISSA A LMFT	11/14/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
52253	Fee-for-Service	1023273208	1023273208	1	1	LUCK, JAIME W LMFT	2/19/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
52288	Fee-for-Service	1497847701	1497847701	1	1	LACOST, CINDY G PHD	8/22/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2101 N GLENOAKS BLVD	None	BURBANK	CA	91504	0000	19	06037	34.19790492	-118.3264418	Los Angeles County
52318	Fee-for-Service	1447252218	1447252218	1	1	LEIBZON, ROMAN MD	1/28/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71810	41	Internal Medicine	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
52335	Fee-for-Service	1326729369	1326729369	1	1	LIU, MICHAEL Z CRNA	12/17/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
52348	Fee-for-Service	1558703363	1558703363	1	1	LARSON, KRISZTINA I MD	1/15/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	158003	68	Hematology	0	In state provider	None	11550 INDIAN HILLS RD	SUITE 330	MISSION HILLS	CA	91345	1203	19	06037	34.28024575	-118.4588775	Los Angeles County
52381	Fee-for-Service	1043553746	1043553746	1	1	LIU, XINRAN MD	10/31/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	158874	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
52407	Fee-for-Service	1205888922	1205888922	1	1	LOPEZ, MARIA C S MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	77794	01	General Practice	0	In state provider	None	5823 YORK BLVD	SUITE 1	LOS ANGELES	CA	90042	2634	19	06037	34.11850913	-118.1915335	Los Angeles County
52416	Fee-for-Service	1093748238	1093748238	1	1	LESLIE, KATHLEEN M LCSW	5/18/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6355 TELEGRAPH AVENUE	STE 207	OAKLAND	CA	94609	1373	01	06001	37.84958903	-122.2606403	Alameda County
52423	Fee-for-Service	1326589581	1326589581	1	1	LEE, MATTHEW H DO	9/6/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	17254	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
52450	Fee-for-Service	1508967761	1508967761	1	1	LOMAS, GREGORY M MD	1/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	77161	34	Urology and Urological Surgery	0	In state provider	None	2624 EDITH AVE	None	REDDING	CA	96001	3043	45	06089	40.57136027	-122.397513	Shasta County
52495	Fee-for-Service	1114185923	1114185923	1	1	LEE, STEPHEN J MD	4/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137492	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
52518	Fee-for-Service	1548782253	1548782253	1	1	LAI, KATHERINE A OD	4/15/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
52605	Fee-for-Service	1558357723	1558357723	1	1	LIN, WENDY W MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71769	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
52612	Fee-for-Service	1225413719	1225413719	1	1	LEE, RU MIN MD	12/17/2021	207R00000X	NA	Other	026	PHYSICIANS	172348	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
52629	Fee-for-Service	1083063408	1083063408	1	1	LEE, DAVID Y MD	5/14/2020	207L00000X	NA	Other	026	PHYSICIANS	140395	05	Anesthesiology	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
52684	Fee-for-Service	1356413181	1356413181	1	1	LEVENTHAL, JEANNE L MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52060	36	Psychiatry	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
52705	Fee-for-Service	1669587341	1669587341	1	1	LE, DUC T MD	10/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105410	41	Internal Medicine	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	3608	37	06073	33.1857	-117.290538	San Diego County
52714	Fee-for-Service	1407366495	1407366495	1	1	LUCERO, JONATHAN	6/27/2024	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
52725	Fee-for-Service	1356632178	1356632178	1	1	LE, MAI T DO	10/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12463	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
52735	Fee-for-Service	1568699882	1568699882	1	1	LLANO DIALYSIS LLC	1/1/2010	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	5352 CLAREMONT AVE	STE B	OAKLAND	CA	94618	1035	01	06001	37.84054413	-122.2593631	Alameda County
52744	Fee-for-Service	1699382671	1699382671	1	1	LA ELDER HOSPICE AND	12/1/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE, INC	6454 VAN NUYS BLVD	STE 110/8	VAN NUYS	CA	91401	1445	19	06037	34.187886	-118.448714	Los Angeles County
52747	Fee-for-Service	1861581423	1861581423	1	1	LEW, DESMOND K MD	8/4/2011	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	69873	40	Pediatrics	0	In state provider	None	1820 W LINCOLN AVE	None	ANAHEIM	CA	92801	6730	30	06059	33.83242148	-117.946809	Orange County
52757	Fee-for-Service	1386888303	1386888303	1	1	LOPEZ, MALAVIKA LMFT	5/21/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3726 TIBBETTS	STE A	RIVERSIDE	CA	92506	2660	33	06065	33.94722348	-117.397728	Riverside County
52762	Fee-for-Service	1801137369	1801137369	1	1	LIGON, SHEILA A NP	2/24/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
52778	Fee-for-Service	1811157423	1811157423	1	1	LARKS, LORI J LMFT	1/22/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
52782	Fee-for-Service	1467749473	1467749473	1	1	LEE, JUNG J MD	10/17/2018	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	156225	39	Preventive (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
52792	Fee-for-Service	1013176551	1013176551	1	1	LORENZEN, BRENT C MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142802	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
52793	Fee-for-Service	1558685859	1558685859	1	1	LESTER, THOMAS C MD	6/22/2016	2084P0800X	NA	Psychiatry	026	PHYSICIANS	34679	36	Psychiatry	0	In state provider	None	3400 W BALL RD	STE 100B	ANAHEIM	CA	92804	3738	30	06059	33.81724472	-118.0083216	Orange County
52796	Fee-for-Service	1003575499	1003575499	1	1	LOS ROBLES PHARMACY INC	7/27/2022	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	68 LONG CT	STE 1C	THOUSAND OAKS	CA	91360	7413	56	06111	34.17751875	-118.8666662	Ventura County
52809	Fee-for-Service	1922074319	1922074319	1	1	LOFTUS, JOHN P MD	1/10/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	84281	02	General Surgery	0	In state provider	None	3443 VILLA LN	STE 3	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
52853	Fee-for-Service	1851530646	1851530646	1	1	LOS PALOS GASTROENTEROLOGY	4/30/2009	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	INC	1081 LOS PALOS DRIVE	SUITE B	SALINAS	CA	93901	3916	27	06053	36.65833134	-121.6450872	Monterey County
52937	Fee-for-Service	1134296007	1134296007	1	1	LIM, ALBERT Y MD	11/30/1987	207RC0200X	NA	Other	026	PHYSICIANS	58089	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
52948	Fee-for-Service	1770998726	1770998726	1	1	LIQUIDO, FERNANDO H MD	12/20/2017	390200000X	NA	Other	026	PHYSICIANS	142321	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
52954	Fee-for-Service	1528352622	1528352622	2	1	LEBENSON, JOSHUA R MD	9/30/2024	207L00000X	NA	Other	026	PHYSICIANS	184765	05	Anesthesiology	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
52958	Fee-for-Service	1417226655	1417226655	1	1	LYNCH, GENEVIEVE M NP	11/7/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	SUITE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
52986	Fee-for-Service	1720020894	1720020894	1	1	LOH, YINCE MD	8/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92388	None	None	0	In state provider	None	300 UCLA MEDICAL PLZ	STE 200	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
52993	Fee-for-Service	1083135743	1083135743	1	1	LEE, DANIELLE M DPM	8/20/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	11332 MOUNTAIN VIEW AVE	STE A	LOMA LINDA	CA	92354	3854	36	06071	34.04709935	-117.2436936	San Bernardino County
52994	Fee-for-Service	1700421120	1700421120	1	1	LACANLALE, JASON PT	4/9/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2492 NISSEN DRIVE	None	LIVERMORE	CA	94551	7704	01	06001	37.69957314	-121.8152197	Alameda County
52999	Fee-for-Service	1902925621	1902925621	1	1	LAUERMANN, MICHAEL W MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	25668	41	Internal Medicine	0	In state provider	A PROFESSIONAL CORP	2865 ATLANTIC AVE	STE 221	LONG BEACH	CA	90806	7430	19	06037	33.809418	-118.185058	Los Angeles County
53016	Fee-for-Service	1750313045	1750313045	1	1	LOCKHART, CHRISTOPHER MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	65678	22	Pathology (M.D. only)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
53028	Fee-for-Service	1508420555	1508420555	1	1	LIPPEY, NINA M DO	8/22/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19516	None	None	0	In state provider	None	1301 SHOREWAY RD	STE 100	BELMONT	CA	94002	4110	41	06081	37.5239043	-122.2667778	San Mateo County
53032	Fee-for-Service	1699382671	1699382671	1	1	LA ELDER HOSPICE AND	12/1/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE, INC	6454 VAN NUYS BLVD	STE 110/8	VAN NUYS	CA	91401	1445	19	06037	34.187886	-118.448714	Los Angeles County
53045	Fee-for-Service	1043673437	1043673437	1	1	LOFTUS-FARREN, KARA J MD	10/1/2020	207L00000X	NA	Other	026	PHYSICIANS	155357	None	None	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
53053	Fee-for-Service	1902077035	1902077035	1	1	LIU, SHIRLEY H MD	4/13/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95004	-	NOT APPLICABLE	0	In state provider	None	1340 TULLY ROAD	301 AND 304	SAN JOSE	CA	95122	3055	43	06085	37.31710924	-121.8334186	Santa Clara County
53064	Fee-for-Service	1053526756	1053526756	1	1	LA MAESTRA FAMILY CLINIC INC	10/2/2006	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	NATIONAL CITY	217 HIGHLAND AVE	None	NATIONAL CITY	CA	91950	1518	37	06073	32.68298968	-117.1005464	San Diego County
53117	Fee-for-Service	1164433371	1164433371	1	1	LAYFIELD & ASSOCIATES	9/16/2013	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	PHYSICAL THERAPY INC	16101 VENTURA BLVD	STE 336	ENCINO	CA	91436	2516	19	06037	34.15646951	-118.4842635	Los Angeles County
53132	Fee-for-Service	1538231865	1538231865	1	1	LEE, IVAN S MD	1/1/1993	208800000X	NA	Other	026	PHYSICIANS	49449	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
53140	Fee-for-Service	1851530646	1851530646	1	1	LOS PALOS GASTROENTEROLOGY	4/30/2009	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	INC	1081 LOS PALOS DRIVE	SUITE B	SALINAS	CA	93901	3916	27	06053	36.65833134	-121.6450872	Monterey County
53152	Fee-for-Service	1992347330	1992347330	1	1	LEE, SOO HYUN S CNP	9/8/2022	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4922 WHITTIER BLVD	None	LOS ANGELES	CA	90022	1111	19	06037	34.02163273	-118.1631725	Los Angeles County
53168	Fee-for-Service	1528072287	1528072287	1	1	LUCID, WENDY A MD	12/10/2019	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
53182	Fee-for-Service	1063451920	1063451920	1	1	LORRAINE LAROY M.D.	1/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
53198	Fee-for-Service	1558429092	1558429092	1	1	LAKE FOREST MED GROUP	1/20/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	24401 MUIRLANDS BLVD	STE A	LAKE FOREST	CA	92630	3948	30	06059	33.6282277	-117.7039104	Orange County
53203	Fee-for-Service	1831145564	1831145564	1	1	LU, DI MD	4/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55052	22	Pathology (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
53217	Fee-for-Service	1326799248	1326799248	1	1	LAGPACAN, EMILIO B PT	4/22/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
53241	Fee-for-Service	1528350261	1528350261	1	1	LEE, EDWARD S MD	9/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131695	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
53256	Fee-for-Service	1265844476	1265844476	1	1	LUKOWSKI, MICHAEL S MD	1/8/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	27200 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.8955513	-117.189743	Riverside County
53266	Fee-for-Service	1427553221	1427553221	1	1	LEVIN, CAROLYN C MD	10/21/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165719	None	None	0	In state provider	None	1520 SAN PABLO ST	STE 1300	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
53271	Fee-for-Service	1376629881	1376629881	1	1	LIU, SUSAN MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60447	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
53277	Fee-for-Service	1770560542	1770560542	1	1	LY, JUSTIN Q MD	2/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	90777	30	Radiology	0	In state provider	None	10666 N TORREY PINES RD	None	SAN DIEGO	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
53300	Fee-for-Service	1972774792	1972774792	1	1	LOERA, VERONICA LCSW	7/26/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	225 W HOSPITALITY LN	STE 208D	SAN BERNARDINO	CA	92408	3245	36	06071	34.06586109	-117.2884682	San Bernardino County
53301	Fee-for-Service	1750313045	1750313045	1	1	LOCKHART, CHRISTOPHER MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	65678	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
53308	Fee-for-Service	1942971163	1942971163	1	1	LIU-BINET, YANG	6/16/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
53365	Fee-for-Service	1083243521	1083243521	1	1	LEWIS, GEORGE MD	8/8/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	182914	None	None	0	In state provider	None	11420 WARNER AVE.	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
53366	Fee-for-Service	1174566046	1174566046	1	1	LANDER, JEFFREY K MD	8/7/2018	207N00000X	NA	Dermatology	026	PHYSICIANS	93332	07	Dermatology	0	In state provider	None	24431 CALLE DE LA LOUISA	SUITE 200	LAGUNA HILLS	CA	92653	7641	30	06059	33.60954397	-117.7084741	Orange County
53424	Fee-for-Service	1114960960	1114960960	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1395 E PROSPERITY AVE	None	TULARE	CA	93274	8053	54	06107	36.22580733	-119.3269347	Tulare County
53451	Fee-for-Service	1215963582	1215963582	1	1	LELEVIER, JON A MD INC	1/1/1979	207R00000X	NA	Other	026	PHYSICIANS	39907	41	Internal Medicine	0	In state provider	None	3998 VISTA WAY	STE A	OCEANSIDE	CA	92056	4514	37	06073	33.18370179	-117.292963	San Diego County
53487	Fee-for-Service	1558429092	1558429092	1	1	LAKE FOREST MED GROUP	1/20/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	24401 MUIRLANDS BLVD	STE A	LAKE FOREST	CA	92630	3948	30	06059	33.6282277	-117.7039104	Orange County
53496	Fee-for-Service	1902879885	1902879885	1	1	LERNHARDT, ELISABETH B MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	47847	41	Internal Medicine	0	In state provider	None	11286 PLEASANT VALLEY RD	None	PENN VALLEY	CA	95946	9413	29	06057	39.22267045	-121.2039605	Nevada County
53517	Fee-for-Service	1619679388	1619679388	1	1	LE, ERIK	1/30/2025	390200000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
53577	Fee-for-Service	1033294798	1033294798	1	1	LYM, JOEL K MD	1/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84306	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 230	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
53591	Fee-for-Service	1568567840	1568567840	1	1	LUGO, PHIL M MD	1/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75110	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
53606	Fee-for-Service	1194179937	1194179937	1	1	LAKHOO, JANESH MD	3/15/2023	2085R0204X	NA	Other	026	PHYSICIANS	175594	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
53612	Fee-for-Service	1770899940	1770899940	1	1	LEW, VINCENT K MD	3/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115534	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
53642	Fee-for-Service	1578668927	1578668927	1	1	LIN, JONATHAN C MD	12/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	92677	10	Gastroenterology (M.D. only)	0	In state provider	None	35900 BOB HOPE DR	275	RANCHO MIRAGE	CA	92270	1767	33	06065	33.790311	-116.405864	Riverside County
53647	Fee-for-Service	1104801414	1104801414	1	1	LI, JOHN T MD	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62243	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
53697	Fee-for-Service	1972747988	1972747988	1	1	LARSON, BENJAMIN T MD	6/27/2019	208800000X	NA	Other	026	PHYSICIANS	136009	34	Urology and Urological Surgery	0	In state provider	None	25495 MEDICAL CENTER DR	204	MURRIETA	CA	92562	4903	33	06065	33.55804188	-117.1834064	Riverside County
53699	Fee-for-Service	1457635963	1457635963	1	1	LOEWY, DEREK H PHD	11/9/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
53702	Fee-for-Service	1275720799	1275720799	1	1	LEVESQUE, BARRETT G MD	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	92093	10	Gastroenterology (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
53703	Fee-for-Service	1164635264	1164635264	1	1	LISA MARIE VINCIJANOVIC M.D.	2/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	475 S DOBSON RD	None	CHANDLER	AZ	85224	5605	00	None	33.29768043	-111.8761089	Maricopa County
53746	Fee-for-Service	1861417834	1861417834	1	1	LIAU, LINDA M MD	12/1/1998	207T00000X	NA	General Surgery	026	PHYSICIANS	76908	14	Neurological Surgery	0	In state provider	None	300 MEDICAL PLAZA	STE 200	LOS ANGELES	CA	90024	0000	19	06037	34.06473399	-118.445865	Los Angeles County
53748	Fee-for-Service	1881617025	1881617025	1	1	LEPKOWSKI, GREGORY S MD	7/1/1998	207P00000X	NA	Other	026	PHYSICIANS	62420	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
53767	Fee-for-Service	1851805881	1851805881	1	1	LEWIS, COREY R	1/29/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4735 W AVENUE J3	None	LANCASTER	CA	93536	2305	19	06037	34.686855	-118.215891	Los Angeles County
53782	Fee-for-Service	1578348835	1578348835	1	1	LI, YIBO MD	9/12/2024	390200000X	NA	Other	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
53789	Fee-for-Service	1629147830	1629147830	1	1	LEE, STEPHAN I MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74285	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
53805	Fee-for-Service	1750720223	1750720223	1	1	LAO, MELISSA C MD	8/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140330	01	General Practice	0	In state provider	None	2825 J ST	STE 300	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
53814	Fee-for-Service	1801455092	1801455092	1	1	LANG, HOLLY R	11/18/2019	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1676 EAST 6TH ST	None	BEAUMONT	CA	92223	2550	33	06065	33.92948188	-116.9484306	Riverside County
53832	Fee-for-Service	1124106646	1124106646	1	1	LANARK FAMILY MED CLINIC	5/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	8040 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	6010	19	06037	34.21736595	-118.4487378	Los Angeles County
53843	Fee-for-Service	1417273830	1417273830	1	1	LE, TAMMY H MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111734	41	Internal Medicine	0	In state provider	None	9655 MONTE VISTA AVE	#402	MONTCLAIR	CA	91763	2238	36	06071	34.07991502	-117.6982245	San Bernardino County
53856	Fee-for-Service	1801209705	1801209705	1	1	LEE, CHRIS Y DO	8/1/2022	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
53880	Fee-for-Service	1982646709	1982646709	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3420 CAMINO TASSAJARA	None	DANVILLE	CA	94506	4680	07	06013	37.79897812	-121.9207902	Contra Costa County
53887	Fee-for-Service	1821058793	1821058793	1	1	LINN, MICHAEL B MD	1/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	56337	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
53898	Fee-for-Service	1639172273	1639172273	1	2	LARCABAL, JOHN E OD	8/15/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12138 FIRESTONE BLVD	None	NORWALK	CA	90650	2908	19	06037	33.90876295	-118.0747274	Los Angeles County
53911	Fee-for-Service	1922654193	1922654193	1	1	LIN, YI CHING PT	8/11/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
53922	Fee-for-Service	1396323507	1396323507	1	1	LILLEY, BRENNA MD	10/25/2024	208M00000X	NA	Other	026	PHYSICIANS	184299	41	Internal Medicine	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
53934	Fee-for-Service	1104801414	1104801414	1	1	LI, JOHN T MD	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62243	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
53943	Fee-for-Service	1154682003	1154682003	1	1	LIU, DANIEL P MD	9/17/2019	207L00000X	NA	Other	026	PHYSICIANS	151453	05	Anesthesiology	0	In state provider	None	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
53970	Fee-for-Service	1588906663	1588906663	1	1	LAI, STELLA MD	10/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154245	13	Neurology (M.D. only)	0	In state provider	None	990 SONOMA AVE	STE 17	SANTA ROSA	CA	95404	4813	49	06097	38.439729	-122.701545	Sonoma County
53986	Fee-for-Service	1457394280	1457394280	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	662 E BORONDA RD	None	SALINAS	CA	93906	3130	27	06053	36.714384	-121.625073	Monterey County
54000	Fee-for-Service	1275720799	1275720799	1	1	LEVESQUE, BARRETT G MD	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	92093	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
54002	Fee-for-Service	1760093884	1760093884	1	1	LABROSSE, SOPHIA OT	7/19/2021	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3760 CONVOY STREET	100	SAN DIEGO	CA	92111	3743	37	06073	32.81197521	-117.1531278	San Diego County
54009	Fee-for-Service	1326505165	1326505165	2	1	LAMBERT-BLUM, DOMINIQUE	10/3/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	610 SANTA MONICA BLVD	SUITE 205	SANTA MONICA	CA	90401	1645	19	06037	34.01816927	-118.4930051	Los Angeles County
54015	Fee-for-Service	1750332409	1750332409	1	1	LE, MICHAEL H MD	3/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67456	41	Internal Medicine	0	In state provider	None	450 E HUNTINGTON DR	None	ARCADIA	CA	91006	3748	19	06037	34.14015053	-118.0208745	Los Angeles County
54035	Fee-for-Service	1881617025	1881617025	1	1	LEPKOWSKI, GREGORY S MD	7/1/1998	207P00000X	NA	Other	026	PHYSICIANS	62420	01	General Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
54049	Fee-for-Service	1144212614	1144212614	1	1	LU, HUNG S MD	11/19/2013	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	5330 S HWY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
54053	Fee-for-Service	1851805881	1851805881	1	1	LEWIS, COREY R	1/29/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4735 W AVENUE J3	None	LANCASTER	CA	93536	2305	19	06037	34.686855	-118.215891	Los Angeles County
54055	Fee-for-Service	1912754334	1912754334	1	1	LEINES, AMANDA	9/25/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
54072	Fee-for-Service	1790836930	1790836930	1	1	LUTCH, MATTHEW J MD	9/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91929	04	Otology, Laryngology, Rhinology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
54087	Fee-for-Service	1477666105	1477666105	1	1	LEE, BOCK SOON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	40355	05	Anesthesiology	0	In state provider	None	2701 W ALAMEDA AVE	STE 203	BURBANK	CA	91505	4406	19	06037	34.15751343	-118.3303715	Los Angeles County
54113	Fee-for-Service	1629606173	1629606173	1	1	LAREAUX, DANIEL O MD	7/26/2023	207P00000X	NA	Other	026	PHYSICIANS	184974	None	None	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
54123	Fee-for-Service	1124106646	1124106646	1	1	LANARK FAMILY MED CLINIC	6/3/2019	No Taxonomy Provided	NA	None	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	8040 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	6010	19	06037	34.21736595	-118.4487378	Los Angeles County
54129	Fee-for-Service	1417273830	1417273830	1	1	LE, TAMMY H MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111734	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	9655 MONTE VISTA AVE	#402	MONTCLAIR	CA	91763	2238	36	06071	34.07991502	-117.6982245	San Bernardino County
54134	Fee-for-Service	1831254176	1831254176	1	1	LIVE OAK ELEM SCHOOL	4/1/1997	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	984 BOSTWICK LN	STE 1	SANTA CRUZ	CA	95062	1775	44	06087	36.98413062	-121.9854332	Santa Cruz County
54144	Fee-for-Service	1669550216	1669550216	1	1	LOPEZ, RODOLFO S MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65276	40	Pediatrics	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
54147	Fee-for-Service	1235553173	1235553173	1	1	LOWMAN, JACQUELYN CNP	5/24/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1720 S BASCOM AVE	None	CAMPBELL	CA	95008	0608	43	06085	37.292472	-121.9315815	Santa Clara County
54164	Fee-for-Service	1003310079	1003310079	1	1	LIN, ALEX DO	5/5/2022	207P00000X	NA	Other	026	PHYSICIANS	19144	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
54168	Fee-for-Service	1013223072	1013223072	1	1	LE, BAO QUOC MD INC	12/31/1980	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	34114	08	Family Practice	0	In state provider	None	2944 E ANAHEIM ST	None	LONG BEACH	CA	90804	3726	19	06037	33.78257254	-118.1571705	Los Angeles County
54205	Fee-for-Service	1699959890	1699959890	1	1	LIAO, WEI-HSUN MD	8/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100818	36	Psychiatry	0	In state provider	None	2081 ARENA BLVD	STE 160	SACRAMENTO	CA	95835	2095	34	06067	38.647737	-121.510467	Sacramento County
54251	Fee-for-Service	1447690227	1447690227	1	1	LEE, LEONARD K MD	8/1/2018	207L00000X	NA	Other	026	PHYSICIANS	134504	05	Anesthesiology	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
54254	Fee-for-Service	1114958501	1114958501	1	1	LAPTALO, LUKO M MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	66405	68	Hematology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
54276	Fee-for-Service	1215069489	1215069489	1	1	LEAL, OSCAR I	6/29/2020	208200000X	NA	General Surgery	026	PHYSICIANS	53420	24	Plastic Surgery	0	In state provider	None	22419 KENT AVE	None	TORRANCE	CA	90505	2303	19	06037	33.824448	-118.3564765	Los Angeles County
54304	Fee-for-Service	1427077171	1427077171	1	1	LIN, BRYAN T MD	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54251	None	None	0	In state provider	None	21114 VANOWEN ST	None	CANOGA PARK	CA	91303	2821	19	06037	34.19373808	-118.5935645	Los Angeles County
54320	Fee-for-Service	1619318938	1619318938	1	1	LEE, ROGER C MD	7/25/2018	390200000X	NA	Other	026	PHYSICIANS	135840	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
54326	Fee-for-Service	1801953237	1801953237	1	1	LEONG, FREDERIC J MD INC	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	71490	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	555 MARIN ST	STE 220	THOUSAND OAKS	CA	91360	4105	56	06111	34.18377743	-118.8801886	Ventura County
54339	Fee-for-Service	1942414024	1942414024	1	1	LALEZARZADEH, KATRIN DO	6/23/2008	2080H0002X	NA	Pediatric Primary Care	026	PHYSICIANS	10295	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
54343	Fee-for-Service	1114582004	1114582004	1	1	LISING, MICHELLE OD	6/4/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
54351	Fee-for-Service	1659352276	1659352276	1	1	LABORATORY COPORATION OF	3/1/1980	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	AMERICA	13112 EVENING CREEK DR S	# 200	SAN DIEGO	CA	92128	4108	37	06073	32.95589602	-117.0983666	San Diego County
54405	Fee-for-Service	1366514358	1366514358	1	1	LANDAU, MICHAEL D MD	11/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	58711	08	Family Practice	0	In state provider	None	3544 W OLYMPIC BLVD	STE 100	LOS ANGELES	CA	90019	3529	19	06037	34.05246985	-118.3163186	Los Angeles County
54407	Fee-for-Service	1124106646	1124106646	1	1	LANARK FAMILY MED CLINIC	5/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	8040 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	6010	19	06037	34.21736595	-118.4487378	Los Angeles County
54463	Fee-for-Service	1467566224	1467566224	1	1	LARSON, NANCY A	12/12/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
54495	Fee-for-Service	1184769341	1184769341	1	1	LIN, ALICE MD	6/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92802	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
54522	Fee-for-Service	1497769731	1497769731	1	1	LOMA LINDA FOOT AND	3/24/2005	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	ANKLE CENTER	11332 MOUNTAIN VIEW AVE	STE A	LOMA LINDA	CA	92354	3854	36	06071	34.04709935	-117.2436936	San Bernardino County
54545	Fee-for-Service	1538588462	1538588462	1	1	LEE, JOSHUA MD	9/11/2020	207L00000X	NA	Other	026	PHYSICIANS	143202	05	Anesthesiology	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
54547	Fee-for-Service	1235111014	1235111014	1	1	LORETTO GLYNN, M.D.	1/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2160 S. FIRST AVE	None	MAYWOOD	IL	60153	0000	00	None	41.86025379	-87.83381752	Cook County
54555	Fee-for-Service	1114958501	1114958501	1	1	LAPTALO, LUKO M MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	66405	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
54611	Fee-for-Service	1356530208	1356530208	1	1	LOSEY, TRAVIS E MD	5/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84234	13	Neurology (M.D. only)	0	In state provider	None	11370 ANDERSON STREET	SUITE 2400	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
54638	Fee-for-Service	1417024340	1417024340	1	1	LEE, ELISE H MD	1/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72967	25	Physical Medicine and Rehabilitation	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
54653	Fee-for-Service	1750439600	1750439600	1	1	LOW, WESLEY S MD	9/20/2007	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	75592	84	Surgery-Head and Neck	0	In state provider	None	865 3RD AVE	STE 123	CHULA VISTA	CA	91911	1300	37	06073	32.62189562	-117.0722453	San Diego County
54656	Fee-for-Service	1962664326	1962664326	1	1	LANOT, CHRISTIAN C MD	7/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146712	41	Internal Medicine	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
54687	Fee-for-Service	1831132679	1831132679	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1621 LANDER AVE	None	TURLOCK	CA	95380	6200	50	06099	37.47769844	-120.8490274	Stanislaus County
54692	Fee-for-Service	1013095876	1013095876	1	1	LEE, PATRICIA P MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81332	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
54704	Fee-for-Service	1699068940	1699068940	1	1	LONG BEACH MEMORIAL MEDICAL	4/29/2011	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	CENTER	1720 TERMINO AVE	None	LONG BEACH	CA	90804	2104	19	06037	33.78889871	-118.1458784	Los Angeles County
54713	Fee-for-Service	1316984842	1316984842	1	1	LEER, LEO R MD	4/30/1994	174400000X	NA	Other	026	PHYSICIANS	55144	08	Family Practice	0	In state provider	None	2412 BUHNE ST	None	EUREKA	CA	95501	3207	12	06023	40.78592828	-124.1411482	Humboldt County
54716	Fee-for-Service	1558880062	1558880062	1	1	LI, YANXIA NP	9/5/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
54753	Fee-for-Service	1164818175	1164818175	1	1	LEVIN, MARC A MD	12/19/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	None	None	1	Border provider	None	3001 SAINT ROSE PKWY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
54762	Fee-for-Service	1316982150	1316982150	1	1	LEE, GI-HYUNG M MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	72584	30	Radiology	0	In state provider	None	740 E ARROW HWY	STE A	COVINA	CA	91722	2144	19	06037	34.10550087	-117.8764722	Los Angeles County
54806	Fee-for-Service	1215909437	1215909437	1	1	LOGIE, GENEVIEVE A MD	2/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139040	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
54812	Fee-for-Service	1831769256	1831769256	1	1	LOVE, KRISTIN CRNA	6/12/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
54820	Fee-for-Service	1548371172	1548371172	1	1	LAMP, KAREN C MD	10/31/1986	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	58712	66	Emergency Medicine (Urgent Care)	0	In state provider	None	801 S CHEVY CHASE DR	None	GLENDALE	CA	91205	4431	19	06037	34.136757	-118.2396195	Los Angeles County
54829	Fee-for-Service	1205600517	1205600517	1	1	LOST HILLS UNION SCHOOL DIST	3/10/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	20979 PAVILION WAY	None	LOST HILLS	CA	93249	0000	57	06113	35.6155451	-119.7013637	Kern County
54853	Fee-for-Service	1902540602	1902540602	1	1	LESLEY S VANNOY	8/4/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	13731 DELLBROOK STREET	None	CORONA	CA	92880	5521	33	06065	33.94580849	-117.5829075	Riverside County
54870	Fee-for-Service	1295883098	1295883098	1	1	LEE, HONG Y MD	2/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86067	02	General Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
54895	Fee-for-Service	1053672444	1053672444	1	1	LEE, BEGEM MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126770	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
54946	Fee-for-Service	1992139323	1992139323	1	1	LIANG, ANA MD	7/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126873	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94706	1809	01	06001	37.83734639	-122.2672128	Alameda County
54955	Fee-for-Service	1750763439	1750763439	1	1	LAI, ISABELLA E MD	7/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149405	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
54960	Fee-for-Service	1427402031	1427402031	1	1	LIN, HILARY M MD	7/12/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	171489	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
54970	Fee-for-Service	1255417705	1255417705	2	1	LATTO, IRA S MEDICAL	12/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	12260	18	Ophthalmology	0	In state provider	None	6850 SEPULVEDA BLVD	SUITE 110	VAN NUYS	CA	91405	4465	19	06037	34.1955	-118.4661705	Los Angeles County
54977	Fee-for-Service	1083717391	1083717391	1	1	LEE, HWE-SEUNG L	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68205	None	None	0	In state provider	None	18406 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.2206967	-118.5342638	Los Angeles County
54980	Fee-for-Service	1023538931	1023538931	1	1	LEAO, MALA LCSW	8/14/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	155 S CALLE DA GAMA	None	ANAHEIM	CA	92807	3904	30	06059	33.85002329	-117.7866727	Orange County
54982	Fee-for-Service	1871849471	1871849471	1	1	LEE, MICHELE J MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125588	41	Internal Medicine	0	In state provider	None	1501 TROUSDALE DRIVE	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
54993	Fee-for-Service	1164508677	1164508677	1	1	LITAK, CARL W MD	3/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	56825	05	Anesthesiology	0	In state provider	None	25 N 14TH ST	STE 560	SAN JOSE	CA	95112	6204	43	06085	37.34293357	-121.8775187	Santa Clara County
54995	Fee-for-Service	1871653816	1871653816	1	1	LIEN, THOI H MD	11/11/2003	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	75628	None	None	0	In state provider	None	1004 E GARVEY AVE	None	MONTEREY PARK	CA	91755	3031	19	06037	34.06248182	-118.1090836	Los Angeles County
55006	Fee-for-Service	1275876856	1275876856	1	1	LOUISSAINT, PHILIPPE F MD	5/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140508	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
55025	Fee-for-Service	1255899217	1255899217	1	1	LIFETIME PHARMACY RX	7/7/2020	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	347 E LA HABRA BLVD	None	LA HABRA	CA	90631	5439	30	06059	33.93190047	-117.9420165	Orange County
55037	Fee-for-Service	1700886348	1700886348	1	1	LANE,EDWARD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 N WILMOT	None	TUCSON	AZ	85711	0000	00	None	32.227209	-110.8556595	Pima County
55059	Fee-for-Service	1568446953	1568446953	1	1	LIMB, ANDREA H	8/1/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
55084	Fee-for-Service	1477930287	1477930287	1	1	LASSITER, MIRIAM F MD	10/20/2020	207P00000X	NA	Other	026	PHYSICIANS	168582	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
55128	Fee-for-Service	1275148249	1275148249	1	1	LUZ, JUSTIN C MD	11/14/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
55134	Fee-for-Service	1922101534	1922101534	1	1	LENZKES, BRIAN J MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74524	41	Internal Medicine	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
55140	Fee-for-Service	1750347837	1750347837	1	1	LOW, DENNIS G MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	34486	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
55164	Fee-for-Service	1982750972	1982750972	1	1	LEE, CHING-MUH MD	5/31/1982	207L00000X	NA	Other	026	PHYSICIANS	25835	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
55175	Fee-for-Service	1427279819	1427279819	1	1	LEMAN, NATASHA R MD	7/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96945	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
55180	Fee-for-Service	1720065949	1720065949	1	1	LOPEZ, MONICA MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66406	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
55189	Fee-for-Service	1275578593	1275578593	2	1	LAMOUREUX, CHRISTINE A MD	10/1/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	77835	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
55206	Fee-for-Service	1770969321	1770969321	1	1	LEBARON, MELODY LMFT	9/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	STE 230	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
55232	Fee-for-Service	1326103102	1326103102	1	1	LONG, MICHELE E MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74359	41	Internal Medicine	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
55244	Fee-for-Service	1306073531	1306073531	1	1	LASKER, MICHAEL V MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114401	02	General Surgery	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
55283	Fee-for-Service	1457986168	1457986168	1	1	LIRA, MARITZA J CNP	10/6/2022	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11103 VENICE BLVD	None	LOS ANGELES	CA	90034	6914	19	06037	34.01379685	-118.4159354	Los Angeles County
55295	Fee-for-Service	1275893984	1275893984	1	1	LATEV, ALEXANDER V MD	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143983	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2309 ANTONIO AVENUE	None	CAMARILLO	CA	93010	1414	56	06111	34.24435917	-119.0191975	Ventura County
55303	Fee-for-Service	1225236896	1225236896	1	1	LEON, ARGENTINA MD	4/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114554	08	Family Practice	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
55312	Fee-for-Service	1124315601	1124315601	1	1	LEWANDOWSKI, NATHAN D MD	5/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141213	01	General Practice	0	In state provider	None	23845 HOLMAN HIGHWAY	STE 227	MONTEREY	CA	93940	5901	27	06053	36.57594044	-121.9132944	Monterey County
55340	Fee-for-Service	1407086739	1407086739	1	1	LOWRY, KATIE M OD	9/18/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 E SANTA BARBARA ST	C	SANTA PAULA	CA	93060	2675	56	06111	34.35269772	-119.069955	Ventura County
55341	Fee-for-Service	1235233610	1235233610	1	1	LEE, YOUNG SIK MD	1/1/1999	207P00000X	NA	Other	026	PHYSICIANS	39577	41	Internal Medicine	0	In state provider	None	803 E WASHINGTON ST	None	SAN DIEGO	CA	92103	0000	37	06073	32.75005077	-117.157164	San Diego County
55360	Fee-for-Service	1114196607	1114196607	1	1	LIU, KWANG-SAN MD	6/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	48682	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	ONE HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
55390	Fee-for-Service	1366656209	1366656209	1	1	LAUBACH, SUSAN S MD	10/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114061	03	Allergy	0	In state provider	None	5776 RUFFIN RD	None	SAN DIEGO	CA	92123	1013	37	06073	32.83931384	-117.1274102	San Diego County
55434	Fee-for-Service	1982929535	1982929535	1	1	LOUIE, SARAH L MD	3/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119067	08	Family Practice	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
55437	Fee-for-Service	1811207756	1811207756	1	1	LISTER, CRYSTAL J CNM	7/14/2014	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2 WEST FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
55457	Fee-for-Service	1205960242	1205960242	1	1	LYEW, SIMONE A OD	10/1/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5200 VAN BUREN BLVD	None	RIVERSIDE	CA	92503	2544	33	06065	33.937065	-117.4541295	Riverside County
55497	Fee-for-Service	1295954360	1295954360	1	1	LAI, CHIA-LI MD	8/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112899	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
55507	Fee-for-Service	1003285107	1003285107	1	1	LOPEZ, LESLIE LCSW	1/29/2025	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12440 FIRESTONE BLVD	3001	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
55515	Fee-for-Service	1518333202	1518333202	1	1	LARES, ANALUISA NP	4/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
55517	Fee-for-Service	1891722997	1891722997	1	1	LEE, THOMAS HON-JEH MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	80606	30	Radiology	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
55520	Fee-for-Service	1477088979	1477088979	1	1	LAZZARINI, THOMAS A MD	11/7/2023	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	191729	None	None	0	In state provider	None	41900 WINCHESTER RD	SUITE 201	TEMECULA	CA	92590	3403	33	06065	33.51467986	-117.1703489	Riverside County
55521	Fee-for-Service	1326103102	1326103102	1	1	LONG, MICHELE E MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74359	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
55591	Fee-for-Service	1205834322	1205834322	1	1	LIFE MEDICAL HOME CARE	7/2/1994	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	8051 IMPERIAL HWY	None	DOWNEY	CA	90242	3713	19	06037	33.92334897	-118.1503677	Los Angeles County
55599	Fee-for-Service	1689611089	1689611089	1	1	LAGLIA, ANTHONY G MD	5/31/1983	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	30627	30	Radiology	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
55613	Fee-for-Service	1174709950	1174709950	1	1	LOGAN HEIGHTS FAMILY	7/1/1994	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
55617	Fee-for-Service	1215496427	1215496427	1	1	LEE, RAMON	4/7/2025	208M00000X	NA	Other	026	PHYSICIANS	177303	41	Internal Medicine	0	In state provider	None	2700 GRANT ST	STE 110	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
55657	Fee-for-Service	1407890973	1407890973	1	1	LEE, KEVIN C MD	10/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95763	18	Ophthalmology	0	In state provider	None	1850 SULLIVAN AVE	STE 540	DALY CITY	CA	94015	2215	41	06081	37.68085904	-122.4728842	San Mateo County
55703	Fee-for-Service	1770674202	1770674202	1	1	LEWIS, ALISON C MD	11/7/2017	207R00000X	NA	Other	026	PHYSICIANS	142752	41	Internal Medicine	0	In state provider	None	699 W TEFFT STREET	SUITE A	NIPOMO	CA	93444	9288	40	06079	35.03414619	-120.4894206	San Luis Obispo County
55718	Fee-for-Service	1932398054	1932398054	1	1	LIN, HENRY MD INC	11/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70227	41	Internal Medicine	0	In state provider	OF INLAND EMPIRE	8008 MONET AVE	STE 107	RANCHO CUCAMONGA	CA	91739	7509	36	06071	34.10783185	-117.5345753	San Bernardino County
55725	Fee-for-Service	1710196910	1710196910	1	1	LU, NU T MD	11/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99720	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MED PLAZA	#365, 420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
55727	Fee-for-Service	1871630160	1871630160	1	1	LEWIS, GARY R PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8686 CAPRICORN WAY	None	SAN DIEGO	CA	92126	1851	37	06073	32.92418663	-117.1367295	San Diego County
55733	Fee-for-Service	1184798274	1184798274	1	1	LEWIS, RICHARD A MD	6/5/2006	207W00000X	NA	Ophthalmology	026	PHYSICIANS	40561	18	Ophthalmology	0	In state provider	None	1515 RIVER PARK DR	STE 100	SACRAMENTO	CA	95815	4605	34	06067	38.599947	-121.437279	Sacramento County
55763	Fee-for-Service	1497048243	1497048243	1	1	LIN, SAMANTHA K MD	10/19/2018	207K00000X	NA	Other	026	PHYSICIANS	155487	03	Allergy	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
55785	Fee-for-Service	1689364143	1689364143	1	1	LUZAICH, PERNILLE E M	9/26/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	85 W MATHESON STREET	None	HEALDSBURG	CA	95448	4810	49	06097	38.60965678	-122.8736807	Sonoma County
55801	Fee-for-Service	1003176710	1003176710	1	1	LORENTS, EVELYN M MD	1/24/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	158528	30	Radiology	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
55842	Fee-for-Service	1932124518	1932124518	1	1	LEE, CHUNG H MD	5/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52878	30	Radiology	0	In state provider	None	1411 EAST 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
55846	Fee-for-Service	1063273035	1063273035	1	1	LINDA J BOUCHARD MD, INC	3/28/2024	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	None	520 E. CENTER ST.	None	MANTECA	CA	95336	4720	39	06077	37.79906255	-121.2105195	San Joaquin County
55889	Fee-for-Service	1184236135	1184236135	1	1	LEM, JOSLYN R CCC-SLP	4/25/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 S HAVEN AVE	SUITE 190	ONTARIO	CA	91761	2969	36	06071	34.046307	-117.576387	San Bernardino County
55890	Fee-for-Service	1760881270	1760881270	1	1	LILIT YESAYAN OD A PROFESSIO	9/6/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1141 N. BRAND BLVD.	201	GLENDALE	CA	91202	3647	19	06037	34.162983	-118.2550855	Los Angeles County
55906	Fee-for-Service	1649602160	1649602160	1	1	LAVANI, CHIRAG A MD	7/26/2022	207R00000X	NA	Other	026	PHYSICIANS	175051	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
55922	Fee-for-Service	1447371505	1447371505	1	1	LEE, NATALIE C MD	9/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69882	02	General Surgery	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
55980	Fee-for-Service	1417311556	1417311556	1	1	LIN, KENNETH M MD	6/28/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	171724	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
55982	Fee-for-Service	1154633964	1154633964	1	1	LIPING, LIU MD	2/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152236	22	Pathology (M.D. only)	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
55986	Fee-for-Service	1922080969	1922080969	1	1	LEVI, LORI ALISA MD	6/21/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67252	08	Family Practice	0	In state provider	None	5757 WILSHIRE BLVD	None	LOS ANGELES	CA	90036	5810	19	06037	34.0624504	-118.3534253	Los Angeles County
55988	Fee-for-Service	1104357755	1104357755	1	1	LIM, SANDY S A	7/24/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
56001	Fee-for-Service	1609918556	1609918556	1	1	LIEDTKE, MICHAELA MD	9/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86006	68	Hematology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
56006	Fee-for-Service	1528464476	1528464476	1	1	LI, CONNIE NP	10/24/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
56019	Fee-for-Service	1710196910	1710196910	1	1	LU, NU T MD	11/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99720	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365, 420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
56024	Fee-for-Service	1235141136	1235141136	1	1	LAVRETSKY, ELEANOR MD	8/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51035	36	Psychiatry	0	In state provider	WESTWOOD CONSULTANTS MED	462 N LINDEN DR	STE 230	BEVERLY HILLS	CA	90212	2264	19	06037	34.06760415	-118.4080892	Los Angeles County
56034	Fee-for-Service	1679230809	1679230809	1	1	LIFE BUILDERS INCORPORATED	2/19/2025	106H00000X	NA	Mental Health Outpatient Services	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	11175 AZUSA CT	STE# 110	RANCHO CUCAMONGA	CA	91730	4933	36	06071	34.09081588	-117.5605461	San Bernardino County
56046	Fee-for-Service	1023093069	1023093069	1	1	LYNCH, KENNETH E MD	2/1/1984	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	17130	01	General Practice	0	In state provider	RADIOLOGICAL ASSOC	UNIV OF CALIFORNIA	None	IRVINE	CA	92664	0000	30	06059	33.63913017	-117.8515598	Orange County
56057	Fee-for-Service	1457491938	1457491938	1	1	LISS, KIMBERLY CRNA	5/11/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	320 SANTA FE DRIVE	SUITE 305	ENCINITAS	CA	92024	2526	37	06073	33.038847	-117.285579	San Diego County
56058	Fee-for-Service	1982750014	1982750014	1	1	LOPA, NASRIN Z MD	12/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95490	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
56060	Fee-for-Service	1023540796	1023540796	1	1	LEE, HELEN G MD	6/24/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	176148	None	None	0	In state provider	None	3629 VISTA WAY	None	OCEANSIDE	CA	92056	4522	37	06073	33.1814285	-117.3093613	San Diego County
56061	Fee-for-Service	1265744718	1265744718	1	1	LENGVILAS, RAY C MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123121	40	Pediatrics	0	In state provider	None	742 W HIGHLAND AVE	None	SAN BERNARDINO	CA	92405	3839	36	06071	34.13604853	-117.29952	San Bernardino County
56073	Fee-for-Service	1689364143	1689364143	1	1	LUZAICH, PERNILLE E M	9/26/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	85 W MATHESON STREET	None	HEALDSBURG	CA	95448	4810	49	06097	38.60965678	-122.8736807	Sonoma County
56074	Fee-for-Service	1972893923	1972893923	1	1	LANGER, JESSICA M MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123869	None	None	0	In state provider	None	10833 LE CONTE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
56075	Fee-for-Service	1184700932	1184700932	1	1	LAM, ARTHUR M MD	4/10/2017	207L00000X	NA	Other	026	PHYSICIANS	48789	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
56110	Fee-for-Service	1881692176	1881692176	1	1	LEUNG,CHEA H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	40190	01	General Practice	0	In state provider	None	937 PACIFIC AVE	None	SAN FRANCISCO	CA	94133	4223	38	06075	37.79641146	-122.4106899	San Francisco County
56151	Fee-for-Service	1982719829	1982719829	1	1	LUKS, ANDREW MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	MS 359110 C/O UWP	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
56162	Fee-for-Service	1609923861	1609923861	1	1	LAWNDALE ELEMENTARY SCHOOL	4/1/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	4161 W 147TH ST	None	LAWNDALE	CA	90260	1709	19	06037	33.8983413	-118.3479126	Los Angeles County
56166	Fee-for-Service	1902225295	1902225295	1	1	LAMBERT, NICHOLAS MD	6/13/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	21413	30	Radiology	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
56183	Fee-for-Service	1164833018	1164833018	1	1	LEE, MICHAEL M DO	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14526	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
56186	Fee-for-Service	1578370656	1578370656	1	1	LEE, SUSAN LMFT	1/14/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
56192	Fee-for-Service	1598531162	1598531162	1	1	LARA, ALEXANDRA CCC-SLP	4/29/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
56198	Fee-for-Service	1013627520	1013627520	1	1	LAI, ALEXANDRIA J	2/3/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
56210	Fee-for-Service	1265747778	1265747778	1	1	LEE, HAN S MD	1/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	113864	13	Neurology (M.D. only)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
56254	Fee-for-Service	1578145173	1578145173	1	1	LEWSADDER, CHARLES W DO	7/1/2024	207P00000X	NA	Other	026	PHYSICIANS	20324	66	Emergency Medicine (Urgent Care)	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
56274	Fee-for-Service	1922080969	1922080969	1	1	LEVI, LORI ALISA MD	6/21/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67252	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5757 WILSHIRE BLVD	None	LOS ANGELES	CA	90036	5810	19	06037	34.0624504	-118.3534253	Los Angeles County
56294	Fee-for-Service	1124055538	1124055538	1	1	LANTZ, MELISSA M DO	10/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
56312	Fee-for-Service	1245658301	1245658301	1	1	LIN, JUDY C MD	11/27/2017	390200000X	NA	Other	026	PHYSICIANS	150466	40	Pediatrics	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
56315	Fee-for-Service	1235141136	1235141136	1	1	LAVRETSKY, ELEANOR MD	8/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51035	01	General Practice	0	In state provider	WESTWOOD CONSULTANTS MED	462 N LINDEN DR	STE 230	BEVERLY HILLS	CA	90212	2264	19	06037	34.06760415	-118.4080892	Los Angeles County
56317	Fee-for-Service	1992985873	1992985873	1	1	LEE, JAY J MD	8/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97063	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
56358	Fee-for-Service	1205910437	1205910437	1	1	LIM, ARTHUR H PHARMD	12/7/2021	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2242 UNIVERSITY AVE	None	PALO ALTO	CA	94303	1715	41	06081	37.46683537	-122.1414492	San Mateo County
56359	Fee-for-Service	1851441414	1851441414	1	1	LAVERY, ALEKSEY W MD	4/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	107285	14	Neurological Surgery	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
56384	Fee-for-Service	1700337599	1700337599	1	1	LAM, EMMA H	5/15/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
56406	Fee-for-Service	1326153693	1326153693	1	1	LYNN HORNICK NP	11/26/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
56438	Fee-for-Service	1477504066	1477504066	1	1	LOPEZ, JOHN A MD	8/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94675	14	Neurological Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
56444	Fee-for-Service	1588820955	1588820955	1	1	LARSON, SARAH M MD	4/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117249	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	STE #365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
56451	Fee-for-Service	1275604175	1275604175	1	1	LEINO, RONALD J MD	12/31/1987	2084P0800X	NA	Psychiatry	026	PHYSICIANS	43244	36	Psychiatry	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
56455	Fee-for-Service	1649630914	1649630914	1	1	LEE, HEE SEUNG LMFT	10/18/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	520 N MAIN ST	SUITE 120	SANTA ANA	CA	92701	4623	30	06059	33.749316	-117.868123	Orange County
56485	Fee-for-Service	1609034644	1609034644	1	1	LEDGERWOOD, LEVI G MD	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110014	84	Surgery-Head and Neck	0	In state provider	None	7300 WYNDHAM DRIVE	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
56488	Fee-for-Service	1689126260	1689126260	1	1	LOZADA, MICHELLE C NP	4/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
56503	Fee-for-Service	1073824942	1073824942	1	1	LI, JICHANG MD APC	7/12/2010	207L00000X	NA	Other	026	PHYSICIANS	102566	05	Anesthesiology	0	In state provider	None	438 W LAS TUNAS DRIVE	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
56511	Fee-for-Service	1841247327	1841247327	1	1	LEIDERMAN, JOSHUA D MD	6/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93209	08	Family Practice	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
56558	Fee-for-Service	1346306164	1346306164	1	1	LIN RADIOLOGICAL ASSOCIATES	7/14/2015	2085R0204X	NA	Other	026	PHYSICIANS	78149	30	Radiology	0	In state provider	None	506 W VALLEY BLVD	STE 300	SAN GABRIEL	CA	91776	3731	19	06037	34.07936003	-118.1070139	Los Angeles County
56573	Fee-for-Service	1639443369	1639443369	1	1	LU, YUE W MD	4/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118830	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
56594	Fee-for-Service	1750771739	1750771739	1	1	LIE, ERINA MD	10/30/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	178222	None	None	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
56597	Fee-for-Service	1154314011	1154314011	1	1	LYONS, DENNIS J DPM	3/17/1982	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	4247 MACARTHUR BLVD	None	OAKLAND	CA	94619	1907	01	06001	37.78782156	-122.195244	Alameda County
56609	Fee-for-Service	1336193879	1336193879	1	1	LAFEVERS, LAURA L NP	2/21/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15301 TYLER FOOTE ROAD	None	NEVADA CITY	CA	95959	9318	29	06057	39.36622661	-121.0368658	Nevada County
56642	Fee-for-Service	1013950898	1013950898	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	201 W NAPA ST	STE 35	SONOMA	CA	95476	6643	49	06097	38.290923	-122.4626625	Sonoma County
56675	Fee-for-Service	1245573476	1245573476	1	1	LOO, DYANI MD	3/7/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	153491	36	Psychiatry	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
56689	Fee-for-Service	1215015847	1215015847	1	1	LA BOURENE, JAY I MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	79536	33	Thoracic Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
56724	Fee-for-Service	1093210676	1093210676	1	1	LAM, OLIVIA MD	10/10/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163706	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
56728	Fee-for-Service	1578655106	1578655106	1	1	LOREN, GREGORY J MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	75140	20	Orthopedic Surgery	0	In state provider	None	320 SANTA FE DR	STE 204	ENCINITAS	CA	92024	5179	37	06073	33.038847	-117.285579	San Diego County
56737	Fee-for-Service	1588820955	1588820955	1	1	LARSON, SARAH M MD	4/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117249	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE #365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
56770	Fee-for-Service	1336103456	1336103456	1	1	LUONG, QUAN T DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11556	40	Pediatrics	0	In state provider	None	45104 10TH ST W	None	LANCASTER	CA	93534	2310	19	06037	34.702929	-118.1480935	Los Angeles County
56776	Fee-for-Service	1700427598	1700427598	1	1	LEE, ALYSE CCC-SLP	5/2/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
56808	Fee-for-Service	1912076365	1912076365	1	1	LA JOLLA PULMONARY AND	2/28/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CRITICAL CARE INC	9850 GENESEE AVE	STE 780	LA JOLLA	CA	92037	1232	37	06073	32.882913	-117.226341	San Diego County
56842	Fee-for-Service	1598738734	1598738734	1	1	LEEDS, SCOTT M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79005	41	Internal Medicine	0	In state provider	None	9808 VENICE BLVD	STE 503	CULVER CITY	CA	90232	6804	19	06037	34.0236396	-118.3980847	Los Angeles County
56845	Fee-for-Service	1861627879	1861627879	1	1	LYONS, ELIZABETH A MD	4/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107785	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
56859	Fee-for-Service	1164476511	1164476511	1	2	LAN, YUHUAN MD	12/1/2004	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	78928	25	Physical Medicine and Rehabilitation	0	In state provider	None	723 S GARFIELD AVE	STE 304	ALHAMBRA	CA	91801	4430	19	06037	34.08841931	-118.1231009	Los Angeles County
56864	Fee-for-Service	1356341671	1356341671	1	1	LETAMENDI, ROBERT F MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	50002	01	General Practice	0	In state provider	CLINICA MEDICA SANTA MAR	21 BRENNAN ST	STE 21	WATSONVILLE	CA	95076	4337	44	06087	36.91328845	-121.7576583	Santa Cruz County
56918	Fee-for-Service	1538212170	1538212170	1	1	LOS ANGELES UROLOGY	4/8/1994	208800000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	MEDICAL GROUP, INC	1701 E CESAR E CHAVEZ AV	STE 500	LOS ANGELES	CA	90033	2464	19	06037	34.05112725	-118.2173921	Los Angeles County
56925	Fee-for-Service	1841457306	1841457306	1	1	LEE, TIMOTHY C MD	10/27/2020	2086S0120X	NA	General Surgery	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
56935	Fee-for-Service	1841796539	1841796539	1	1	LEGER, KATHERINE MD	8/31/2022	390200000X	NA	Other	026	PHYSICIANS	175132	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
56938	Fee-for-Service	1134207947	1134207947	1	1	LARSON, KIMBERLY K MD	3/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85327	36	Psychiatry	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
56977	Fee-for-Service	1215015847	1215015847	1	1	LA BOURENE, JAY I MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	79536	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
56982	Fee-for-Service	1093973422	1093973422	1	1	LIPANA, JONATHAN D MD	8/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103801	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
56997	Fee-for-Service	1669550570	1669550570	1	1	LIN, ERIC MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73872	41	Internal Medicine	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
57008	Fee-for-Service	1902218910	1902218910	1	1	LM HOME HEALTH CARE SERVICES	10/2/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	17777 VENTURA BLVD	SUITE 240	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
57009	Fee-for-Service	1548487010	1548487010	1	1	LEONARDI, MICHAEL J MD	12/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	92011	02	General Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
57017	Fee-for-Service	1285762633	1285762633	1	1	LOIS R FLEMING DPM	1/26/2018	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	A PODIATRY	441 LAKE BLVD	None	REDDING	CA	96003	2406	45	06089	40.61333509	-122.3847457	Shasta County
57026	Fee-for-Service	1588820955	1588820955	1	1	LARSON, SARAH M MD	4/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117249	68	Hematology	0	In state provider	None	200 MEDICAL PLAZA	STE #365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
57048	Fee-for-Service	1720588098	1720588098	1	1	LOUIE, ALWIN DO	7/20/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	17952	None	None	0	In state provider	None	1505 W 17TH ST	None	SAN BERNARDINO	CA	92411	1202	36	06071	34.13045153	-117.31869	San Bernardino County
57064	Fee-for-Service	1225019110	1225019110	1	1	LEWIS, DREW D DO	12/19/2023	208VP0014X	NA	Other	026	PHYSICIANS	21540	None	None	0	In state provider	None	1739 COLORADO AVE	None	TURLOCK	CA	95382	2714	50	06099	37.508976	-120.835306	Stanislaus County
57084	Fee-for-Service	1518034438	1518034438	1	1	LEE, THEODORE F MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	80166	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
57121	Fee-for-Service	1457469157	1457469157	1	1	LAVADIA, ELSA T MD	10/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	72966	40	Pediatrics	0	In state provider	None	300 OLD RIVER RD	STE 105	BAKERSFIELD	CA	93311	9503	15	06029	35.352648	-119.1122505	Kern County
57165	Fee-for-Service	1457857419	1457857419	1	1	LEE, SAMANTHA G MD	9/2/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	164463	None	None	0	In state provider	None	1418 E MAIN ST	210	SANTA MARIA	CA	93454	4833	42	06083	34.95286855	-120.4137315	Santa Barbara County
57174	Fee-for-Service	1033305164	1033305164	1	2	LAMONT PHYSICAL THERAPY INC	6/30/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10130 MAIN ST	STE A	LAMONT	CA	93241	1740	15	06029	35.262873	-118.9145185	Kern County
57180	Fee-for-Service	1134756091	1134756091	1	1	LIN, CHUNG-KUANG MD	10/19/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	46690 MOHAVE DR	None	FREMONT	CA	94539	7001	01	06001	37.49166118	-121.9261313	Alameda County
57233	Fee-for-Service	1972158277	1972158277	1	1	LAND OF PEACE 4	9/20/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	22615 KITTRIDGE ST	None	WEST HILLS	CA	91307	3628	19	06037	34.19152354	-118.619532	Los Angeles County
57244	Fee-for-Service	1295744563	1295744563	1	1	LE, TASHA T MD	1/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78863	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
57274	Fee-for-Service	1033278767	1033278767	1	1	LUM, KRIS W OD	2/28/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	444 GLEN OAKS BLVD	None	GLENDALE	CA	91202	2917	19	06037	34.1598361	-118.2632528	Los Angeles County
57278	Fee-for-Service	1346255924	1346255924	1	3	LADENHEIM, ERIC D MD INC	9/29/2010	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	900 W OLIVE AVE	SUITE D	MERCED	CA	93548	2401	24	06047	37.31913547	-120.4842784	Merced County
57293	Fee-for-Service	1821013962	1821013962	1	1	LARSEN, LANCE G MD	10/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88814	05	Anesthesiology	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
57310	Fee-for-Service	1235634015	1235634015	1	1	LASALLE, ELIZABETH E MD	11/4/2024	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	173973	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
57316	Fee-for-Service	1205868510	1205868510	1	1	LUSCHWITZ, BRIAN S MD	11/21/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60517	40	Pediatrics	0	In state provider	None	134 GRAPEVINE RD	None	VISTA	CA	92083	4004	37	06073	33.191415	-117.2751055	San Diego County
57338	Fee-for-Service	1417990557	1417990557	1	1	LEVITAN, PAUL A MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	80263	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
57397	Fee-for-Service	1245460062	1245460062	1	1	LEAL-LOPEZ, SANDRA LMFT	9/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
57493	Fee-for-Service	1083825095	1083825095	1	2	LEITSON, SAGE K LMFT	8/2/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
57497	Fee-for-Service	1124084579	1124084579	1	1	LEVINE, MARCIE L MD	12/1/1995	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	44379	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
57503	Fee-for-Service	1790723773	1790723773	1	1	LOUIS-JACQUES, M ANTOINE	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	MD	2735 SILVER CREEK RD	None	BULLHEAD CITY	AZ	86442	7924	00	None	35.110926	-114.5552445	Mohave County
57551	Fee-for-Service	1558694273	1558694273	1	1	LEE, DARRIN J MD	8/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	114062	14	Neurological Surgery	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
57562	Fee-for-Service	1750743225	1750743225	1	1	LIU, GABRIELLE MD	8/14/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	153014	None	None	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
57563	Fee-for-Service	1346255924	1346255924	1	3	LADENHEIM, ERIC D MD INC	9/29/2010	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	900 W OLIVE AVE	SUITE D	MERCED	CA	93548	2401	24	06047	37.31913547	-120.4842784	Merced County
57571	Fee-for-Service	1144490053	1144490053	1	1	LIGHTHOUSE HEALTHCARE CTR	3/1/2007	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2222 SANTA ANA BLVD S	None	LOS ANGELES	CA	90059	1350	19	06037	33.93502684	-118.2327239	Los Angeles County
57607	Fee-for-Service	1578756912	1578756912	1	1	LU,MA BELINDA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	185 HOSPITAL RD	None	WINCHESTER	TN	37398	2404	00	None	35.17613205	-86.09098687	Franklin County
57625	Fee-for-Service	1417990557	1417990557	1	1	LEVITAN, PAUL A MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	80263	08	Family Practice	0	In state provider	None	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
57646	Fee-for-Service	1548704844	1548704844	1	1	LIM, CHIN S MD INC	12/19/2016	207L00000X	NA	Other	026	PHYSICIANS	85495	05	Anesthesiology	0	In state provider	None	9080 COLIMA ROAD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
57658	Fee-for-Service	1043247281	1043247281	1	1	LEVERENZ, DARREN W MD	4/30/2020	207L00000X	NA	Other	026	PHYSICIANS	108804	05	Anesthesiology	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
57696	Fee-for-Service	1447485206	1447485206	1	2	LIU, JAMES H MD INC	6/8/2004	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	64811	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	18102 PIONEER BLVD	STE 203	ARTESIA	CA	90701	4406	19	06037	33.86654413	-118.0821405	Los Angeles County
57700	Fee-for-Service	1548546344	1548546344	1	1	LEWIS, MYKEISHA LCSW	3/20/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
57705	Fee-for-Service	1164861282	1164861282	1	1	LIU, KRISTINA MD	1/7/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	173144	None	None	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
57734	Fee-for-Service	1366584302	1366584302	1	1	LINDER, EILEEN M OD	3/9/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4051 LONE TREE WAY STE E	None	ANTIOCH	CA	94531	6204	07	06013	37.97536168	-121.8003374	Contra Costa County
57735	Fee-for-Service	1821474370	1821474370	1	1	LEVER, SHIFRA M LCSW	5/30/2019	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1335 N WATERMAN AVENUE	None	SAN BERNARDINO	CA	92404	5385	36	06071	34.124274	-117.2787625	San Bernardino County
57738	Fee-for-Service	1306543046	1306543046	2	1	LOS ANGELES COUNTY DEPARTMEN	9/25/2023	374J00000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
57744	Fee-for-Service	1609265339	1609265339	1	1	LIBRA HOME HEALTH CARE INC	4/22/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1215 E COLORADO ST	SUITE 201	GLENDALE	CA	91205	1494	19	06037	34.14267584	-118.2391187	Los Angeles County
57782	Fee-for-Service	1619908936	1619908936	1	1	LOPER, KAREN S MD	2/28/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	76438	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
57785	Fee-for-Service	1225387079	1225387079	1	1	LOW, ALLISON L	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
57792	Fee-for-Service	1275520819	1275520819	1	1	LI, MICHELLE L MD	7/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69093	02	General Surgery	0	In state provider	None	3838 CALIFORNIA ST	RM 616	SAN FRANCISCO	CA	94118	1508	38	06075	37.78591809	-122.4575439	San Francisco County
57811	Fee-for-Service	1669030987	1669030987	1	1	LUCASAN, DANAH MAJORIE F CNP	9/6/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10565 CIVIC CENTER DR	WEST BLDG., SUITE 165	RANCHO CUCAMONGA	CA	91730	3853	36	06071	34.10278226	-117.5747989	San Bernardino County
57818	Fee-for-Service	1871096669	1871096669	1	1	LAM, PHUONG-QUANG H MD	2/27/2022	207R00000X	NA	Other	026	PHYSICIANS	166002	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
57820	Fee-for-Service	1144812181	1144812181	1	1	LAL, NIMA	8/30/2023	163W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
57828	Fee-for-Service	1235609413	1235609413	1	3	LEO L FONG CORPORATION	10/1/2019	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	D CENTER	1610 S. COURT STREET	None	VISALIA	CA	93277	4946	54	06107	36.316323	-119.291715	Tulare County
57831	Fee-for-Service	1033245840	1033245840	1	1	LEE, PETER P MD	11/13/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70263	68	Hematology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
57864	Fee-for-Service	1538435433	1538435433	1	1	LEE, YUNA MD	6/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129693	05	Anesthesiology	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
57934	Fee-for-Service	1578675807	1578675807	1	1	LEE, LINDA OD	9/1/1998	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	FRANCE VISION OPTOMETRY	3104 W OLYMPIC BLVD	None	LOS ANGELES	CA	90006	2414	19	06037	34.05259662	-118.3034498	Los Angeles County
57944	Fee-for-Service	1477004067	1477004067	1	1	LORENZI-SPURLOCK, LAUREN M N	1/25/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	P	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
57971	Fee-for-Service	1336100759	1336100759	2	1	L A GOOD SAMARITAN PATHOLOGY	7/20/2010	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	MEDICAL GROUP INC	2777 PACIFIC AVE	H201, I202	LONG BEACH	CA	90806	2625	19	06037	33.80761478	-118.193744	Los Angeles County
57984	Fee-for-Service	1962858001	1962858001	1	1	LI, CHARLES H MD	12/11/2019	390200000X	NA	Other	026	PHYSICIANS	151467	30	Radiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
57991	Fee-for-Service	1619262771	1619262771	1	1	LEE, KRISTY A CCC-SP	3/22/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
58000	Fee-for-Service	1174151724	1174151724	1	1	LIN, ANDREW B MD	10/31/2024	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	185333	25	Physical Medicine and Rehabilitation	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
58010	Fee-for-Service	1013946532	1013946532	1	1	LEMIEUX, JOHN R MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	1240 E 9TH STREET	None	RENO	NV	89512	2964	00	None	39.53846574	-119.7974202	Washoe County
58021	Fee-for-Service	1518935253	1518935253	1	1	LOWRY, KATHERINE D CRNA	9/24/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	95305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
58047	Fee-for-Service	1528288669	1528288669	1	1	LAKUSTA, AMANDA R MD	10/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154815	18	Ophthalmology	0	In state provider	None	5021 W NOBLE AVE	STE A	VISALIA	CA	93277	8310	54	06107	36.326655	-119.345895	Tulare County
58073	Fee-for-Service	1255741328	1255741328	1	1	LEE, SARAH S MD	10/31/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	191703	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
58074	Fee-for-Service	1013237361	1013237361	1	1	LI, JEFFREY K MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136922	30	Radiology	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
58086	Fee-for-Service	1891778379	1891778379	1	1	LLOYD, CYNTHIA J MD	5/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	71461	30	Radiology	0	In state provider	None	1300 WEST 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
58101	Fee-for-Service	1083279905	1083279905	1	1	LEWIS, JADEVYONNA M	11/12/2019	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	18031 US HIGHWAY 18 STE	B	APPLE VALLEY	CA	92307	2152	36	06071	34.54008717	-117.2706344	San Bernardino County
58125	Fee-for-Service	1427039288	1427039288	1	1	LEE, EDWARD D MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84388	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
58126	Fee-for-Service	1528117991	1528117991	1	2	LEE, CHANG J MD INC	10/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	36129	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3203 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5831	19	06037	33.97264641	-118.2101997	Los Angeles County
58185	Fee-for-Service	1437184660	1437184660	1	1	LUTHER, PAUL K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	30758	36	Psychiatry	0	In state provider	A PROFESSIONAL CORP	1171 7TH AVE	None	SANTA CRUZ	CA	95062	2714	44	06087	36.97411127	-121.9948682	Santa Cruz County
58231	Fee-for-Service	1467469924	1467469924	1	1	LITTLEJOHN, BEN L D III	4/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87510	08	Family Practice	0	In state provider	MD	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
58268	Fee-for-Service	1376843672	1376843672	1	2	LAFONTAINE, TAMARA J LMFT	9/8/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	5870 ARLINGTON AVE	SUITE 103	RIVERSIDE	CA	92504	2037	33	06065	33.94592702	-117.4313099	Riverside County
58309	Fee-for-Service	1043990070	1043990070	1	1	LA SENIOR HOME INC	9/19/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	7825 SIMPSON AVENUE	None	NORTH HOLLYWOOD	CA	91605	2529	19	06037	34.21278732	-118.3888992	Los Angeles County
58319	Fee-for-Service	1275542599	1275542599	1	1	LIN, WEI-PIAU MD	4/18/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	39727	40	Pediatrics	0	In state provider	None	915 W 7TH ST	None	OXNARD	CA	93030	6755	56	06111	34.19516388	-119.1889217	Ventura County
58321	Fee-for-Service	1457527251	1457527251	1	1	LE, NGOC M D MD	7/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148294	13	Neurology (M.D. only)	0	In state provider	None	3003 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2700	37	06073	32.79785552	-117.1563475	San Diego County
58333	Fee-for-Service	1538166780	1538166780	1	1	LEVEN, STEVEN B MD	5/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	49708	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
58378	Fee-for-Service	1689687303	1689687303	1	1	LUC, KIEU-LOAN T MD	7/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10536	08	Family Practice	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
58392	Fee-for-Service	1114380086	1114380086	1	1	LAIWALLA, AZIM	8/23/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	155285	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
58431	Fee-for-Service	1407898802	1407898802	1	1	LORING, KEITH I MD	2/28/1994	207P00000X	NA	Other	026	PHYSICIANS	51091	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
58437	Fee-for-Service	1932319886	1932319886	1	1	LEE, EUNHAE A	4/27/2022	207L00000X	NA	Other	026	PHYSICIANS	89642	None	None	0	In state provider	None	104 E OLIVE AVE	STE 100	REDLANDS	CA	92373	5255	36	06071	34.0540723	-117.1800104	San Bernardino County
58443	Fee-for-Service	1740335157	1740335157	1	1	LOS ANGELES COUNTY CCS	10/1/1993	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	PEREZ MTU	4540 MICHIGAN AVE	None	LOS ANGELES	CA	90022	1130	19	06037	34.03873951	-118.1678985	Los Angeles County
58454	Fee-for-Service	1770762700	1770762700	1	1	LEIBOWITZ, STEVEN MD INC	4/4/2010	207W00000X	NA	Ophthalmology	026	PHYSICIANS	42694	None	None	0	In state provider	None	8641 WILSHIRE BLVD	# 312	BEVERLY HILLS	CA	90211	2921	19	06037	34.06614972	-118.3798912	Los Angeles County
58485	Fee-for-Service	1255484895	1255484895	1	1	LEVY, CHARLES H OD	8/1/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8106 LONG BEACH BLVD	None	SOUTH GATE	CA	90280	2053	19	06037	33.96487429	-118.225145	Los Angeles County
58500	Fee-for-Service	1497981575	1497981575	1	1	LIN, OLIVER N MD	4/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	113263	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
58528	Fee-for-Service	1730573635	1730573635	1	1	LENTZ, JACOB F MD	10/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146848	66	Emergency Medicine (Urgent Care)	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
58549	Fee-for-Service	1275577009	1275577009	2	1	LONGS DRUG STORES CA LLC	4/23/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1730 SWEETWATER RD	None	NATIONAL CITY	CA	91950	7625	37	06073	32.66152632	-117.0806899	San Diego County
58566	Fee-for-Service	1700433877	1700433877	1	1	LESSARD, NATHAN	10/2/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1922 HACIENDA DR	None	VISTA	CA	92081	0000	37	06073	33.1855682	-117.2834788	San Diego County
58602	Fee-for-Service	1588102164	1588102164	1	1	LOVELACE, PARKER DO	3/25/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	22697	30	Radiology	0	In state provider	None	1306 MARICOPA HIGHWAY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
58616	Fee-for-Service	1992724272	1992724272	1	1	LEE, PETER P MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67385	68	Hematology	0	In state provider	None	2428 SANTA MONICA BLVD	STE 301	SANTA MONICA	CA	90404	2046	19	06037	34.0317559	-118.4762013	Los Angeles County
58642	Fee-for-Service	1063930402	1063930402	1	1	LOPEZ, LESLIE	2/10/2025	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
58663	Fee-for-Service	1295063196	1295063196	1	1	LITTLE, JENNIFER A LCSW	10/25/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
58669	Fee-for-Service	1689687303	1689687303	1	1	LUC, KIEU-LOAN T MD	7/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10536	01	General Practice	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
58678	Fee-for-Service	1942443361	1942443361	1	1	LIU, MY Y MD	1/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147022	05	Anesthesiology	0	In state provider	None	3555 CESAR CHAVEZ STREET	None	LOS ANGELES	CA	94110	4403	38	06075	37.7479947	-122.4209132	San Francisco County
58697	Fee-for-Service	1700428570	1700428570	1	1	LEE, ANNA LCSW	6/26/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
58700	Fee-for-Service	1134481419	1134481419	1	1	LANDRITO, EARL JAY O MD	6/22/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2874 N CARSON ST	SUITE 300	CARSON CITY	NV	89706	1683	00	None	39.185271	-119.7710595	Consolidated Municipality of Carson City
58735	Fee-for-Service	1811018245	1811018245	1	1	LE, PHUOC V MD	4/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116173	40	Pediatrics	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
58738	Fee-for-Service	1801390216	1801390216	1	1	LIAO, ALBERT MD	5/26/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	178027	None	None	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
58744	Fee-for-Service	1558449462	1558449462	1	1	LIU, YUN MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77639	18	Ophthalmology	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
58752	Fee-for-Service	1104638212	1104638212	1	1	LEE, ALEXANDRA M NP	1/29/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11900 S AVALON BLVD	100 B	LOS ANGELES	CA	90061	2866	19	06037	33.92451047	-118.2652101	Los Angeles County
58762	Fee-for-Service	1932631462	1932631462	1	1	LIU, YINGNA MD	9/29/2023	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	157345	None	None	0	In state provider	None	39055 HASTINGS ST	SUITE #105	FREMONT	CA	94538	1518	01	06001	37.55249404	-121.983385	Alameda County
58763	Fee-for-Service	1093781197	1093781197	1	1	LOLACHI, ANOOSHEH MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51135	41	Internal Medicine	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
58784	Fee-for-Service	1184057291	1184057291	1	1	LAND, MICHAEL R DO	9/19/2022	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	12886	None	None	0	In state provider	None	1313 W 8TH ST	STE 100	LOS ANGELES	CA	90017	4420	19	06037	34.05048998	-118.269586	Los Angeles County
58790	Fee-for-Service	1790788453	1790788453	1	1	LESIN, BENJAMIN E MD INC	9/30/1982	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	18651	20	Orthopedic Surgery	0	In state provider	None	15225 VANOWEN ST	STE 214	VAN NUYS	CA	91405	3603	19	06037	34.19394549	-118.464777	Los Angeles County
58803	Fee-for-Service	1902191083	1902191083	1	1	LI, XIN MD	6/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131259	45	Nephrology (Renal-Kidney)	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	0000	19	06037	37.8237837	-122.2590026	Alameda County
58812	Fee-for-Service	1932237013	1932237013	1	1	LEE, PETER H MD	10/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	35994	41	Internal Medicine	0	In state provider	None	4220 W 3RD ST	STE 203	LOS ANGELES	CA	90020	3450	19	06037	34.0689595	-118.306251	Los Angeles County
58821	Fee-for-Service	1982995684	1982995684	1	1	LEWIS, MIKAELA B DO	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12496	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
58846	Fee-for-Service	1386651867	1386651867	1	1	LEE, SANG W MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137773	02	General Surgery	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
58849	Fee-for-Service	1497045298	1497045298	2	1	LEE, CHUNG U MD	3/4/2019	207SG0201X	NA	Other	026	PHYSICIANS	112527	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
58863	Fee-for-Service	1902357817	1902357817	1	1	LUDLOW, ALEXANDRIA CNP	5/15/2019	363LX0001X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
58879	Fee-for-Service	1376585109	1376585109	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1496 POLLARD RD	None	LOS GATOS	CA	95032	1031	43	06085	37.2646503	-121.9837657	Santa Clara County
58887	Fee-for-Service	1457732661	1457732661	1	1	LIU, JOHN	12/7/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	180518	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
58888	Fee-for-Service	1225701535	1225701535	1	1	LIU, ALAINA	10/31/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3801 KATELLA AVE	STE 130	LOS ALAMITOS	CA	90720	3362	30	06059	33.80318951	-118.066068	Orange County
58905	Fee-for-Service	1992724272	1992724272	1	1	LEE, PETER P MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67385	78	Neoplastic Diseases/Oncology	0	In state provider	None	2428 SANTA MONICA BLVD	STE 301	SANTA MONICA	CA	90404	2046	19	06037	34.0317559	-118.4762013	Los Angeles County
58920	Fee-for-Service	1083793129	1083793129	1	1	LIAO, CHIN H MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42223	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
58960	Fee-for-Service	1790866713	1790866713	1	1	LESLIE E QUINT MD	12/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 E MEDICAL CENTER DR	None	ANN ARBOR	MI	48109	5000	00	None	42.28391347	-83.72716554	Washtenaw County
58981	Fee-for-Service	1871113787	1871113787	1	1	LIGAS, CHANDLER J DPM	7/12/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
58985	Fee-for-Service	1831129063	1831129063	1	1	LA TOWN MEDICAL GRP, INC	8/15/1995	207RG0300X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3663 W 6TH ST	STE 206	LOS ANGELES	CA	90020	3048	19	06037	34.06360557	-118.30199	Los Angeles County
59005	Fee-for-Service	1306378781	1306378781	1	1	LEVIN, MATTHEW A MD	4/19/2021	207P00000X	NA	Other	026	PHYSICIANS	159229	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
59025	Fee-for-Service	1811018245	1811018245	1	1	LE, PHUOC V MD	4/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116173	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
59040	Fee-for-Service	1720467103	1720467103	1	1	LAKHANI, FAYHA DO	9/14/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15055	08	Family Practice	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
59075	Fee-for-Service	1073791828	1073791828	1	1	LA LIBERTAD MED CLNC INC	7/29/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	8427 LONG BEACH BLVD	None	SOUTH GATE	CA	90280	2014	19	06037	33.96094839	-118.2235703	Los Angeles County
59085	Fee-for-Service	1346504636	1346504636	1	1	LEE, JASON J DO	8/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12986	05	Anesthesiology	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
59093	Fee-for-Service	1902191083	1902191083	1	1	LI, XIN MD	6/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131259	41	Internal Medicine	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	0000	19	06037	37.8237837	-122.2590026	Alameda County
59124	Fee-for-Service	1578002689	1578002689	1	1	LANGE, JARED S CRNA	9/18/2020	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
59135	Fee-for-Service	1538342225	1538342225	1	1	LEUNG, SUK TAK LAC	2/20/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2185 E 14TH ST	None	SAN LEANDRO	CA	94577	6024	01	06001	37.71830238	-122.1468908	Alameda County
59147	Fee-for-Service	1841759974	1841759974	1	1	LANTZ, LINNEA MD	7/26/2022	207P00000X	NA	Other	026	PHYSICIANS	19416	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
59167	Fee-for-Service	1629053145	1629053145	1	1	LEAMON, MARTIN MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	59296	36	Psychiatry	0	In state provider	None	2340 CLAY ST	FL 7	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
59169	Fee-for-Service	1417028390	1417028390	1	1	LIN, ROBERT K MD	9/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74286	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
59199	Fee-for-Service	1154301307	1154301307	1	1	LAZO, EDWARD H DPM	7/24/2012	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1155 N VERMONT AVE	#200	LOS ANGELES	CA	90029	1728	19	06037	34.092549	-118.2917875	Los Angeles County
59216	Fee-for-Service	1376717496	1376717496	1	1	LOPEZ GONZALEZ, MIGUEL A MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135399	14	Neurological Surgery	0	In state provider	None	25455 BARTON RD	STE A108	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
59222	Fee-for-Service	1720007420	1720007420	1	2	LEE, JAI H MD	1/27/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	38492	-	NOT APPLICABLE	0	In state provider	None	3727 W 6TH STREET	SUITE 411	LOS ANGELES	CA	90020	5112	19	06037	34.06358655	-118.3037656	Los Angeles County
59254	Fee-for-Service	1861429813	1861429813	1	1	LONG, DAWN M MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126299	08	Family Practice	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
59259	Fee-for-Service	1144378183	1144378183	1	1	LAL, PANKAJ DO	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8651	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
59273	Fee-for-Service	1831129063	1831129063	1	1	LA TOWN MEDICAL GRP, INC	8/15/1995	207RG0300X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3663 W 6TH ST	STE 206	LOS ANGELES	CA	90020	3048	19	06037	34.06360557	-118.30199	Los Angeles County
59276	Fee-for-Service	1760865950	1760865950	1	1	LEON, ARMANDO A JR MD	6/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144533	01	General Practice	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94409	4364	41	06081	37.53039072	-122.2987772	San Mateo County
59340	Fee-for-Service	1740680669	1740680669	1	1	LEE, JULIAN LMFT	10/4/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	570 BLOSSOM HILL RD	None	SAN JOSE	CA	95123	3212	43	06085	37.25054647	-121.840839	Santa Clara County
59341	Fee-for-Service	1760875843	1760875843	1	1	LARSON, BENJAMIN PT	7/14/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	860 SEQUOIA AVE	STE A	LINDSAY	CA	93247	1425	54	06107	36.21418314	-119.096029	Tulare County
59368	Fee-for-Service	1386996122	1386996122	1	1	LLAMAS, GLADYS C LMFT	5/22/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
59393	Fee-for-Service	1710065321	1710065321	1	1	LUKASZEWICZ, GREGORY C	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	84587	02	General Surgery	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
59394	Fee-for-Service	1386750438	1386750438	2	1	LUONG, DANNY B MD	4/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	80573	None	None	0	In state provider	None	200 JOSE FIGUERES AVE	STE 350	SAN JOSE	CA	95116	1555	43	06085	37.36122014	-121.8505998	Santa Clara County
59419	Fee-for-Service	1801076633	1801076633	1	1	LOGAN, AARON C MD	9/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101414	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVENUE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
59422	Fee-for-Service	1881797686	1881797686	1	1	LUIS FERNANDEZ	2/26/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	760 BROADWAY	None	BROOKLYN	NY	11206	5317	00	None	40.700349	-73.9416015	Kings County
59427	Fee-for-Service	1114707866	1114707866	1	1	LACEK, ANDREW T CRNA	1/3/2025	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
59451	Fee-for-Service	1467525469	1467525469	1	1	LEE-HONG, GIN MD	1/30/1997	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	72426	40	Pediatrics	0	In state provider	None	1301 20TH ST	None	SANTA MONICA	CA	90404	2050	19	06037	34.02976782	-118.4812493	Los Angeles County
59454	Fee-for-Service	1417028390	1417028390	1	1	LIN, ROBERT K MD	9/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74286	10	Gastroenterology (M.D. only)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
59494	Fee-for-Service	1184022253	1184022253	1	1	LAWRENCE D. SINGER, M.D. & A	10/17/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	-	None	None	2	Out of state provider	SSOCIATES, PA	63 OFFICE PARK DRIVE	None	ROANOKE RAPIDS	NC	27870	4940	00	None	36.434889	-77.6444175	Halifax County
59518	Fee-for-Service	1619054566	1619054566	1	1	LEE, DARLENE C MD	6/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85328	40	Pediatrics	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
59536	Fee-for-Service	1255538138	1255538138	1	1	LIBERMANN, ROSE A LCSW	6/30/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
59556	Fee-for-Service	1891032421	1891032421	1	1	LITWIN, TIMOTHY G DO	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12348	41	Internal Medicine	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94105	2770	41	06081	37.66312028	-122.4631592	San Mateo County
59565	Fee-for-Service	1003273384	1003273384	1	1	LUKATO, DYLAN MD	7/11/2022	390200000X	NA	Other	026	PHYSICIANS	177113	None	None	0	In state provider	None	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	39	06077	37.744011	-121.4349725	San Joaquin County
59606	Fee-for-Service	1235254772	1235254772	1	1	LE, MINH-TRI V MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	63818	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
59630	Fee-for-Service	1669438529	1669438529	1	1	LOH, MARGARET S MD	6/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	76993	30	Radiology	0	In state provider	DR BANUELOS	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
59647	Fee-for-Service	1659432136	1659432136	1	1	LUKEZIC, KATHERINE T	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
59654	Fee-for-Service	1245214055	1245214055	1	1	LAU, WILLIAM K MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	77	Infectious Disease	2	Out of state provider	None	1329 LUSITANA ST	STE 305	HONOLULU	HI	96813	2429	00	None	21.30713158	-157.8522661	Honolulu County
59682	Fee-for-Service	1710174099	1710174099	1	1	LIANG, KEITH MD	3/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	3160 J ST	None	SACRAMENTO	CA	95816	4403	34	06067	38.572011	-121.4637165	Sacramento County
59724	Fee-for-Service	1013404912	1013404912	1	1	LEE, SANDY DO	7/24/2024	207RR0500X	NA	Other	026	PHYSICIANS	17623	83	Rheumatology	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
59731	Fee-for-Service	1134650922	1134650922	1	1	LY, EDDIE MD	5/19/2020	207R00000X	NA	Other	026	PHYSICIANS	159769	41	Internal Medicine	0	In state provider	None	450 E SPRING STREET	SUITE 1	LONG BEACH	CA	90806	1625	19	06037	33.8099218	-118.1872346	Los Angeles County
59741	Fee-for-Service	1801903513	1801903513	1	1	LIPSON, BARRY K MD	5/31/1993	207W00000X	NA	Ophthalmology	026	PHYSICIANS	57021	18	Ophthalmology	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
59767	Fee-for-Service	1871571398	1871571398	1	1	LATCHAW, RICHARD E MD	12/5/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	35061	13	Neurology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
59835	Fee-for-Service	1497918254	1497918254	1	1	LEE, GA Y MD	1/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115495	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1147 RED TAIL WAY	None	SIMI VALLEY	CA	93065	7232	56	06111	34.25942227	-118.7951311	Ventura County
59880	Fee-for-Service	1689785131	1689785131	1	1	LIE, ROBIN K DPM	10/18/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	11340 MOUNTAIN VIEW AVE	SUITE B1	LOMA LINDA	CA	92354	3884	36	06071	34.04699925	-117.2436953	San Bernardino County
59896	Fee-for-Service	1508355983	1508355983	1	1	LAYSON, JAMES T DO	9/12/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	23069	20	Orthopedic Surgery	0	In state provider	None	3905 WARING RD	None	OCEANSIDE	CA	92056	4405	37	06073	33.18781249	-117.2923383	San Diego County
59901	Fee-for-Service	1669904322	1669904322	1	1	LIU, TIANYUAN MD	8/12/2022	390200000X	NA	Other	026	PHYSICIANS	176697	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
59915	Fee-for-Service	1679867345	1679867345	1	1	LAND, RACHEL A MD	12/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	152329	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
59924	Fee-for-Service	1184801557	1184801557	1	1	LIN,KRISTIE L MD	1/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114433	18	Ophthalmology	0	In state provider	None	44815 FIG AVE	None	LANCASTER	CA	93534	3144	19	06037	34.69630244	-118.1431105	Los Angeles County
59940	Fee-for-Service	1245214055	1245214055	1	1	LAU, WILLIAM K MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	1329 LUSITANA ST	STE 305	HONOLULU	HI	96813	2429	00	None	21.30713158	-157.8522661	Honolulu County
59957	Fee-for-Service	1770589707	1770589707	1	1	LUM, ROBERT P MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	46608	78	Neoplastic Diseases/Oncology	0	In state provider	RENEWED HOPE RADIATION O	1901 HOLSER WALK	STE 305	OXNARD	CA	93036	2633	56	06111	34.22020891	-119.1546204	Ventura County
59958	Fee-for-Service	1356788244	1356788244	1	1	LEE, KYUNG H	8/16/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	STE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
59962	Fee-for-Service	1174746911	1174746911	1	1	LE, WILLIAM M MD	9/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90079	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
60011	Fee-for-Service	1275057317	1275057317	1	1	LEE, XZANIA W PHD	8/16/2023	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5000 W SUNSET BLVD	FL 4	LOS ANGELES	CA	90027	5861	19	06037	34.0981066	-118.2986382	Los Angeles County
60045	Fee-for-Service	1003349168	1003349168	1	1	LADNA, NATALIE V MD	9/5/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	187060	None	None	0	In state provider	None	6555 COYLE AVENUE	SUITE 280	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
60050	Fee-for-Service	1902235997	1902235997	1	1	LAMME, CATHERINE R LCSW	2/26/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
60143	Fee-for-Service	1144397852	1144397852	1	1	LEE, SUN HI MD	3/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	38521	40	Pediatrics	0	In state provider	None	9905 BACE AVE	None	BAKERSFIELD	CA	93307	6211	15	06029	35.264556	-119.004446	Kern County
60161	Fee-for-Service	1407806961	1407806961	1	1	LAWTON, ROBYN D MD	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	72812	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1480 S HARBOR BLVD	STE 10	LA HABRA	CA	90631	7572	30	06059	33.91276851	-117.931697	Orange County
60171	Fee-for-Service	1487943510	1487943510	1	1	LEE, MARK Y MD	7/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	116281	01	General Practice	0	In state provider	None	2898 LINDEN AVE	None	LONG BEACH	CA	90806	1627	19	06037	33.809688	-118.1868115	Los Angeles County
60196	Fee-for-Service	1063628618	1063628618	1	1	LEE, FAYE M MD	12/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100693	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15107 VAN OWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
60237	Fee-for-Service	1881639417	1881639417	1	1	LABUGUEN, RONALD H MD	12/13/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	81418	None	None	0	In state provider	None	1400 S GRAND AVE	STE 101	LOS ANGELES	CA	90015	3048	19	06037	34.03692236	-118.2655238	Los Angeles County
60241	Fee-for-Service	1326010356	1326010356	1	1	LAMPERT, PAUL MD	7/1/1997	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
60246	Fee-for-Service	1780620666	1780620666	1	1	LARS GORAN HEGNELL M.D.	2/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PARK	None	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
60250	Fee-for-Service	1306999164	1306999164	1	1	LEWIS, ROGER J MD	1/31/1988	207P00000X	NA	Other	026	PHYSICIANS	63560	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 S FLOWER ST	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
60268	Fee-for-Service	1447590245	1447590245	1	1	LANDON, MATTHEW MD	7/28/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	173169	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
60269	Fee-for-Service	1205007986	1205007986	1	1	LACE, JOHN W MD INC	1/1/2001	193400000X	NA	Other	026	PHYSICIANS	85746	41	Internal Medicine	0	In state provider	None	140 LITTON DR	STE 120	GRASS VALLEY	CA	95945	5080	29	06057	39.23422354	-121.0525426	Nevada County
60318	Fee-for-Service	1528117991	1528117991	1	1	LEE, CHANG J MD INC	5/1/1984	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	36129	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4811 E FLORENCE AVE	None	BELL	CA	90201	4316	19	06037	33.96966355	-118.1814996	Los Angeles County
60322	Fee-for-Service	1891711909	1891711909	1	2	LALLA-REDDY, SUJATA MD	12/11/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	75875	77	Infectious Disease	0	In state provider	None	11180 WARNER AVE	353	FOUNTAIN VALLEY	CA	92708	7501	30	06059	33.71632048	-117.9334575	Orange County
60336	Fee-for-Service	1871614453	1871614453	1	1	LEINWEBER, THERESA J LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
60355	Fee-for-Service	1326042680	1326042680	1	1	LEE, PAUL T MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64277	41	Internal Medicine	0	In state provider	None	607 S GLENOAKS BLVD	None	BURBANK	CA	91502	1424	19	06037	34.17950025	-118.3013539	Los Angeles County
60460	Fee-for-Service	1487943510	1487943510	1	1	LEE, MARK Y MD	7/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	116281	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2898 LINDEN AVE	None	LONG BEACH	CA	90806	1627	19	06037	33.809688	-118.1868115	Los Angeles County
60498	Fee-for-Service	1356640932	1356640932	1	1	LEE, JACKLYN Y MD	12/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143562	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
60506	Fee-for-Service	1275646713	1275646713	1	1	LAUDATI, ROSALYN M PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 NEWPORT CENTER DR	STE 203	NEWPORT BEACH	CA	92660	7503	30	06059	33.61264489	-117.8745305	Orange County
60516	Fee-for-Service	1467494286	1467494286	2	1	LONGS DRUG STORES CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 BROADWAY ST	None	REDWOOD CITY	CA	94063	2522	41	06081	37.48708375	-122.2156784	San Mateo County
60540	Fee-for-Service	1346244126	1346244126	1	1	LOURDES HOSPITAL INC	2/28/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1530 LONE OAK ROAD	None	PADUCAH	KY	42003	7901	00	None	37.050444	-88.6472865	McCracken County
60543	Fee-for-Service	1831445352	1831445352	1	1	LY, HIEU M OD	8/30/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	521 S HAM LANE	STE A	LODI	CA	95242	3528	39	06077	38.12793778	-121.2883049	San Joaquin County
60552	Fee-for-Service	1306053186	1306053186	1	1	LEVINSON, SIMONE PSYD	5/4/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4190 DOUGLAS BLVD	SUITE 300	ROSEVILLE	CA	95746	5918	31	06061	38.740617	-121.2229935	Placer County
60557	Fee-for-Service	1205007986	1205007986	1	1	LACE, JOHN W MD INC	1/1/2001	193400000X	NA	Other	026	PHYSICIANS	85746	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	140 LITTON DR	STE 120	GRASS VALLEY	CA	95945	5080	29	06057	39.23422354	-121.0525426	Nevada County
60560	Fee-for-Service	1649253691	1649253691	1	1	LUONG, KHOA C DO	3/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	7838	None	None	0	In state provider	None	27300 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.89552551	-117.186021	Riverside County
60575	Fee-for-Service	1598956526	1598956526	1	1	LEVY, ALAN W PHD	4/14/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3151 AIRWAY AVENUE	SUITE A-2	COSTA MESA	CA	92626	3301	30	06059	33.67783408	-117.8720921	Orange County
60579	Fee-for-Service	1639546054	1639546054	1	1	LAM, HAI HOANG NP	12/17/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	102 MILE OF CARS WAY	None	NATIONAL CITY	CA	91950	6603	37	06073	32.66148939	-117.1033907	San Diego County
60608	Fee-for-Service	1467495200	1467495200	2	1	LONGS DRUG STORES CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	650 SAN RAMON VALLEY BLV	None	DANVILLE	CA	94526	4022	07	06013	37.81327687	-121.9956697	Contra Costa County
60618	Fee-for-Service	1124213715	1124213715	1	1	LIN, TIMOTHY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	960 JOE FRANK HARRIS PKW	None	CARTERSVILLE	GA	30120	2129	00	None	34.19984075	-84.79568996	Bartow County
60623	Fee-for-Service	1457642639	1457642639	1	1	LYNCH, MEAGHAN M MD	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134163	25	Physical Medicine and Rehabilitation	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
60653	Fee-for-Service	1871594903	1871594903	1	1	LATHAM, EMI M MD	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81406	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
60658	Fee-for-Service	1407148224	1407148224	1	1	LEUNG, ALLISON W MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136663	40	Pediatrics	0	In state provider	None	11980 SAN VICENTE BLVD	SUITE 102	LOS ANGELES	CA	90049	5012	19	06037	34.05221538	-118.4721745	Los Angeles County
60687	Fee-for-Service	1821443870	1821443870	1	1	LOSLOSO, ARLENE JANE SAHARA	1/5/2022	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	C DO	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
60699	Fee-for-Service	1245737998	1245737998	1	1	LEE, JANE MD	10/6/2022	207L00000X	NA	Other	026	PHYSICIANS	176556	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
60710	Fee-for-Service	1124266093	1124266093	1	1	LEGEND MEDICAL EQUIPMENT &	4/21/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	SUPPLIES INC	17725 CRENSHAW BLVD	#303	TORRANCE	CA	90504	4159	19	06037	33.86941815	-118.3265141	Los Angeles County
60732	Fee-for-Service	1245391820	1245391820	1	1	LISKANICH, RONALD D DO	3/1/2002	207NS0135X	NA	Dermatology	026	PHYSICIANS	4952	05	Anesthesiology	0	In state provider	None	886 W FOOTHILL BLVD	STE G	UPLAND	CA	91786	3780	36	06071	34.10666432	-117.6628171	San Bernardino County
60759	Fee-for-Service	1689727794	1689727794	1	1	LEFTIK, ELIZABETH R PSYD	10/14/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
60769	Fee-for-Service	1629723036	1629723036	1	1	LEGASPI, CHRISTIAN PT	8/3/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
60792	Fee-for-Service	1275694432	1275694432	1	2	LEE, OK Y CA	8/6/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1935 W LA HABRA BLVD	None	LA HABRA	CA	90631	5158	30	06059	33.9319113	-117.967297	Orange County
60833	Fee-for-Service	1346244126	1346244126	1	1	LOURDES HOSPITAL INC	2/28/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1530 LONE OAK ROAD	None	PADUCAH	KY	42003	7901	00	None	37.050444	-88.6472865	McCracken County
60852	Fee-for-Service	1225033087	1225033087	1	1	LALLANA, ENRICO C MD	11/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54791	13	Neurology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
60868	Fee-for-Service	1194870733	1194870733	1	1	LOS ANGELES COUNTY CCS	7/15/2005	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	DOWNEY MTU	12340 WOODRUFF AVE	RM N6	DOWNEY	CA	90241	5610	19	06037	33.9196042	-118.116633	Los Angeles County
60885	Fee-for-Service	1881739175	1881739175	1	1	LORENTZEN, DAVID PSYD	5/31/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	623 E LATHAM AVE	None	HEMET	CA	92543	4342	33	06065	33.74934351	-116.9656065	Riverside County
60901	Fee-for-Service	1346255924	1346255924	1	1	LADENHEIM, ERIC D MD INC	9/29/2010	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	6057 N FIRST ST	STE 105	FRESNO	CA	93710	5468	10	06019	36.824193	-119.7723865	Fresno County
60943	Fee-for-Service	1679739957	1679739957	1	1	LEUNG, TIFFANY I MD	2/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125004	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
60944	Fee-for-Service	1720030760	1720030760	1	1	LOTT, IRA T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	40813	79	Neurology-Child	0	In state provider	None	19732 MACARTHUR BLVD	None	IRVINE	CA	92612	2419	30	06059	33.65659666	-117.8624166	Orange County
60947	Fee-for-Service	1407148224	1407148224	1	1	LEUNG, ALLISON W MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136663	01	General Practice	0	In state provider	None	11980 SAN VICENTE BLVD	SUITE 102	LOS ANGELES	CA	90049	5012	19	06037	34.05221538	-118.4721745	Los Angeles County
60959	Fee-for-Service	1255651311	1255651311	1	1	LEE, AMIE Y MD	5/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127533	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
60967	Fee-for-Service	1235576612	1235576612	1	1	LIN, MAEVE W DO	9/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12323	08	Family Practice	0	In state provider	None	2601 E MAIN ST	SUITE 104	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
60973	Fee-for-Service	1376937938	1376937938	1	1	LAU, LAWRENCE MD	10/15/2018	207P00000X	NA	Other	026	PHYSICIANS	155093	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
61017	Fee-for-Service	1245391820	1245391820	1	1	LISKANICH, RONALD D DO	3/1/2002	207NS0135X	NA	Dermatology	026	PHYSICIANS	4952	07	Dermatology	0	In state provider	None	886 W FOOTHILL BLVD	STE G	UPLAND	CA	91786	3780	36	06071	34.10666432	-117.6628171	San Bernardino County
61027	Fee-for-Service	1013425305	1013425305	1	1	LOYAL CONSULTING INC	1/8/2019	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	151 N LYON AVE	None	HEMET	CA	95243	3381	33	06065	33.748578	-116.9891565	Riverside County
61030	Fee-for-Service	1265063895	1265063895	1	1	LEEDS, HAYDEN MD	4/4/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
61054	Fee-for-Service	1295506814	1295506814	1	1	LA CANADA PHARMACY LLC	9/21/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	928 FOOTHILL BLVD	None	LA CANADA FLINTRI	CA	91011	3338	19	06037	34.20380153	-118.1989917	Los Angeles County
61063	Fee-for-Service	1528520988	1528520988	1	1	LIM, YEUN MD	12/13/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	177221	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
61064	Fee-for-Service	1932119229	1932119229	1	1	LANARO, VERA LMFT	7/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1320 WILLOW PASS RD	600	CONCORD	CA	94520	5292	07	06013	37.96879608	-122.0519798	Contra Costa County
61071	Fee-for-Service	1437340783	1437340783	1	1	LONG, GREGORY J CO	5/8/2009	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	13203 HADLEY ST	#209	WHITTIER	CA	90601	4538	19	06037	33.98273153	-118.0347615	Los Angeles County
61077	Fee-for-Service	1154331999	1154331999	1	1	LEE, EUGENE E MD	6/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94565	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
61090	Fee-for-Service	1710116744	1710116744	1	1	LEMIEUX, KATIE MD	10/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112004	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	276 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
61120	Fee-for-Service	1639100498	1639100498	1	1	LIM, RENE A MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	44687	01	General Practice	0	In state provider	None	14415 CHASE ST	None	PANORAMA CITY	CA	91402	3017	19	06037	34.22478679	-118.4475099	Los Angeles County
61170	Fee-for-Service	1194768077	1194768077	1	1	LEW, CLARKE R MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	54668	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1330 NATIVIDAD RD	None	SALINAS	CA	93906	3101	27	06053	36.696996	-121.633173	Monterey County
61172	Fee-for-Service	1619984507	1619984507	1	1	LOMA LINDA KIDNEY CENTER	9/1/1991	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	11375 ANDERSON ST	None	LOMA LINDA	CA	92354	3407	36	06071	34.046865	-117.2610915	San Bernardino County
61185	Fee-for-Service	1013272228	1013272228	1	1	LOUIS, WILLINE NP	2/15/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5850 EL CAMINO REAL	None	ATASCADERO	CA	93422	3318	40	06079	35.48962035	-120.670989	San Luis Obispo County
61186	Fee-for-Service	1346255924	1346255924	1	2	LADENHEIM, ERIC D MD INC	9/29/2010	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	119 SOUTH LOCUST STREET	SUITE B	VISALIA	CA	93291	6251	54	06107	36.329382	-119.2937355	Tulare County
61214	Fee-for-Service	1437130655	1437130655	1	1	LALLISS, STEVEN J MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142801	20	Orthopedic Surgery	0	In state provider	None	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
61223	Fee-for-Service	1629149604	1629149604	1	1	LIPTON, BRUCE M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36461	66	Emergency Medicine (Urgent Care)	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
61241	Fee-for-Service	1386703049	1386703049	1	1	LEWIS, HARRY GARNET MD	6/27/1996	2084P0800X	NA	Psychiatry	026	PHYSICIANS	49390	36	Psychiatry	0	In state provider	None	4477 W 118TH ST	STE 400	HAWTHORNE	CA	90250	2259	19	06037	33.92734752	-118.354221	Los Angeles County
61246	Fee-for-Service	1609954346	1609954346	1	1	LIM, ALAN Y	4/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	44763	24	Plastic Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
61251	Fee-for-Service	1457641870	1457641870	1	1	LEE, KEVIN K MD	11/1/2023	208800000X	NA	Other	026	PHYSICIANS	142519	None	None	0	In state provider	None	2486 N PONDEROSA DR	STE D-202	CAMARILLO	CA	93010	2470	56	06111	34.24266768	-119.0228157	Ventura County
61253	Fee-for-Service	1992783302	1992783302	1	1	LEVITAN, RUSSELL MD	6/21/2000	174400000X	NA	Other	026	PHYSICIANS	58508	05	Anesthesiology	0	In state provider	None	345 S HALCYON RD	None	ARROYO GRANDE	CA	93420	3896	40	06079	35.113419	-120.5915945	San Luis Obispo County
61265	Fee-for-Service	1528224474	1528224474	1	1	LAN,SHAUN X MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1130 NW 22ND AVE	STE 220	PORTLAND	OR	97210	0000	00	None	45.53087783	-122.6966012	Multnomah County
61330	Fee-for-Service	1225360530	1225360530	1	1	LEBLEU, GREGORY MD PA	7/13/2010	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	53588	25	Physical Medicine and Rehabilitation	0	In state provider	None	6 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76683038	-121.2481833	Placer County
61345	Fee-for-Service	1801403498	1801403498	1	1	LEGACY HOME HEALTH SERVICE	8/3/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	10201 RIVERSIDE DR	SUITE 202	TOLUCA LAKE	CA	91602	2538	19	06037	34.15223447	-118.3530465	Los Angeles County
61354	Fee-for-Service	1124211248	1124211248	1	1	LEE, MONICA K MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100298	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
61360	Fee-for-Service	1811179757	1811179757	1	1	LARSEN, TODD E MD	4/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99741	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
61363	Fee-for-Service	1548329253	1548329253	1	1	LU, CATHY B NP	10/18/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
61369	Fee-for-Service	1417171711	1417171711	1	1	LIWANPO, LLANYEE I MD	12/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94281	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
61370	Fee-for-Service	1295851426	1295851426	1	1	LINK, MAUREEN T CRNA	6/8/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
61390	Fee-for-Service	1487262259	1487262259	1	1	LOVING HANDS HOME CARE LLC	8/6/2020	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1701 WESTWIND DR.	STE 224	BAKERSFIELD	CA	93301	3047	15	06029	35.374239	-119.042547	Kern County
61393	Fee-for-Service	1902895451	1902895451	1	1	LE, TUONG-VI H OD	8/16/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INTERNATIONAL OPTO INC	600 INTERNATIONAL BLVD	STE 101	OAKLAND	CA	94606	2993	01	06001	37.79488125	-122.2528163	Alameda County
61407	Fee-for-Service	1639100498	1639100498	1	1	LIM, RENE A MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	44687	40	Pediatrics	0	In state provider	None	14415 CHASE ST	None	PANORAMA CITY	CA	91402	3017	19	06037	34.22478679	-118.4475099	Los Angeles County
61440	Fee-for-Service	1205347820	1205347820	1	1	LEE, JULIE J MD	10/18/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	157006	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
61449	Fee-for-Service	1184008112	1184008112	1	1	LOVVORN, ANDREA LCSW	5/8/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5051 CANYON CREST DR	SUITE 204	RIVERSIDE	CA	92507	0000	33	06065	33.9589602	-117.3311519	Riverside County
61465	Fee-for-Service	1790703197	1790703197	1	1	LUCAS, JESUS Z MD	4/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	76832	08	Family Practice	0	In state provider	None	1515 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	5399	33	06065	33.84324	-116.528209	Riverside County
61475	Fee-for-Service	1649728296	1649728296	1	1	LULEJIAN, JAMIE OT	9/8/2023	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3413 W PACIFIC AVE	100, 200	BURBANK	CA	91505	1555	19	06037	34.18839272	-118.3485967	Los Angeles County
61484	Fee-for-Service	1346255924	1346255924	1	1	LADENHEIM, ERIC D MD INC	9/29/2010	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	6057 N FIRST ST	STE 105	FRESNO	CA	93710	5468	10	06019	36.824193	-119.7723865	Fresno County
61497	Fee-for-Service	1104388123	1104388123	1	1	LIU, SIRUI MD	9/6/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177653	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
61510	Fee-for-Service	1629149604	1629149604	1	1	LIPTON, BRUCE M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36461	41	Internal Medicine	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
61511	Fee-for-Service	1124311618	1124311618	1	1	LEE, ELIZABETH NP	4/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
61532	Fee-for-Service	1609954346	1609954346	1	1	LIM, ALAN Y	4/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	44763	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
61545	Fee-for-Service	1487764064	1487764064	2	1	LAST FRONTIER HEALTHCARE	7/1/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1111 N NAGLE ST	None	ALTURAS	CA	96101	3841	25	06049	41.48746641	-120.5528507	Modoc County
61549	Fee-for-Service	1972645513	1972645513	1	1	LEMON, SUSAN I DO	2/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	8700	83	Rheumatology	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
61552	Fee-for-Service	1912008582	1912008582	1	2	L.A. VASCULAR AND ENDOVASCUL	4/17/2008	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	AR SURGERY A MEDICAL COR	2950 W BURBANK BLVD	None	BURBANK	CA	91505	2309	19	06037	34.17708126	-118.3429814	Los Angeles County
61559	Fee-for-Service	1306111687	1306111687	1	1	LEE, TIFFANY C MD	1/28/2021	390200000X	NA	Other	026	PHYSICIANS	144421	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
61571	Fee-for-Service	1255871711	1255871711	1	1	LIN, ETHAN W MD	6/28/2023	208M00000X	NA	Other	026	PHYSICIANS	164328	None	None	0	In state provider	None	6001 NORRIS CANYON RD	None	SAN RAMON	CA	94583	5400	07	06013	37.7755858	-121.958923	Contra Costa County
61588	Fee-for-Service	1174710586	1174710586	1	1	LUKE-ZEITOUN, MONA MD	7/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100955	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
61604	Fee-for-Service	1508802992	1508802992	1	2	LIN-HURTUBISE, KEVIN M MD	12/8/2020	208600000X	NA	General Surgery	026	PHYSICIANS	88017	None	None	0	In state provider	None	1325 E CHURCH ST	STE 202	SANTA MARIA	CA	93454	5915	42	06083	34.95209265	-120.4147348	Santa Barbara County
61634	Fee-for-Service	1841330065	1841330065	1	1	LELCHUK, REDENCION A	11/30/1995	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	27495 BAHAMA AVE	None	HAYWARD	CA	94545	4016	01	06001	37.62697986	-122.1015092	Alameda County
61658	Fee-for-Service	1508849258	1508849258	1	1	LINHARES, CATHLEEN M	2/8/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	SPEECH PATH, THE	1752 WALNUT TREE LN	None	CHICO	CA	95928	6979	04	06007	39.704697	-121.8400255	Butte County
61721	Fee-for-Service	1073692471	1073692471	1	1	LAPPIN, MICHAEL B MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	30285	18	Ophthalmology	0	In state provider	None	801 N TUSTIN AVE	STE 700	SANTA ANA	CA	92705	3611	30	06059	33.752286	-117.8341735	Orange County
61739	Fee-for-Service	1902241607	1902241607	1	1	LI, ROBERT L MD	7/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142061	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 530	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
61760	Fee-for-Service	1346255924	1346255924	1	2	LADENHEIM, ERIC D MD INC	9/29/2010	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	119 SOUTH LOCUST STREET	SUITE B	VISALIA	CA	93291	6251	54	06107	36.329382	-119.2937355	Tulare County
61810	Fee-for-Service	1407015092	1407015092	1	1	LITTLE, MILTON T MD	9/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131292	20	Orthopedic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
61820	Fee-for-Service	1598780801	1598780801	1	1	LANGLEY, AUDRA K PHD	8/1/2005	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
61832	Fee-for-Service	1487764064	1487764064	2	1	LAST FRONTIER HEALTHCARE	7/1/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1111 N NAGLE ST	None	ALTURAS	CA	96101	3841	25	06049	41.48746641	-120.5528507	Modoc County
61840	Fee-for-Service	1841796430	1841796430	1	1	LANGLO, CHRISTOPHER S MD	7/7/2022	390200000X	NA	Other	026	PHYSICIANS	178596	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
61841	Fee-for-Service	1528366085	1528366085	1	1	LOBATO, CARL E MD	8/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	1800 W CHARLESTON BLVD	SUITE 507	LAS VEGAS	NV	89102	2230	00	None	36.1590063	-115.1674415	Clark County
61842	Fee-for-Service	1194974295	1194974295	1	1	LIRAN, OMER MD	3/4/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	116679	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
61849	Fee-for-Service	1538330261	1538330261	1	1	LANDA, MATTY LCSW	5/15/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	18818 HWY 18	None	APPLE VALLEY	CA	92307	2323	36	06071	34.53795619	-117.2533531	San Bernardino County
61866	Fee-for-Service	1235287020	1235287020	1	1	LIN, LI-SHEI MD	2/28/1992	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	74008	None	None	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
61881	Fee-for-Service	1477631273	1477631273	1	1	LI, PAUL E MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79771	34	Urology and Urological Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
61912	Fee-for-Service	1356637854	1356637854	1	1	LIN, MICHAEL H MD	7/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128072	01	General Practice	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
61926	Fee-for-Service	1407891534	1407891534	1	1	LIM, PETER C MD LTD	10/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	78	Neoplastic Diseases/Oncology	1	Border provider	CENTER OF HOPE	75 PRINGLE WAY	None	RENO	NV	89502	1464	00	None	39.52621891	-119.7944075	Washoe County
61961	Fee-for-Service	1881600393	1881600393	1	1	LEE, DAVID M MD	1/1/1999	207P00000X	NA	Other	026	PHYSICIANS	63044	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15615 POMERADO RD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
62017	Fee-for-Service	1568780096	1568780096	1	1	LEE-FELKER, STEPHANIE A MD	5/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118554	30	Radiology	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
62021	Fee-for-Service	1699721035	1699721035	1	1	LAMON, JOEL M MD	8/4/1999	207RH0003X	NA	Oncology	026	PHYSICIANS	28164	None	None	0	In state provider	None	701 E GRAND AVE	None	ESCONDIDO	CA	92025	4466	37	06073	33.1249585	-117.0726834	San Diego County
62024	Fee-for-Service	1205389095	1205389095	2	1	LANDO, MICHELE LCSW	9/30/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	468 MANZANITA AVE STE 2	None	CHICO	CA	95926	1358	04	06007	39.75707298	-121.8433455	Butte County
62027	Fee-for-Service	1902241607	1902241607	1	1	LI, ROBERT L MD	7/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142061	01	General Practice	0	In state provider	None	200 MEDICAL PLAZA	STE 530	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
62032	Fee-for-Service	1083903967	1083903967	1	1	LEVIN, ROSS E MD	5/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123122	66	Emergency Medicine (Urgent Care)	0	In state provider	None	147 NORTH BRENT ST	None	VENTURA	CA	93003	2854	56	06111	34.2746295	-119.2573399	Ventura County
62037	Fee-for-Service	1902826472	1902826472	1	1	LEE, ANDREA MD	6/29/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75526	22	Pathology (M.D. only)	0	In state provider	None	2800 L ST	None	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
62046	Fee-for-Service	1093364465	1093364465	1	1	LUTZ, ASHER D LCSW	11/3/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
62068	Fee-for-Service	1538452529	1538452529	1	1	LE, TRUC H CRNA	6/15/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
62133	Fee-for-Service	1538336292	1538336292	1	1	LIU, MEI MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
62138	Fee-for-Service	1336307297	1336307297	1	1	LARSON, SUZANNE MD	6/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
62141	Fee-for-Service	1144405515	1144405515	1	1	LU, DAVID Y MD	8/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107946	22	Pathology (M.D. only)	0	In state provider	None	PUEBLO AT BATH ST	None	SANTA BARBARA	CA	93105	4390	42	06083	34.430526	-119.72196	Santa Barbara County
62162	Fee-for-Service	1528788841	1528788841	1	1	LOZANO, DANIEL PT	8/28/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
62172	Fee-for-Service	1093738270	1093738270	1	1	LEWIS, HARRIETTE E MD	12/31/1986	207P00000X	NA	Other	026	PHYSICIANS	61865	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2648 E 14TH ST	None	OAKLAND	CA	94601	1506	01	06001	37.78093089	-122.2316571	Alameda County
62191	Fee-for-Service	1386855856	1386855856	2	1	L&N INC	7/25/2006	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	655 COMMERCIAL AVE	None	S SAN FRANCISCO	CA	94080	3423	41	06081	37.65582288	-122.4226635	San Mateo County
62211	Fee-for-Service	1407891534	1407891534	1	1	LIM, PETER C MD LTD	10/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	CENTER OF HOPE	75 PRINGLE WAY	None	RENO	NV	89502	1464	00	None	39.52621891	-119.7944075	Washoe County
62225	Fee-for-Service	1346995859	1346995859	1	1	LAB QUEST	6/7/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	2183 FAIRVIEW RD	100	COSTA MESA	CA	92627	5663	30	06059	33.65369997	-117.9076152	Orange County
62228	Fee-for-Service	1518909332	1518909332	2	1	LONGS DRUG STORES CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	243 W JACKSON ST	None	HAYWARD	CA	94544	1811	01	06001	37.65200569	-122.0901619	Alameda County
62230	Fee-for-Service	1992975957	1992975957	1	1	LEE, SUSAN J MD	8/20/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	102538	08	Family Practice	0	In state provider	None	25455 BARTON RD	STE 204B	LOMA LINDA	CA	92354	3450	36	06071	34.04805253	-117.249534	San Bernardino County
62242	Fee-for-Service	1720242977	1720242977	1	1	LILLY SILVA NP	2/2/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13020 MERIDIAN AVE S	None	EVERETT	WA	98208	6422	00	None	47.8799292	-122.2332137	Snohomish County
62245	Fee-for-Service	1821744178	1821744178	1	1	LASALA, JASON B NP	4/10/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
62256	Fee-for-Service	1376981183	1376981183	1	1	LEWIS, STEVEN MD	5/3/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	155034	30	Radiology	0	In state provider	None	74785 US HIGHWAY 111	STE 101	INDIAN WELLS	CA	92210	7129	33	06065	33.72131925	-116.360116	Riverside County
62278	Fee-for-Service	1437151073	1437151073	1	1	LEMON, DENNIS DO	7/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	4880 S WYNN RD	None	LAS VEGAS	NV	89103	5406	00	None	36.10169134	-115.1953733	Clark County
62281	Fee-for-Service	1497356398	1497356398	1	1	LOYOLA HUAMAN, LOURDES LMFT	7/2/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 420	ENCINO	CA	91436	1000	19	06037	34.15524484	-118.4756687	Los Angeles County
62288	Fee-for-Service	1962264150	1962264150	1	1	LOWE, MARGARET L DOULA	1/24/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
62296	Fee-for-Service	1134167760	1134167760	2	1	LINCARE INC	10/8/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	875 NATIONAL DRIVE	SUITE 105	SACRAMENTO	CA	95834	1162	34	06067	38.652975	-121.4884305	Sacramento County
62303	Fee-for-Service	1467554287	1467554287	1	1	LIU, WINSON MD INC	6/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64329	08	Family Practice	0	In state provider	None	3838 SHERMAN DR	STE 10	RIVERSIDE	CA	92503	4001	33	06065	33.92678822	-117.4368632	Riverside County
62345	Fee-for-Service	1588628598	1588628598	1	1	LAMBE, SUSAN C MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60722	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
62356	Fee-for-Service	1437255981	1437255981	1	1	LAWRENCE, ALICE J MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70667	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
62360	Fee-for-Service	1396852653	1396852653	1	1	LEVIN, AMY B MD	6/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76995	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
62361	Fee-for-Service	1730683798	1730683798	1	1	LEUNG, ERIC Y DO	8/12/2022	207R00000X	NA	Other	026	PHYSICIANS	19709	None	None	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
62470	Fee-for-Service	1013951458	1013951458	2	1	LONGS DRUG STORES CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	77 BOVET RD	None	SAN MATEO	CA	94402	3104	41	06081	37.55071278	-122.3149214	San Mateo County
62580	Fee-for-Service	1629106141	1629106141	1	1	LAGOS, JULIO C MSW LCSW	9/7/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 18TH ST	SUITE 350	SAN FRANCISCO	CA	94110	2077	38	06075	37.76218347	-122.4141845	San Francisco County
62584	Fee-for-Service	1013411917	1013411917	1	1	LI, LEO L MD	6/8/2022	207L00000X	NA	Other	026	PHYSICIANS	165597	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
62620	Fee-for-Service	1962988287	1962988287	1	1	LOS ANGELES CENTERS FOR	3/5/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	ALCOHOL AND DRUG ABUSE	10210 ORR AND DAY RD	STE B	SANTA FE SPRINGS	CA	90670	3581	19	06037	33.94432489	-118.090377	Los Angeles County
62624	Fee-for-Service	1770573941	1770573941	1	1	LI, JOSEPH Y MD	6/1/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	40118	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10 CONGRESS ST	STE 403	PASADENA	CA	91105	3023	19	06037	34.13396893	-118.1528162	Los Angeles County
62629	Fee-for-Service	1407878028	1407878028	1	1	LOS ANGELES CO	12/1/1977	282N00000X	NA	Hospitals	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	LA CO OLIVE VIEW-UCLA	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	19	06037	34.32450186	-118.4456317	Los Angeles County
62651	Fee-for-Service	1457882664	1457882664	1	1	LOLLIE, TRANG K MD	7/21/2021	207ZP0102X	NA	Other	026	PHYSICIANS	160763	None	None	0	In state provider	None	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
62697	Fee-for-Service	1750424339	1750424339	1	1	LEE, JIMMY OD	1/24/1998	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
62719	Fee-for-Service	1942521927	1942521927	1	1	LASALA, GREGORY S MD	7/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133485	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
62721	Fee-for-Service	1407908635	1407908635	1	1	LEVINE, SHARON L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34682	40	Pediatrics	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
62758	Fee-for-Service	1093907149	1093907149	1	1	LEWIS, ALICIA M LMFT	6/28/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2201 F STREET	None	BAKERSFIELD	CA	93301	3850	15	06029	35.379342	-119.023506	Kern County
62761	Fee-for-Service	1649768938	1649768938	1	1	LANDVATTER, JACOB MD	3/2/2021	208M00000X	NA	Other	026	PHYSICIANS	-	70	Clinic (mixed specialty)	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
62768	Fee-for-Service	1821070632	1821070632	1	1	LAU, KAM Y MD	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	37080	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
62789	Fee-for-Service	1649944000	1649944000	1	1	LEE, TYLER PT	11/2/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9080 IRVINE CENTER DRIVE	None	IRVINE	CA	92618	4658	30	06059	33.63644038	-117.7392454	Orange County
62809	Fee-for-Service	1811907512	1811907512	1	1	LODI MEMORIAL HSP OB MED	11/17/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	2415 W VINE ST	STE 103	LODI	CA	95242	3731	39	06077	38.1228953	-121.3052826	San Joaquin County
62816	Fee-for-Service	1376837021	1376837021	1	1	LEE, PHOEBE G MD	9/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129078	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
62823	Fee-for-Service	1134422934	1134422934	1	1	LEE, RAYMOND C MD	7/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114498	02	General Surgery	0	In state provider	None	863 N DOUGLAS STREET	#100	EL SEGUNDO	CA	90245	2081	19	06037	33.92830583	-118.3831669	Los Angeles County
62826	Fee-for-Service	1134210107	1134210107	1	1	LENHART, LAWRENCE D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	26101	41	Internal Medicine	0	In state provider	None	39 N SAN MATEO DR	None	SAN MATEO	CA	94401	2885	41	06081	37.56748642	-122.327359	San Mateo County
62830	Fee-for-Service	1336230127	1336230127	1	1	LEVIANT, CURTIS DPM	1/24/2025	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1 SHRADER ST	SUITE 580	SAN FRANCISCO	CA	94117	1016	38	06075	37.77467326	-122.4529451	San Francisco County
62854	Fee-for-Service	1811144637	1811144637	1	1	LIANG, JULIANA K MD	5/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107206	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
62858	Fee-for-Service	1750470118	1750470118	1	1	LAURA GRAEFF-ARMAS	9/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA	None	OMAHA	NE	68198	0001	00	None	0	0	None
62866	Fee-for-Service	1013070085	1013070085	1	1	LINNEMEYER, KRISTEN E	5/10/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
62876	Fee-for-Service	1114073566	1114073566	1	1	LEMOORE UNION ELEM SD	8/1/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	100 VINE ST	None	LEMOORE	CA	93245	3418	16	06031	36.296667	-119.7897625	Kings County
62923	Fee-for-Service	1851462840	1851462840	2	1	LINCARE INC	6/6/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3819 WALNUT DR	STE A	EUREKA	CA	95503	8950	12	06023	40.77293794	-124.1428937	Humboldt County
62929	Fee-for-Service	1871977033	1871977033	1	1	LE, DENNIS M LMFT	5/8/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
62935	Fee-for-Service	1659430213	1659430213	1	1	LIN, YEN-LIANG H MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81524	05	Anesthesiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
62939	Fee-for-Service	1427703156	1427703156	1	1	LIFEHEALTH MEDICINE APC	3/29/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	None	None	0	In state provider	None	7850 VISTA HILL AVE	None	SAN DIEGO	CA	92123	2717	37	06073	32.79493052	-117.155268	San Diego County
62944	Fee-for-Service	1255691895	1255691895	1	1	LAYTH S.I AL JASHAAMI	7/12/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 W THOMAS RD	STE 100	PHOENIX	AZ	85013	4255	00	None	33.481485	-112.080816	Maricopa County
62956	Fee-for-Service	1336414630	1336414630	1	1	LI, ALICE C MD	2/12/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	156029	68	Hematology	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
63014	Fee-for-Service	1245366632	1245366632	1	1	LAU, SIEW Y MD	1/13/2009	207L00000X	NA	Other	026	PHYSICIANS	103037	05	Anesthesiology	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
63024	Fee-for-Service	1205827623	1205827623	1	1	LALL, ASHOK MD	1/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	64108	41	Internal Medicine	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
63030	Fee-for-Service	1063712594	1063712594	1	1	LEVY, JENNIFER J MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112337	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
63039	Fee-for-Service	1871535609	1871535609	2	1	LONGS DRUG STORE CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5039 FOLSOM BLVD	None	SACRAMENTO	CA	95819	4440	34	06067	38.5614	-121.444335	Sacramento County
63046	Fee-for-Service	1437438280	1437438280	1	1	LAMB, DANIEL P MD	11/1/2016	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3899	36	06071	34.04824949	-117.2401425	San Bernardino County
63053	Fee-for-Service	1245579481	1245579481	1	2	LO, LYNN F NP	5/12/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	22372	-	NOT APPLICABLE	0	In state provider	None	1111 MARKET STREET	1ST AND 2ND FLOORS	SAN FRANCISCO	CA	94103	1513	38	06075	37.78018987	-122.4128297	San Francisco County
63058	Fee-for-Service	1821070632	1821070632	1	1	LAU, KAM Y MD	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	37080	41	Internal Medicine	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
63074	Fee-for-Service	1972519189	1972519189	1	1	LARSON, JAMES M MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	38734	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
63075	Fee-for-Service	1356423339	1356423339	1	1	LEBEAU, DAVID J MD	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	70934	30	Radiology	0	In state provider	None	300 LEWIS ST	None	SAN DIEGO	CA	92103	2108	37	06073	32.75191911	-117.1621589	San Diego County
63120	Fee-for-Service	1366286197	1366286197	1	1	LUNAS, MARRINA B	6/28/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	17	06033	0	0	None
63132	Fee-for-Service	1902529969	1902529969	1	1	LARA, GABRIELA	1/24/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	13079 VAN NUYS BLVD	STE 1	PACOIMA	CA	91320	1144	19	06037	34.26908885	-118.4180507	Los Angeles County
63137	Fee-for-Service	1114085388	1114085388	1	1	LARA PHARMACY CORPORATION	3/3/1989	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8031 VINELAND AVE	None	SUN VALLEY	CA	91352	3951	19	06037	34.21705161	-118.3703599	Los Angeles County
63222	Fee-for-Service	1467571091	1467571091	1	1	LIU, MICHAEL Y MD	4/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80666	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
63225	Fee-for-Service	1174574404	1174574404	1	1	LUE, PETER C MD	5/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89644	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
63229	Fee-for-Service	1114001385	1114001385	1	1	LARAINE LOW OD	1/31/1990	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7309 STOCKTON BLVD	None	SACRAMENTO	CA	95823	2782	34	06067	38.492028	-121.4267355	Sacramento County
63252	Fee-for-Service	1144574732	1144574732	1	1	LAM, LY P OD	8/29/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8190 MANGO AVE	None	FONTANA	CA	92335	3610	36	06071	34.10497032	-117.4314648	San Bernardino County
63267	Fee-for-Service	1568699338	1568699338	1	1	LIZAMA, ANA G MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131661	13	Neurology (M.D. only)	0	In state provider	None	280 SIERRA COLLEGE DR	STE 120	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
63319	Fee-for-Service	1982879599	1982879599	1	1	LEVENBERG, WRENN E MD	11/16/2010	207P00000X	NA	Other	026	PHYSICIANS	112251	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
63332	Fee-for-Service	1437438280	1437438280	1	1	LAMB, DANIEL P MD	12/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124026	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3899	36	06071	34.04824949	-117.2401425	San Bernardino County
63333	Fee-for-Service	1205302114	1205302114	1	1	LOVE, DEBRA K	1/23/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	20008 SHADOW ISLAND DR	None	SANTA CLARITA	CA	91351	5798	19	06037	34.42811767	-118.4830117	Los Angeles County
63337	Fee-for-Service	1245579481	1245579481	1	1	LO, LYNN F NP	12/19/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16323 CLARK AVENUE	None	BELLFLOWER	CA	90706	5209	19	06037	33.885693	-118.1339975	Los Angeles County
63339	Fee-for-Service	1992094015	1992094015	1	1	LEE, RONG X MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130070	01	General Practice	0	In state provider	None	7601 STONERIDGE DRIVE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
63352	Fee-for-Service	1255422085	1255422085	2	1	LAX PHARMACY INC	1/31/2008	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4457 LENNOX BLVD	None	LENNOX	CA	90304	2303	19	06037	33.9382383	-118.3545209	Los Angeles County
63358	Fee-for-Service	1487953725	1487953725	1	1	LIMES, JULIA E MD	8/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
63382	Fee-for-Service	1760596076	1760596076	1	1	LORCH, LYNNETTE A NP	1/31/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	726 N MEDICAL CTR DR E	STE 209	CLOVIS	CA	93611	6886	10	06019	36.84186593	-119.6624867	Fresno County
63398	Fee-for-Service	1568637361	1568637361	1	1	LEE, JOHN H MD	9/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	100887	18	Ophthalmology	0	In state provider	None	29826 HAUN RD	STE 100	MENIFEE	CA	92586	6547	33	06065	33.68719818	-117.1748757	Riverside County
63435	Fee-for-Service	1922309681	1922309681	1	2	LANDMARK SPECIALTY PHARMACY	9/1/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1208 W. MAGNOLIA BLVD	None	BURBANK	CA	91506	1830	19	06037	34.17622533	-118.321985	Los Angeles County
63462	Fee-for-Service	1659363331	1659363331	1	1	LICKTEIG,KAREN H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2801 N GANTENBEIN AVE	None	PORTLAND	OR	97227	0000	00	None	45.54387841	-122.6696022	Multnomah County
63463	Fee-for-Service	1760439939	1760439939	1	1	LIAO, DANIEL E MD	4/1/1995	207P00000X	NA	Other	026	PHYSICIANS	78157	66	Emergency Medicine (Urgent Care)	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
63545	Fee-for-Service	1518900851	1518900851	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7096 N WEST AVE	None	FRESNO	CA	93711	0462	10	06019	36.83875103	-119.8262343	Fresno County
63560	Fee-for-Service	1730114521	1730114521	1	1	LUO, FRANK FENG MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64965	22	Pathology (M.D. only)	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
63572	Fee-for-Service	1639125354	1639125354	1	1	LEONG, MICHAEL G MD	8/27/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48608	01	General Practice	0	In state provider	None	7223 CHURCH ST	STE C	HIGHLAND	CA	92346	5816	36	06071	34.122888	-117.1737945	San Bernardino County
63574	Fee-for-Service	1912082017	1912082017	1	1	LAVI, JOSEPH M MD AMC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72094	41	Internal Medicine	0	In state provider	None	23861 MCBEAN PKWY	STE D10	VALENCIA	CA	91355	2003	19	06037	34.39567343	-118.5542698	Los Angeles County
63586	Fee-for-Service	1659390979	1659390979	1	1	LIU, JOHNS N MD	11/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	58887	30	Radiology	0	In state provider	None	2301 BAHAMAS DR	None	BAKERSFIELD	CA	93309	0663	15	06029	35.37447628	-119.0453594	Kern County
63606	Fee-for-Service	1982164067	1982164067	1	1	LOZANO, REBECCA E MD	7/18/2023	207P00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
63622	Fee-for-Service	1699922252	1699922252	1	1	LEHMER, MELISSA A MD	12/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98009	13	Neurology (M.D. only)	0	In state provider	None	108 LA CASA VIA	STE 105	WALNUT CREEK	CA	94598	3032	07	06013	37.9124899	-122.0426939	Contra Costa County
63625	Fee-for-Service	1205302114	1205302114	1	1	LOVE, DEBRA K	1/23/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	20008 SHADOW ISLAND DR	None	SANTA CLARITA	CA	91351	5798	19	06037	34.42811767	-118.4830117	Los Angeles County
63676	Fee-for-Service	1740221266	1740221266	1	1	LEE, LINDA OD	2/21/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3104 W OLYMPIC BLVD	None	LOS ANGELES	CA	90006	2414	19	06037	34.05259662	-118.3034498	Los Angeles County
63721	Fee-for-Service	1205855848	1205855848	1	1	LEE, JEFFERY MD	10/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80215	41	Internal Medicine	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
63789	Fee-for-Service	1518747419	1518747419	1	1	LAMBOY, DEREK L NP	10/3/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
63817	Fee-for-Service	1316406317	1316406317	1	1	LIU, SIYUAN MD	6/4/2024	2085R0001X	NA	Other	026	PHYSICIANS	180710	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
63830	Fee-for-Service	1639824501	1639824501	1	1	LEPE, LISSET PT	5/4/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5767 GREENBACK LANE	None	SACRAMENTO	CA	95841	2013	34	06067	38.68164	-121.327164	Sacramento County
63839	Fee-for-Service	1427070374	1427070374	1	1	LA CLINICA DE LA RAZA	4/1/1992	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	SAN ANTONIO NBRHD HLTH	1030 INTERNATIONAL BLVD	None	OAKLAND	CA	94606	3730	01	06001	37.7917365	-122.2492617	Alameda County
63843	Fee-for-Service	1134457633	1134457633	1	1	LEHMAN, MATTHEW J LMFT	6/4/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23151 MOULTON PKWY	STE 108	LAGUNA HILLS	CA	92653	1206	30	06059	33.62638366	-117.7305455	Orange County
63876	Fee-for-Service	1760494645	1760494645	1	1	LEE, EMILY MD	9/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84468	41	Internal Medicine	0	In state provider	None	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
63901	Fee-for-Service	1780627547	1780627547	2	1	LONGS DRUG STORES CALIFORNIA	12/8/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	LLC	191 DEPOT ST	None	VACAVILLE	CA	95688	3900	48	06095	38.35836443	-121.9817196	Solano County
63925	Fee-for-Service	1265438964	1265438964	1	1	LINSTADT, DAVID E MD	1/31/1989	2085R0001X	NA	Other	026	PHYSICIANS	44217	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
63932	Fee-for-Service	1770777872	1770777872	1	1	LAKESIDE UNION SD	12/11/2000	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	12335 WOODSIDE AVE	None	LAKESIDE	CA	92040	3015	37	06073	32.85672335	-116.9260001	San Diego County
63947	Fee-for-Service	1518220235	1518220235	1	1	LEE, JESSICA M MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129553	02	General Surgery	0	In state provider	None	2221 STOCKTON BOULEVARD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
63970	Fee-for-Service	1073859526	1073859526	1	1	LOWE, DEREK H MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114178	05	Anesthesiology	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4378	43	06085	37.36893518	-122.0779448	Santa Clara County
63974	Fee-for-Service	1518375542	1518375542	1	1	LORENZ, PETER PT	8/23/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1922 HACIENDA DR	None	VISTA	CA	92081	0000	37	06073	33.1855682	-117.2834788	San Diego County
63993	Fee-for-Service	1003361239	1003361239	1	1	LAKEPORT UNIFIED SCHOOL	7/1/2016	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	2508 HOWARD AVE	None	LAKEPORT	CA	95453	6908	17	06033	39.06263444	-122.918504	Lake County
64006	Fee-for-Service	1356054803	1356054803	1	1	LA MEDICAL RETINA, INC.	10/31/2023	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	None	None	None	0	In state provider	None	23622 CALABASAS RD	SUITE 145	CALABASAS	CA	91302	1549	19	06037	34.15634882	-118.6418781	Los Angeles County
64032	Fee-for-Service	1780868281	1780868281	1	1	LAURSEN, JESSICA K MD	5/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111147	18	Ophthalmology	0	In state provider	None	100 STEIN PLAZA	STE 1-340	LOS ANGELES	CA	90095	0001	19	06037	34.06489065	-118.4443287	Los Angeles County
64068	Fee-for-Service	1104387901	1104387901	1	1	LAGUNA HILLS HOSPICE	10/17/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	23232 PERALTA DR	STE 200	LAGUNA HILLS	CA	92653	1437	30	06059	33.62507998	-117.7250262	Orange County
64069	Fee-for-Service	1962542159	1962542159	1	1	LAGUNA-VIEJO PED MED GRP	11/17/1981	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	STE 5-A	24953 PASEO DE VALENCIA	None	LAGUNA HILLS	CA	92653	4342	30	06059	33.60028568	-117.7010887	Orange County
64076	Fee-for-Service	1508099474	1508099474	1	1	LATERZA, SVJETLANA	5/8/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
64103	Fee-for-Service	1215919865	1215919865	1	1	LATTS, MARA G PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11800 CENTRAL AVE	STE 125	CHINO	CA	91710	7202	36	06071	34.0388092	-117.689654	San Bernardino County
64127	Fee-for-Service	1427070374	1427070374	1	1	LA CLINICA DE LA RAZA	3/1/1997	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	SAN ANTONIO NBRHD HLTH	1030 INTERNATIONAL BLVD	None	OAKLAND	CA	94606	3730	01	06001	37.7917365	-122.2492617	Alameda County
64133	Fee-for-Service	1508252669	1508252669	1	1	LEE, HAN D MD	4/25/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	167305	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
64140	Fee-for-Service	1578875779	1578875779	1	1	LIAU, JOY MD	6/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118110	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
64149	Fee-for-Service	1396173852	1396173852	1	1	LOCKERT, ZOE LMFT	3/7/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
64169	Fee-for-Service	1902013576	1902013576	1	1	LOPEZ, EDWIN F MD	8/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106229	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
64180	Fee-for-Service	1467259242	1467259242	1	1	LL ACUPUNCTURE AND WELLNESS	2/27/2025	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	CENTER	11274 LOS ALAMITOS BLVD	None	LOS ALAMITOS	CA	90720	3958	30	06059	33.798744	-118.0718035	Orange County
64182	Fee-for-Service	1235215740	1235215740	1	1	LAM EVERETT Y MD	8/31/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86821	02	General Surgery	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
64212	Fee-for-Service	1265438964	1265438964	1	1	LINSTADT, DAVID E MD	1/31/1989	2085R0001X	NA	Other	026	PHYSICIANS	44217	78	Neoplastic Diseases/Oncology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
64244	Fee-for-Service	1710006465	1710006465	1	1	LYDON, PATRICK J OD	11/24/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
64293	Fee-for-Service	1841271814	1841271814	1	1	LIN, ALLEN I DO	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8777	None	None	0	In state provider	None	52ND AND F ST	None	SACRAMENTO	CA	95819	0000	34	06067	38.570607	-121.439502	Sacramento County
64295	Fee-for-Service	1659578896	1659578896	1	1	LABRUZZO, SALVATORE V DO	6/14/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	10101 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2517	19	06037	34.15223753	-118.3508865	Los Angeles County
64331	Fee-for-Service	1114029626	1114029626	1	1	LINDA'S SPECIALTY SHOP INC	5/28/2019	332B00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1321 E THOUSAND OAKS	STE 122	THOUSAND OAKS	CA	91362	6274	56	06111	34.17831141	-118.8566489	Ventura County
64334	Fee-for-Service	1578514824	1578514824	2	1	LESLIE, KIERON S MD	1/23/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	101811	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
64357	Fee-for-Service	1104387901	1104387901	1	1	LAGUNA HILLS HOSPICE	10/17/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	23232 PERALTA DR	STE 200	LAGUNA HILLS	CA	92653	1437	30	06059	33.62507998	-117.7250262	Orange County
64364	Fee-for-Service	1437506821	1437506821	1	1	LOGSDON, DANIEL	8/1/2021	208G00000X	NA	General Surgery	026	PHYSICIANS	140331	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
64380	Fee-for-Service	1336261312	1336261312	1	1	LEU, KAREN DO	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9855	41	Internal Medicine	0	In state provider	None	700 LAWERENCE EXPRESSWAY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
64394	Fee-for-Service	1285923623	1285923623	1	4	LEWIS, MARSHALL S MD APC	1/20/2015	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	None	20960 SAGE LN	None	TEHACHAPI	CA	93561	6408	15	06029	35.12375735	-118.4787472	Kern County
64412	Fee-for-Service	1427070374	1427070374	1	1	LA CLINICA DE LA RAZA	4/1/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	SAN ANTONIO NBRHD HLTH	1030 INTERNATIONAL BLVD	None	OAKLAND	CA	94606	3730	01	06001	37.7917365	-122.2492617	Alameda County
64429	Fee-for-Service	1780766147	1780766147	1	1	LEE, GRACE M MD	10/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151691	77	Infectious Disease	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
64439	Fee-for-Service	1417038779	1417038779	1	1	LENDVAY,THOMAS S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY	NE STE # 100	SEATTLE	WA	98105	0000	00	None	47.66165594	-122.2864502	King County
64487	Fee-for-Service	1427456227	1427456227	1	1	LIU, MEI N OD	12/7/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
64502	Fee-for-Service	1265438964	1265438964	1	1	LINSTADT, DAVID E MD	1/31/1989	2085R0001X	NA	Other	026	PHYSICIANS	44217	30	Radiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
64529	Fee-for-Service	1528536760	1528536760	1	1	LA CROIX, DIANDRA LCSW	4/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39159 PASEO PADRE PKWY	STE 121	FREMONT	CA	94538	1600	01	06001	37.5531875	-121.9805141	Alameda County
64630	Fee-for-Service	1679806152	1679806152	1	1	LAYA, DESIREE PT	6/5/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2230 W SUNNYSIDE AVE STE	None	VISALIA	CA	93277	7269	54	06107	36.303912	-119.3156595	Tulare County
64637	Fee-for-Service	1972681716	1972681716	1	1	LI, AIDA C MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40812	41	Internal Medicine	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
64648	Fee-for-Service	1255008850	1255008850	1	1	LUX PHARMACY INC	12/28/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2107 S. SAN PEDRO ST	None	LOS ANGELES	CA	90011	1125	19	06037	34.02562111	-118.2587848	Los Angeles County
64681	Fee-for-Service	1285923623	1285923623	1	4	LEWIS, MARSHALL S MD APC	1/20/2015	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	20960 SAGE LN	None	TEHACHAPI	CA	93561	6408	15	06029	35.12375735	-118.4787472	Kern County
64685	Fee-for-Service	1952451064	1952451064	1	1	LOTUS BLOSSOM THERAPY CT	9/27/2002	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	1305 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4144	19	06037	34.01846721	-118.1121267	Los Angeles County
64695	Fee-for-Service	1992049571	1992049571	1	1	LEE, JASPER F DPM	7/29/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	595 BUCKINGHAM WAY	SUITE 330	SAN FRANCISCO	CA	94132	1909	38	06075	37.73012679	-122.4767395	San Francisco County
64700	Fee-for-Service	1427070374	1427070374	1	1	LA CLINICA DE LA RAZA	7/24/2023	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	SAN ANTONIO NBRHD HLTH	1030 INTERNATIONAL BLVD	None	OAKLAND	CA	94606	3730	01	06001	37.7917365	-122.2492617	Alameda County
64722	Fee-for-Service	1972583102	1972583102	1	1	LAINE, EDWARD DO	7/25/2023	207ZP0102X	NA	Other	026	PHYSICIANS	6623	None	None	0	In state provider	None	2036 RAILROAD AVE	None	REDDING	CA	96001	1801	45	06089	40.57806515	-122.3920754	Shasta County
64745	Fee-for-Service	1154418457	1154418457	1	1	LEVINE, JEFFREY MARK MD	3/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
64755	Fee-for-Service	1962568329	1962568329	1	1	LOCKHART, KEVIN G OD INC	12/31/1991	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6955 DOUGLAS BLVD	None	GRANITE BAY	CA	95746	6256	31	06061	38.74362216	-121.1731152	Placer County
64791	Fee-for-Service	1831289347	1831289347	1	1	LA CHEIM SCHOOL INC	2/14/2014	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	3031 TELEGRAPH AVE	None	OAKLAND	CA	94609	3205	01	06001	37.81967788	-122.2670259	Alameda County
64811	Fee-for-Service	1609102615	1609102615	1	1	LIN, KIRK K MD	7/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110655	10	Gastroenterology (M.D. only)	0	In state provider	None	3200 KEARNEY STREET	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
64813	Fee-for-Service	1265564223	1265564223	1	1	LOPEZ, IRMA S MFT	7/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7630 PAINTER AVE	STE C	WHITTIER	CA	90602	2373	19	06037	33.972534	-118.032652	Los Angeles County
64833	Fee-for-Service	1053317818	1053317818	1	1	LEE, RAYMOND W MD	1/19/2005	207R00000X	NA	Other	026	PHYSICIANS	44983	41	Internal Medicine	0	In state provider	None	200 JOSE FIGUERES AVE	STE 245	SAN JOSE	CA	95116	1588	43	06085	37.36122014	-121.8505998	Santa Clara County
64895	Fee-for-Service	1679515407	1679515407	2	1	LONGS DRUG STORES CA LLC	4/30/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2069 CAMDEN AVE	None	SAN JOSE	CA	95124	2024	43	06085	37.26219076	-121.9349172	Santa Clara County
64941	Fee-for-Service	1205037983	1205037983	1	1	LIN, KAREN K MD	12/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	88983	13	Neurology (M.D. only)	0	In state provider	None	620 CALIFORNIA BLVD J	None	SAN LUIS OBISPO	CA	93401	2598	40	06079	35.28925908	-120.6580523	San Luis Obispo County
64944	Fee-for-Service	1407864374	1407864374	1	1	LUCILE SALTER PACKARD	4/13/1995	251F00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CHILDRENS HOSPITAL AT ST	4600 BOHANNON DRIVE	SUITE 105	MENLO PARK	CA	94025	1034	41	06081	37.479573	-122.1755445	San Mateo County
64950	Fee-for-Service	1982854956	1982854956	3	1	LA VETA PHARMACY LLC	11/30/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1010 W LA VETA AVE	STE 130	ORANGE	CA	92868	4301	30	06059	33.78028244	-117.8635552	Orange County
64953	Fee-for-Service	1386692721	1386692721	1	1	LOONEY, MARK R MD	8/1/2000	363L00000X	NA	Nurse Practitioner	026	PHYSICIANS	69928	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
64969	Fee-for-Service	1285923623	1285923623	1	4	LEWIS, MARSHALL S MD APC	1/20/2015	193200000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	20960 SAGE LN	None	TEHACHAPI	CA	93561	6408	15	06029	35.12375735	-118.4787472	Kern County
64975	Fee-for-Service	1467871806	1467871806	1	1	LIM, ANDREW G MD	8/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155839	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
64986	Fee-for-Service	1609032242	1609032242	1	1	LEU, DIANA MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109214	07	Dermatology	0	In state provider	None	1300 CRANE STREET	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
64995	Fee-for-Service	1275263204	1275263204	1	1	LA CARE RX, INC.	5/3/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15243 VANOWEN ST	100	VAN NUYS	CA	91405	3605	19	06037	34.19394848	-118.4654115	Los Angeles County
65011	Fee-for-Service	1437599065	1437599065	1	1	LOTIA, MARIAM MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140288	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
65023	Fee-for-Service	1326523929	1326523929	1	1	LEE, JEREMY PT	12/2/2019	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	15632 BEAR VALLEY ROAD	108	VICTORVILLE	CA	92395	8518	36	06071	34.47085445	-117.3226975	San Bernardino County
65026	Fee-for-Service	1639112055	1639112055	1	1	LEE, JASON H MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108113	25	Physical Medicine and Rehabilitation	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
65037	Fee-for-Service	1558425413	1558425413	1	1	LEUNG, ALLAN F PHD	9/11/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY STREET	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
65055	Fee-for-Service	1801935622	1801935622	2	1	LARA, JOSE M MD	3/7/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	51277	41	Internal Medicine	0	In state provider	None	4670 GAGE AVE	None	BELL GARDENS	CA	90201	1360	19	06037	33.97755768	-118.1829162	Los Angeles County
65089	Fee-for-Service	1487143749	1487143749	1	1	LAM, JOVIAN W MD	9/20/2021	207R00000X	NA	Other	026	PHYSICIANS	173745	None	None	0	In state provider	None	9888 GENESEE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
65119	Fee-for-Service	1053317818	1053317818	1	1	LEE, RAYMOND W MD	1/19/2005	207R00000X	NA	Other	026	PHYSICIANS	44983	68	Hematology	0	In state provider	None	200 JOSE FIGUERES AVE	STE 245	SAN JOSE	CA	95116	1588	43	06085	37.36122014	-121.8505998	Santa Clara County
65138	Fee-for-Service	1538745559	1538745559	1	1	LEUNG, ERIC B MD	11/25/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
65142	Fee-for-Service	1346323482	1346323482	2	1	LONGS DRUG STORE CA LLC	12/26/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12058 PALMDALE RD	None	ADELANTO	CA	92301	6708	36	06071	34.50671847	-117.4004415	San Bernardino County
65162	Fee-for-Service	1598707564	1598707564	1	1	LYNCH, LORI L DC	2/8/2015	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	LYNCH CHIROPRACTIC	6716 RIO LINDA BLVD	STE C	RIO LINDA	CA	95673	3347	34	06067	38.690064	-121.4565165	Sacramento County
65230	Fee-for-Service	1861457012	1861457012	1	1	LANA WILKINSON	12/16/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2180 MAIN ST	None	WAILUKU	HI	96793	1625	00	None	20.88706871	-156.5045126	Maui County
65250	Fee-for-Service	1225186398	1225186398	1	1	LANCE HENDERSON	10/3/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	134 N STATE ST STE A	None	PRESTON	ID	83263	1143	00	None	42.09922582	-111.8766117	Franklin County
65259	Fee-for-Service	1710986260	1710986260	1	1	LEE, YOUNG SOO MD	10/31/1991	2085R0001X	NA	Other	026	PHYSICIANS	63908	None	None	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
65293	Fee-for-Service	1790119584	1790119584	1	1	LUM, CALVIN K PT	2/3/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11001 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1413	19	06037	34.26991066	-118.4671653	Los Angeles County
65304	Fee-for-Service	1356625974	1356625974	1	1	LUTZOW, KENDRA LCSW	4/8/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
65341	Fee-for-Service	1013312297	1013312297	1	1	LOI, IRENE S DPM	5/8/2020	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
65393	Fee-for-Service	1578958021	1578958021	1	1	LIDSTONE, ERICH A MD	9/5/2019	207P00000X	NA	Other	026	PHYSICIANS	161627	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
65396	Fee-for-Service	1083971592	1083971592	1	1	LAURA G EBBELING	1/6/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	330 MOUNT AUBURN ST	None	CAMBRIDGE	MA	02138	5502	00	None	42.373899	-71.1342405	Middlesex County
65399	Fee-for-Service	1083689269	1083689269	1	1	LOW, LEWIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1015 NW 22ND AVE	None	PORTLAND	OR	97210	3025	00	None	45.53024175	-122.6966202	Multnomah County
65423	Fee-for-Service	1447836358	1447836358	1	1	LIEW, VICTORIA H DPM	4/23/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2907 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98793933	-121.9782322	Santa Cruz County
65431	Fee-for-Service	1881789600	1881789600	1	1	LIN, JAMES Y MD	11/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	69813	41	Internal Medicine	0	In state provider	None	1245 W HUNTINGTON DR	STE 212	ARCADIA	CA	91007	1620	19	06037	34.13083182	-118.0689111	Los Angeles County
65462	Fee-for-Service	1023168614	1023168614	1	1	LEE, KENNETH M OD	11/26/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7601 STONERIDGE DRIVE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
65469	Fee-for-Service	1134747686	1134747686	1	1	LOTUS HOSPICE	9/13/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8925 SEPULVEDA BLVD	STE 204 A	NORTH HILLS	CA	91343	4354	19	06037	34.232355	-118.467768	Los Angeles County
65471	Fee-for-Service	1306308499	1306308499	1	1	LILY ADULT DAY HEALTH CARE	4/20/2021	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	610 S KINGSLEY DRIVE	None	LOS ANGELES	CA	90005	2318	19	06037	34.06302674	-118.3028285	Los Angeles County
65493	Fee-for-Service	1083648752	1083648752	1	1	LUM, MARK S PSYD	8/24/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	CES	1801 E HEIM AVE	SUITE 204	ORANGE	CA	92865	3020	30	06059	33.83024643	-117.8352808	Orange County
65498	Fee-for-Service	1578781134	1578781134	1	1	LESER, ERIC W OD	9/9/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	18013 CHATSWORTH ST	None	GRANADA HILLS	CA	91344	5608	19	06037	34.2648826	-118.5250089	Los Angeles County
65513	Fee-for-Service	1104964089	1104964089	1	1	LEE, HYOJIK	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9290	84	Surgery-Head and Neck	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
65529	Fee-for-Service	1275577611	1275577611	2	1	LONGS DRUG STORES CA LLC	12/26/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3081 STEVENS CREEK BLVD	None	SANTA CLARA	CA	95050	6704	43	06085	37.3234627	-121.949533	Santa Clara County
65538	Fee-for-Service	1649217357	1649217357	1	1	LIEN, NHA T MD	2/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78612	41	Internal Medicine	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
65554	Fee-for-Service	1720303191	1720303191	1	1	LANCE, VALENTIN A MD	7/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118759	None	None	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
65588	Fee-for-Service	1184844011	1184844011	1	1	LEE, SARAH Y MD	6/10/2010	174400000X	NA	Other	026	PHYSICIANS	87981	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	900 E HAMILTON AVE	STE 220	CAMPBELL	CA	95008	0665	43	06085	37.29428651	-121.934403	Santa Clara County
65598	Fee-for-Service	1376332155	1376332155	1	1	LINDER, MANDELA CLD	5/27/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	23	06045	0	0	None
65642	Fee-for-Service	1649388406	1649388406	1	1	LIU, LYNN X MD	6/15/2004	207R00000X	NA	Other	026	PHYSICIANS	76737	41	Internal Medicine	0	In state provider	None	2400 MOORPARK AVE	STE 319	SAN JOSE	CA	95128	2625	43	06085	37.3160785	-121.937121	Santa Clara County
65661	Fee-for-Service	1205083680	1205083680	1	1	LEE, AME K LMFT	9/12/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14241 EAST FIRESTONE BLV	SUITE 400	LA MIRADA	CA	90638	5505	19	06037	33.88516258	-118.0280298	Los Angeles County
65667	Fee-for-Service	1437546496	1437546496	1	1	LUCAS, BRANDON G MD	7/25/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	176494	None	None	0	In state provider	None	16311 VENTURA BLVD	SUITE #1150	ENCINO	CA	91436	4386	19	06037	34.15706864	-118.4885978	Los Angeles County
65687	Fee-for-Service	1043403371	1043403371	1	1	LU, JUN MD	7/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	96524	01	General Practice	0	In state provider	None	2505 WEST HAMMER LANE	None	STOCKTON	CA	95209	2839	39	06077	38.02139448	-121.347738	San Joaquin County
65710	Fee-for-Service	1083078075	1083078075	1	1	LEE, CLARA	4/15/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	15971	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
65718	Fee-for-Service	1255441515	1255441515	1	1	LOPEZ, HECTOR J MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63052	08	Family Practice	0	In state provider	None	2660 W COVELL BLVD	None	DAVIS	CA	95616	5645	57	06113	38.56101005	-121.7821776	Yolo County
65729	Fee-for-Service	1205919222	1205919222	1	1	LUCAS, MICHAEL A	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
65740	Fee-for-Service	1619469558	1619469558	1	1	LIZARRAGA, JACQUELINE B OT	12/22/2023	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
65754	Fee-for-Service	1114075157	1114075157	1	1	LIN, KEVIN Y MD	5/7/2008	207P00000X	NA	Other	026	PHYSICIANS	96363	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
65756	Fee-for-Service	1134747686	1134747686	1	1	LOTUS HOSPICE	9/13/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8925 SEPULVEDA BLVD	STE 204 A	NORTH HILLS	CA	91343	4354	19	06037	34.232355	-118.467768	Los Angeles County
65758	Fee-for-Service	1477906204	1477906204	1	1	LEI, ANDREW OD	1/17/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 W VALLEY BLVD	STE 115	SAN GABRIEL	CA	91776	3784	19	06037	34.07958215	-118.1021957	Los Angeles County
65795	Fee-for-Service	1427239128	1427239128	1	1	LEE, CHANGNIN T MD	1/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	74495	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
65806	Fee-for-Service	1134327398	1134327398	1	1	LEE, KRISTEN H MD	1/1/2023	207RR0500X	NA	Other	026	PHYSICIANS	176188	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
65811	Fee-for-Service	1023031127	1023031127	1	1	LYSINGER, WALTER O CRNA	3/31/1986	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	550 B ST	None	YUBA CITY	CA	95991	5067	51	06101	39.13299265	-121.6155493	Sutter County
65818	Fee-for-Service	1518963321	1518963321	1	1	LEE, JAY K MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85767	None	None	0	In state provider	None	12980 FREDERICK ST	STE A	MORENO VALLEY	CA	92553	5263	33	06065	33.931872	-117.2613835	Riverside County
65829	Fee-for-Service	1316044191	1316044191	1	1	LEE, THOMAS J	10/1/1998	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	388 9TH ST	STE 218	OAKLAND	CA	94607	4293	01	06001	37.80019425	-122.2715222	Alameda County
65855	Fee-for-Service	1467663963	1467663963	1	1	LOPEZ VIZCARRA, MARCO A MD	5/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134501	13	Neurology (M.D. only)	0	In state provider	None	315 MERCY AVE	STE 400	MERCED	CA	95340	8368	24	06047	37.33874349	-120.467493	Merced County
65904	Fee-for-Service	1093914608	1093914608	1	1	LE, MAILINH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	107463	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
65918	Fee-for-Service	1144313552	1144313552	1	2	LEE, DERRON T OD	1/21/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2321 W MARCH LN	A	STOCKTON	CA	95207	5261	39	06077	37.98565925	-121.3356299	San Joaquin County
65964	Fee-for-Service	1811253503	1811253503	1	1	LLANERAS, DORA A LMFT	7/20/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
65967	Fee-for-Service	1285106252	1285106252	1	1	LEVINE, JOANNE LCSW	9/3/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
65974	Fee-for-Service	1043403371	1043403371	1	1	LU, JUN MD	7/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	96524	41	Internal Medicine	0	In state provider	None	2505 WEST HAMMER LANE	None	STOCKTON	CA	95209	2839	39	06077	38.02139448	-121.347738	San Joaquin County
65982	Fee-for-Service	1194102921	1194102921	1	1	LEONG, DEREK W F MD	7/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146264	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
65987	Fee-for-Service	1477763779	1477763779	1	1	LOGAN, TIMOTHY D. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1030 HARRINGTON ST	STE 101	MOUNT CLEMENS	MI	48043	2967	00	None	42.58696111	-82.89803648	Macomb County
65996	Fee-for-Service	1386831071	1386831071	1	1	LIAO, MARIA W MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	64909	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
65998	Fee-for-Service	1457971616	1457971616	1	1	LAND OF PEACE HOSPICE	10/18/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7301 TOPANGA CANYON BLVD	STE 324	CANOGA PARK	CA	91303	3395	19	06037	34.203222	-118.605988	Los Angeles County
66003	Fee-for-Service	1225544927	1225544927	1	1	LA COUR, JACQUELYN N	3/9/2018	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	3808 RIVERSIDE DRIVE	STE 402	BURBANK	CA	91505	5301	19	06037	34.15252315	-118.3412174	Los Angeles County
66005	Fee-for-Service	1255441515	1255441515	1	1	LOPEZ, HECTOR J MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63052	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2660 W COVELL BLVD	None	DAVIS	CA	95616	5645	57	06113	38.56101005	-121.7821776	Yolo County
66023	Fee-for-Service	1609158476	1609158476	1	1	LIFE SPRINGS HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	60 WHITNEY PLACE	None	FREMONT	CA	94539	7662	01	06001	37.47000163	-121.918765	Alameda County
66034	Fee-for-Service	1629084868	1629084868	1	1	LIAO, KUANG C MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	79007	05	Anesthesiology	0	In state provider	None	438 W LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
66046	Fee-for-Service	1508848854	1508848854	1	1	LEGGETT, MAYA D MD	8/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90864	89	Surgery-Traumatic	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
66056	Fee-for-Service	1780694356	1780694356	1	1	LEE, SANG D DPM	3/11/2009	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	897 W VALLEY BLVD	None	COLTON	CA	92324	2009	36	06071	34.06875354	-117.3383997	San Bernardino County
66063	Fee-for-Service	1770157794	1770157794	1	1	LINEAR CARE DIAGNOSTICS	5/1/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	4950 KELLER SPRINGS RD	STE 220	ADDISON	TX	75001	6282	00	None	32.9686135	-96.8265855	Dallas County
66080	Fee-for-Service	1376023762	1376023762	1	1	LAZOVICH, NIKOLA A CRNA	10/24/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
66082	Fee-for-Service	1902128580	1902128580	1	1	LOPEZ, MARIA CRUZ LMFT	3/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
66099	Fee-for-Service	1568438471	1568438471	1	1	LAPORTA, LAUREN D MD	2/15/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	87729	None	None	0	In state provider	None	1707 EYE ST	100	BAKERSFIELD	CA	93301	5208	15	06029	35.37461686	-119.020062	Kern County
66104	Fee-for-Service	1861619819	1861619819	1	1	LEE, JOHN J MD	1/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89946	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
66108	Fee-for-Service	1457577298	1457577298	1	1	LETHERT, KRISTINE H MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94278	41	Internal Medicine	0	In state provider	None	900 HYDE STREET	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
66179	Fee-for-Service	1790180495	1790180495	1	1	LAUIGAN, JOCELYN G	2/9/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
66197	Fee-for-Service	1285029504	1285029504	1	1	LARSEN, BRIANNA LMFT	3/6/2025	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	512 PAULDING CIR	None	ARROYO GRANDE	CA	93420	2857	40	06079	35.12480448	-120.5741901	San Luis Obispo County
66201	Fee-for-Service	1134161011	1134161011	1	1	LUE, JASON F DO	6/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	8149	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
66239	Fee-for-Service	1063733426	1063733426	1	1	LARSEN, LARISSA N	7/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118359	None	None	0	In state provider	None	3301 C STREET	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
66252	Fee-for-Service	1659349173	1659349173	1	1	LEON, FEDERICO G MD	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138145	01	General Practice	0	In state provider	None	510 DOYLE PARK DR	None	SANTA ROSA	CA	95405	4570	49	06097	38.442618	-122.6984265	Sonoma County
66262	Fee-for-Service	1043403371	1043403371	1	1	LU, JUN MD	7/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	96524	03	Allergy	0	In state provider	None	2505 WEST HAMMER LANE	None	STOCKTON	CA	95209	2839	39	06077	38.02139448	-121.347738	San Joaquin County
66288	Fee-for-Service	1457971616	1457971616	1	1	LAND OF PEACE HOSPICE	10/18/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7301 TOPANGA CANYON BLVD	STE 324	CANOGA PARK	CA	91303	3395	19	06037	34.203222	-118.605988	Los Angeles County
66292	Fee-for-Service	1144244484	1144244484	1	1	LARA, GREGORY G MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69087	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
66305	Fee-for-Service	1538537055	1538537055	1	1	LY, BACH T	2/17/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3440 E LA PALMA AVE	None	ANAHEIM	CA	92806	2020	30	06059	33.852105	-117.8444835	Orange County
66306	Fee-for-Service	1518130475	1518130475	1	1	LEE, SEUNG LYANG LAC	12/30/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
66309	Fee-for-Service	1609158476	1609158476	1	1	LIFE SPRINGS HOSPICE	11/15/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	60 WHITNEY PLACE	None	FREMONT	CA	94539	7662	01	06001	37.47000163	-121.918765	Alameda County
66313	Fee-for-Service	1932291648	1932291648	1	1	LIEN, JOHN H MD INC	7/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	63910	01	General Practice	0	In state provider	None	200 JOSE FIGUERES AVE	STE 330	SAN JOSE	CA	95116	1555	43	06085	37.36122014	-121.8505998	Santa Clara County
66316	Fee-for-Service	1790770428	1790770428	1	1	LODGE, FREDERICK A MD	1/10/2006	174400000X	NA	Other	026	PHYSICIANS	57207	05	Anesthesiology	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
66326	Fee-for-Service	1609532704	1609532704	1	1	LOW, CORY E PT	3/14/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
66340	Fee-for-Service	1144262973	1144262973	2	1	LONGS DRUG STORE CAL LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 W HARRIS ST	STE 20	EUREKA	CA	95503	0000	12	06023	40.78058262	-124.1793475	Humboldt County
66350	Fee-for-Service	1356531743	1356531743	1	1	LEE, KEVIN T MD APC	9/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99354	08	Family Practice	0	In state provider	None	5801 ROSEMEAD BLVD	None	TEMPLE CITY	CA	91780	1852	19	06037	34.10523174	-118.073714	Los Angeles County
66368	Fee-for-Service	1326462060	1326462060	1	1	LEE, KATHERINE J DO	2/4/2022	207P00000X	NA	Other	026	PHYSICIANS	16554	None	None	0	In state provider	None	435 H STREET	None	CHULA VISTA	CA	91910	4304	37	06073	32.63282707	-117.0829101	San Diego County
66419	Fee-for-Service	1235570524	1235570524	1	1	LISA ANN MENDEZ	7/27/2013	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1401 BUCKINGHAM DR	None	BRENTWOOD	CA	94513	2988	07	06013	37.92284861	-121.7214254	Contra Costa County
66430	Fee-for-Service	1609211838	1609211838	1	1	LEE, ERIC H MD	4/23/2019	207RX0202X	NA	Oncology	026	PHYSICIANS	132145	41	Internal Medicine	0	In state provider	None	11180 WARNER AVE	STE 351	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
66434	Fee-for-Service	1871328625	1871328625	1	1	LOPEZ, CRYSTAL	9/19/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	75100 MEDITERRANEAN	None	PALM DESERT	CA	92211	9069	33	06065	33.74397149	-116.3546505	Riverside County
66480	Fee-for-Service	1952755910	1952755910	1	1	LIN, STEPHEN Y MD	7/16/2019	207P00000X	NA	Other	026	PHYSICIANS	151272	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
66498	Fee-for-Service	1366891657	1366891657	1	1	LAM, KENRICK C MD	8/18/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	176227	None	None	0	In state provider	None	2800 L STREET	200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
66516	Fee-for-Service	1073527313	1073527313	1	1	LONDON, KERI MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61768	None	None	0	In state provider	None	15615 POMERADO RD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
66539	Fee-for-Service	1306870050	1306870050	1	1	LIN, JEANNIE C MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78339	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	SUITE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
66565	Fee-for-Service	1316175276	1316175276	1	1	LLOYD, JENNA J DO	6/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12863	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
66572	Fee-for-Service	1992965354	1992965354	1	1	LERNER, DIMITRY L MD	12/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	92223	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1455 MONTEGO	SUITE 100	WALNUT CREEK	CA	94598	2990	07	06013	37.91046956	-122.0418669	Contra Costa County
66575	Fee-for-Service	1508833377	1508833377	1	1	LEE, KENDRICK E MD	5/1/1998	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	62668	02	General Surgery	0	In state provider	None	3300 WEBSTER ST	STE 1200	OAKLAND	CA	94609	3126	01	06001	37.82132826	-122.2621843	Alameda County
66599	Fee-for-Service	1043322936	1043322936	1	1	LEONG, STANLEY S MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	40231	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
66630	Fee-for-Service	1417599796	1417599796	1	1	LANGLOIS, JORDANA CNP	12/2/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
66672	Fee-for-Service	1548673379	1548673379	1	1	LEE, EUGENIA E MD	9/1/2020	208600000X	NA	General Surgery	026	PHYSICIANS	130830	02	General Surgery	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
66683	Fee-for-Service	1144313552	1144313552	1	1	LEE, DERRON T OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5110 PACIFIC AVE	None	STOCKTON	CA	95207	6305	39	06077	37.99626148	-121.31454	San Joaquin County
66706	Fee-for-Service	1235570524	1235570524	1	1	LISA ANN MENDEZ	7/27/2013	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1401 BUCKINGHAM DR	None	BRENTWOOD	CA	94513	2988	07	06013	37.92284861	-121.7214254	Contra Costa County
66713	Fee-for-Service	1720007420	1720007420	1	1	LEE, JAI H MD	1/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	38492	20	Orthopedic Surgery	0	In state provider	None	520 S VIRGIL AVE	STE 103	LOS ANGELES	CA	90020	1416	19	06037	34.064487	-118.2870305	Los Angeles County
66716	Fee-for-Service	1609211838	1609211838	1	1	LEE, ERIC H MD	4/23/2019	207RX0202X	NA	Oncology	026	PHYSICIANS	132145	68	Hematology	0	In state provider	None	11180 WARNER AVE	STE 351	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
66725	Fee-for-Service	1598031072	1598031072	1	1	LINDQUIST, BENJAMIN D MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126522	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
66762	Fee-for-Service	1700191178	1700191178	1	1	LAMBERT, STEVEN	8/31/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	01	General Practice	0	In state provider	None	9280 W STOCKTON BLVD	STE 116	SACRAMENTO	CA	95758	8073	34	06067	38.420235	-121.394961	Sacramento
66774	Fee-for-Service	1649468869	1649468869	1	1	LEHRER-GRAIWER, JOSHUA M	11/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80837	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
66796	Fee-for-Service	1326426750	1326426750	1	1	LIN, AMBER R MD	12/16/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144745	None	None	0	In state provider	None	12291 WASHINGTON BLVD	SUITE 500	WHITTIER	CA	90606	2500	19	06037	33.96734104	-118.0508773	Los Angeles County
66811	Fee-for-Service	1972685378	1972685378	1	1	LAURENCE, JODY B DPM	10/25/2010	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5 MEDICAL PLAZA DRIVE	SUITE 110	ROSEVILLE	CA	95661	2866	31	06061	38.76604411	-121.2466761	Placer County
66822	Fee-for-Service	1174973739	1174973739	1	1	LI, RICHARD J	12/5/2022	2085R0001X	NA	Other	026	PHYSICIANS	151481	None	None	0	In state provider	None	12393 WASHINGTON BLVD	None	WHITTIER	CA	90606	2502	19	06037	33.96719187	-118.0496563	Los Angeles County
66841	Fee-for-Service	1700964574	1700964574	1	1	LE, XUAN HA MD	3/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	48791	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
66860	Fee-for-Service	1992965354	1992965354	1	1	LERNER, DIMITRY L MD	12/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	92223	78	Neoplastic Diseases/Oncology	0	In state provider	None	1455 MONTEGO	SUITE 100	WALNUT CREEK	CA	94598	2990	07	06013	37.91046956	-122.0418669	Contra Costa County
66874	Fee-for-Service	1619438918	1619438918	1	1	LE, JOY Y MD	8/22/2023	207L00000X	NA	Other	026	PHYSICIANS	182393	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
66907	Fee-for-Service	1912057720	1912057720	1	1	LE, ELAINE H MD	3/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93022	08	Family Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
66926	Fee-for-Service	1104066877	1104066877	1	1	LYNDON & BELINDA SENAR	3/10/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MDS INC	9840 BRIMHALL RD	STE 100	BAKERSFIELD	CA	93312	2792	15	06029	35.36881048	-119.111382	Kern County
66931	Fee-for-Service	1295091536	1295091536	1	1	LAGBAS, CLINT S MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127467	01	General Practice	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
66941	Fee-for-Service	1093150559	1093150559	1	1	LIU, BRANDY A DO	12/18/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	14179	-	NOT APPLICABLE	0	In state provider	None	11776 MARIPOSA ROAD	SUITES 101, 103, 104	HESPERIA	CA	92345	1622	36	06071	34.46463128	-117.3491141	San Bernardino County
66942	Fee-for-Service	1225538440	1225538440	1	1	LALAS, STEPHANIE	7/16/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
66943	Fee-for-Service	1750624177	1750624177	1	1	LAURA HOEFERT M.D.	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	323 SW 10TH ST	None	MADISON	SD	57042	3200	00	None	43.99302789	-97.11819925	Lake County
66953	Fee-for-Service	1174682645	1174682645	1	1	LENHARDT, KATE M PHD	1/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
66964	Fee-for-Service	1235452871	1235452871	1	1	LAU, HELEN W MD	7/19/2023	207RE0101X	NA	Endocrinology	026	PHYSICIANS	106495	None	None	0	In state provider	None	901 CAMPUS DR.	None	DALY CITY	CA	94015	4900	41	06081	37.66535778	-122.4763793	San Mateo County
66966	Fee-for-Service	1619990116	1619990116	1	1	LIEBER, MICHAEL J MD	5/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	32244	41	Internal Medicine	0	In state provider	None	2101 NORTH WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
66970	Fee-for-Service	1043373889	1043373889	1	1	LIN, BERTHA B MD	7/20/2007	207N00000X	NA	Dermatology	026	PHYSICIANS	85904	07	Dermatology	0	In state provider	None	7862 EL CAJON BLVD	STE C	LA MESA	CA	91941	3712	37	06073	32.76906394	-117.0278499	San Diego County
66975	Fee-for-Service	1073819611	1073819611	1	1	LESTINO, STEPHANIE S	3/2/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	50 E FOOTHILL BLVD	STE 100	ARCADIA	CA	91006	2314	19	06037	34.15096965	-118.0295442	Los Angeles County
66990	Fee-for-Service	1013980317	1013980317	1	1	LOS ANGELES-INGLEWOOD	7/6/2001	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	ENDOSCOPY ASC, LP	8110 AIRPORT BLVD	FL 1	LOS ANGELES	CA	90045	3119	19	06037	33.96526302	-118.3852705	Los Angeles County
67005	Fee-for-Service	1780279257	1780279257	1	1	LONG LIFE HOSPICE INC	6/29/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6454 VAN NUYS BLVD	STE 40	VAN NUYS	CA	91401	1445	19	06037	34.187886	-118.448714	Los Angeles County
67008	Fee-for-Service	1528080470	1528080470	1	6	LA CLINICA DE LA RAZA	6/24/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	850 E LELAND RD	None	PITTSBURG	CA	94565	5340	07	06013	38.00913197	-121.8786635	Contra Costa County
67012	Fee-for-Service	1699947317	1699947317	1	1	LEE, IVY A MD	11/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111232	07	Dermatology	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
67014	Fee-for-Service	1134523046	1134523046	1	1	LEGASPI-PARTO, CRIZEL PT	2/10/2020	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AND WELLNESS	44850 LAS PALMAS AVENUE	F	PALM DESERT	CA	92260	3558	33	06065	33.72231653	-116.3839762	Riverside County
67064	Fee-for-Service	1285845651	1285845651	1	1	LEE, MICHAEL B DO	12/17/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	10591	08	Family Practice	0	In state provider	None	801 CORPORATE CENTER DR	STE 130	POMONA	CA	91768	2641	19	06037	34.06418933	-117.8018692	Los Angeles County
67071	Fee-for-Service	1376722165	1376722165	1	1	LEE, JAMES MD INC	7/21/2015	207L00000X	NA	Other	026	PHYSICIANS	45399	05	Anesthesiology	0	In state provider	None	12601 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1908	30	06059	33.77450951	-117.913014	Orange County
67086	Fee-for-Service	1740338078	1740338078	1	1	LEYDIG, JUDY A	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
67095	Fee-for-Service	1184967762	1184967762	1	1	LESSARD, ELI H MD	8/10/2022	207P00000X	NA	Other	026	PHYSICIANS	132484	None	None	0	In state provider	None	520 WEST I ST	None	LOS BANOS	CA	95616	6201	24	06047	37.06346603	-120.8593647	Merced County
67100	Fee-for-Service	1528080470	1528080470	1	4	LA CLINICA DE LA RAZA	4/8/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4141 HARBOR STREET	None	PITTSBURG	CA	94565	6156	07	06013	37.998828	-121.8870245	Contra Costa County
67129	Fee-for-Service	1588175764	1588175764	1	1	LINDO, MELISSA A LMFT	3/31/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	124400	-	NOT APPLICABLE	0	In state provider	None	3288 EL CAJON BLVD	STE 1A,1B,3,5-6,8-13	SAN DIEGO	CA	92104	1430	37	06073	32.75537145	-117.1228095	San Diego County
67140	Fee-for-Service	1154470789	1154470789	1	1	LEE, JAMES M MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97062	None	None	0	In state provider	None	700 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
67151	Fee-for-Service	1447272810	1447272810	1	1	LEE, CHARLES MD	5/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	80935	05	Anesthesiology	0	In state provider	None	425 W JUNIPERO ST	STE 3	SANTA BARBARA	CA	93105	4294	42	06083	34.42973253	-119.7249544	Santa Barbara County
67173	Fee-for-Service	1821027418	1821027418	2	1	LE, BAO Q MD	8/22/2011	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34114	08	Family Practice	0	In state provider	None	2944 E ANAHEIM ST	None	LONG BEACH	CA	90804	3726	19	06037	33.78257254	-118.1571705	Los Angeles County
67174	Fee-for-Service	1780947408	1780947408	1	1	LANDMAN, ZACHARY C MD	4/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138740	20	Orthopedic Surgery	0	In state provider	None	4053 LONE TREE WAY	101	ANTIOCH	CA	94531	6210	07	06013	37.97569499	-121.800733	Contra Costa County
67217	Fee-for-Service	1306853767	1306853767	1	1	LUO, JIAN HUA CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	15865 GALE AVE	STE B	HACIENDA HEIGHTS	CA	91745	1643	19	06037	34.01024323	-117.9608688	Los Angeles County
67222	Fee-for-Service	1356355978	1356355978	1	1	LIN, JO M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2000 HOSPITAL DR	None	SEDRO WOOLLEY	WA	98284	4327	00	None	48.49548051	-122.2760925	Skagit County
67224	Fee-for-Service	1326044819	1326044819	1	1	LYNN, PHILIP ANTHONY MD	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	66511	40	Pediatrics	0	In state provider	None	14411 BROOKHURST ST	STE D	GARDEN GROVE	CA	92843	4667	30	06059	33.753348	-117.9550255	Orange County
67254	Fee-for-Service	1619990116	1619990116	1	1	LIEBER, MICHAEL J MD	5/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	32244	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2101 NORTH WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
67281	Fee-for-Service	1104172915	1104172915	1	1	LOPEZ, SARAH A MD FAAP	5/5/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	167688	40	Pediatrics	0	In state provider	None	1062 N CHERRY ST	None	TULARE	CA	93274	2251	54	06107	36.22322475	-119.3375086	Tulare County
67292	Fee-for-Service	1780279257	1780279257	1	1	LONG LIFE HOSPICE INC	6/29/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6454 VAN NUYS BLVD	STE 40	VAN NUYS	CA	91401	1445	19	06037	34.187886	-118.448714	Los Angeles County
67297	Fee-for-Service	1528080470	1528080470	1	6	LA CLINICA DE LA RAZA	6/24/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	850 E LELAND RD	None	PITTSBURG	CA	94565	5340	07	06013	38.00913197	-121.8786635	Contra Costa County
67308	Fee-for-Service	1134170772	1134170772	1	1	LACY, ELIZABETH A DO	6/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13779	66	Emergency Medicine (Urgent Care)	0	In state provider	None	347 ANDRIEUX STREET	None	SONOMA	CA	95476	6863	49	06097	38.28843573	-122.4651035	Sonoma County
67311	Fee-for-Service	1821194572	1821194572	1	1	LAW, DAVID C MD	2/8/2015	207RP1001X	NA	Pulmonology	026	PHYSICIANS	25684	41	Internal Medicine	0	In state provider	B-1	24411 HEALTH CENTER DR	STE 370	LAGUNA HILLS	CA	92653	3687	30	06059	33.6087201	-117.7076948	Orange County
67319	Fee-for-Service	1609937911	1609937911	1	2	LAKE TAHOE ORTHO INSTITU	5/27/2009	207XS0106X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	935 MICA DR	STE 13	CARSON CITY	NV	89705	7181	00	None	39.091285	-119.7766585	Douglas County
67335	Fee-for-Service	1104350651	1104350651	1	1	LUU, ELIZABETH N OD	3/10/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 E HERNDON AVE	STE 301	FRESNO	CA	93720	3326	10	06019	36.83744648	-119.7646425	Fresno County
67358	Fee-for-Service	1104904739	1104904739	1	1	LEIKEN, EDWARD L MD	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	74805	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
67370	Fee-for-Service	1871767335	1871767335	1	1	LEE, GEUN D MD	9/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101159	40	Pediatrics	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
67381	Fee-for-Service	1841096211	1841096211	1	1	LYONS, CRYSTAL CPD	3/12/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	44	06087	0	0	None
67388	Fee-for-Service	1528080470	1528080470	1	4	LA CLINICA DE LA RAZA	4/8/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4141 HARBOR STREET	None	PITTSBURG	CA	94565	6156	07	06013	37.998828	-121.8870245	Contra Costa County
67398	Fee-for-Service	1851428890	1851428890	1	1	LEE, LI-FEN MD	3/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	52577	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
67400	Fee-for-Service	1700944956	1700944956	1	1	LITTLE, REBECCA J PHD	5/1/2001	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
67410	Fee-for-Service	1073175675	1073175675	1	1	LIVINGSTON COMMUNITY HEALTH	1/19/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	600 B ST	BLDG B	LIVINGSTON	CA	95334	9593	24	06047	37.38589253	-120.734559	Merced County
67412	Fee-for-Service	1851750491	1851750491	1	1	LIN, JAMIE MD INC	2/22/2016	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	94496	77	Infectious Disease	0	In state provider	None	438 W LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
67420	Fee-for-Service	1598259509	1598259509	1	1	LEWIS, CASEY A DPM	7/20/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	635 ANDERSON RD STE 19	None	DAVIS	CA	95616	3505	57	06113	38.54876426	-121.7587542	Yolo County
67425	Fee-for-Service	1699907337	1699907337	1	1	LEE, JUSTINE W MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126264	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
67428	Fee-for-Service	1487601357	1487601357	1	1	LAGREW, DAVID C JR MD	3/21/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	49681	01	General Practice	0	In state provider	None	3325 PALO VERDE AVE	STE 105	LONG BEACH	CA	90808	4132	19	06037	33.81701249	-118.1078791	Los Angeles County
67430	Fee-for-Service	1881896520	1881896520	1	1	LIU, MICHAEL D MD	10/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94335	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
67432	Fee-for-Service	1124242664	1124242664	1	1	LIFE SHARING HEALTH CARE	6/1/1994	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	NORWALK DIV	13000 SAN ANTONIO DR	None	NORWALK	CA	90650	4335	19	06037	33.91168607	-118.073756	Los Angeles County
67437	Fee-for-Service	1194913103	1194913103	1	1	LASERVUE EYE CENTER MEDICAL	6/11/2009	261QS0132X	NA	Other	026	PHYSICIANS	66178	None	None	0	In state provider	CORPORATION	3540 MENDOCINO AVE	STE 200	SANTA ROSA	CA	95403	3639	49	06097	38.473938	-122.7258495	Sonoma County
67443	Fee-for-Service	1437305026	1437305026	1	2	LOPEZ, JACQUELINE M MD	6/24/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	100820	None	None	0	In state provider	None	3801 W TEMPLE AVE	BUILDING #46	POMONA	CA	91768	2557	19	06037	34.061508	-117.821268	Los Angeles County
67447	Fee-for-Service	1609071869	1609071869	1	1	LURASCHI-MONJAGATTA, MARIA D	11/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1707 W CHARLESTON BLVD	STE 220	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
67456	Fee-for-Service	1689871493	1689871493	1	1	LANE, STEPHANIE Z LCSW	7/24/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
67460	Fee-for-Service	1144370727	1144370727	1	1	LESTER, PATRICIA L PHD	10/3/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	837 3RD ST	None	EUREKA	CA	95501	0511	12	06023	40.80417466	-124.1627039	Humboldt County
67462	Fee-for-Service	1437896305	1437896305	1	1	LI, SUSAN DO	10/14/2024	390200000X	NA	Other	026	PHYSICIANS	22109	08	Family Practice	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
67500	Fee-for-Service	1275511735	1275511735	1	1	LARRY LOVELACE, DO	1/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 NE 13TH ST	None	OKLAHOMA CITY	OK	73104	5004	00	None	35.480961	-97.5013965	Oklahoma County
67506	Fee-for-Service	1578649406	1578649406	1	1	LEE, PHILIP C MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	64112	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
67509	Fee-for-Service	1326044819	1326044819	1	1	LYNN, PHILIP ANTHONY MD	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	66511	41	Internal Medicine	0	In state provider	None	14411 BROOKHURST ST	STE D	GARDEN GROVE	CA	92843	4667	30	06059	33.753348	-117.9550255	Orange County
67510	Fee-for-Service	1376838987	1376838987	1	1	LEE, ELINOR MD	5/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135482	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
67518	Fee-for-Service	1780880179	1780880179	1	1	LEE, JUHEE E MD	7/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	100461	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
67547	Fee-for-Service	1841590379	1841590379	1	1	LESER, ERIC W OD A	8/1/2011	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	18013 CHATSWORTH ST	None	GRANADA HILLS	CA	91344	5608	19	06037	34.2648826	-118.5250089	Los Angeles County
67558	Fee-for-Service	1780688069	1780688069	1	1	LETOURNEAU, THOMAS MD	2/3/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	151869	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
67559	Fee-for-Service	1013056688	1013056688	1	1	LEE, KWANG B LAC	5/2/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	27403 YNEZ RD	214	TEMECULA	CA	92591	5603	33	06065	33.5066395	-117.15022	Riverside County
67596	Fee-for-Service	1376615112	1376615112	1	1	LEE, SANDRA K MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72002	40	Pediatrics	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
67612	Fee-for-Service	1932614229	1932614229	1	1	LALEZARI SURGICAL	1/18/2018	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	321 N LARCHMONT BLVD	505	LOS ANGELES	CA	90004	3025	19	06037	34.0769016	-118.323663	Los Angeles County
67659	Fee-for-Service	1508337783	1508337783	1	1	LOPEZ, MARISSA LCSW	11/5/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
67669	Fee-for-Service	1265796478	1265796478	1	1	LATIF, SHARIF I MD	9/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137008	01	General Practice	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
67695	Fee-for-Service	1679637805	1679637805	1	1	LAKE CHARLES MEMORIAL HOSP	6/19/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1701 OAK PARK BLVD	None	LAKE CHARLES	LA	70601	8911	00	None	30.20350746	-93.1976775	Calcasieu Parish
67715	Fee-for-Service	1487601357	1487601357	1	1	LAGREW, DAVID C JR MD	3/21/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	49681	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3325 PALO VERDE AVE	STE 105	LONG BEACH	CA	90808	4132	19	06037	33.81701249	-118.1078791	Los Angeles County
67723	Fee-for-Service	1275611980	1275611980	1	1	LOO, CASSANDRA C MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73654	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
67731	Fee-for-Service	1639558067	1639558067	1	1	LIN, ANDREW J DO	10/10/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14954	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
67732	Fee-for-Service	1003964099	1003964099	1	1	LIEU, DALE MD	6/30/1985	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	55261	41	Internal Medicine	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
67734	Fee-for-Service	1609071869	1609071869	1	1	LURASCHI-MONJAGATTA, MARIA D	11/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1707 W CHARLESTON BLVD	STE 220	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
67799	Fee-for-Service	1376838987	1376838987	1	1	LEE, ELINOR MD	5/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135482	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
67810	Fee-for-Service	1083395305	1083395305	1	1	LONG, ALYSSA CRNA	1/29/2025	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
67860	Fee-for-Service	1730146408	1730146408	1	1	LUMBLEY, DEBRA S CRNA	7/27/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
67880	Fee-for-Service	1184949299	1184949299	1	1	LANGAN, HEIDI A	2/9/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
67895	Fee-for-Service	1689901068	1689901068	1	1	LIGHTBRIDGE MEDICAL	11/24/2010	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ES, INC	6155 CORNERSTONE CT E	220	SAN DIEGO	CA	92121	4736	37	06073	32.89582335	-117.1880966	San Diego County
67903	Fee-for-Service	1306871330	1306871330	1	1	LABUNSKY, LEO MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55949	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5000 VAN NUYS BLVD	STE 200	SHERMAN OAKS	CA	91403	1717	19	06037	34.16148087	-118.4486642	Los Angeles County
67911	Fee-for-Service	1801188974	1801188974	1	1	LANG, KHRISTINE J LMFT	7/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
67915	Fee-for-Service	1457514176	1457514176	1	1	LIN, YOUNG S MD	3/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103887	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
67916	Fee-for-Service	1033349113	1033349113	1	1	LIU, YEN-PO DPM	2/9/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	INC	841 W VALLEY BLVD	STE 102	ALHAMBRA	CA	91803	3251	19	06037	34.07803221	-118.1327862	Los Angeles County
67929	Fee-for-Service	1023738564	1023738564	1	1	LEW, CONSTANCE JIE OT	2/16/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 BARRANCA	380	WEST COVINA	CA	91791	1637	19	06037	34.073073	-117.8812535	Los Angeles County
67950	Fee-for-Service	1053893354	1053893354	1	1	LE, SANDY N CRNA	10/8/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
67967	Fee-for-Service	1912167719	1912167719	1	1	LI, JENNIFER Y MD	6/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107997	18	Ophthalmology	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
67989	Fee-for-Service	1336494202	1336494202	1	1	LEE, JEREL L LMFT	2/10/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 SANTA MONICA	370W, 380W, 860W, 1070	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
68002	Fee-for-Service	1326570888	1326570888	1	1	LE, SIDNEY T	8/25/2024	208600000X	NA	General Surgery	026	PHYSICIANS	160721	02	General Surgery	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
68013	Fee-for-Service	1336729862	1336729862	1	1	LEYVA, JOSHUE	2/20/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
68020	Fee-for-Service	1780221044	1780221044	1	1	LENSER & BRUSH PEDIATRICS, I	4/25/2023	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ENT CARE	1300 SYLVAN AVE	C7	MODESTO	CA	95355	1340	50	06099	37.68886155	-120.97503	Stanislaus County
68023	Fee-for-Service	1609071869	1609071869	1	1	LURASCHI-MONJAGATTA, MARIA D	11/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	1	Border provider	None	1707 W CHARLESTON BLVD	STE 220	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
68067	Fee-for-Service	1689988644	1689988644	1	1	LETZING, MICHAEL A MD	8/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156951	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
68131	Fee-for-Service	1578834057	1578834057	1	1	LUI, EMILY I LMFT	8/9/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18000 STUDEBAKER RD	SUITE 700	CERRITOS	CA	90703	2684	19	06037	33.86863289	-118.0988933	Los Angeles County
68134	Fee-for-Service	1184286593	1184286593	1	1	LE, ANDY N LCSW	7/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
68148	Fee-for-Service	1427136514	1427136514	1	1	LIN, HSIU-WEI MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	44619	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
68183	Fee-for-Service	1366948713	1366948713	1	1	LUDI, ALEXIS MD DO	5/22/2023	207R00000X	NA	Other	026	PHYSICIANS	17652	None	None	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
68189	Fee-for-Service	1619385929	1619385929	1	1	LEVERICH, JOHN T CRNA	4/27/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
68190	Fee-for-Service	1629012075	1629012075	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2900 STANDIFORD AVE	None	MODESTO	CA	95350	0167	50	06099	37.68524735	-121.0481217	Stanislaus County
68193	Fee-for-Service	1306871330	1306871330	1	1	LABUNSKY, LEO MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55949	08	Family Practice	0	In state provider	None	5000 VAN NUYS BLVD	STE 200	SHERMAN OAKS	CA	91403	1717	19	06037	34.16148087	-118.4486642	Los Angeles County
68287	Fee-for-Service	1336188838	1336188838	1	1	LEE, LINDA MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78555	08	Family Practice	0	In state provider	None	1850 N RIVERSIDE AVE	None	RIALTO	CA	92376	8071	36	06071	34.132905	-117.3704675	San Bernardino County
68296	Fee-for-Service	1093852360	1093852360	1	1	LIEU, CHRISTOPHER H MD	4/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	78	Neoplastic Diseases/Oncology	1	Border provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
68307	Fee-for-Service	1780221044	1780221044	1	1	LENSER & BRUSH PEDIATRICS, I	4/25/2023	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ENT CARE	1300 SYLVAN AVE	C7	MODESTO	CA	95355	1340	50	06099	37.68886155	-120.97503	Stanislaus County
68309	Fee-for-Service	1427091214	1427091214	2	1	LONGS DRUG STORES CA LLC	4/20/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10045 COMBIE RD	None	AUBURN	CA	95602	8901	31	06061	39.04265144	-121.093222	Nevada County
68322	Fee-for-Service	1770937641	1770937641	1	1	LEE, JENNIFER A MD	2/8/2019	363AS0400X	NA	Physician Assistant	026	PHYSICIANS	153111	02	General Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
68333	Fee-for-Service	1881698439	1881698439	1	1	LIBERATOR MEDICAL SUPPLY INC	11/22/2013	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	1823 SE AIRPORT ROAD	None	STUART	FL	34996	4012	00	None	27.17771956	-80.22764521	Martin County
68405	Fee-for-Service	1093838385	1093838385	1	1	LESTER, FELICIA C MD	10/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99635	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
68411	Fee-for-Service	1619037645	1619037645	1	1	LACY, BERTILDA D LCSW	9/8/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
68419	Fee-for-Service	1356429096	1356429096	1	1	LOEFFLER, RODNEY A MD	10/23/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48901	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 L ST	None	SACRAMENTO	CA	95816	5615	34	06067	38.57202	-121.4692695	Sacramento County
68422	Fee-for-Service	1225046097	1225046097	1	1	LALL, SANGEETA MD	12/17/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	52079	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
68433	Fee-for-Service	1730613548	1730613548	1	1	LACOMBE, MELISSA E	2/21/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
68437	Fee-for-Service	1427136514	1427136514	1	1	LIN, HSIU-WEI MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	44619	41	Internal Medicine	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
68477	Fee-for-Service	1528080470	1528080470	1	10	LA CLINICA DE LA RAZA	6/24/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	55 CASTLEWOOD DR	None	PITTSBURG	CA	94565	5739	07	06013	37.99545952	-121.897764	Contra Costa County
68482	Fee-for-Service	1306871330	1306871330	1	1	LABUNSKY, LEO MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55949	01	General Practice	0	In state provider	None	5000 VAN NUYS BLVD	STE 200	SHERMAN OAKS	CA	91403	1717	19	06037	34.16148087	-118.4486642	Los Angeles County
68487	Fee-for-Service	1508814393	1508814393	1	1	LEVINE, SARI R MD	11/30/1990	208800000X	NA	Other	026	PHYSICIANS	70871	34	Urology and Urological Surgery	0	In state provider	None	205 SOUTH DR	None	MOUNTAIN VIEW	CA	94040	4323	43	06085	37.36723252	-122.0797125	Santa Clara County
68490	Fee-for-Service	1528080470	1528080470	1	5	LA CLINICA DE LA RAZA	4/8/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	50 E 8TH STREET	None	PITTSBURG	CA	94565	2442	07	06013	38.02944737	-121.8848918	Contra Costa County
68495	Fee-for-Service	1659685568	1659685568	1	1	LATIF, RAFIK MD A MEDICAL	11/8/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	33726	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CORPORATION	18250 ROSCOE BLVD	STE 330	NORTHRIDGE	CA	91325	4281	19	06037	34.22076142	-118.5313223	Los Angeles County
68510	Fee-for-Service	1619322658	1619322658	1	1	LUDWIG, JOHN MD	5/1/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
68529	Fee-for-Service	1952856031	1952856031	1	1	LEA, DINNA OD	11/8/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10525 S DE ANZA BLVD	STE 190	CUPERTINO	CA	95014	4448	43	06085	37.31526	-122.032408	Santa Clara County
68530	Fee-for-Service	1609166719	1609166719	1	1	LENNIG, MICHAEL A MD	8/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134604	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
68542	Fee-for-Service	1407934045	1407934045	1	1	LAM, KINH MY MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68319	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
68550	Fee-for-Service	1710436894	1710436894	1	1	LOPEZ, PRESTON LMFT	12/27/2024	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9201 W SUNSET BLVD	SUITE 812	WEST HOLLYWOOD	CA	90069	3709	19	06037	34.09054375	-118.392295	Los Angeles County
68609	Fee-for-Service	1588730881	1588730881	1	3	LRC HOMES, INC	3/21/1997	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	24531 ARTEMIA AVE	None	MISSION VIEJO	CA	92691	4615	30	06059	33.60599527	-117.6829565	Orange County
68617	Fee-for-Service	1417480948	1417480948	1	1	LEE, JOSEPH Y MD	11/8/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164201	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
68640	Fee-for-Service	1407199458	1407199458	1	1	LAKHOO, KRUTIKA MD	10/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136180	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1737	19	06037	34.07671715	-118.3799413	Los Angeles County
68685	Fee-for-Service	1316953243	1316953243	1	1	LUDEMA, THOMAS M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53135	13	Neurology (M.D. only)	0	In state provider	MISSION NEUROLOGY MEDICA	27800 MEDICAL CENTER RD	STE 263	MISSION VIEJO	CA	92691	6447	30	06059	33.55952733	-117.6645199	Orange County
68692	Fee-for-Service	1821094970	1821094970	1	1	LUU, THUAN M DPM	2/8/2015	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2114 SENTER RD	STE 18	SAN JOSE	CA	95112	2608	43	06085	37.31161529	-121.8513661	Santa Clara County
68697	Fee-for-Service	1689693582	1689693582	1	1	LAZARUS, MICHAEL E MD	2/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76992	None	None	0	In state provider	None	200 MEDICAL PLAZA	#365, 420	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
68724	Fee-for-Service	1235120734	1235120734	1	1	LEE-HATA, NANCY MD	5/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87025	08	Family Practice	0	In state provider	None	250 E YALE LOOP	STE 200	IRVINE	CA	92604	4697	30	06059	33.67473753	-117.7880547	Orange County
68748	Fee-for-Service	1952467698	1952467698	1	1	LIU, STEVEN S MD	6/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110988	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
68754	Fee-for-Service	1093095028	1093095028	1	1	LAHEY, MICHELLE M NP	5/11/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
68767	Fee-for-Service	1528080470	1528080470	1	10	LA CLINICA DE LA RAZA	6/24/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	55 CASTLEWOOD DR	None	PITTSBURG	CA	94565	5739	07	06013	37.99545952	-121.897764	Contra Costa County
68768	Fee-for-Service	1235289273	1235289273	1	1	LIM, EMILINA MD	10/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141929	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
68775	Fee-for-Service	1528080470	1528080470	1	5	LA CLINICA DE LA RAZA	4/8/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	50 E 8TH STREET	None	PITTSBURG	CA	94565	2442	07	06013	38.02944737	-121.8848918	Contra Costa County
68781	Fee-for-Service	1104869940	1104869940	2	1	LONGS DRUG STORES CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 SILVER SPUR RD.	None	ROLLING HILLS EST	CA	90274	3805	19	06037	33.76990003	-118.3660286	Los Angeles County
68813	Fee-for-Service	1396863684	1396863684	1	1	LATTER, MITCHELL C MD	5/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	40013	18	Ophthalmology	0	In state provider	None	10230 ARTESIA BLVD	STE 204	BELLFLOWER	CA	90706	6768	19	06037	33.8728276	-118.1160403	Los Angeles County
68856	Fee-for-Service	1487023990	1487023990	1	1	LAURA FUHRMAN	7/14/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	202 PROSPECT DR	None	GLENDIVE	MT	59330	1943	00	None	47.116899	-104.7042405	Dawson County
68868	Fee-for-Service	1801821574	1801821574	1	1	LEE, SEUNG B CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4155 MOORPARK AVE	STE 14	SAN JOSE	CA	95117	1714	43	06085	37.31587947	-121.974255	Santa Clara County
68903	Fee-for-Service	1861950081	1861950081	1	1	LEE, FRANK A DC	3/16/2021	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
68927	Fee-for-Service	1306809991	1306809991	1	1	LAWRENCE D DALAN M.D.	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	615 S NEW BALLAS RD	None	SAINT LOUIS	MO	63141	4010	00	None	38.644902	-90.4462065	St. Louis County
68940	Fee-for-Service	1831432988	1831432988	1	1	LIN, YUANKAI V MD	5/30/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	138455	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
68947	Fee-for-Service	1144395542	1144395542	1	1	LEWIS, ARASELI P PHD	3/3/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
68954	Fee-for-Service	1710173570	1710173570	1	1	LIN, YUEZHEN MD	1/1/2022	2080P0205X	NA	Endocrinology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
68974	Fee-for-Service	1093931123	1093931123	1	1	LEAL, MICHAEL H	9/12/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
68987	Fee-for-Service	1205908548	1205908548	1	1	LINDA S SNYDER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
69017	Fee-for-Service	1558780544	1558780544	1	1	LAU, YING TING	2/8/2018	207R00000X	NA	Other	026	PHYSICIANS	144786	None	None	0	In state provider	None	1420 S CENTRAL AVENUE	None	GLENDALE	CA	91204	1000	19	06037	34.12811155	-118.2577764	Los Angeles County
69055	Fee-for-Service	1235289273	1235289273	1	1	LIM, EMILINA MD	10/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141929	83	Rheumatology	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
69141	Fee-for-Service	1285650952	1285650952	1	1	LANGE, NICHOLAS J MD	6/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154628	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
69192	Fee-for-Service	1548419393	1548419393	1	1	LEACH, ROSALINDA T LCSW	9/6/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
69199	Fee-for-Service	1326617648	1326617648	1	1	LAGUNA, ILEANA MD	7/31/2024	207R00000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	5401 WHITE LANE	None	BAKERSFIELD	CA	93309	6279	15	06029	35.31803715	-119.0627831	Kern County
69201	Fee-for-Service	1013056498	1013056498	1	1	LEE, JOHNSON CA	2/8/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1637 STROBRIDGE AVE	None	CASTRO VALLEY	CA	94546	5101	01	06001	37.69157104	-122.0898969	Alameda County
69209	Fee-for-Service	1376794966	1376794966	1	1	LIPELES, JAMIE A DO	10/28/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	10501	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4560 ADMIRALTY WAY	SUITE 105	MARINA DEL REY	CA	90292	5423	19	06037	33.98364904	-118.4449069	Los Angeles County
69211	Fee-for-Service	1699910562	1699910562	1	1	LADO-ABEAL, JOSE J MD	4/1/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	175943	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
69229	Fee-for-Service	1417220872	1417220872	1	1	LUXE HOMECARE INC	1/6/2017	251E00000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	881 ALMA REAL DRIVE	STE 316A	PACIFIC PALISADES	CA	90272	5019	19	06037	34.04487687	-118.5250831	Los Angeles County
69273	Fee-for-Service	1295179497	1295179497	1	1	LIPPNER, ELIZABETH A MD	8/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135609	01	General Practice	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
69276	Fee-for-Service	1154409787	1154409787	1	1	LEUNG, JOSEPH MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81974	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
69293	Fee-for-Service	1689092140	1689092140	1	1	LEE, NICHOLAS G DO	10/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14410	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
69308	Fee-for-Service	1730507690	1730507690	1	1	LA, MELVIN T MD	7/30/2019	207L00000X	NA	Other	026	PHYSICIANS	161073	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
69356	Fee-for-Service	1841619095	1841619095	2	1	LE, HOANGVY MD	7/11/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151870	08	Family Practice	0	In state provider	None	15420 CRENSHAW BLVD	None	GARDENA	CA	90249	4524	19	06037	33.8903685	-118.3264725	Los Angeles County
69402	Fee-for-Service	1558350736	1558350736	1	1	LEWIS, BRADLEY H MD	6/29/1989	207RH0000X	NA	Hematology	026	PHYSICIANS	52101	78	Neoplastic Diseases/Oncology	0	In state provider	None	1 QUALITY DR	None	VALLEJO	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
69414	Fee-for-Service	1083764757	1083764757	1	1	LEWIS, SCOTT A OPTOMETRI	4/30/1991	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA OAKS VISION	24400 JACKSON AVE	# A	MURRIETA	CA	92562	1987	33	06065	33.57240222	-117.2050098	Riverside County
69496	Fee-for-Service	1962433235	1962433235	1	1	LAU, MARK M MD	3/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	31865	20	Orthopedic Surgery	0	In state provider	None	2826 HARRIS ST	None	EUREKA	CA	95503	4809	12	06023	40.78047614	-124.1355056	Humboldt County
69504	Fee-for-Service	1275697765	1275697765	1	1	LUNDQUIST, MEHRANGIZ R PHD	1/8/2020	2084P0800X	NA	Psychiatry	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 NEWPORT CENTER DR	SUITE 305	NEWPORT BEACH	CA	92660	7504	30	06059	33.61264489	-117.8745305	Orange County
69514	Fee-for-Service	1467566976	1467566976	1	1	LEVITTE, SUSAN S MD	2/20/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	163140	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
69521	Fee-for-Service	1417220872	1417220872	1	1	LUXE HOMECARE INC	12/8/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	881 ALMA REAL DRIVE	STE 316A	PACIFIC PALISADES	CA	90272	5019	19	06037	34.04487687	-118.5250831	Los Angeles County
69534	Fee-for-Service	1811316110	1811316110	1	1	LALICATA, KATARZYNA CNP	6/4/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	645 E PALOMAR ST	None	CHULA VISTA	CA	91911	6974	37	06073	32.61446195	-117.0260102	San Diego County
69554	Fee-for-Service	1518163005	1518163005	1	1	LOPEZ, NICOLE E MD	8/14/2017	208C00000X	NA	General Surgery	026	PHYSICIANS	107945	28	Proctology (colon and rectal)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
69560	Fee-for-Service	1295179497	1295179497	1	1	LIPPNER, ELIZABETH A MD	8/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135609	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
69561	Fee-for-Service	1124415765	1124415765	1	1	LIANG, ANGELA J LMFT	10/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
69580	Fee-for-Service	1669583530	1669583530	1	1	LEE, ROBERT H MD	7/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86736	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
69614	Fee-for-Service	1073555892	1073555892	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1520 EAST F ST	None	OAKDALE	CA	95361	9611	50	06099	37.7728534	-120.8308183	Stanislaus County
69616	Fee-for-Service	1629378302	1629378302	1	1	LURINKS GARCIA, MARIA C LCSW	11/21/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CE	41185 GOLDEN GATE CIR	202	MURRIETA	CA	92562	1421	33	06065	33.53698574	-117.1753026	Riverside County
69619	Fee-for-Service	1679985584	1679985584	1	1	LEE, JASON OD	11/24/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
69627	Fee-for-Service	MTN01276F	None	1	2	LYFT HEALTHCARE INC	9/30/2022	No Taxonomy Provided	NMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	185 BERRY ST	STE 5000	SAN FRANCISCO	CA	94107	2503	38	06075	37.77667282	-122.3921584	San Francisco County
69646	Fee-for-Service	1285770628	1285770628	1	1	LY, RICHARD V OD	7/7/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
69657	Fee-for-Service	1972703924	1972703924	1	1	LOHMANN, PABLO MD	10/1/2020	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
69668	Fee-for-Service	1326508136	1326508136	1	1	LIM, ALEGRIA C DO	4/7/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19411	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
69689	Fee-for-Service	1558350736	1558350736	1	1	LEWIS, BRADLEY H MD	6/29/1989	207RH0000X	NA	Hematology	026	PHYSICIANS	52101	41	Internal Medicine	0	In state provider	None	1 QUALITY DR	None	VALLEJO	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
69707	Fee-for-Service	1770631608	1770631608	1	1	LEE, JEAN H MD	4/30/1994	207R00000X	NA	Other	026	PHYSICIANS	79489	41	Internal Medicine	0	In state provider	None	17821 PIONEER BLVD	None	ARTESIA	CA	90701	3901	19	06037	33.8691791	-118.0823685	Los Angeles County
69714	Fee-for-Service	1225040363	1225040363	1	1	LYONS, BRUCE A PHD	10/21/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	415 W ROUTE 66	202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
69730	Fee-for-Service	1164468450	1164468450	1	1	LAWRENCE, ADRIAN C MD	11/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68954	66	Emergency Medicine (Urgent Care)	0	In state provider	None	77 CADILLAC DR	STE 210	SACRAMENTO	CA	95825	5480	34	06067	38.572551	-121.4181585	Sacramento County
69735	Fee-for-Service	1710958285	1710958285	1	1	LODE, GEORGE J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42781	08	Family Practice	0	In state provider	None	1555 EAST ST	STE 210	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
69751	Fee-for-Service	1952662686	1952662686	1	2	LIVINGSTONE COMMUNITY	11/13/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	111 W BASTANCHURY RD	UNIT 1A	FULLERTON	CA	92835	2527	30	06059	33.89536345	-117.9297467	Orange County
69804	Fee-for-Service	1487864005	1487864005	1	1	LEON-SANCHEZ, ANDERS R MD	5/6/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99766	41	Internal Medicine	0	In state provider	None	290 N WAYTE LN	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
69824	Fee-for-Service	1285625236	1285625236	1	1	LEE, RICHARD D MD	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72042	08	Family Practice	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
69847	Fee-for-Service	1295179497	1295179497	1	1	LIPPNER, ELIZABETH A MD	8/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135609	43	Pediatric Allergy	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
69858	Fee-for-Service	1740379866	1740379866	1	1	LYONS RALPH C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1136 CLEVELAND AVE	STE 603	EAST POINT	GA	30344	0000	00	None	33.68140434	-84.42585013	Fulton County
69870	Fee-for-Service	1790876720	1790876720	1	1	LUND, ERIN E MD MPH	8/13/2012	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	96724	01	General Practice	0	In state provider	None	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	49	06097	38.479743	-122.729625	Sonoma County
69895	Fee-for-Service	1952671265	1952671265	1	1	LIU, YUE OD	1/9/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
69906	Fee-for-Service	1982424263	1982424263	1	1	LIFEPATH CENTER	10/14/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3769 TIBBETTS ST	STE A	RIVERSIDE	CA	92506	2638	33	06065	33.94726645	-117.3990645	Riverside County
69931	Fee-for-Service	1427340082	1427340082	1	1	LOMBARDI, TRESA M MD	8/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134945	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
69977	Fee-for-Service	1558350736	1558350736	1	1	LEWIS, BRADLEY H MD	6/29/1989	207RH0000X	NA	Hematology	026	PHYSICIANS	52101	68	Hematology	0	In state provider	None	1 QUALITY DR	None	VALLEJO	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
70005	Fee-for-Service	1295154854	1295154854	1	1	LOCKE, NATHAN J MD	9/24/2019	390200000X	NA	Other	026	PHYSICIANS	164586	34	Urology and Urological Surgery	0	In state provider	None	1400 E PALOMAR ST	None	CHULA VISTA	CA	91913	1800	37	06073	32.62382113	-116.9960539	San Diego County
70008	Fee-for-Service	1720155583	1720155583	1	1	LEIGHTON, THOMAS A MD	4/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	64985	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
70013	Fee-for-Service	1225081441	1225081441	1	1	LILJA, JAMES F MD	10/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85643	None	None	0	In state provider	None	777 KNOWLES DR	STE 12	LOS GATOS	CA	95032	1417	43	06085	37.26160688	-121.9683379	Santa Clara County
70018	Fee-for-Service	1164468450	1164468450	1	1	LAWRENCE, ADRIAN C MD	11/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68954	41	Internal Medicine	0	In state provider	None	77 CADILLAC DR	STE 210	SACRAMENTO	CA	95825	5480	34	06067	38.572551	-121.4181585	Sacramento County
70039	Fee-for-Service	1194147645	1194147645	1	1	LINN, SANDAR MD	8/6/2018	390200000X	NA	Other	026	PHYSICIANS	153102	10	Gastroenterology (M.D. only)	0	In state provider	None	2545 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.0214303	-121.3461515	San Joaquin County
70121	Fee-for-Service	1003214503	1003214503	1	1	LIEU, MACY CNP	12/18/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1350 FLORIN RD	None	SACRAMENTO	CA	95822	4202	34	06067	38.495232	-121.505409	Sacramento County
70129	Fee-for-Service	1174655724	1174655724	1	1	LOLLIS, TAMINECA N LCSW	8/10/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5479 E ABBEYFIELD ST	STE 3	LONG BEACH	CA	90815	3050	19	06037	33.79388819	-118.1261825	Los Angeles County
70134	Fee-for-Service	1922145259	1922145259	1	1	LE, CINDY M MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	99633	36	Psychiatry	0	In state provider	None	3825 HOPYARD ROAD	STE 140	PLEASANTON	CA	94566	8528	01	06001	37.683009	-121.9036935	Alameda County
70163	Fee-for-Service	1790876720	1790876720	1	1	LUND, ERIN E MD MPH	8/13/2012	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	96724	15	Obstetrics (D.O. only)	0	In state provider	None	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	49	06097	38.479743	-122.729625	Sonoma County
70166	Fee-for-Service	1649213497	1649213497	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8351 ELK GROVE FLORIN RD	None	SACRAMENTO	CA	95829	9453	34	06067	38.454345	-121.3703505	Sacramento County
70168	Fee-for-Service	1235181454	1235181454	1	1	LLANES, MARIA L S MD	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	80090	36	Psychiatry	0	In state provider	None	5970 S CENTRAL AVENUE	None	LOS ANGELES	CA	90001	0000	19	06037	33.985584	-118.256433	Los Angeles County
70196	Fee-for-Service	1437700283	1437700283	2	1	LAUREN MIZAK	8/19/2020	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 1ST AVE	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
70199	Fee-for-Service	1205076700	1205076700	1	1	LEVITON, SUSAN J LMFT	7/16/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16055 VENTURA BLVD	SUITE 1110	ENCINO	CA	91436	2612	19	06037	34.15632563	-118.4832351	Los Angeles County
70209	Fee-for-Service	1710514930	1710514930	1	1	LOS ANGELES MEDICAL CENTER	7/15/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	2010 WILSHIRE BLVD	2ND FLOOR	LOS ANGELES	CA	90057	3505	19	06037	34.05748989	-118.2750432	Los Angeles County
70253	Fee-for-Service	1306574694	1306574694	1	1	LO, PHOEBE OD	8/19/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1575 B STREET	None	HAYWARD	CA	94541	3017	01	06001	37.67905755	-122.072805	Alameda County
70293	Fee-for-Service	1871117200	1871117200	1	1	LOVING TOUCH HOSPICE AND	6/16/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	1442 IRVINE BLVD	STE 135	TUSTIN	CA	92780	3801	30	06059	33.74510442	-117.8049024	Orange County
70307	Fee-for-Service	1164468450	1164468450	1	1	LAWRENCE, ADRIAN C MD	11/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68954	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	77 CADILLAC DR	STE 210	SACRAMENTO	CA	95825	5480	34	06067	38.572551	-121.4181585	Sacramento County
70339	Fee-for-Service	1164466504	1164466504	1	1	LEE, GRACE I MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61069	05	Anesthesiology	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
70353	Fee-for-Service	1962446310	1962446310	2	1	LONGS DRUG STORES CA LLC	12/8/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	738 BANCROFT RD	None	WALNUT CREEK	CA	94598	1531	07	06013	37.92857256	-122.041705	Contra Costa County
70413	Fee-for-Service	1831193408	1831193408	1	1	LUSK, DAVID P	2/28/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	57066	08	Family Practice	0	In state provider	None	1111 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3131	15	06029	35.64171	-117.669847	Kern County
70429	Fee-for-Service	1003133885	1003133885	1	1	LINCOLN MEDICAL ASSOCIATES	7/22/2010	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	1530 3RD ST	STE 106	LINCOLN	CA	95648	1562	31	06061	38.88922046	-121.303647	Placer County
70446	Fee-for-Service	1326127374	1326127374	1	1	LII, ANGELA D MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65035	None	None	0	In state provider	None	531 W LAS TUNAS DR	STE D	SAN GABRIEL	CA	91776	1166	19	06037	34.10247346	-118.107324	Los Angeles County
70469	Fee-for-Service	1780975136	1780975136	1	1	LEE, BYUNG DO	7/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12262	41	Internal Medicine	0	In state provider	None	7257 N FRESNO ST	None	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
70482	Fee-for-Service	1487697223	1487697223	2	1	LONGS DRUG STORE CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1382 SOLANO AVE	None	ALBANY	CA	94706	1832	01	06001	37.89072501	-122.2904326	Alameda County
70485	Fee-for-Service	1174527139	1174527139	1	1	LANDA, DANIEL WM MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	33509	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2720 N HARBOR BLVD	STE 210	FULLERTON	CA	92835	2626	30	06059	33.90126238	-117.9292154	Orange County
70507	Fee-for-Service	1184196586	1184196586	1	1	LOTUS RX PHARMACY, INC.	8/5/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7851 WALKER ST	STE 102	LA PALMA	CA	90623	1734	30	06059	33.848253	-118.037309	Orange County
70557	Fee-for-Service	1679110837	1679110837	1	1	LEAL, RACHEL R LMFT	10/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19330 JESSE LN	STE 280	RIVERSIDE	CA	92508	5091	33	06065	33.90484164	-117.3254297	Riverside County
70581	Fee-for-Service	1871117200	1871117200	1	1	LOVING TOUCH HOSPICE AND	6/16/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	1442 IRVINE BLVD	STE 135	TUSTIN	CA	92780	3801	30	06059	33.74510442	-117.8049024	Orange County
70635	Fee-for-Service	1073775474	1073775474	1	1	LEE, MONICA S Y MD	9/29/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	95488	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
70636	Fee-for-Service	1497753354	1497753354	1	1	LLOYD, MICHAEL B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 N MEDICAL DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77069459	-111.8370155	Salt Lake County
70667	Fee-for-Service	1114126158	1114126158	1	1	LICHTBLAU, ETHAN MD	1/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88013	20	Orthopedic Surgery	0	In state provider	None	1531 ESPLANDE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
70671	Fee-for-Service	1164503652	1164503652	1	1	LAS PALMAS MEDICAL GROUP	3/30/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CORPORATION	1003 N STATE STREET	None	HEMET	CA	92543	4435	33	06065	33.76422692	-116.9719003	Riverside County
70699	Fee-for-Service	1851550651	1851550651	1	1	LEE, ARAM J MD	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108429	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
70723	Fee-for-Service	1194072769	1194072769	1	1	LANGE, ALLEGRA LMFT	6/23/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
70727	Fee-for-Service	1447292263	1447292263	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6750 N CEDAR AVE	None	FRESNO	CA	93710	4403	10	06019	36.83629087	-119.7538709	Fresno County
70800	Fee-for-Service	1659407476	1659407476	1	1	LEE, YIU FUN D MD INC	4/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81110	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2440 S HACIENDA BLVD	STE 115 & 116	HACIENDA HEIGHTS	CA	91745	4763	19	06037	33.9911773	-117.9688954	Los Angeles County
70805	Fee-for-Service	1568465706	1568465706	1	1	LAZARUS, ELIZABETH CRNA	8/1/2001	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3050 E AIRPORT WAY	None	LONG BEACH	CA	90806	2404	19	06037	33.81043253	-118.156726	Los Angeles County
70838	Fee-for-Service	1801038179	1801038179	1	1	LOUIE, BRIAN B PHD	4/2/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
70859	Fee-for-Service	1205377470	1205377470	1	1	LI, ANQI MD	8/27/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	161753	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
70877	Fee-for-Service	1588736060	1588736060	1	1	LEE, HOLLIS H	8/29/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45264	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
70918	Fee-for-Service	1285912113	1285912113	1	1	LAW, PAMELA W MD	9/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123478	25	Physical Medicine and Rehabilitation	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
70920	Fee-for-Service	1528080470	1528080470	1	7	LA CLINICA DE LA RAZA	6/24/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2555 E LELAND RD	None	PITTSBURG	CA	94565	7444	07	06013	38.00822044	-121.860812	Contra Costa County
70958	Fee-for-Service	1285062489	1285062489	1	1	LAKE HEALTH DISTRICT	3/1/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	535 S MAIN STREET	None	ALTURAS	CA	96101	4114	25	06049	41.4803401	-120.5425134	Modoc County
70980	Fee-for-Service	1558416057	1558416057	1	1	LOS ANGELES COUNTY CCS	10/18/1993	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	MAR VISTA MTU	3960 E CENTINELA	None	LOS ANGELES	CA	90066	4905	19	06037	34.00099529	-118.4314733	Los Angeles County
70988	Fee-for-Service	1851550651	1851550651	1	1	LEE, ARAM J MD	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108429	01	General Practice	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
70989	Fee-for-Service	1790844306	1790844306	1	1	LUGO, MONICA L MD	1/31/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	68446	01	General Practice	0	In state provider	None	133 N SUNOL DR	None	LOS ANGELES	CA	90063	1429	19	06037	34.03774331	-118.1785056	Los Angeles County
71004	Fee-for-Service	1417042953	1417042953	2	1	LOUIS, DAVID MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	39231	01	General Practice	0	In state provider	None	350 30TH ST	STE 211	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
71015	Fee-for-Service	1023067055	1023067055	1	1	LONG, WILLIAM T MD	4/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	60239	20	Orthopedic Surgery	0	In state provider	None	637 S LUCAS AVENUE	1ST FLOOR	LOS ANGELES	CA	90017	1912	19	06037	34.05351827	-118.2646017	Los Angeles County
71019	Fee-for-Service	1174026926	1174026926	1	1	LEW, EDMUND H MD INC	12/19/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55213	38	Geriatrics	0	In state provider	None	1505 WILSON TERRACE	STE 250	GLENDALE	CA	91206	4071	19	06037	34.14960934	-118.2313491	Los Angeles County
71031	Fee-for-Service	1053910950	1053910950	1	1	LIBERTY HOSPICE SERVICES INC	5/26/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	28 N OAK AVE	SUITE 203	PASADENA	CA	91107	5870	19	06037	34.146387	-118.1075515	Los Angeles County
71038	Fee-for-Service	1083647325	1083647325	1	1	LAY, SOPHIE A MD	11/17/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	65033	None	None	0	In state provider	None	160 GLEN COVE MARINA	103	VALLEJO	CA	94591	7290	48	06095	38.07062486	-122.2124251	Solano County
71050	Fee-for-Service	1114948981	1114948981	1	1	LENSER, BILLY K MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9671	05	Anesthesiology	0	In state provider	None	1421 OAKDALE RD	None	MODESTO	CA	95355	3359	50	06099	37.664802	-120.9576055	Stanislaus County
71070	Fee-for-Service	1447271036	1447271036	1	1	LEE, YOUNG J MD	12/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81390	41	Internal Medicine	0	In state provider	Y J LEE M D CORP	3663 W 6TH ST	STE 103	LOS ANGELES	CA	90020	3047	19	06037	34.06360557	-118.30199	Los Angeles County
71072	Fee-for-Service	1912295361	1912295361	1	1	LIANG, YINGJIAN MD	4/26/2016	2084P0800X	NA	Psychiatry	026	PHYSICIANS	127013	36	Psychiatry	0	In state provider	None	7850 VISTA HILL AVE	None	SAN DIEGO	CA	92123	2717	37	06073	32.79493052	-117.155268	San Diego County
71114	Fee-for-Service	1467694265	1467694265	1	1	LUI, NATALIE S MD	2/11/2011	208600000X	NA	General Surgery	026	PHYSICIANS	10749	02	General Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
71130	Fee-for-Service	1326081118	1326081118	2	1	LONGS, DRUG STORE CA, INC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	880 SIR FRANCIS DRAKE BL	None	SAN ANSELMO	CA	94960	1914	21	06041	37.98031427	-122.5655885	Marin County
71134	Fee-for-Service	1295747152	1295747152	1	1	LOPEZ SOLORZA, JUAN MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66634	08	Family Practice	0	In state provider	None	401 PARADISE RD	STE E	MODESTO	CA	95351	3104	50	06099	37.62692973	-121.0131742	Stanislaus County
71169	Fee-for-Service	1982931473	1982931473	1	1	LEHMAN, JANICE D PHD	8/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
71180	Fee-for-Service	1194987628	1194987628	1	1	LIM, MIRA MD	9/16/2009	207W00000X	NA	Ophthalmology	026	PHYSICIANS	108588	18	Ophthalmology	0	In state provider	None	122 LA CASA VIA	STE 222	WALNUT CREEK	CA	94598	3014	07	06013	37.91198028	-122.041845	Contra Costa County
71205	Fee-for-Service	1689611568	1689611568	1	1	LODI PAIN CLINIC INC	11/10/2015	208VP0014X	NA	Other	026	PHYSICIANS	83373	05	Anesthesiology	0	In state provider	None	777 S HAM LANE	SUITE F	LODI	CA	95242	3592	39	06077	38.125224	-121.2882885	San Joaquin County
71206	Fee-for-Service	1518998558	1518998558	1	1	LEUCHTER, ANDREW F MD	2/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	37496	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
71211	Fee-for-Service	1528080470	1528080470	1	7	LA CLINICA DE LA RAZA	6/24/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2555 E LELAND RD	None	PITTSBURG	CA	94565	7444	07	06013	38.00822044	-121.860812	Contra Costa County
71244	Fee-for-Service	1467461954	1467461954	1	1	LAWRENCE MIYASHIRO, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	91-2141 FORT WEAVER RD	None	EWA BEACH	HI	96706	0000	00	None	21.3717827	-158.02605	Honolulu County
71245	Fee-for-Service	1285062489	1285062489	1	1	LAKE HEALTH DISTRICT	3/1/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	535 S MAIN STREET	None	ALTURAS	CA	96101	4114	25	06049	41.4803401	-120.5425134	Modoc County
71259	Fee-for-Service	1114285491	1114285491	1	1	LINZMEIER, KATHLEEN A MD	12/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128613	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
71308	Fee-for-Service	1174026926	1174026926	1	1	LEW, EDMUND H MD INC	12/19/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55213	08	Family Practice	0	In state provider	None	1505 WILSON TERRACE	STE 250	GLENDALE	CA	91206	4071	19	06037	34.14960934	-118.2313491	Los Angeles County
71320	Fee-for-Service	1053910950	1053910950	1	1	LIBERTY HOSPICE SERVICES INC	5/26/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	28 N OAK AVE	SUITE 203	PASADENA	CA	91107	5870	19	06037	34.146387	-118.1075515	Los Angeles County
71334	Fee-for-Service	1881030112	1881030112	1	1	LONG, WILLIAM T MD INC APC	10/24/2013	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	60239	20	Orthopedic Surgery	0	In state provider	None	637 LUCAS AVE	FLOOR 1	LOS ANGELES	CA	90017	1997	19	06037	34.05351827	-118.2646017	Los Angeles County
71364	Fee-for-Service	1467773598	1467773598	1	1	LUNN, MITCHELL R MD	6/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124674	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
71366	Fee-for-Service	1669730925	1669730925	1	1	LASOFF, DANIEL R MD	4/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122162	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
71377	Fee-for-Service	1699271478	1699271478	1	1	LEE, MICHELLE H MD	1/27/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	164356	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
71388	Fee-for-Service	1902323033	1902323033	1	1	LAW, TYLER MD	9/20/2017	207L00000X	NA	Other	026	PHYSICIANS	151125	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
71416	Fee-for-Service	1538328000	1538328000	1	1	LO, JOYCE C MD	11/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119525	05	Anesthesiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
71447	Fee-for-Service	1760687925	1760687925	1	1	LIEBIG, JONATHAN MD	8/2/2023	208600000X	NA	General Surgery	026	PHYSICIANS	184408	None	None	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
71454	Fee-for-Service	1437291028	1437291028	1	1	LAM, LIANA OD	2/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3900 LAKEVIEW HWY	None	PETALUMA	CA	94954	5698	49	06097	38.32168809	-122.6254468	Sonoma County
71467	Fee-for-Service	1417968512	1417968512	1	1	LOZANOV, NIKOLA Y MD	9/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93178	08	Family Practice	0	In state provider	None	1450 MEDICAL CENTER DR	None	ROHNERT PARK	CA	94928	2924	49	06097	38.34758366	-122.6816633	Sonoma County
71476	Fee-for-Service	1003847583	1003847583	1	2	LEE, JOW-SHONE MD INC	4/7/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33688	40	Pediatrics	0	In state provider	None	1169 W RAMSEY ST	None	BANNING	CA	92220	4443	33	06065	33.92545045	-116.8894845	Riverside County
71491	Fee-for-Service	1497891238	1497891238	1	1	LUND, JESSE H OD	7/17/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1680-D E. ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
71531	Fee-for-Service	1720021066	1720021066	2	1	LONGS DRUG STORE CA LLC	12/18/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	950 N LAKE BLVD	SUITE 100	TAHOE CITY	CA	96145	7110	31	06061	39.17444367	-120.13735	Placer County
71544	Fee-for-Service	1053583401	1053583401	1	1	LEWIS, JON M MD	4/4/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	184497	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
71554	Fee-for-Service	1588006134	1588006134	1	1	LAX, RAIZEL C LCSW	9/23/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
71562	Fee-for-Service	1093705261	1093705261	1	1	LEVINS, PAUL C MD	10/31/1992	207N00000X	NA	Dermatology	026	PHYSICIANS	76819	07	Dermatology	0	In state provider	None	200 MED PLAZA 465	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
71564	Fee-for-Service	1811098726	1811098726	1	1	LIN, GRACE Y MD	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85948	22	Pathology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
71571	Fee-for-Service	1194892034	1194892034	1	1	LEE, YU FON MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40111	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
71573	Fee-for-Service	1518169580	1518169580	1	1	LAM, IAN Y MD	11/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77204	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
71590	Fee-for-Service	1770917262	1770917262	1	1	LUMINARE, ANCA B MD	1/7/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	138560	None	None	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
71597	Fee-for-Service	1285720805	1285720805	1	1	LINDQUIST, REBECCA A	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO STREET	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
71608	Fee-for-Service	1891133864	1891133864	2	1	LANTAN LLC	3/23/2015	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	8043 2ND STREET	SUITE 103	DOWNEY	CA	90241	3621	19	06037	33.94296553	-118.1360957	Los Angeles County
71625	Fee-for-Service	1396005823	1396005823	1	1	LDAC SURGERY CENTER INC	12/26/2012	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	6153 N THESTA AVE	None	FRESNO	CA	93710	5466	10	06019	36.82548093	-119.7831422	Fresno County
71632	Fee-for-Service	1962627349	1962627349	1	1	LY, KIM-OANH T MD	2/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85074	36	Psychiatry	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
71646	Fee-for-Service	1205451440	1205451440	1	1	LE, DANNY DO	2/12/2025	207P00000X	NA	Other	026	PHYSICIANS	22456	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
71673	Fee-for-Service	1356800114	1356800114	1	1	LEON, PAOLA LMFT	8/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
71676	Fee-for-Service	1407819170	1407819170	1	1	LAI, ROGER C MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71765	66	Emergency Medicine (Urgent Care)	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
71682	Fee-for-Service	1639464340	1639464340	1	1	LIU, IRENE C MD	11/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135715	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
71686	Fee-for-Service	1063569655	1063569655	2	1	LIMBERG, MICHAEL B MD	8/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	62604	18	Ophthalmology	0	In state provider	None	210 CANAL STREET	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
71713	Fee-for-Service	1902225139	1902225139	1	1	LIANG, XINGFU MD	9/24/2020	207RC0200X	NA	Other	026	PHYSICIANS	160637	05	Anesthesiology	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
71719	Fee-for-Service	1952933558	1952933558	1	1	LOVE AND CARE HOSPICE	3/12/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	SERVICE, INC	5658 SEPULVEDA BLVD	214	SHERMAN OAKS	CA	91411	2915	19	06037	34.173774	-118.466123	Los Angeles County
71729	Fee-for-Service	1124521935	1124521935	1	1	LIN, AUNG Z DO	3/10/2020	390200000X	NA	Other	026	PHYSICIANS	17768	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
71778	Fee-for-Service	1578540886	1578540886	1	1	LEGLER, GLENN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	664 STONELEIGH AVE	None	CARMEL	NY	10512	3940	00	None	41.382522	-73.6636545	Putnam County
71825	Fee-for-Service	1457733347	1457733347	1	1	LASHAI, MEHRBANOO MD	10/18/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	187775	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
71834	Fee-for-Service	1649641176	1649641176	1	1	LI, DONNA MD	12/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137758	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
71835	Fee-for-Service	1548629926	1548629926	1	1	LOPEZ, REYLENA M LCSW	5/3/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
71854	Fee-for-Service	1962464115	1962464115	1	1	LEE, JOHN H DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	7297	08	Family Practice	0	In state provider	None	162 N RAYMOND AVE	None	FULLERTON	CA	92831	4610	30	06059	33.871887	-117.906961	Orange County
71858	Fee-for-Service	1326057670	1326057670	1	1	LURIE, MARK D MD	4/28/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	28221	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3475 TORRANCE BLVD	STE A	TORRANCE	CA	90503	5800	19	06037	33.83762089	-118.3467904	Los Angeles County
71862	Fee-for-Service	1194892034	1194892034	1	1	LEE, YU FON MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40111	20	Orthopedic Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
71881	Fee-for-Service	1881145688	1881145688	1	1	LOWRY, HANNAH LMFT	12/21/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15455 SAN FERNANDO MISSO	#300	MISSION HILLS	CA	91345	1353	19	06037	34.27194157	-118.469079	Los Angeles County
71955	Fee-for-Service	1982721718	1982721718	1	1	LIU, ALEXANDER H.Y. MD	4/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78743	34	Urology and Urological Surgery	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
71958	Fee-for-Service	1437204658	1437204658	1	1	LAI, MINHTRUONG L MD	4/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	87630	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2520 SAMARITAN DR	SUITE 210	SAN JOSE	CA	95124	4106	43	06085	37.25213274	-121.9501476	Santa Clara County
71963	Fee-for-Service	1033210232	1033210232	1	1	LEE, KANG H MD	11/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8969	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
71997	Fee-for-Service	1043552490	1043552490	1	1	LUU, HUBERT Y MD	9/5/2023	208G00000X	NA	General Surgery	026	PHYSICIANS	136080	None	None	0	In state provider	None	3941 J STREET	SUITE 270	SACRAMENTO	CA	95819	3624	34	06067	38.570652	-121.4535465	Sacramento County
72001	Fee-for-Service	1346282118	1346282118	1	1	LOBO, ERROL P MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	69007	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
72002	Fee-for-Service	1902225139	1902225139	1	1	LIANG, XINGFU MD	9/24/2020	207RC0200X	NA	Other	026	PHYSICIANS	160637	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
72008	Fee-for-Service	1720451396	1720451396	1	1	LOS ANGELES GAY AND LESBIAN	1/31/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	COMMUNITY SERVICE CENTER	8745 SANTA MONICA BLVD	2ND FLOOR	WEST HOLLYWOOD	CA	90069	4507	19	06037	34.08686067	-118.3813839	Los Angeles County
72009	Fee-for-Service	1952933558	1952933558	1	1	LOVE AND CARE HOSPICE	3/12/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	SERVICE, INC	5658 SEPULVEDA BLVD	214	SHERMAN OAKS	CA	91411	2915	19	06037	34.173774	-118.466123	Los Angeles County
72029	Fee-for-Service	1922007210	1922007210	1	1	LEE, FRANK DO	7/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	4880 S WYNN RD	None	LAS VEGAS	NV	89103	5406	00	None	36.10169134	-115.1953733	Clark County
72032	Fee-for-Service	1467435321	1467435321	1	1	LANE, NANCY E MD	3/1/1984	207R00000X	NA	Other	026	PHYSICIANS	45856	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
72038	Fee-for-Service	1518166941	1518166941	1	1	LIN, TINA C DO	6/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	9366	13	Neurology (M.D. only)	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
72050	Fee-for-Service	1740368349	1740368349	1	1	LO, MY-NGHI MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74808	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
72071	Fee-for-Service	1366471757	1366471757	1	1	LYONS, COZZETTE J MD	6/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	69529	01	General Practice	0	In state provider	None	18546 ROSCOE BLVD	SUITE 300	NORTHRIDGE	CA	91325	4137	19	06037	34.22069869	-118.537684	Los Angeles County
72072	Fee-for-Service	1316938301	1316938301	1	1	LODI MEMORIAL HOSPITAL	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5179	39	06077	38.12188356	-121.285872	San Joaquin County
72086	Fee-for-Service	1376924035	1376924035	1	1	LEE, HENG DO	4/23/2019	207P00000X	NA	Other	026	PHYSICIANS	15393	66	Emergency Medicine (Urgent Care)	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
72094	Fee-for-Service	1740395904	1740395904	1	1	LINNAU, KEN FLORIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	None	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
72095	Fee-for-Service	1649433541	1649433541	1	1	LIAO, MICHELLE M MD	8/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119618	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	SUITE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
72132	Fee-for-Service	1871120576	1871120576	1	1	LEE, GUN HO	7/29/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	None	07	Dermatology	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
72133	Fee-for-Service	1114375219	1114375219	1	1	LEE, LUKE MD	8/31/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	154228	None	None	0	In state provider	None	3883 AIRWAY DR	201	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
72169	Fee-for-Service	1659909737	1659909737	1	1	LATIF, BILAL MD	9/8/2023	207P00000X	NA	Other	026	PHYSICIANS	188089	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
72186	Fee-for-Service	1023565595	1023565595	1	1	LUA, SERGIO A LMFT	10/14/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
72235	Fee-for-Service	1073047767	1073047767	1	1	LARA, ALBA E MD	4/6/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	183125	None	None	0	In state provider	None	7111 FRESNO ST	STE 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
72242	Fee-for-Service	1427206796	1427206796	1	1	LESSENGER, JAMES E MD	1/16/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	34856	-	NOT APPLICABLE	0	In state provider	None	1149 WARREN AVE	None	VALLEJO	CA	94591	9512	48	06095	38.08809527	-122.2141876	Solano County
72256	Fee-for-Service	1518965490	1518965490	1	1	LEHRMAN, KENNETH L MD	3/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	22980	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1515 TROUSDALE DR	STE 216	BURLINGAME	CA	94010	4515	41	06081	37.59358295	-122.3841295	San Mateo County
72288	Fee-for-Service	1841542313	1841542313	1	1	LASSEN, DAVID W CRNA	12/3/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
72289	Fee-for-Service	1649442328	1649442328	1	1	LEIS, AMBER R MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	108820	20	Orthopedic Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	#55	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
72296	Fee-for-Service	1720451396	1720451396	1	1	LOS ANGELES GAY AND LESBIAN	1/31/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	COMMUNITY SERVICE CENTER	8745 SANTA MONICA BLVD	2ND FLOOR	WEST HOLLYWOOD	CA	90069	4507	19	06037	34.08686067	-118.3813839	Los Angeles County
72306	Fee-for-Service	1194935932	1194935932	1	1	LIN, JENNIFER C MD	7/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104698	None	None	0	In state provider	None	665 MUNRAS AVE	SUITE 109	MONTEREY	CA	93940	3136	27	06053	36.59569303	-121.8931095	Monterey County
72312	Fee-for-Service	1144520396	1144520396	1	1	LOPEZ, SARAH G MD	3/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114022	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
72320	Fee-for-Service	1770018640	1770018640	1	1	LO, KATHLEEN MD	6/1/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157577	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
72329	Fee-for-Service	1932115219	1932115219	1	1	LEE, LESLIE H MD	6/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108114	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
72357	Fee-for-Service	1760457709	1760457709	1	1	LEE, MAUREEN M	2/28/1991	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1480 SUTTER ST	None	SAN FRANCISCO	CA	94109	5451	38	06075	37.78720952	-122.424704	San Francisco County
72372	Fee-for-Service	1265252258	1265252258	1	1	LEA WILSON, ANGIE CNP	12/10/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1401 S BALDWIN AVE	None	ARCADIA	CA	91007	7922	19	06037	34.12357479	-118.0551359	Los Angeles County
72379	Fee-for-Service	1831432566	1831432566	1	1	LU, SYDNEY X MD	11/22/2021	207R00000X	NA	Other	026	PHYSICIANS	175114	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
72399	Fee-for-Service	1770114530	1770114530	1	1	LA COUNTY HOSPICE INC	10/16/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1259 S GLENDALE AVE	SUITE D	GLENDALE	CA	91205	3280	19	06037	34.13003451	-118.2525595	Los Angeles County
72400	Fee-for-Service	1730612821	1730612821	1	1	LEE, VALLENT MD	7/1/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	158791	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
72419	Fee-for-Service	1932467750	1932467750	1	1	LI, XINNUO LMFT	9/17/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
72433	Fee-for-Service	1558407643	1558407643	1	1	LEUNG, JOHN W MD	7/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89183	05	Anesthesiology	0	In state provider	None	25500 MEDICAL CENTER DR	None	MURIETTA	CA	92562	9565	33	06065	33.5580705	-117.1835458	Riverside County
72448	Fee-for-Service	1144460387	1144460387	1	1	LUNG, JULIE C LAC	5/24/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	222 MORNING SUN	None	CLIO	CA	96106	0407	32	06063	39.77259392	-120.5286965	Plumas County
72473	Fee-for-Service	1821582651	1821582651	1	1	LOHMAN, PAMELA J	7/31/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	110 GOPHER FLAT ROAD	None	SUTTER CREEK	CA	95685	9709	03	06005	38.39750931	-120.7995206	Amador County
72481	Fee-for-Service	1144261637	1144261637	1	1	LEVINSON, STEPHEN R MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71459	41	Internal Medicine	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
72545	Fee-for-Service	1518965490	1518965490	1	1	LEHRMAN, KENNETH L MD	3/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	22980	01	General Practice	0	In state provider	None	1515 TROUSDALE DR	STE 216	BURLINGAME	CA	94010	4515	41	06081	37.59358295	-122.3841295	San Mateo County
72546	Fee-for-Service	1659313468	1659313468	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	463 STONY POINT RD	None	SANTA ROSA	CA	95401	5900	49	06097	38.433159	-122.743854	Sonoma County
72554	Fee-for-Service	1881804888	1881804888	1	1	LARSON, ANNE-MARIE NP	6/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
72594	Fee-for-Service	1487889341	1487889341	1	1	LO, CHIN-YU J MD	7/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106147	None	None	0	In state provider	None	43830 N 10TH ST WEST	None	LANCASTER	CA	93534	4826	19	06037	34.67913961	-118.1478725	Los Angeles County
72623	Fee-for-Service	1760893853	1760893853	1	1	LAMSAL GHIMIRE, ALKA MD	1/17/2022	208M00000X	NA	Other	026	PHYSICIANS	165199	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
72674	Fee-for-Service	1588639041	1588639041	1	1	LEHR, LEONARD K MD INC	11/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	25608	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7601 HOSPITAL DR	STE 202	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
72688	Fee-for-Service	1770114530	1770114530	1	1	LA COUNTY HOSPICE INC	10/16/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1259 S GLENDALE AVE	SUITE D	GLENDALE	CA	91205	3280	19	06037	34.13003451	-118.2525595	Los Angeles County
72710	Fee-for-Service	1770678377	1770678377	1	1	LIOU, JOHN H M MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66301	40	Pediatrics	0	In state provider	None	11 PROFESSIONAL CENTER P	None	SAN RAFAEL	CA	94903	2702	21	06041	38.00987589	-122.5401279	Marin County
72711	Fee-for-Service	1063184745	1063184745	1	1	LUCAS, LAUREN	11/29/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1610 ARDEN WAY	SUITE 195	SACRAMENTO	CA	95815	4035	34	06067	38.598597	-121.42863	Sacramento County
72725	Fee-for-Service	1891890158	1891890158	2	1	LONG BEACH MEMORIAL MEDICAL	12/7/2012	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	2801 ATLANTIC AVE	None	LONG BEACH	CA	90801	1701	19	06037	33.808185	-118.1850575	Los Angeles County
72740	Fee-for-Service	1801059803	1801059803	1	1	LU, KAI MD	5/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112257	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
72749	Fee-for-Service	1891802856	1891802856	1	1	LINEBARGER, HEATHER MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72971	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
72763	Fee-for-Service	1336141308	1336141308	1	1	LAKIREDDY, HANIMIREDDY MD	11/9/1989	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	39957	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	310 MERCY AVE	None	MERCED	CA	95340	9100	24	06047	37.33870622	-120.4661454	Merced County
72764	Fee-for-Service	1821582651	1821582651	1	1	LOHMAN, PAMELA J	7/31/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	110 GOPHER FLAT ROAD	None	SUTTER CREEK	CA	95685	9709	03	06005	38.39750931	-120.7995206	Amador County
72767	Fee-for-Service	1144261637	1144261637	1	1	LEVINSON, STEPHEN R MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71459	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
72778	Fee-for-Service	1699972042	1699972042	1	1	LAM, GIANG-TUYET N MD	3/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108259	05	Anesthesiology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
72832	Fee-for-Service	1356978738	1356978738	1	1	LU, KEVIN L MD	6/14/2023	207ZP0102X	NA	Other	026	PHYSICIANS	184980	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
72848	Fee-for-Service	1841352283	1841352283	1	2	LEUNG, ELEANOR K MD	7/3/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	75522	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	50 ALESSANDRO PL	SUITE 320	PASADENA	CA	91105	3192	19	06037	34.13101049	-118.151532	Los Angeles County
72897	Fee-for-Service	1891970745	1891970745	1	1	LEO, BRIAN S MD	8/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101701	08	Family Practice	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
72911	Fee-for-Service	1699720946	1699720946	1	1	LEE, SCOTT E MD	11/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87505	18	Ophthalmology	0	In state provider	None	1420 TARA HILLS DR	STE D	PINOLE	CA	94564	2530	07	06013	37.99573909	-122.304492	Contra Costa County
72921	Fee-for-Service	1104175363	1104175363	1	1	LEGASPI, MAELYN Q	8/7/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
72922	Fee-for-Service	1699826859	1699826859	1	1	LYNN EYE MEDIAL GROUP IN	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	BUTERA, MATZKIN, COOPER	2230 LYNN RD	STE 2	THOUSAND OAKS	CA	91360	1901	56	06111	34.20894685	-118.885185	Ventura County
72928	Fee-for-Service	1285476812	1285476812	1	1	LUZ PILIPINAS T VELASCO	6/5/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	138 BELLERIVE DRIVE	None	VISTA	CA	92084	5712	37	06073	33.20458202	-117.2214189	San Diego County
72935	Fee-for-Service	1578826749	1578826749	1	1	LOJA, MELISSA N MD	8/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	127991	01	General Practice	0	In state provider	None	3100 SAN PABLO AVE	STE 420	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
72955	Fee-for-Service	1669403911	1669403911	1	1	LUDWIG, JON K MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73629	None	None	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
72998	Fee-for-Service	1265593701	1265593701	1	1	LUKE, JOHN C MD	2/26/2008	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	52740	08	Family Practice	0	In state provider	None	11000 OLSON DR	STE 100	RANCHO CORDOVA	CA	95670	5605	34	06067	38.595123	-121.2820155	Sacramento County
72999	Fee-for-Service	1982799953	1982799953	1	1	LEE, RYAN K MD	7/1/2012	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	79984	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1500 S CENTRAL AVE	STE 210	GLENDALE	CA	91204	2579	19	06037	34.12736888	-118.257777	Los Angeles County
73018	Fee-for-Service	1144621723	1144621723	1	1	LOMITA CARE PHARMACY INC	12/26/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3655 LOMITA BLVD	SUITE 102	TORRANCE	CA	90505	1900	19	06037	33.81497113	-118.3489779	Los Angeles County
73020	Fee-for-Service	1821030271	1821030271	1	1	LIEBERMAN, AMARA A MD	12/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	77573	07	Dermatology	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
73026	Fee-for-Service	1346669207	1346669207	1	1	LAU, SAMANTHA F MD	8/24/2021	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	142174	None	None	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	3663	30	06059	33.62421676	-117.9309656	Orange County
73029	Fee-for-Service	1528412244	1528412244	1	1	LARSON, JESSE DPM	5/15/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	71 N MAIN ST	None	TEMPLETON	CA	93465	5326	40	06079	35.55712018	-120.7011706	San Luis Obispo County
73038	Fee-for-Service	1265071500	1265071500	1	1	LA COMMUNITY HEALTH CENTER	7/7/2022	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	7335 VAN NUYS BLVD	SUITE 117	VAN NUYS	CA	91405	1951	19	06037	34.203843	-118.448776	Los Angeles County
73051	Fee-for-Service	1427195916	1427195916	1	1	LUNDBERG, MARK A MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	64443	08	Family Practice	0	In state provider	None	4941 OLIVEHURST AVE	None	OLIVEHURST	CA	95961	4225	58	06115	39.09746115	-121.5514942	Yuba County
73062	Fee-for-Service	1952577256	1952577256	1	1	LINZER, RICHARD G LMFT	4/11/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	572 DUNHOLME WAY	None	SUNNYVALE	CA	94087	3300	43	06085	37.34482247	-122.0283135	Santa Clara County
73103	Fee-for-Service	1659734267	1659734267	1	1	LI, SHIQIAN MD	5/15/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	153954	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
73107	Fee-for-Service	1932529138	1932529138	1	1	LEE, PHILIP T MD	4/2/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	149198	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
73120	Fee-for-Service	1477627081	1477627081	1	1	LOPEZ, LISSETTE MD	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91294	08	Family Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
73139	Fee-for-Service	1932564333	1932564333	1	1	LOVELACE, JENNIFER LCSW	2/6/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1000 TEXAS ST	STE D	FAIRFIELD	CA	94533	5700	48	06095	38.24926548	-122.046354	Solano County
73185	Fee-for-Service	1255439006	1255439006	1	1	LUE, CHUNG H MD	9/11/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	34434	25	Physical Medicine and Rehabilitation	0	In state provider	None	600 N GARFIELD AVE	STE 208	MONTEREY PARK	CA	91754	1170	19	06037	34.06820797	-118.1228835	Los Angeles County
73199	Fee-for-Service	1770211666	1770211666	1	1	LEON, EVERARDO PSYD	12/30/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
73262	Fee-for-Service	1770541039	1770541039	1	1	LUPO, MICHAEL A MD	6/21/2000	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	68074	25	Physical Medicine and Rehabilitation	0	In state provider	None	15031 RINALDI ST	None	SAN FERNANDO	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
73275	Fee-for-Service	1740293406	1740293406	1	1	L B CARR MEDICAL GROUP	7/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
73279	Fee-for-Service	1598789406	1598789406	1	1	LONG, ANGELA N LMFT	11/9/2018	106H00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4305 GESNER STREET	SUITE 101	SAN DIEGO	CA	92117	6673	37	06073	32.79155107	-117.2027579	San Diego County
73285	Fee-for-Service	1265506133	1265506133	1	1	LEWIS, KATHY MD	1/1/1982	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	33776	40	Pediatrics	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
73346	Fee-for-Service	1639100845	1639100845	1	1	LIPHAM, JOHN C MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	62161	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
73357	Fee-for-Service	1457401069	1457401069	1	1	LU, JULIE Y MD	6/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100889	41	Internal Medicine	0	In state provider	None	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
73358	Fee-for-Service	1164500526	1164500526	1	1	LAWTON, THOMAS J JR MD	12/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	79230	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
73361	Fee-for-Service	1487946885	1487946885	1	1	LIN, VIRGINIA W NP	4/27/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
73389	Fee-for-Service	1629084447	1629084447	1	1	LANTIS STEMERMAN, AMY L MD	11/18/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	99993	None	None	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
73392	Fee-for-Service	1932434529	1932434529	1	1	LANGE, DAVID C MD	5/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117130	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
73399	Fee-for-Service	1740514256	1740514256	1	1	LEWIS, CATHERINE E PHD	12/14/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2790 TRUXTON RD	STE 150	SAN DIEGO	CA	92106	6135	37	06073	32.74048807	-117.2130601	San Diego County
73430	Fee-for-Service	1386793669	1386793669	1	1	LEE, WILLIAM W MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24186	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
73438	Fee-for-Service	1144466780	1144466780	1	1	LIASI, NASSER T	4/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115058	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
73457	Fee-for-Service	1972753093	1972753093	1	1	LOH, BRYAN MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	92301	02	General Surgery	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
73475	Fee-for-Service	1255439006	1255439006	1	1	LUE, CHUNG H MD	9/11/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	34434	01	General Practice	0	In state provider	None	600 N GARFIELD AVE	STE 208	MONTEREY PARK	CA	91754	1170	19	06037	34.06820797	-118.1228835	Los Angeles County
73481	Fee-for-Service	1982150645	1982150645	1	1	LOS ANGELES CENTERS FOR	9/21/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	ALCOHOL AND DRUG ABUSE	14100 GLENGYLE ST	None	WHITTIER	CA	90604	2434	19	06037	33.93799562	-118.0338598	Los Angeles County
73508	Fee-for-Service	1356429534	1356429534	1	1	LEACH, TIMOTHY A MD	6/14/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	81727	None	None	0	In state provider	None	110 TAMPICO DRIVE	SUITE 210	WALNUT CREEK	CA	94598	2512	07	06013	37.91113845	-122.0458263	Contra Costa County
73509	Fee-for-Service	1053018978	1053018978	1	1	LEYVA, EMILY M PT	2/14/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	740 S PLACENTIA AVE	STE 100	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
73533	Fee-for-Service	1659389120	1659389120	1	1	LE, DAVID M MD	12/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	69310	02	General Surgery	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
73562	Fee-for-Service	1184175838	1184175838	1	1	LEE, ALAN PT	2/3/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	32819 YUCAIPA BLVD	SUITE 3	YUCAIPA	CA	92399	1944	36	06071	34.03378554	-117.0888075	San Bernardino County
73581	Fee-for-Service	1770615213	1770615213	1	1	LESTER, GREGORY K DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	16390 MAIN ST	STE C	GUERNEVILLE	CA	95446	9677	49	06097	38.5020015	-123.0000255	Sonoma County
73587	Fee-for-Service	1609132265	1609132265	1	1	LEAH K MIDDELBERG	11/24/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
73600	Fee-for-Service	1366824070	1366824070	1	1	LOBO MORENO, PAMELA M MD	10/26/2018	207R00000X	NA	Other	026	PHYSICIANS	156453	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
73608	Fee-for-Service	1346623550	1346623550	1	1	LIAO, HUNG-I MD	3/24/2021	207RP1001X	NA	Pulmonology	026	PHYSICIANS	156056	None	None	0	In state provider	None	1211 W LA PALMA AVE	STE 207	ANAHEIM	CA	92801	2139	30	06059	33.84718298	-117.933758	Orange County
73625	Fee-for-Service	1093857021	1093857021	1	1	LAL, RICHA MD	4/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105409	40	Pediatrics	0	In state provider	None	630 S GLASSELL	SUITE 106A	ORANGE	CA	92866	3004	30	06059	33.77799	-117.8532285	Orange County
73670	Fee-for-Service	1659737906	1659737906	1	1	LAC VERDUGO OPERATIONS LLC	1/1/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	250 N VERDUGO ROAD	None	GLENDALE	CA	91206	3930	19	06037	34.14969316	-118.2359928	Los Angeles County
73680	Fee-for-Service	1568624401	1568624401	1	1	LUCUS, ANTHONY R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
73717	Fee-for-Service	1386793669	1386793669	1	1	LEE, WILLIAM W MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24186	07	Dermatology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
73730	Fee-for-Service	1427004555	1427004555	1	1	LUERS, PATRICK R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 HILAND AVE	None	BURLEY	ID	83318	0000	00	None	42.53489313	-113.7833899	Cassia County
73758	Fee-for-Service	1972651792	1972651792	1	1	LIN, JU AN MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66139	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
73780	Fee-for-Service	1720540321	1720540321	1	1	LEE, ALAN R MD	6/7/2022	390200000X	NA	Other	026	PHYSICIANS	176263	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
73788	Fee-for-Service	1881653681	1881653681	1	1	LU, SUSAN MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77344	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
73817	Fee-for-Service	1184293219	1184293219	1	1	LOPEZ, JENNIE LMFT	12/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	550 W ALLUVIAL AVE	STE 108	FRESNO	CA	93711	5857	10	06019	36.84447289	-119.8025883	Fresno County
73827	Fee-for-Service	1487102794	1487102794	1	1	LY, SANDY NP	8/30/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5601 NORRIS CANYON RD	STE 340	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
73834	Fee-for-Service	1679635353	1679635353	3	1	LIN, DAVID Y MD	4/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3925 N ROSEMEAD BLVD	SUITE 101	ROSEMEAD	CA	91770	1933	19	06037	34.07930385	-118.0732531	Los Angeles County
73836	Fee-for-Service	1194044263	1194044263	1	1	LE CLERCQ, OLGA S DO	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11986	01	General Practice	0	In state provider	None	6189 LA PALMA AVE	None	BUENA PARK	CA	90620	2858	30	06059	33.84662776	-118.0247919	Orange County
73859	Fee-for-Service	1174571491	1174571491	1	1	LEE, JENNIFER K	6/1/2009	174400000X	NA	Other	026	PHYSICIANS	81453	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
73904	Fee-for-Service	1881078467	1881078467	1	1	LANKARANI, DAISY S MD	8/17/2021	390200000X	NA	Other	026	PHYSICIANS	152319	None	None	0	In state provider	None	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	19	06037	34.13101049	-118.151532	Los Angeles County
73914	Fee-for-Service	1598926636	1598926636	1	1	LEE, AARON S MD	10/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117483	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
73927	Fee-for-Service	1902337090	1902337090	1	1	LI, JIWEN MD	3/5/2021	207R00000X	NA	Other	026	PHYSICIANS	159919	None	None	0	In state provider	None	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
73929	Fee-for-Service	1447699590	1447699590	1	1	LAWRENCE, CHRISTOPHER W A MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146616	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
73965	Fee-for-Service	1598780025	1598780025	1	1	LE, YU-PO MD	6/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	71000	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
73988	Fee-for-Service	1841742400	1841742400	1	1	LOPRESTI, CALLIE M NP	4/17/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
74000	Fee-for-Service	1316917339	1316917339	1	1	LUQUE, LEE-JIUAN OD	3/27/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	638 CAMINO DE LOS MARES	STE A120	SAN CLEMENTE	CA	92673	2863	30	06059	33.45932277	-117.6517315	Orange County
74025	Fee-for-Service	1134581010	1134581010	1	1	LEONE, STEPHEN E	5/4/2016	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	3144 EL CAMINO REAL	SUITE 105	CARLSBAD	CA	92008	2194	37	06073	33.17287617	-117.323264	San Diego County
74050	Fee-for-Service	1003830191	1003830191	1	1	LAM, RICHARD C MD INC	3/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	61542	41	Internal Medicine	0	In state provider	None	27994 BRADLEY RD	STE C	SUN CITY	CA	92586	2240	33	06065	33.71392455	-117.1912253	Riverside County
74058	Fee-for-Service	1427267053	1427267053	1	1	LI, YANG MD	10/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106445	18	Ophthalmology	0	In state provider	None	3925 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
74079	Fee-for-Service	1457453094	1457453094	1	1	LIN, JOHN S MD	1/1/1979	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	30223	41	Internal Medicine	0	In state provider	None	938 N CHERRY ST	None	TULARE	CA	93274	2210	54	06107	36.221211	-119.337643	Tulare County
74107	Fee-for-Service	1437182136	1437182136	1	1	LOS ANGELES VASCULAR SPE	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	A PROFESSIONAL MEDICAL C	15243 VANOWEN ST	STE 203	VAN NUYS	CA	91405	4542	19	06037	34.19394848	-118.4654115	Los Angeles County
74133	Fee-for-Service	1114086873	1114086873	1	1	LEONG, STEPHANIE Y MD	8/2/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	55711	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
74153	Fee-for-Service	1407233216	1407233216	1	1	LEVI FILLER	4/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
74189	Fee-for-Service	1225276652	1225276652	1	1	LEE, DAVID M MD	6/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88958	None	None	0	In state provider	None	1510 S CENTRAL AVENUE	#150	GLENDALE	CA	91204	2541	19	06037	34.12709764	-118.2577911	Los Angeles County
74197	Fee-for-Service	1578611497	1578611497	1	1	LUFTMAN, GALLIT S DO	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7298	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
74211	Fee-for-Service	1316938301	1316938301	1	4	LODI MEMORIAL HOSPITAL	4/4/2022	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2600 REYNOLDS RANCH PKWY	SUITE 120	LODI	CA	95240	6888	39	06077	38.10089406	-121.2663713	San Joaquin County
74256	Fee-for-Service	1902433543	1902433543	1	1	LE, DOMINIC MD	9/18/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	177665	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
74261	Fee-for-Service	1811239064	1811239064	1	1	LEE, WIGGIN W MD	1/6/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	134789	07	Dermatology	0	In state provider	None	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	37	06073	32.90618683	-117.1814064	San Diego County
74271	Fee-for-Service	1952662686	1952662686	1	1	LIVINGSTONE COMMUNITY	9/1/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	DEVELOPMENT CORPORATION	12362 BEACH BLVD	STE 10	STANTON	CA	90680	3944	30	06059	33.78298855	-117.9927453	Orange County
74318	Fee-for-Service	1356647044	1356647044	1	1	LAKIREDDY, PRAJAPATHI R MD	3/13/2024	207R00000X	NA	Other	026	PHYSICIANS	116089	None	None	0	In state provider	None	185 E 7TH AVE	STE A	CHICO	CA	95926	3356	04	06007	39.74473059	-121.8488381	Butte County
74320	Fee-for-Service	1346317104	1346317104	1	1	LEE, ROSAL L NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9449 IMPERIAL HWY	STE ABCD	DOWNEY	CA	90242	2814	19	06037	33.91714048	-118.1262915	Los Angeles County
74328	Fee-for-Service	1396010856	1396010856	1	1	LIANG, BERTRAND C MD	8/13/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	86288	13	Neurology (M.D. only)	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
74339	Fee-for-Service	1629411582	1629411582	1	1	LI, YANG DO	7/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13614	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
74374	Fee-for-Service	1114487709	1114487709	1	1	LU, CONNIE M MD	6/6/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
74394	Fee-for-Service	1437182136	1437182136	1	1	LOS ANGELES VASCULAR SPE	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	A PROFESSIONAL MEDICAL C	15243 VANOWEN ST	STE 203	VAN NUYS	CA	91405	4542	19	06037	34.19394848	-118.4654115	Los Angeles County
74424	Fee-for-Service	1992167654	1992167654	1	1	LEE, WON H MD	6/3/2022	207L00000X	NA	Other	026	PHYSICIANS	153005	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
74425	Fee-for-Service	1326146333	1326146333	2	1	LAST FRONTIER HEALTHCARE	7/1/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	228 W MCDOWELL AVE	None	ALTURAS	CA	96101	3934	25	06049	41.48004239	-120.5440923	Modoc County
74444	Fee-for-Service	1578911376	1578911376	1	1	LEI, JIBONG DPM	8/18/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
74487	Fee-for-Service	1922232289	1922232289	1	1	LE, THU T MD	6/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	94429	30	Radiology	0	In state provider	None	1700 S COURT STREET	SUITE F	VISALIA	CA	93277	4931	54	06107	36.315108	-119.2916925	Tulare County
74509	Fee-for-Service	1851329239	1851329239	1	1	LE, LAUREN N DPM	6/3/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2200 E GONZALES RD	None	OXNARD	CA	93036	0619	56	06111	34.21872951	-119.148768	Ventura County
74537	Fee-for-Service	1588674279	1588674279	1	1	LISA PARKER	2/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	NW BRAIN AND SPINE CLIN	2275 NE DOCTORS DRIVE	SUITE 2	BENS	OR	97701	0000	00	None	44.06963188	-121.2672829	Deschutes County
74541	Fee-for-Service	1518384684	1518384684	1	1	LOWRY, EUGENE MD	4/25/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	139751	18	Ophthalmology	0	In state provider	None	2241 CENTRAL AVE	STE A	ALAMEDA	CA	94501	4430	01	06001	37.76537189	-122.2454213	Alameda County
74558	Fee-for-Service	1952662686	1952662686	1	1	LIVINGSTONE COMMUNITY	9/1/2017	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	DEVELOPMENT CORPORATION	12362 BEACH BLVD	STE 10	STANTON	CA	90680	3944	30	06059	33.78298855	-117.9927453	Orange County
74565	Fee-for-Service	1205196029	1205196029	1	1	LEPEZ, DAVID Z MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130348	01	General Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
74596	Fee-for-Service	1548203409	1548203409	1	1	LINK, THOMAS M	6/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95767	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
74597	Fee-for-Service	1649273293	1649273293	1	1	LOPEZ-VELEZ, DOMINGO A	7/30/1995	207ND0900X	NA	Dermatology	026	PHYSICIANS	10411	07	Dermatology	0	In state provider	None	230 PROSPECT PL	STE 260	CORONADO	CA	92118	1987	37	06073	32.69468235	-117.1677128	San Diego County
74646	Fee-for-Service	1780067405	1780067405	1	1	LA REMEDY HEALTH INC	9/1/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2300 WESTWOOD BLVD	SUITE 102	LOS ANGELES	CA	90064	2015	19	06037	34.04230484	-118.4303216	Los Angeles County
74655	Fee-for-Service	1720155740	1720155740	1	1	LIM, ON W MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34879	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
74660	Fee-for-Service	1619327871	1619327871	1	1	LAVENTURE, ALEX B MD	9/14/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177056	None	None	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
74663	Fee-for-Service	1982080313	1982080313	1	1	LIU, CHEN Y LMFT	6/7/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	933 S SUNSET AVE	105	WEST COVINA	CA	91790	3410	19	06037	34.06428275	-117.9432037	Los Angeles County
74773	Fee-for-Service	1699079624	1699079624	1	2	LATASHA GATES	8/18/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	148 H STREET	None	CHULA VISTA	CA	91910	4816	34	06067	32.63589577	-117.071015	San Diego County
74776	Fee-for-Service	1255383634	1255383634	1	1	LAWSON, DAVID R MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81464	None	None	0	In state provider	None	3900 SHERMAN DR	STE K	RIVERSIDE	CA	92503	4005	33	06065	33.92756479	-117.4375031	Riverside County
74795	Fee-for-Service	1891716411	1891716411	1	1	LEE, MYLES E MD INC	12/1/2003	208G00000X	NA	General Surgery	026	PHYSICIANS	20526	33	Thoracic Surgery	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
74808	Fee-for-Service	1366638447	1366638447	1	1	LIEU, JOHN G MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88898	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
74813	Fee-for-Service	1841708328	1841708328	1	1	LIANG, GARRETT Y	5/29/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
74847	Fee-for-Service	1952662686	1952662686	1	1	LIVINGSTONE COMMUNITY	9/1/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	DEVELOPMENT CORPORATION	12362 BEACH BLVD	STE 10	STANTON	CA	90680	3944	30	06059	33.78298855	-117.9927453	Orange County
74853	Fee-for-Service	1487696191	1487696191	2	1	LIFELONG MEDICAL CARE	3/7/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	SAN PABLO	2023 VALE ROAD	#107	SAN PABLO	CA	94806	3834	07	06013	37.95369824	-122.3378493	Contra Costa County
74859	Fee-for-Service	1154832640	1154832640	1	1	LEE, MICHELLE S CCC-SLP	6/13/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
74861	Fee-for-Service	1992903876	1992903876	1	1	LANGFORD, SPRING T	10/20/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
74916	Fee-for-Service	1396791901	1396791901	1	1	LOMA LINDA UNIV UROLOGY	1/1/1989	208800000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	11370 ANDERSON ST	# 1100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
74959	Fee-for-Service	1063796944	1063796944	1	1	LIBET, LEV A MD	12/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117711	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
74968	Fee-for-Service	1174617963	1174617963	1	1	LEE, JONATHAN H MD	3/1/2001	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	68174	08	Family Practice	0	In state provider	None	440 AIRPORT BLVD	STE A	SALINAS	CA	93905	3302	27	06053	36.66527366	-121.616758	Monterey County
74997	Fee-for-Service	1346545431	1346545431	1	1	LEIBOVICH, SARA A MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114298	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
75059	Fee-for-Service	1699079624	1699079624	1	2	LATASHA GATES	8/18/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	148 H STREET	None	CHULA VISTA	CA	91910	4816	34	06067	32.63589577	-117.071015	San Diego County
75069	Fee-for-Service	1770035024	1770035024	1	2	LANDMARK ANESTHESIA MEDICAL	5/2/2019	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
75076	Fee-for-Service	1306876883	1306876883	1	1	LEVINSON, MICHAEL U MD	3/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	63654	36	Psychiatry	0	In state provider	None	15630 18TH AVE	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
75081	Fee-for-Service	1891716411	1891716411	1	1	LEE, MYLES E MD INC	12/1/2003	208G00000X	NA	General Surgery	026	PHYSICIANS	20526	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
75117	Fee-for-Service	1386778322	1386778322	1	1	LENROW, LAURIE B LCSW	11/20/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
75121	Fee-for-Service	1376801431	1376801431	1	1	LEEFLANG, ELISABETH J MD	10/13/2021	208600000X	NA	General Surgery	026	PHYSICIANS	124263	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
75135	Fee-for-Service	1952662686	1952662686	1	1	LIVINGSTONE COMMUNITY	11/7/2018	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	DEVELOPMENT CORPORATION	12362 BEACH BLVD	STE 10	STANTON	CA	90680	3944	30	06059	33.78298855	-117.9927453	Orange County
75140	Fee-for-Service	1225511454	1225511454	1	1	LOWERY, MAIDA RCP	10/4/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
75142	Fee-for-Service	1487696191	1487696191	2	1	LIFELONG MEDICAL CARE	3/7/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	SAN PABLO	2023 VALE ROAD	#107	SAN PABLO	CA	94806	3834	07	06013	37.95369824	-122.3378493	Contra Costa County
75162	Fee-for-Service	1689741449	1689741449	1	1	LAI, JANE H CRNA	4/5/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
75178	Fee-for-Service	1811029929	1811029929	1	1	LEE, STEPHEN Y MD INC	7/1/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	32681	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 E BEVERLY BLVD	STE 300	MONTEBELLO	CA	90640	4316	19	06037	34.01556395	-118.0983878	Los Angeles County
75207	Fee-for-Service	1801893466	1801893466	2	1	LA PHARMACIE, INC	6/1/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1152 VIA VERDE	None	SAN DIMAS	CA	91773	4410	19	06037	34.07313857	-117.829884	Los Angeles County
75217	Fee-for-Service	1598129819	1598129819	1	1	LESS, KENNEN	4/29/2022	207P00000X	NA	Other	026	PHYSICIANS	162472	None	None	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
75253	Fee-for-Service	1144716481	1144716481	1	1	LAURENT, CAREY PT	10/25/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	120 S CHAPARRAL CT	150	ANAHEIM	CA	92808	2237	30	06059	33.86492127	-117.7445525	Orange County
75280	Fee-for-Service	1841766185	1841766185	1	1	LIU, SABRINA CNP	1/8/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	925 S GARFIELD AVE	STE 201	ALHAMBRA	CA	91801	4442	19	06037	34.08499473	-118.1230937	Los Angeles County
75282	Fee-for-Service	1972607364	1972607364	1	1	LEE, YONG TAI MD	10/29/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67974	25	Physical Medicine and Rehabilitation	0	In state provider	None	3544 W OLYMPIC BLVD	None	LOS ANGELES	CA	90019	3500	19	06037	34.05246985	-118.3163186	Los Angeles County
75344	Fee-for-Service	1134205099	1134205099	1	1	LEE, HYO-RANG MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78554	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
75356	Fee-for-Service	1770035024	1770035024	1	2	LANDMARK ANESTHESIA MEDICAL	12/13/2018	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
75358	Fee-for-Service	1942232723	1942232723	1	1	LERCEL, GREGORY R MD	10/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78925	None	None	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
75363	Fee-for-Service	1003012931	1003012931	1	1	LOPEZ, NICETO MD	7/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	96421	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
75381	Fee-for-Service	1528080470	1528080470	1	8	LA CLINICA DE LA RAZA	6/24/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	204 ODESSA AVE	None	PITTSBURG	CA	94565	1946	07	06013	38.03587382	-121.8899425	Contra Costa County
75432	Fee-for-Service	1487696191	1487696191	2	1	LIFELONG MEDICAL CARE	7/28/2014	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	SAN PABLO	2023 VALE ROAD	#107	SAN PABLO	CA	94806	3834	07	06013	37.95369824	-122.3378493	Contra Costa County
75510	Fee-for-Service	1760456248	1760456248	1	1	LIN, ROBERT T MD	5/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55952	18	Ophthalmology	0	In state provider	IQ MEDICAL CENTER	18725 GALE AVE	STE 140	CITY OF INDUSTRY	CA	91748	1358	19	06037	33.99452087	-117.8945676	Los Angeles County
75523	Fee-for-Service	1164676516	1164676516	1	1	LEE, GIN-HORN D DPM INC	9/30/1992	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	420 N GARFIELD AVE	STE 206B	MONTEREY PARK	CA	91754	1206	19	06037	34.0670077	-118.1228585	Los Angeles County
75533	Fee-for-Service	1831693068	1831693068	1	1	LAZZARESCHI, DANIEL V MD	2/6/2025	207L00000X	NA	Other	026	PHYSICIANS	166562	05	Anesthesiology	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
75535	Fee-for-Service	1093272338	1093272338	1	1	LEE, EUNICE NP	4/4/2020	163WP0808X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3030 W OLYMPIC BLVD	STE 217	LOS ANGELES	CA	90006	6507	19	06037	34.05260995	-118.3015825	Los Angeles County
75537	Fee-for-Service	1528080470	1528080470	1	11	LA CLINICA DE LA RAZA	6/24/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2131 CRESTVIEW LANE	None	PITTSBURG	CA	94565	7444	07	06013	38.01575261	-121.8930739	Contra Costa County
75551	Fee-for-Service	1942220421	1942220421	2	1	LAIBCO, LLC	1/1/2006	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	14165 PURCHE AVE	None	GARDENA	CA	90249	2824	19	06037	33.902793	-118.320676	Los Angeles County
75586	Fee-for-Service	1154816114	1154816114	1	1	LIAO, LAWRENCE DO	9/10/2021	207P00000X	NA	Other	026	PHYSICIANS	18906	None	None	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
75608	Fee-for-Service	1205017035	1205017035	1	1	LE, TUAN D MD	8/1/2001	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	60032	08	Family Practice	0	In state provider	A PROFESSIONAL	1151 E HOLT AVE	STE Q	POMONA	CA	91767	5828	19	06037	34.06300002	-117.7272202	Los Angeles County
75632	Fee-for-Service	1134205099	1134205099	1	1	LEE, HYO-RANG MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78554	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
75657	Fee-for-Service	1619608882	1619608882	1	1	LOUIE, CHRISTOPHER M OD	11/1/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1023 9TH ST	None	SACRAMENTO	CA	95814	3507	34	06067	38.579814	-121.494897	Sacramento County
75667	Fee-for-Service	1528080470	1528080470	1	8	LA CLINICA DE LA RAZA	6/24/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	204 ODESSA AVE	None	PITTSBURG	CA	94565	1946	07	06013	38.03587382	-121.8899425	Contra Costa County
75672	Fee-for-Service	1417143421	1417143421	1	1	LOPEZ, MARLENE C LCSW	9/23/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
75685	Fee-for-Service	1255419750	1255419750	1	1	LEWIS, AARON M MD	4/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78048	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
75693	Fee-for-Service	1174554240	1174554240	1	1	LUNDERGAN, FAYE S MD	7/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76943	40	Pediatrics	0	In state provider	None	1456 PROFESSIONAL DR	STE 405	PETALUMA	CA	94954	6639	49	06097	38.25510486	-122.6336868	Sonoma County
75695	Fee-for-Service	1073210753	1073210753	1	5	LEGACY MD MEDICAL GROUP INC	7/29/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	290 MAIN ST	None	BRAWLEY	CA	92227	2351	13	06025	32.97860147	-115.5375855	Imperial County
75716	Fee-for-Service	1922268556	1922268556	1	1	LEE, KEVIN B MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	111339	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
75721	Fee-for-Service	1790451326	1790451326	1	1	LOVING HOME CARE LLC	10/21/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	13402 HOOVER STREET	None	WESTMINSTER	CA	92683	2396	30	06059	33.76777366	-117.9985066	Orange County
75733	Fee-for-Service	1285874560	1285874560	1	1	LAUREL WELLNESS AND NURSING	8/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER LLC	7509 N LAUREL AVE	None	FONTANA	CA	92336	2315	36	06071	34.117317	-117.414011	San Bernardino County
75737	Fee-for-Service	1366447781	1366447781	1	1	LAUPPE, HOLLEMBERG, AGRAWAL	11/7/1995	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	KNOLL & WARREN	250 W BONITA AVE	STE 200	POMONA	CA	91767	1850	19	06037	34.09664881	-117.751261	Los Angeles County
75739	Fee-for-Service	1558757484	1558757484	1	1	LEE, SUNG E DO	8/15/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	19626	None	None	0	In state provider	None	4955 VAN NUYS BLVD	SUITE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
75742	Fee-for-Service	1467941401	1467941401	1	1	LEE, JAEWON NP	2/18/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	30	06059	33.74496	-117.818857	Orange County
75762	Fee-for-Service	1275585424	1275585424	1	1	LINDGREN, TIBERIO MD	1/31/1986	207RH0003X	NA	Oncology	026	PHYSICIANS	39277	01	General Practice	0	In state provider	None	12751 HARBOR BLVD	None	GARDEN GROVE	CA	92840	5800	30	06059	33.77746612	-117.9151381	Orange County
75765	Fee-for-Service	1760478606	1760478606	1	1	LISING, CHRISTIAN M MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67386	08	Family Practice	0	In state provider	None	4900 PROSPECT AVE	None	YORBA LINDA	CA	92886	2128	30	06059	33.88961003	-117.8379389	Orange County
75779	Fee-for-Service	1609227636	1609227636	1	1	LADIES RECOVERY 4 LIFE	5/5/2017	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	115 NORTH D STREET	UNITS A B C	LOMPOC	CA	93436	6911	42	06083	34.6395669	-120.4528373	Santa Barbara County
75799	Fee-for-Service	1316196041	1316196041	1	1	LUNDQUIST, RYAN B MD	5/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113722	30	Radiology	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
75810	Fee-for-Service	1538240908	1538240908	1	1	LOPEZ, IRMA MD	1/17/2008	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	57022	08	Family Practice	0	In state provider	None	527 N PALM AVE	SUITE 106	ONTARIO	CA	91762	3215	36	06071	34.069059	-117.6538455	San Bernardino County
75815	Fee-for-Service	1053582452	1053582452	1	1	LURIE, LAWRENCE B MD	7/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	6540	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
75828	Fee-for-Service	1528080470	1528080470	1	11	LA CLINICA DE LA RAZA	6/24/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2131 CRESTVIEW LANE	None	PITTSBURG	CA	94565	7444	07	06013	38.01575261	-121.8930739	Contra Costa County
75863	Fee-for-Service	1336533728	1336533728	1	1	LLAURADOR CARABALLO, GABRIEL	11/1/2022	2080P0207X	NA	Hematology	026	PHYSICIANS	-	None	None	2	Out of state provider	A A MD	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
75866	Fee-for-Service	1144263997	1144263997	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1700 MISSION ST	None	SANTA CRUZ	CA	95060	4745	44	06087	36.96501237	-122.0417493	Santa Cruz County
75882	Fee-for-Service	1073210753	1073210753	1	3	LEGACY MD MEDICAL GROUP INC	4/26/2024	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	81812 DOCTOR CARREON BLV	STE E	INDIO	CA	92201	5594	33	06065	33.70742848	-116.236728	Riverside County
75912	Fee-for-Service	1376585182	1376585182	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	330 BON AIR SHOPPING CTR	None	GREENBRAE	CA	94904	3017	21	06041	37.94560457	-122.5228902	Marin County
75936	Fee-for-Service	1104844893	1104844893	1	1	LAROQUE, ELLY S MD	12/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79971	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
75945	Fee-for-Service	1578931978	1578931978	1	1	LOOP, CAROL B LCSW	6/23/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
75956	Fee-for-Service	1942225982	1942225982	1	1	LEE,ARTHUR B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2709 HEMLOCK ST	None	BREMERTON	WA	98310	0000	00	None	47.58373255	-122.6277939	Kitsap County
75980	Fee-for-Service	1073210753	1073210753	1	5	LEGACY MD MEDICAL GROUP INC	7/29/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	290 MAIN ST	None	BRAWLEY	CA	92227	2351	13	06025	32.97860147	-115.5375855	Imperial County
75982	Fee-for-Service	1649360595	1649360595	1	1	LEVIN,WENDY J MD	12/1/2000	207RH0003X	NA	Oncology	026	PHYSICIANS	72408	41	Internal Medicine	0	In state provider	None	2705 LOMA VISTA RD	None	VENTURA	CA	93003	1581	56	06111	34.27504051	-119.2600018	Ventura County
76042	Fee-for-Service	1649214198	1649214198	1	1	LEUNG, JOHN MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	81012	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
76063	Fee-for-Service	1003894841	1003894841	1	1	LENOX HEALTHCARE OF YUMA	2/10/1997	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	1	Border provider	PALM VIEW REHAB & CARE	2222 S AVENUE A	None	YUMA	AZ	85364	8315	00	None	32.68693033	-114.6333332	Yuma County
76071	Fee-for-Service	1932248630	1932248630	1	1	LARUE, DAVID ERNEST MD	6/1/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	6010	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
76099	Fee-for-Service	1538240908	1538240908	1	1	LOPEZ, IRMA MD	1/17/2008	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	57022	01	General Practice	0	In state provider	None	527 N PALM AVE	SUITE 106	ONTARIO	CA	91762	3215	36	06071	34.069059	-117.6538455	San Bernardino County
76154	Fee-for-Service	1215416102	1215416102	1	1	LUU, KAREN CNP	7/2/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
76169	Fee-for-Service	1073210753	1073210753	1	3	LEGACY MD MEDICAL GROUP INC	4/25/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	81812 DOCTOR CARREON BLV	STE E	INDIO	CA	92201	5594	33	06065	33.70742848	-116.236728	Riverside County
76207	Fee-for-Service	1972123164	1972123164	1	1	LOCKWOOD, NISHITA V MD	4/25/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
76249	Fee-for-Service	1093806382	1093806382	1	1	LAZAR, SHELLEE R MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66921	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
76265	Fee-for-Service	1598040289	1598040289	1	1	LAU, TIFFANY W C	11/7/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
76269	Fee-for-Service	1154659050	1154659050	1	1	LANKFORD, SAMANTHA C LCSW	6/12/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
76270	Fee-for-Service	1073210753	1073210753	1	5	LEGACY MD MEDICAL GROUP INC	10/16/2024	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	290 MAIN ST	None	BRAWLEY	CA	92227	2351	13	06025	32.97860147	-115.5375855	Imperial County
76285	Fee-for-Service	1548398670	1548398670	1	1	LEWIS, NATALIE A NP	2/27/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1188 N EUCLID STREET	None	ANAHEIM	CA	92801	1900	30	06059	33.850314	-117.9416115	Orange County
76329	Fee-for-Service	1497307847	1497307847	1	1	LOPEZ-COLIN, ALYSON OT	6/11/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	18700 BEACH BLVD	SUITE 120	HUNTINGTON BEACH	CA	92648	2089	30	06059	33.69070037	-117.9886896	Orange County
76353	Fee-for-Service	1184711269	1184711269	1	1	LEMERY, JOHN M MD	6/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
76366	Fee-for-Service	1730395286	1730395286	1	1	LOOMOS, DIMITRA J	12/19/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
76375	Fee-for-Service	1386220085	1386220085	1	1	LEE, JENNIFER YOUNG MIN MD	3/19/2025	208800000X	NA	Other	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
76459	Fee-for-Service	1073210753	1073210753	1	3	LEGACY MD MEDICAL GROUP INC	5/3/2024	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	81812 DOCTOR CARREON BLV	STE E	INDIO	CA	92201	5594	33	06065	33.70742848	-116.236728	Riverside County
76461	Fee-for-Service	1396835252	1396835252	1	1	LINKER, DAVID T. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	None	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
76486	Fee-for-Service	1982954103	1982954103	1	1	LEE, VIRGINIA MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122362	79	Neurology-Child	0	In state provider	None	1111 EXPOSITION BLVD	BLDG 700 STE 102	SACRAMENTO	CA	95815	4338	34	06067	38.598876	-121.4502885	Sacramento County
76493	Fee-for-Service	1710054317	1710054317	1	1	LIBED, JEANA G DPM	1/28/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	12001 W WASHINGTON BLVD	None	LOS ANGELES	CA	90066	5801	19	06037	33.99760695	-118.4228296	Los Angeles County
76527	Fee-for-Service	1538211750	1538211750	1	1	LAWRENCE, JAMES B MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39647	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1330 CUTTING BLVD	None	RICHMOND	CA	94804	2555	07	06013	37.92518651	-122.3564715	Contra Costa County
76540	Fee-for-Service	1659332872	1659332872	1	1	LAN, JIE	4/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92765	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
76543	Fee-for-Service	1093133183	1093133183	1	1	LING, CHRISTINA L MD	7/29/2020	390200000X	NA	Other	026	PHYSICIANS	140400	10	Gastroenterology (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
76556	Fee-for-Service	1699776898	1699776898	1	1	LAI-WU, LILLIAN MD	1/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82020	08	Family Practice	0	In state provider	None	1041 E YORBA LINDA BLVD	STE 5	PLACENTIA	CA	92870	3736	30	06059	33.88848865	-117.8451029	Orange County
76557	Fee-for-Service	1073210753	1073210753	1	5	LEGACY MD MEDICAL GROUP INC	10/16/2024	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	290 MAIN ST	None	BRAWLEY	CA	92227	2351	13	06025	32.97860147	-115.5375855	Imperial County
76570	Fee-for-Service	1922103654	1922103654	1	2	LIGONS, SANAA I DO	12/1/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	8792	-	NOT APPLICABLE	0	In state provider	None	1070 E RAMSEY STREET	None	BANNING	CA	92220	5924	33	06065	33.92534349	-116.8644555	Riverside County
76590	Fee-for-Service	1437346806	1437346806	1	1	LUNA-PIZANO, MARISOL S MD	2/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103473	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
76617	Fee-for-Service	1073926275	1073926275	1	1	LOPEZ, ANGELENA R MD	6/29/2018	207R00000X	NA	Other	026	PHYSICIANS	148910	41	Internal Medicine	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
76619	Fee-for-Service	1245205475	1245205475	1	1	LE, TAN K MD	12/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91924	None	None	0	In state provider	None	1001 N TUSTIN AVENUE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
76637	Fee-for-Service	1386020220	1386020220	1	1	LEIMBERG, NOVELLA LAC	7/30/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	127 HOSPITAL DR	SUITE #203	VALLEJO	CA	94589	2500	48	06095	38.13103371	-122.2387342	Solano County
76679	Fee-for-Service	1962985101	1962985101	1	1	LEE, JINNY J NP	10/17/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
76704	Fee-for-Service	1366555310	1366555310	1	1	LEWIS, REBEKAH A MD	12/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88139	08	Family Practice	0	In state provider	None	1287 FULTON RD	None	SANTA ROSA	CA	95401	4923	49	06097	38.45043	-122.7715245	Sonoma County
76707	Fee-for-Service	1134899693	1134899693	1	1	LIFE RIVER ACUPUNCTURE AND I	3/10/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	NTEGRATIVEMEDICINE INC	9711 VILLAGE CENTER DR	STE 110	GRANITE BAY	CA	95746	6493	31	06061	38.72308891	-121.2096364	Placer County
76721	Fee-for-Service	1023048469	1023048469	1	1	LAL, ASHUTOSH MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80388	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
76732	Fee-for-Service	1427671288	1427671288	1	1	LEW, CAITLYN Y OD	1/20/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
76743	Fee-for-Service	1790492205	1790492205	1	1	LEE, THERESA L CNP	12/1/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
76745	Fee-for-Service	1073210753	1073210753	1	3	LEGACY MD MEDICAL GROUP INC	3/8/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	81812 DOCTOR CARREON BLV	STE E	INDIO	CA	92201	5594	33	06065	33.70742848	-116.236728	Riverside County
76766	Fee-for-Service	1700359593	1700359593	1	1	LESSANI, KHASHAYAR	2/25/2019	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	23572 MOULTON PKWY	STE 105	LAGUNA WOODS	CA	92637	1977	30	06059	33.62066328	-117.7313635	Orange County
76794	Fee-for-Service	1770544652	1770544652	1	1	LE, TAM H MD INC	11/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	59425	None	None	0	In state provider	None	10760 WARNER AVE	STE 200	FOUNTAIN VALLEY	CA	92708	3845	30	06059	33.71627097	-117.9410205	Orange County
76870	Fee-for-Service	1780733626	1780733626	1	1	LEE, NICOLE M PT	2/9/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1535 RIVER PARK DR	STE 1000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
76895	Fee-for-Service	1134539927	1134539927	1	1	LAUNIER, KRISTEN MD	10/8/2019	390200000X	NA	Other	026	PHYSICIANS	139894	30	Radiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
76900	Fee-for-Service	1194881136	1194881136	1	1	LINGARD, PEGGY S LCSW	3/8/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	92521	3377	39	06077	38.017701	-121.297869	San Joaquin County
76904	Fee-for-Service	1588604128	1588604128	1	1	LAKSHMI MURTHY	4/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
76906	Fee-for-Service	1699966291	1699966291	1	1	LEE, JASON T MD	4/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	114377	40	Pediatrics	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
76910	Fee-for-Service	1952523482	1952523482	1	1	LEIGH, TYLER MD	7/30/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	140760	14	Neurological Surgery	0	In state provider	None	147 BRENT	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
76921	Fee-for-Service	1114377926	1114377926	1	1	LI, KEVIN J MD	8/30/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	166538	36	Psychiatry	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
76998	Fee-for-Service	1487888483	1487888483	1	1	LOGE, HILARY B MD	1/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	11379	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
77000	Fee-for-Service	1497137863	1497137863	1	1	LI, JOSEPH E MD	8/1/2019	207R00000X	NA	Other	026	PHYSICIANS	149762	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
77032	Fee-for-Service	1073210753	1073210753	1	3	LEGACY MD MEDICAL GROUP INC	9/20/2024	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	81812 DOCTOR CARREON BLV	STE E	INDIO	CA	92201	5594	33	06065	33.70742848	-116.236728	Riverside County
77037	Fee-for-Service	1760742498	1760742498	1	1	LOTFI, JUSTIN B MD	7/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128900	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
77042	Fee-for-Service	1174648661	1174648661	1	1	LIN, JUE H CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	14650 JUNIPER ST	None	SAN LEANDRO	CA	94579	1041	01	06001	37.69724706	-122.1605758	Alameda County
77079	Fee-for-Service	1295747152	1295747152	1	2	LOPEZ SOLORZA, JUAN MD	5/19/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66634	08	Family Practice	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
77085	Fee-for-Service	1609814086	1609814086	1	1	LACARRA, ANTONIO C	3/1/1994	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	18531 ROSCOE BLVD	STE 201	NORTHRIDGE	CA	91324	5976	19	06037	34.22075552	-118.5373395	Los Angeles County
77104	Fee-for-Service	1518044460	1518044460	1	1	LEE, LILY C MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	65111	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
77118	Fee-for-Service	1033363973	1033363973	1	1	LIVINGSTON, JEREMY CO	1/13/2009	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	7700 IMPERIAL HWY	#E-2	DOWNEY	CA	90242	3466	19	06037	33.92670648	-118.1580043	Los Angeles County
77151	Fee-for-Service	1578506226	1578506226	1	1	LIAT SHAMA	9/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
77164	Fee-for-Service	1942399050	1942399050	1	1	LANG, LYNN MD	5/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	68738	08	Family Practice	0	In state provider	None	1558 POOLE BLVD	None	YUBA CITY	CA	95993	2607	51	06101	39.14469453	-121.642578	Sutter County
77205	Fee-for-Service	1235143256	1235143256	1	1	LINGAM, SUCHIT K MD	9/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102775	41	Internal Medicine	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
77209	Fee-for-Service	1831299528	1831299528	1	1	LIU, CLIFFORD MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70044	41	Internal Medicine	0	In state provider	None	1182 N EUCLID ST	None	ANAHEIM	CA	92801	1900	30	06059	33.849909	-117.9416115	Orange County
77212	Fee-for-Service	1558498089	1558498089	1	1	LAVIGNA, GRANT LMFT	12/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	155 GRANADA ST	STE N	CAMARILLO	CA	93010	7866	56	06111	34.21527102	-119.0535007	Ventura County
77241	Fee-for-Service	1912432634	1912432634	1	1	LOVE TRANSIT INC	11/30/2018	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	131 N TUSTIN AVE	STE 212	TUSTIN	CA	92780	2937	30	06059	33.746526	-117.834094	Orange County
77248	Fee-for-Service	1831133669	1831133669	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3158 DANVILLE BLVD	None	ALAMO	CA	94507	1540	07	06013	37.8513514	-122.0331801	Contra Costa County
77250	Fee-for-Service	1588724157	1588724157	1	1	LEE, JOONKOO	2/24/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	711 S VERMONT AVE	STE 203	LOS ANGELES	CA	90005	1586	19	06037	34.05916557	-118.2916703	Los Angeles County
77264	Fee-for-Service	1457410102	1457410102	1	1	LUNA, TERESA MD	3/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79594	13	Neurology (M.D. only)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
77272	Fee-for-Service	1710105309	1710105309	1	1	LINDSEY, JAMES M MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108589	22	Pathology (M.D. only)	0	In state provider	None	1400 E CHURCH	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
77277	Fee-for-Service	1407433113	1407433113	1	1	LUM, BREANNA DO	9/1/2024	207R00000X	NA	Other	026	PHYSICIANS	20743	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
77321	Fee-for-Service	1518045145	1518045145	1	1	LUPTON, THOMAS D MD	10/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82801	36	Psychiatry	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
77408	Fee-for-Service	1023636156	1023636156	1	1	LASHER, SIMERDEEP K NP	7/28/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	135 CARMEN LN	None	SANTA MARIA	CA	93458	7729	42	06083	34.92484952	-120.4374645	Santa Barbara County
77414	Fee-for-Service	1235172024	1235172024	2	1	LONGS DRUG STORES CA LLC	11/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 TRAVIS BLVD	None	FAIRFIELD	CA	94533	3804	48	06095	38.25829146	-122.0358915	Solano County
77422	Fee-for-Service	1164684502	1164684502	1	1	LAW, RICHARD M MD	12/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
77425	Fee-for-Service	1073210753	1073210753	1	4	LEGACY MD MEDICAL GROUP INC	7/18/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	1699 N IMPERIAL AVE	None	EL CENTRO	CA	92243	1320	13	06025	32.808204	-115.5697505	Imperial County
77435	Fee-for-Service	1932106390	1932106390	1	1	LOEB, JOHN M MD	1/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	29097	41	Internal Medicine	0	In state provider	None	120 LA CASA VIA	STE 204	WALNUT CREEK	CA	94598	3007	07	06013	37.91202407	-122.0419227	Contra Costa County
77481	Fee-for-Service	1649732769	1649732769	1	1	LISTER, ALEXANDER DPM	8/14/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	4097 SOLAIRE DR	None	ROSEVILLE	CA	95747	8760	31	06061	38.77097254	-121.3834905	Placer County
77487	Fee-for-Service	1225042674	1225042674	1	1	LIAO, OTTO Y MD	8/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	68959	03	Allergy	0	In state provider	None	1101 E BRYAN AVE	STE B	TUSTIN	CA	92780	4401	30	06059	33.74272355	-117.8149529	Orange County
77497	Fee-for-Service	1497393904	1497393904	1	1	LEON, DICK OD	9/16/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
77526	Fee-for-Service	1639508195	1639508195	1	1	LAYOKUN, MONILOLA M NP	4/5/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
77529	Fee-for-Service	1235117268	1235117268	1	1	LANG, COLLIS H CRNA	4/11/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
77539	Fee-for-Service	1972792877	1972792877	1	1	LIAO, PATRICIA P MD	10/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85514	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
77549	Fee-for-Service	1417970567	1417970567	1	1	LOS ANGELES COUNTY OLIVE	7/1/2005	282N00000X	NA	Hospitals	060	COUNTY HOSPITAL INPATIENT	-	-	NOT APPLICABLE	0	In state provider	VIEW-UCLA MEDICAL CENTER	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	19	06037	34.32450186	-118.4456317	Los Angeles County
77558	Fee-for-Service	1194816140	1194816140	1	1	LOPEZ, EDWARD J DPM	1/3/2020	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
77564	Fee-for-Service	1770700445	1770700445	1	1	LOPEZ, CESAR A MD	9/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106798	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
77588	Fee-for-Service	1285736504	1285736504	1	1	LEAMER FAMILY CHIROPRACTIC	11/3/2006	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	INC	810 4TH STREET	None	MODESTO	CA	95351	2803	50	06099	37.63466476	-121.0041146	Stanislaus County
77639	Fee-for-Service	1497943823	1497943823	1	1	LLAMAS, KATRINA D MD	12/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109786	01	General Practice	0	In state provider	None	3733 SAN DIMAS STREET	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
77670	Fee-for-Service	1871547752	1871547752	1	1	LEE, SUSAN J MD	12/6/2007	207W00000X	NA	Ophthalmology	026	PHYSICIANS	100048	18	Ophthalmology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
77694	Fee-for-Service	1316234347	1316234347	1	1	LWIN, ZAR C MD	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137243	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
77704	Fee-for-Service	1437497963	1437497963	1	1	LEWIS, SARAH C	12/22/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
77713	Fee-for-Service	1073210753	1073210753	1	4	LEGACY MD MEDICAL GROUP INC	7/18/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1699 N IMPERIAL AVE	None	EL CENTRO	CA	92243	1320	13	06025	32.808204	-115.5697505	Imperial County
77719	Fee-for-Service	1518341791	1518341791	1	1	LEE, MELISSA C LMFT	7/26/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3650 AUBURN BLVD	C 206	SACRAMENTO	CA	95821	2082	34	06067	38.638503	-121.378518	Sacramento County
77722	Fee-for-Service	1932106390	1932106390	1	1	LOEB, JOHN M MD	1/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	29097	83	Rheumatology	0	In state provider	None	120 LA CASA VIA	STE 204	WALNUT CREEK	CA	94598	3007	07	06013	37.91202407	-122.0419227	Contra Costa County
77726	Fee-for-Service	1770899460	1770899460	1	1	LEGASSE, MATTHEW CO	4/7/2011	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	1236 N EL DORADO ST	SUITE A-C	STOCKTON	CA	95202	1324	39	06077	37.96528882	-121.293196	San Joaquin County
77761	Fee-for-Service	1336267921	1336267921	1	1	LE, JENNIFER T MD	5/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	97015	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
77767	Fee-for-Service	1932284080	1932284080	1	1	LINCARE, INC	10/1/1995	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	990 KLAMATH LN	STE 25	YUBA CITY	CA	95993	8979	51	06101	39.13992431	-121.6517328	Sutter County
77809	Fee-for-Service	1295717411	1295717411	1	1	LACEY, CAROLYN S MD	11/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131968	None	None	0	In state provider	None	1450 TREAT BLVD	SUITE 220B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
77812	Fee-for-Service	1871938597	1871938597	1	1	LEE, CHRISTINE MD	3/22/2019	207P00000X	NA	Other	026	PHYSICIANS	154937	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
77830	Fee-for-Service	1912949736	1912949736	2	1	LONGS DRUG STORES CA LLC	4/23/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	24167 PASEO DE VALENCIA	None	LAGUNA WOODS	CA	92637	3110	30	06059	33.61166633	-117.7131048	Orange County
77837	Fee-for-Service	1558518878	1558518878	1	1	LEE, SHARON MD	2/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111043	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
77877	Fee-for-Service	1770636896	1770636896	1	1	LIN, ALICE H OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ZUZAI EYEQ OPTOMETRY INC	39055 CEDAR BLVD	STE 133	NEWARK	CA	94560	5009	01	06001	37.52444585	-122.0070335	Alameda County
77891	Fee-for-Service	1548450497	1548450497	1	1	LEVISMAN, JEFFREY M MD	7/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	97382	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
77893	Fee-for-Service	1063049278	1063049278	1	1	LAWRENCE, KARINA DO	6/14/2022	1835P1300X	NA	Other	026	PHYSICIANS	19486	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
77907	Fee-for-Service	1871661926	1871661926	1	1	LING, MICHAEL C.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	98-1079 MOANALUA RD	None	AIEA	HI	96701	4713	00	None	21.38373524	-157.937629	Honolulu County
77914	Fee-for-Service	1841531803	1841531803	1	1	LINGDON DAYRIT	3/18/2013	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1816 TALON ROAD	None	ROCKLIN	CA	95765	5434	31	06061	38.82145035	-121.2708106	Placer County
77928	Fee-for-Service	1063653582	1063653582	1	1	LY, WILSON O MD	5/18/2023	207L00000X	NA	Other	026	PHYSICIANS	181380	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
77946	Fee-for-Service	1417498544	1417498544	1	1	LTG HOLDING INC	4/19/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	15152 VICTORY BLVD	None	VAN NUYS	CA	91411	1718	19	06037	34.18663148	-118.4636655	Los Angeles County
77958	Fee-for-Service	1114908910	1114908910	1	1	LUNDSTROM, LARS E DC	7/31/1992	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2686 JOHNSON DR	STE 104	VENTURA	CA	93003	7243	56	06111	34.25082161	-119.1964954	Ventura County
77959	Fee-for-Service	1326110891	1326110891	1	1	LIU, HONG LAC	12/5/2022	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3880 S BASCOM AVE	SUITE 108	SAN JOSE	CA	95124	2674	43	06085	37.25942826	-121.9471504	Santa Clara County
77968	Fee-for-Service	1710446422	1710446422	1	1	LANDEROS, PERLA M LMFT	9/6/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
77971	Fee-for-Service	1578520771	1578520771	1	1	LIN, XIANG-HONG E MD	9/28/2009	207R00000X	NA	Other	026	PHYSICIANS	69095	41	Internal Medicine	0	In state provider	X ELSIE LIN MEDICAL CORP	500 N GARFIELD AVE	STE 110	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
78002	Fee-for-Service	1073210753	1073210753	1	4	LEGACY MD MEDICAL GROUP INC	10/16/2024	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1699 N IMPERIAL AVE	None	EL CENTRO	CA	92243	1320	13	06025	32.808204	-115.5697505	Imperial County
78034	Fee-for-Service	1295883874	1295883874	1	1	LIU, SHIWEN LAC	12/29/2020	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3400 W BALL RD	101A	ANAHEIM	CA	92804	3738	30	06059	33.81724472	-118.0083216	Orange County
78042	Fee-for-Service	1255949202	1255949202	1	1	LEE RENAL CARE	10/31/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	None	None	0	In state provider	None	18370 BURBANK BLVD	STE 211	TARZANA	CA	91356	2854	19	06037	34.17173059	-118.5331881	Los Angeles County
78046	Fee-for-Service	1881242378	1881242378	1	1	LA VIDA HOME HEALTH, INC	10/14/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	348 E OLIVE AVE	STE G	BURBANK	CA	91502	1250	19	06037	34.18267998	-118.3068106	Los Angeles County
78050	Fee-for-Service	1467961565	1467961565	1	1	LAM, GEORGE	1/31/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	800 FERRARI	SUITE 200	ONTARIO	CA	91764	5031	36	06071	34.07149256	-117.5624985	San Bernardino County
78053	Fee-for-Service	1780914036	1780914036	1	1	LYDON LAM, JENNIFER R PHD	8/18/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3000 LAS POSITAS ROAD	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
78073	Fee-for-Service	1255590238	1255590238	1	1	LAGUNA CREEK OPTOMETRY	4/21/2010	193400000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5050 LAGUNA BLVD	STE 113	ELK GROVE	CA	95758	4151	34	06067	38.422071	-121.446189	Sacramento County
78103	Fee-for-Service	1003019001	1003019001	1	1	LI, BEN C MD	8/18/2010	390200000X	NA	Other	026	PHYSICIANS	111887	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
78117	Fee-for-Service	1902801889	1902801889	1	1	LOGERFO, PETER E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11025 CANYON RD E	STE A	PUYALLUP	WA	98373	4268	00	None	47.155284	-122.3571825	Pierce County
78124	Fee-for-Service	1043824204	1043824204	1	1	LEADING HOME HEALTH CARE INC	2/15/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	8444 RESEDA BLVD	STE 1	NORTHRIDGE	CA	91324	5984	19	06037	34.223922	-118.536052	Los Angeles County
78132	Fee-for-Service	1912935396	1912935396	1	1	LIEB, GARY MD	4/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51356	None	None	0	In state provider	None	888 S HILL RD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
78136	Fee-for-Service	1003839242	1003839242	1	1	LUM, MARCUS W MD	8/21/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	73347	08	Family Practice	0	In state provider	None	15625 IMPERIAL HWY	None	LA MIRADA	CA	90638	1627	19	06037	33.91736145	-117.9981225	Los Angeles County
78170	Fee-for-Service	1942282801	1942282801	1	1	LEWIS, WILLIAM R MD	1/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42881	47	Miscellaneous	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
78214	Fee-for-Service	1255520789	1255520789	1	1	LEDUC, MATTHEW L MD	12/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102952	05	Anesthesiology	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
78244	Fee-for-Service	1861435653	1861435653	2	1	LONGS DRUG STORE CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	600 F ST	None	ARCATA	CA	95521	6301	12	06023	40.86641235	-124.0855357	Humboldt County
78255	Fee-for-Service	1588692313	1588692313	1	1	LI, YIH-CHANG MD	8/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85725	05	Anesthesiology	0	In state provider	None	11632 BUTTERFIELD ST	None	LOMA LINDA	CA	92354	3956	36	06071	34.04245392	-117.2371028	San Bernardino County
78257	Fee-for-Service	1578520771	1578520771	1	1	LIN, XIANG-HONG E MD	9/28/2009	207R00000X	NA	Other	026	PHYSICIANS	69095	66	Emergency Medicine (Urgent Care)	0	In state provider	X ELSIE LIN MEDICAL CORP	500 N GARFIELD AVE	STE 110	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
78291	Fee-for-Service	1073210753	1073210753	1	4	LEGACY MD MEDICAL GROUP INC	9/20/2024	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1699 N IMPERIAL AVE	None	EL CENTRO	CA	92243	1320	13	06025	32.808204	-115.5697505	Imperial County
78316	Fee-for-Service	1740677913	1740677913	1	1	LALUZ, VICTOR R MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144200	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
78337	Fee-for-Service	1265693709	1265693709	1	1	LEMOINE, PHILIPPE H MD APC	6/13/2012	208G00000X	NA	General Surgery	026	PHYSICIANS	79758	33	Thoracic Surgery	0	In state provider	None	1010 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	5929	19	06037	33.886314	-118.395912	Los Angeles County
78339	Fee-for-Service	1023628344	1023628344	1	1	LIFE & HOPE HOME HEALTH CARE	8/28/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1807 W GLENOAKS BLVD	STE 203	GLENDALE	CA	91201	4741	19	06037	34.17285625	-118.2918788	Los Angeles County
78443	Fee-for-Service	1609309368	1609309368	1	1	LEONG, MICHELLE N DO	3/12/2024	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	21547	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
78447	Fee-for-Service	1821627753	1821627753	1	1	LOWE, ANGELA MD	11/15/2023	207QA0505X	NA	Adult Primary Care	026	PHYSICIANS	185897	None	None	0	In state provider	None	18133 VENTURA BLVD	204 & 402	TARZANA	CA	91335	0000	19	06037	34.1657808	-118.5283188	Los Angeles County
78457	Fee-for-Service	1023646999	1023646999	1	1	LIU, CONAN S MD	9/5/2023	207R00000X	NA	Other	026	PHYSICIANS	176715	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
78462	Fee-for-Service	1467526780	1467526780	1	1	LASSLO, RICHARD G MD	7/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81021	41	Internal Medicine	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
78464	Fee-for-Service	1851602270	1851602270	1	1	LIU-BARBARO, DOROTHY MD	4/14/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	115342	36	Psychiatry	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
78489	Fee-for-Service	1235634676	1235634676	1	1	LAMA, DANIEL J MD	4/6/2023	208800000X	NA	Other	026	PHYSICIANS	184669	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
78532	Fee-for-Service	1982653085	1982653085	1	1	LINTON DALE M	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	32442	41	Internal Medicine	0	In state provider	None	925 E SAN ANTONIO DR	None	LONG BEACH	CA	90807	2210	19	06037	33.83838926	-118.1823231	Los Angeles County
78533	Fee-for-Service	1467419788	1467419788	1	1	LEE, LYDIA K MD	12/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52897	15	Obstetrics (D.O. only)	0	In state provider	None	8700 BEVERLY BLVD	#3611	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
78541	Fee-for-Service	1265820435	1265820435	1	1	LIU, JENNIFER A	3/18/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
78550	Fee-for-Service	1013924356	1013924356	1	1	LEBISCHAK, CAROL MD	9/11/2023	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	183232	None	None	0	In state provider	None	815 POLLARD	None	LOS GATOS	CA	95032	1438	43	06085	37.26214754	-121.9701986	Santa Clara County
78577	Fee-for-Service	1073210753	1073210753	1	4	LEGACY MD MEDICAL GROUP INC	7/18/2024	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1699 N IMPERIAL AVE	None	EL CENTRO	CA	92243	1320	13	06025	32.808204	-115.5697505	Imperial County
78611	Fee-for-Service	1710983358	1710983358	1	1	LEE, SUSAN W MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84653	78	Neoplastic Diseases/Oncology	0	In state provider	None	5151 F ST	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
78629	Fee-for-Service	1023250917	1023250917	1	1	LOWE, ALARICE C MD	8/29/2019	207ZP0101X	NA	Other	026	PHYSICIANS	104353	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
78643	Fee-for-Service	1477891448	1477891448	1	1	LIN, IRIS OT	12/5/2018	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3002 DOW AVE STE 114	None	TUSTIN	CA	92780	7247	30	06059	33.70954889	-117.8043627	Orange County
78663	Fee-for-Service	1356903454	1356903454	1	1	LAKELI PHARMACY GROUP INC	11/15/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	88 S PALM AVE	None	ALHAMBRA	CA	91801	3101	19	06037	34.08954907	-118.1465308	Los Angeles County
78672	Fee-for-Service	1740708163	1740708163	1	1	LOISELLE, FANAY LMFT	9/2/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	601 E YORBA LINDA BLVD.	SUITE 2	PLACENTIA	CA	92870	3006	30	06059	33.88937165	-117.8544856	Orange County
78674	Fee-for-Service	1770657249	1770657249	1	1	LEW, DEBORAH M	8/21/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	69113	05	Anesthesiology	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
78689	Fee-for-Service	1275606261	1275606261	1	1	LAU, ERIC B MD	6/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	70371	40	Pediatrics	0	In state provider	None	2840 LONG BEACH BLVD	STE 315	LONG BEACH	CA	90806	1589	19	06037	33.808743	-118.189341	Los Angeles County
78702	Fee-for-Service	1790857506	1790857506	1	1	LEE, ELISA S MD	3/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
78777	Fee-for-Service	1871683920	1871683920	1	1	LEE, WILLIAM B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	888 S KING ST	None	HONOLULU	HI	96813	3009	00	None	21.30218603	-157.8505732	Honolulu County
78781	Fee-for-Service	1508853896	1508853896	1	1	LEE, CRYSTINE M MD	1/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	65187	41	Internal Medicine	0	In state provider	None	4000 CIVIC CENTER DR	None	SAN RAFAEL	CA	94903	4171	21	06041	38.0041783	-122.538861	Marin County
78801	Fee-for-Service	1013362391	1013362391	1	1	LI, FREDERICK MD	10/1/2020	207L00000X	NA	Other	026	PHYSICIANS	168284	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
78804	Fee-for-Service	1306845847	1306845847	1	1	LEE, ARTHUR A MD	9/30/1983	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	47732	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
78870	Fee-for-Service	1629022553	1629022553	1	1	LATIF, SHAHID MD	8/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129435	None	None	0	In state provider	None	18280 SISKYOU RD	None	APPLE VALLEY	CA	92307	1413	36	06071	34.5445115	-117.2648745	San Bernardino County
78901	Fee-for-Service	1710983358	1710983358	1	1	LEE, SUSAN W MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84653	30	Radiology	0	In state provider	None	5151 F ST	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
78908	Fee-for-Service	1053741280	1053741280	1	1	LAI, ELSON MD APC	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116241	18	Ophthalmology	0	In state provider	None	9428 VALLEY BLVD	SUITE 201	ROSEMEAD	CA	91770	1514	19	06037	34.0811223	-118.0635319	Los Angeles County
78916	Fee-for-Service	1871120725	1871120725	1	1	LOFFTUS, SERENA Y	11/29/2022	208600000X	NA	General Surgery	026	PHYSICIANS	179595	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
78955	Fee-for-Service	1104094036	1104094036	1	1	LIBERTY DIALYSIS-SPARKS LLC	5/22/2012	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	None	5915 S LOS ALTOS PARKWAY	None	SPARKS	NV	89436	2506	00	None	39.56495637	-119.7039924	Washoe County
78970	Fee-for-Service	1801214861	1801214861	1	1	LADUE, TYLER L MD	8/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157015	01	General Practice	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
78981	Fee-for-Service	1346510484	1346510484	1	1	LOUIE MEDICAL GROUP, INC	1/7/2013	208800000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5365 WALNUT AVE	STE P	CHINO	CA	91710	2622	36	06071	34.02626051	-117.6883155	San Bernardino County
79011	Fee-for-Service	1568855187	1568855187	1	1	LEWIS, CRISTI M	3/9/2016	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	577 E ELDER ST	SUITE H	FALLBROOK	CA	92028	3079	37	06073	33.3801147	-117.2456536	San Diego County
79039	Fee-for-Service	1457772675	1457772675	1	1	LIVINGCARE HOSPICE INC	2/25/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8560 VINEYARD AVE	STE 516	RANCHO CUCAMONGA	CA	91730	4350	36	06071	34.098435	-117.611127	San Bernardino County
79048	Fee-for-Service	1649910589	1649910589	1	1	LUIS ALESANDRO LARRAZABAL MA	10/3/2022	103T00000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	ROUP	4153 24TH STREET	4	SAN FRANCISCO	CA	94114	3614	38	06075	37.75120501	-122.4352246	San Francisco County
79067	Fee-for-Service	1437193885	1437193885	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4424 TREAT BLVD	None	CONCORD	CA	94521	2704	07	06013	37.96281338	-121.9936995	Contra Costa County
79078	Fee-for-Service	1336646165	1336646165	1	1	LOW, WESLEY PT	10/15/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
79099	Fee-for-Service	1457360935	1457360935	1	1	LEWIS, ALAN MD	7/1/1996	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	23314	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
79102	Fee-for-Service	1275194201	1275194201	1	1	LIMANSKIY, VIKTOR MD	3/1/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178728	None	None	0	In state provider	None	1235 W VINE ST	None	LODI	CA	95240	5144	39	06077	38.12279179	-121.2879362	San Joaquin County
79110	Fee-for-Service	1992310106	1992310106	1	1	LEUNG, ERIC OD	2/2/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 W VALLEY BLVD	STE 115	SAN GABRIEL	CA	91776	3784	19	06037	34.07958215	-118.1021957	Los Angeles County
79124	Fee-for-Service	1396190237	1396190237	1	1	LAROYA, JONATHAN MD	11/24/2019	207P00000X	NA	Other	026	PHYSICIANS	151131	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
79130	Fee-for-Service	1598736779	1598736779	1	1	LANE, CHRISTOPHER T MD	7/25/2006	146D00000X	NA	Other	026	PHYSICIANS	61513	02	General Surgery	0	In state provider	None	999 N TUSTIN AVE	STE 109	SANTA ANA	CA	92705	6504	30	06059	33.754167	-117.834191	Orange County
79147	Fee-for-Service	1023377637	1023377637	1	1	LOWERY, MARY A MD	7/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51566	41	Internal Medicine	0	In state provider	None	901 OAK PARK BLVD	STE 101	PISMO BEACH	CA	93449	3409	40	06079	35.13460775	-120.6050814	San Luis Obispo County
79169	Fee-for-Service	1528277688	1528277688	1	1	LEE, MICHAEL J MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	106425	41	Internal Medicine	0	In state provider	None	1169 W RAMSEY ST	None	BANNING	CA	92220	4443	33	06065	33.92545045	-116.8894845	Riverside County
79176	Fee-for-Service	1396490090	1396490090	1	1	LEUNG, ANDREA W LMFT	5/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
79177	Fee-for-Service	1972933430	1972933430	1	1	LARKIN, JESSICA PT	7/18/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2636 CHURN CREEK RD	STE A	REDDING	CA	96002	1167	45	06089	40.569165	-122.3531255	Shasta County
79183	Fee-for-Service	1679589923	1679589923	1	1	LAM, KEVLIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 SQUALICUM PKWY	None	BELLINGHAM	WA	98225	1851	00	None	48.77211992	-122.473101	Whatcom County
79234	Fee-for-Service	1184760969	1184760969	1	1	LEUNG, MAN KONG MD	2/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74902	13	Neurology (M.D. only)	0	In state provider	None	4466 BLACK AVE	STE A	PLEASANTON	CA	94566	6130	01	06001	37.67215489	-121.8770294	Alameda County
79292	Fee-for-Service	1316938301	1316938301	1	3	LODI MEMORIAL HOSPITAL	1/1/2013	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5179	39	06077	38.12188356	-121.285872	San Joaquin County
79305	Fee-for-Service	1861635013	1861635013	1	1	LYDIA S GLASS PHD PSYCHOLOGI	5/22/2024	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	CAL & MEDIATION SERVIC	200 E DEL MAR BLVD	STE 210	PASADENA	CA	91105	2551	19	06037	34.14047497	-118.1464685	Los Angeles County
79307	Fee-for-Service	1770526949	1770526949	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1201 W MAIN ST	STE 14	RIPON	CA	95366	3027	39	06077	37.73951848	-121.136625	San Joaquin County
79327	Fee-for-Service	1932682283	1932682283	1	1	LANG, TIFFANI LCSW	7/5/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	315 WALL STREET	SUITE 5	CHICO	CA	95926	2820	04	06007	39.73003453	-121.8382886	Butte County
79328	Fee-for-Service	1457772675	1457772675	1	1	LIVINGCARE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8560 VINEYARD AVE	STE 516	RANCHO CUCAMONGA	CA	91730	4350	36	06071	34.098435	-117.611127	San Bernardino County
79334	Fee-for-Service	1255394516	1255394516	1	1	LLOYD, DAVID J MD	7/8/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	55262	05	Anesthesiology	0	In state provider	None	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	36	06071	34.1268333	-117.2705634	San Bernardino County
79337	Fee-for-Service	1649910589	1649910589	1	1	LUIS ALESANDRO LARRAZABAL MA	10/11/2023	103T00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ROUP	4153 24TH STREET	4	SAN FRANCISCO	CA	94114	3614	38	06075	37.75120501	-122.4352246	San Francisco County
79406	Fee-for-Service	1396254439	1396254439	1	1	LAFRANCE, CYNTHIA LMFT	11/5/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1300 SHAW	SUITE 109	FRESNO	CA	93710	7917	10	06019	36.80872147	-119.765979	Fresno County
79473	Fee-for-Service	1821151143	1821151143	1	1	LY, DOMINIQUE M NP	8/2/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
79506	Fee-for-Service	1548298532	1548298532	1	1	LOS ANGELES LGBT CENTER	7/2/2009	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1625 SCHRADER BLVD	FL 3	LOS ANGELES	CA	90028	6213	19	06037	34.100523	-118.3324855	Los Angeles County
79521	Fee-for-Service	1588740096	1588740096	1	1	LALWANI, SUNITA MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73509	41	Internal Medicine	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
79526	Fee-for-Service	1376621979	1376621979	1	1	LASKOWSKA, GIZELA M MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60873	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
79545	Fee-for-Service	1033278692	1033278692	1	1	LONDONO, COLLEEN M MD	1/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77405	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
79548	Fee-for-Service	1639161243	1639161243	1	1	LEE, KENNETH T MD	1/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97229	33	Thoracic Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
79561	Fee-for-Service	1982256392	1982256392	1	1	LOUNEY, KELLY CCC-SLP	12/21/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3416 AMERICAN RIVER DR S	None	SACRAMENTO	CA	95864	5753	34	06067	38.569212	-121.3840755	Sacramento County
79584	Fee-for-Service	1619052388	1619052388	1	1	LEO, EDMUN W MD	2/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61123	40	Pediatrics	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
79594	Fee-for-Service	1598876070	1598876070	1	1	LEONG, FREDERIC J MD	3/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	71490	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	5400 BALBOA BLVD	STE 202	ENCINO	CA	91316	1529	19	06037	34.169283	-118.501072	Los Angeles County
79624	Fee-for-Service	1649910589	1649910589	1	1	LUIS ALESANDRO LARRAZABAL MA	6/1/2024	103T00000X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	ROUP	4153 24TH STREET	4	SAN FRANCISCO	CA	94114	3614	38	06075	37.75120501	-122.4352246	San Francisco County
79626	Fee-for-Service	1972583490	1972583490	1	1	LEE, STEVEN S MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67457	41	Internal Medicine	0	In state provider	None	1127 WILSHIRE BLVD # 600	None	LOS ANGELES	CA	90095	0001	19	06037	34.05270508	-118.2641005	Los Angeles County
79668	Fee-for-Service	1275553653	1275553653	1	1	LICKNESS, DANNY L MD	11/5/1997	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	44986	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	100 CASA ST	STE B	SAN LUIS OBISPO	CA	93405	8803	40	06079	35.29273885	-120.6647926	San Luis Obispo County
79673	Fee-for-Service	1215342175	1215342175	1	1	LAUREL CANYON DIALYSIS LLC	4/8/2015	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	8987 LAUREL CANYON BLVD	None	SUN VALLEY	CA	91352	1732	19	06037	34.23281262	-118.4046583	Los Angeles County
79724	Fee-for-Service	1376586123	1376586123	2	1	LONGS DRUG STORE CAL LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4400 LATROBE RD	None	EL DORADO HILLS	CA	95762	6704	09	06017	38.64576145	-121.0682559	El Dorado County
79733	Fee-for-Service	1932212206	1932212206	1	1	LIZZUL, PAUL F MD	8/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96670	07	Dermatology	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
79747	Fee-for-Service	1689842882	1689842882	1	1	LIN, RAYMOND R MD	3/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115164	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
79750	Fee-for-Service	1154077683	1154077683	1	1	LIN, JUNG HSUAN MARISA PT	5/6/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1135 S SUNSET AVE	SUITE 101	WEST COVINA	CA	91790	3938	19	06037	34.06215064	-117.9453997	Los Angeles County
79754	Fee-for-Service	1144714874	1144714874	1	1	LERNER, SHANI MD	3/27/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	178075	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
79776	Fee-for-Service	1114011566	1114011566	1	1	LOGVIN, MARK R MD	12/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	97020	41	Internal Medicine	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
79792	Fee-for-Service	1548298532	1548298532	1	1	LOS ANGELES LGBT CENTER	7/2/2009	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1625 SCHRADER BLVD	FL 3	LOS ANGELES	CA	90028	6213	19	06037	34.100523	-118.3324855	Los Angeles County
79793	Fee-for-Service	1922054493	1922054493	1	2	LOMA LINDA FAMILY MED GR	6/14/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC	25455 BARTON RD	STE 201A	LOMA LINDA	CA	92354	3173	36	06071	34.04805253	-117.249534	San Bernardino County
79803	Fee-for-Service	1952414179	1952414179	1	1	LIM, LILIAN E A MD	5/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	657 TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
79807	Fee-for-Service	1366466740	1366466740	1	1	LEE, CHANG-NIN TERENCE	10/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	74495	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
79837	Fee-for-Service	1639161243	1639161243	1	1	LEE, KENNETH T MD	1/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97229	02	General Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
79864	Fee-for-Service	1184651101	1184651101	1	1	LAWRENCE, DAVID M MD	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	40485	22	Pathology (M.D. only)	0	In state provider	None	3701 SOUTH HIGUERA ST	None	SAN LUIS OBISPO	CA	93401	7462	40	06079	35.2507845	-120.6712168	San Luis Obispo County
79879	Fee-for-Service	1134153695	1134153695	1	1	LINCARE, INC	3/25/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	LINCARE, INC	1380 GREG STREET	SUITE 201	SPARKS	NV	89431	6069	00	None	39.52341171	-119.7606089	Washoe County
79907	Fee-for-Service	1275640864	1275640864	1	1	LO, VINCENT C MD	11/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52099	08	Family Practice	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
79912	Fee-for-Service	1649910589	1649910589	1	1	LUIS ALESANDRO LARRAZABAL MA	10/3/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ROUP	4153 24TH STREET	4	SAN FRANCISCO	CA	94114	3614	38	06075	37.75120501	-122.4352246	San Francisco County
79943	Fee-for-Service	1447243365	1447243365	1	1	LEONG, IDA G MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38441	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
79964	Fee-for-Service	1043229693	1043229693	1	1	LEE, SIMON Y MD	1/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89711	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
79971	Fee-for-Service	1972528172	1972528172	1	1	LEON, EDUARDO	11/1/2000	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1127 WILSHIRE BLVD	STE 901	LOS ANGELES	CA	90017	3910	19	06037	34.05270508	-118.2641005	Los Angeles County
79990	Fee-for-Service	1295019669	1295019669	1	1	LA WELLNESS HEALTH CARE INC	7/27/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5652 VINELAND AVE	SUITE 202A	NORTH HOLLYWOOD	CA	91601	2061	19	06037	34.17374219	-118.3702596	Los Angeles County
80010	Fee-for-Service	1073210753	1073210753	1	6	LEGACY MD MEDICAL GROUP INC	10/16/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	690 OTAY LAKES RD	125	CHULA VISTA	CA	91910	8904	37	06073	32.6476566	-117.0042986	San Diego County
80041	Fee-for-Service	1154364487	1154364487	2	1	LONGS DRUG STORES CA LLC	12/8/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2116 SOUTH BROADWAY	None	SANTA MARIA	CA	93454	7812	42	06083	34.922259	-120.435903	Santa Barbara County
80069	Fee-for-Service	1669082095	1669082095	1	1	LIAUW, SHANNON L CNP	4/20/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	19353 VICTORY BLVD	None	RESEDA	CA	91335	6302	19	06037	34.18659936	-118.5552114	Los Angeles County
80092	Fee-for-Service	1295165538	1295165538	1	1	LOVE CARE HOSPICE AND	5/8/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE SERVICES INC	2070 BUSINESS CENTER DR	STE 105	IRVINE	CA	92612	1112	30	06059	33.67891303	-117.8564293	Orange County
80121	Fee-for-Service	1417317512	1417317512	1	1	LI, DAVID PT	4/17/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
80134	Fee-for-Service	1003443235	1003443235	1	1	LUI, BRANDON	11/9/2023	207R00000X	NA	Other	026	PHYSICIANS	20964	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
80144	Fee-for-Service	1205440708	1205440708	1	1	LONG, KEVIN R PT	9/29/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11930 HERITAGE OAKS PL	STE 8 & 9	AUBURN	CA	95603	0000	31	06061	38.94059662	-121.0995593	Placer County
80150	Fee-for-Service	1164467205	1164467205	1	3	LIN AND WILSON RADIOLOGY	5/16/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	42	Nuclear Medicine	0	In state provider	MEDICAL GROUP, INC	3731 S PLAZA DR	None	SANTA ANA	CA	92704	7463	30	06059	33.69869705	-117.8887031	Orange County
80154	Fee-for-Service	1992149538	1992149538	1	1	LE, AMY T DO	8/29/2023	207P00000X	NA	Other	026	PHYSICIANS	20478	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
80169	Fee-for-Service	1194924381	1194924381	1	1	LEE, EDWARD S MD	8/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91810	05	Anesthesiology	0	In state provider	None	1798 NORTH GAREY AVENUE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
80172	Fee-for-Service	1699846501	1699846501	1	1	LAM, NAM K MD	12/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65273	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
80265	Fee-for-Service	1215967385	1215967385	1	1	LEE, JASON C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	81235	05	Anesthesiology	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
80277	Fee-for-Service	1013095686	1013095686	1	1	LE, ANH H MD	1/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92720	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
80297	Fee-for-Service	1073210753	1073210753	1	6	LEGACY MD MEDICAL GROUP INC	10/16/2024	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	690 OTAY LAKES RD	125	CHULA VISTA	CA	91910	8904	37	06073	32.6476566	-117.0042986	San Diego County
80298	Fee-for-Service	1346310083	1346310083	1	1	LAM, NAOMI K MD	2/14/2008	2084P0800X	NA	Psychiatry	026	PHYSICIANS	69652	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	0001	38	06075	37.76344756	-122.4581992	San Francisco County
80306	Fee-for-Service	1518367986	1518367986	1	1	LOPEZ, EVANGELINA M LCSW	6/18/2021	171M00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
80335	Fee-for-Service	1518931757	1518931757	1	1	LIN, CAROL MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104087	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
80336	Fee-for-Service	1104106392	1104106392	1	1	LUIZ, JESSICA B PSYD	8/6/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5665 COLLEGE AVENUE	SUITE 240D	OAKLAND	CA	93704	2303	01	06001	37.84429616	-122.2518174	Alameda County
80344	Fee-for-Service	1396505202	1396505202	1	1	LUMBA, CHERRYLEE V CNP	2/12/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95029773	-	NOT APPLICABLE	0	In state provider	None	125 WEST F ST	SUITE 101	ONTARIO	CA	91762	3201	36	06071	34.069302	-117.652158	San Bernardino County
80359	Fee-for-Service	1841303419	1841303419	1	1	LIM, ROSEMARIE S MD	2/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51827	41	Internal Medicine	0	In state provider	RSLCHEST CLIN A MED CORP	502 EUCLID AVE	STE 304	NATIONAL CITY	CA	91950	8900	37	06073	32.68505421	-117.0832793	San Diego County
80362	Fee-for-Service	1790951754	1790951754	1	1	LYNWOOD UNIFIED SCH DIST	10/30/2005	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	11321 BULLIS RD	None	LYNWOOD	CA	90262	3666	19	06037	33.92632011	-118.2000103	Los Angeles County
80379	Fee-for-Service	1295165538	1295165538	1	1	LOVE CARE HOSPICE AND	5/8/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE SERVICES INC	2070 BUSINESS CENTER DR	STE 105	IRVINE	CA	92612	1112	30	06059	33.67891303	-117.8564293	Orange County
80397	Fee-for-Service	1487188629	1487188629	1	1	LEE, JASON	1/17/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	157810	None	None	0	In state provider	None	14860 ROSCOE BLVD	#200	PANORAMA CITY	CA	91402	4683	19	06037	34.2214515	-118.4573205	Los Angeles County
80425	Fee-for-Service	1396979050	1396979050	1	1	LEE, KATHERINA K J MD	9/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132817	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
80433	Fee-for-Service	1831161132	1831161132	1	1	LOPEZ, ELENA R MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149479	01	General Practice	0	In state provider	None	17095 MAIN ST	None	HESPERIA	CA	92345	6004	36	06071	34.41984761	-117.2904344	San Bernardino County
80440	Fee-for-Service	1164467205	1164467205	1	3	LIN AND WILSON RADIOLOGY	5/16/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP, INC	3731 S PLAZA DR	None	SANTA ANA	CA	92704	7463	30	06059	33.69869705	-117.8887031	Orange County
80451	Fee-for-Service	1497035869	1497035869	1	1	LARUE, PENNE M LMFT	7/23/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
80457	Fee-for-Service	1528074176	1528074176	1	1	LANGSFELD, MARK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
80458	Fee-for-Service	1942663166	1942663166	1	1	LEE, DAVID R MD	10/11/2019	208M00000X	NA	Other	026	PHYSICIANS	152391	41	Internal Medicine	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
80465	Fee-for-Service	1255408100	1255408100	1	1	LERNER, THOMAS H MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	50589	40	Pediatrics	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
80515	Fee-for-Service	1619004165	1619004165	1	1	LACUESTA, VALERIE N	5/5/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
80539	Fee-for-Service	1417230327	1417230327	1	1	LIU, SARIAH S MD	5/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117639	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
80559	Fee-for-Service	1689619900	1689619900	1	1	LEE, MARCUS F MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43348	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3890 N CEDAR AVE	None	FRESNO	CA	93726	5269	10	06019	36.78833977	-119.7542073	Fresno County
80577	Fee-for-Service	1699799023	1699799023	1	1	LAKSHMAN, SHANKAR MD	7/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91704	24	Plastic Surgery	0	In state provider	None	300 WEST HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
80585	Fee-for-Service	1073210753	1073210753	1	6	LEGACY MD MEDICAL GROUP INC	10/16/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	690 OTAY LAKES RD	125	CHULA VISTA	CA	91910	8904	37	06073	32.6476566	-117.0042986	San Diego County
80595	Fee-for-Service	1629330030	1629330030	1	1	LI, SARA W Y PHD	10/4/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
80615	Fee-for-Service	1861149163	1861149163	1	1	LOOKINGBILL, LINDSAY B LMFT	11/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
80619	Fee-for-Service	1033740758	1033740758	1	1	LIFE SOURCE HOSPICE INC	10/15/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6819 SEPULVEDA BLVD	SUITE 209	VAN NUYS	CA	91405	4440	19	06037	34.194564	-118.4662195	Los Angeles County
80621	Fee-for-Service	1558582866	1558582866	1	1	LENSKY, MARK MD	12/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86838	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
80648	Fee-for-Service	1841303419	1841303419	1	1	LIM, ROSEMARIE S MD	2/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51827	66	Emergency Medicine (Urgent Care)	0	In state provider	RSLCHEST CLIN A MED CORP	502 EUCLID AVE	STE 304	NATIONAL CITY	CA	91950	8900	37	06073	32.68505421	-117.0832793	San Diego County
80695	Fee-for-Service	1124528047	1124528047	1	1	LITTEN, AMANDA MAY OT	4/16/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7737 MEANY AVE	B5-7	BAKERSFIELD	CA	93308	5266	15	06029	35.39423549	-119.0882835	Kern County
80697	Fee-for-Service	1235305939	1235305939	1	1	LEHOUX, JUAN M MD	12/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	3006 S MARYLAND PKWY	STE 690	LAS VEGAS	NV	89109	2297	00	None	36.135288	-115.1368705	Clark County
80705	Fee-for-Service	1477631026	1477631026	1	1	LOWE, STEPHANIE C MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60226	40	Pediatrics	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
80721	Fee-for-Service	1063418358	1063418358	1	1	LOCKEN, JULIE A MD	11/12/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	5250 NEIL RD	STE 103	RENO	NV	89502	6546	00	None	39.47416458	-119.7784756	Washoe County
80727	Fee-for-Service	1962487025	1962487025	1	1	LIM, MICHELE C MD	9/5/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61445	18	Ophthalmology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
80736	Fee-for-Service	1285605923	1285605923	1	1	LI, XIAODONG MD	4/17/2002	207L00000X	NA	Other	026	PHYSICIANS	78734	05	Anesthesiology	0	In state provider	None	21530 PIONEER BLVD	None	HAWAIIAN GARDENS	CA	90716	2608	19	06037	33.83358457	-118.0817796	Los Angeles County
80787	Fee-for-Service	1396820056	1396820056	1	1	LIAO, XIANG MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75401	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
80841	Fee-for-Service	1891053187	1891053187	1	1	LO, SUNNY DO	7/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13069	01	General Practice	0	In state provider	None	3833 WORSHAM AVE	STE 300	LONG BEACH	CA	90808	1766	19	06037	33.828552	-118.1462755	Los Angeles County
80845	Fee-for-Service	1982884219	1982884219	1	1	LOW, MERVIN MD	2/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	85140	24	Plastic Surgery	0	In state provider	None	863 N DOUGLAS STREET	SUITE 100	EL SEGUNDO	CA	90245	2081	19	06037	33.92830583	-118.3831669	Los Angeles County
80847	Fee-for-Service	1689619900	1689619900	1	1	LEE, MARCUS F MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43348	01	General Practice	0	In state provider	None	3890 N CEDAR AVE	None	FRESNO	CA	93726	5269	10	06019	36.78833977	-119.7542073	Fresno County
80858	Fee-for-Service	1093150864	1093150864	1	1	LIM, CATHRIN H MD	7/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126266	01	General Practice	0	In state provider	None	1451 IRVINE BLVD	None	TUSTIN	CA	92780	3804	30	06059	33.74507677	-117.8047636	Orange County
80874	Fee-for-Service	1073210753	1073210753	1	6	LEGACY MD MEDICAL GROUP INC	10/16/2024	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	690 OTAY LAKES RD	125	CHULA VISTA	CA	91910	8904	37	06073	32.6476566	-117.0042986	San Diego County
80878	Fee-for-Service	1225350200	1225350200	1	1	LICHT, AMNON MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32682	41	Internal Medicine	0	In state provider	None	9808 VENICE BLVD	SUITE 706	CULVER CITY	CA	90232	6827	19	06037	34.0236396	-118.3980847	Los Angeles County
80883	Fee-for-Service	1083275952	1083275952	1	1	LANG, PAUL MD	6/5/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	181391	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
80906	Fee-for-Service	1033740758	1033740758	1	1	LIFE SOURCE HOSPICE INC	10/15/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6819 SEPULVEDA BLVD	SUITE 209	VAN NUYS	CA	91405	4440	19	06037	34.194564	-118.4662195	Los Angeles County
80914	Fee-for-Service	1710145040	1710145040	1	1	LEE, MAYSENG MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101852	05	Anesthesiology	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
80916	Fee-for-Service	1376160358	1376160358	1	1	LIVING ANGELS HOSPICE CARE	9/13/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4959 PALO VERDE ST	STE 208C-1	MONTCLAIR	CA	91763	2360	36	06071	34.08129954	-117.6966135	San Bernardino County
80936	Fee-for-Service	1841303419	1841303419	1	1	LIM, ROSEMARIE S MD	2/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51827	29	Pulmonary Diseases (M.D. only)	0	In state provider	RSLCHEST CLIN A MED CORP	502 EUCLID AVE	STE 304	NATIONAL CITY	CA	91950	8900	37	06073	32.68505421	-117.0832793	San Diego County
80983	Fee-for-Service	1336337542	1336337542	1	1	LITTENBERG, GLENN MD INC	7/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	27849	10	Gastroenterology (M.D. only)	0	In state provider	None	630 S RAYMOND AVE	#240	PASADENA	CA	91105	3283	19	06037	34.13505223	-118.1487761	Los Angeles County
80985	Fee-for-Service	1235305939	1235305939	1	1	LEHOUX, JUAN M MD	12/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	3006 S MARYLAND PKWY	STE 690	LAS VEGAS	NV	89109	2297	00	None	36.135288	-115.1368705	Clark County
80998	Fee-for-Service	1730142571	1730142571	1	1	LIU, GEORGE MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102815	05	Anesthesiology	0	In state provider	None	2420 CAMINO RAMON	STE 270	SAN RAMON	CA	94583	4319	07	06013	37.77229042	-121.9634581	Contra Costa County
81001	Fee-for-Service	1295514263	1295514263	1	1	LOZANO- GIRAL, DAVID MD	11/25/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	B- 254	LOS ANGELES	CA	90095	7065	19	06037	34.06482757	-118.4443441	Los Angeles County
81036	Fee-for-Service	1912062753	1912062753	1	1	LAVERTY, DAVID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1313 RED RIV	STE 200	AUSTIN	TX	78701	1900	00	None	30.2737258	-97.73497936	Travis County
81048	Fee-for-Service	1548646011	1548646011	1	1	LIN, BRUCE HORNG J MD PC	6/14/2016	193400000X	NA	Other	026	PHYSICIANS	88657	None	None	0	In state provider	None	1174 CASTRO STREET	SUITE 200	MOUNTAIN VIEW	CA	94040	2569	43	06085	37.3822628	-122.0861276	Santa Clara County
81057	Fee-for-Service	1144389891	1144389891	1	1	LIN, ABLERT J MD	12/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86839	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
81071	Fee-for-Service	1467443499	1467443499	1	1	LAVERSON, STEVE MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	53607	24	Plastic Surgery	0	In state provider	None	15644 POMERADO RD	STE D	POWAY	CA	92064	2400	37	06073	32.99717879	-117.0579379	San Diego County
81072	Fee-for-Service	1265515290	1265515290	1	1	LI, HO-YIN A MD	2/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	50572	None	None	0	In state provider	None	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	39	06077	37.744011	-121.4349725	San Joaquin County
81102	Fee-for-Service	1518616127	1518616127	1	1	LOPEZ, CHRISTINE PT	10/16/2023	2251P0200X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25467 MEDICAL CENTER DR	100	MURRIETA	CA	92562	1501	33	06065	33.55711632	-117.1860368	Riverside County
81127	Fee-for-Service	1619069838	1619069838	1	1	LIU, ZUNE H MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	61726	41	Internal Medicine	0	In state provider	None	18395 COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	2749	19	06037	33.9884853	-117.9044348	Los Angeles County
81134	Fee-for-Service	1265591853	1265591853	1	1	LUBAVIN, BORIS V MD	1/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81982	None	None	0	In state provider	None	2776 PACIFIC AVE	None	LONG BEACH	CA	90806	2613	19	06037	33.80692698	-118.1936915	Los Angeles County
81167	Fee-for-Service	1639198534	1639198534	1	1	LEE, DAVID MD	12/4/1986	207RN0300X	NA	Nephrology	026	PHYSICIANS	25266	45	Nephrology (Renal-Kidney)	0	In state provider	None	10833 LE CONTE AVE	BLDG 32	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
81203	Fee-for-Service	1376160358	1376160358	1	1	LIVING ANGELS HOSPICE CARE	9/13/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4959 PALO VERDE ST	STE 208C-1	MONTCLAIR	CA	91763	2360	36	06071	34.08129954	-117.6966135	San Bernardino County
81211	Fee-for-Service	1710506779	1710506779	1	1	LITWIN, LIAT M MD	7/31/2024	208M00000X	NA	Other	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
81222	Fee-for-Service	1225265614	1225265614	1	1	LIN, KAREN S MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116960	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
81237	Fee-for-Service	1740397223	1740397223	1	1	LALAJI, ROOPAL P PHD	11/18/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	95438	2310	01	06001	37.55102172	-121.9759026	Alameda County
81248	Fee-for-Service	1558570150	1558570150	1	1	LU, JIN-JOU MD	4/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41229	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	11180 WARNER AVE	STE 461	FOUNTAIN VALLEY	CA	92708	7505	30	06059	33.71632048	-117.9334575	Orange County
81251	Fee-for-Service	1013956671	1013956671	1	2	LAWRENCE, ALLEN L MD	10/3/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	22501	-	NOT APPLICABLE	0	In state provider	None	8330 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4619	19	06037	34.221609	-118.5360405	Los Angeles County
81269	Fee-for-Service	1235305939	1235305939	1	1	LEHOUX, JUAN M MD	12/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	33	Thoracic Surgery	1	Border provider	None	3006 S MARYLAND PKWY	STE 690	LAS VEGAS	NV	89109	2297	00	None	36.135288	-115.1368705	Clark County
81273	Fee-for-Service	1528080470	1528080470	1	1	LA CLINICA DE LA RAZA	1/1/2000	261QD0000X	NA	Dental Clinic	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	PITTSBURG-DENTAL	335 E LELAND RD	None	PITTSBURG	CA	94565	4911	07	06013	38.01141905	-121.8875255	Contra Costa County
81286	Fee-for-Service	1134232598	1134232598	1	1	LIN, JAMES A MD	7/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82380	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
81301	Fee-for-Service	1356319651	1356319651	1	1	LAGOC, RAILEEN C MD INC	9/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	72405	40	Pediatrics	0	In state provider	None	1832 BUENAVENTURA BLVD	STE B	REDDING	CA	96001	3700	45	06089	40.55644085	-122.3971882	Shasta County
81308	Fee-for-Service	1871575142	1871575142	1	1	LEISEROWITZ, GARY S MD	1/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	40780	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	999 S FAIRMONT AVE	SUITE 330	LODI	CA	95240	5142	39	06077	38.1206163	-121.2858323	San Joaquin County
81328	Fee-for-Service	1083792584	1083792584	1	1	LOTSCH, RICHARD C DO	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7837	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5176 HILL RD E	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
81363	Fee-for-Service	1982983565	1982983565	2	1	LEE, JOHN J MD	1/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122378	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
81366	Fee-for-Service	1497717292	1497717292	2	1	LITVINOFF, JEROME S MD	4/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	20193	14	Neurological Surgery	0	In state provider	None	6536 CRYSTALAIRE DRIVE	None	SAN DIEGO	CA	92160	1910	37	06073	32.78902098	-117.0562752	San Diego County
81367	Fee-for-Service	1013277342	1013277342	1	1	LYOU, YUNG MD	8/1/2018	207RX0202X	NA	Oncology	026	PHYSICIANS	132485	68	Hematology	0	In state provider	None	3650 E SOUTH ST	STE 212	LAKEWOOD	CA	90712	1528	19	06037	33.8601747	-118.1494013	Los Angeles County
81375	Fee-for-Service	1467226373	1467226373	1	1	LEE, BLAINE ROBERT C NP	12/18/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
81376	Fee-for-Service	1093751216	1093751216	1	1	LIN, MITCHELL MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79695	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
81380	Fee-for-Service	1528340320	1528340320	1	1	LESCALE, SHADAI A LCSW	6/16/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
81387	Fee-for-Service	1710117262	1710117262	1	1	LAMB, JUDY D PHD	12/10/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8775 AERO DRIVE	STE 238	SAN DIEGO	CA	92123	1756	37	06073	32.80965551	-117.1391563	San Diego County
81402	Fee-for-Service	1144523820	1144523820	1	1	LORINE, KIM-HA N PHD	6/7/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
81417	Fee-for-Service	1053355404	1053355404	2	1	LONGS DRUG STORE CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4959 MARCONI AVE	None	CARMICHAEL	CA	95608	4112	34	06067	38.61873	-121.3475265	Sacramento County
81425	Fee-for-Service	1902121544	1902121544	1	1	LING, TED C MD	9/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117954	None	None	0	In state provider	None	18280 SISKIYOU RD	None	APPLE VALLEY	CA	92307	1413	36	06071	34.5445115	-117.2648745	San Bernardino County
81453	Fee-for-Service	1639198534	1639198534	1	1	LEE, DAVID MD	12/4/1986	207RN0300X	NA	Nephrology	026	PHYSICIANS	25266	41	Internal Medicine	0	In state provider	None	10833 LE CONTE AVE	BLDG 32	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
81459	Fee-for-Service	1871152645	1871152645	1	1	LIU, YU HSIN MD	10/18/2022	207R00000X	NA	Other	026	PHYSICIANS	178741	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
81460	Fee-for-Service	1528457496	1528457496	1	1	LIN, BRIAN MD	10/5/2020	207L00000X	NA	Other	026	PHYSICIANS	147342	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
81490	Fee-for-Service	1952479032	1952479032	1	1	LEHRMAN, GINI LCSW	11/22/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
81497	Fee-for-Service	1245318922	1245318922	1	1	LAWSON, MICHAEL J MD	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48665	10	Gastroenterology (M.D. only)	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
81504	Fee-for-Service	1457905143	1457905143	1	1	LIU, EMILY OD	5/25/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11940 E. FOOTHILL BLVD	103	RANCHO CUCAMONGA	CA	91739	9375	36	06071	34.10646853	-117.544239	San Bernardino County
81510	Fee-for-Service	1023704046	1023704046	1	1	LEE, SO HEE CRNA	6/27/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
81524	Fee-for-Service	1497517973	1497517973	1	1	LEISURE GROVE LLC	11/25/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	413 E CYPRESS STREET	None	GLENDALE	CA	91205	3334	19	06037	34.12950079	-118.2505899	Los Angeles County
81538	Fee-for-Service	1558570150	1558570150	1	1	LU, JIN-JOU MD	4/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41229	41	Internal Medicine	0	In state provider	None	11180 WARNER AVE	STE 461	FOUNTAIN VALLEY	CA	92708	7505	30	06059	33.71632048	-117.9334575	Orange County
81560	Fee-for-Service	1528080470	1528080470	1	1	LA CLINICA DE LA RAZA	1/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	PITTSBURG-DENTAL	335 E LELAND RD	None	PITTSBURG	CA	94565	4911	07	06013	38.01141905	-121.8875255	Contra Costa County
81588	Fee-for-Service	1912784695	1912784695	1	1	LYNCH, JACOB PT	12/22/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
81595	Fee-for-Service	1871575142	1871575142	1	1	LEISEROWITZ, GARY S MD	1/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	40780	08	Family Practice	0	In state provider	None	999 S FAIRMONT AVE	SUITE 330	LODI	CA	95240	5142	39	06077	38.1206163	-121.2858323	San Joaquin County
81615	Fee-for-Service	1790935310	1790935310	1	1	LOZANO, DONNA R	5/22/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14500 ROSCOE BLVD	STE 400	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
81642	Fee-for-Service	1063454882	1063454882	2	1	LONGS DRUG STORES CA LLC	11/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5685 BALBOA AVE	None	SAN DIEGO	CA	92111	2705	37	06073	32.82011911	-117.1787049	San Diego County
81654	Fee-for-Service	1184093817	1184093817	1	1	LUNDQUIST INSTITUTE FOR BIOM	2/27/2017	293D00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1124 WEST CARSON ST	N-33	TORRANCE	CA	90502	2006	19	06037	33.83154152	-118.2954105	Los Angeles County
81706	Fee-for-Service	1720571318	1720571318	1	1	LEE, JENNIFER MD	12/22/2023	207P00000X	NA	Other	026	PHYSICIANS	178341	None	None	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
81729	Fee-for-Service	1043558653	1043558653	1	1	LIU, SHANGLEI MD	9/29/2020	208C00000X	NA	General Surgery	026	PHYSICIANS	128073	02	General Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
81750	Fee-for-Service	1013913300	1013913300	1	1	LIFELONG MEDICAL CARE	11/1/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1860 ALCATRAZ AVE	None	BERKELEY	CA	94703	2715	01	06001	37.84890801	-122.2698934	Alameda County
81795	Fee-for-Service	1922054493	1922054493	1	1	LOMA LINDA FAMILY MED GR	1/10/1990	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC	25455 BARTON RD	STE 204B	LOMA LINDA	CA	92354	3172	36	06071	34.04805253	-117.249534	San Bernardino County
81815	Fee-for-Service	1528707148	1528707148	1	1	LANG, KATHLEEN M PT	6/1/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7551 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
81826	Fee-for-Service	1114540143	1114540143	1	1	LEDEZMA, AMANCAY	4/18/2023	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1140 MANGROVE AVE	STE D	CHICO	CA	95926	3500	04	06007	39.74217522	-121.8384743	Butte County
81855	Fee-for-Service	1003808486	1003808486	1	1	LOUIS SAMUELS LIBBY MD	10/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1111 NE 99TH AVE	STE 200	PORTLAND	OR	97220	9442	00	None	45.53099912	-122.562389	Multnomah County
81861	Fee-for-Service	1285044008	1285044008	1	1	LEE, BENSON DO	12/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14681	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
81863	Fee-for-Service	1942611785	1942611785	1	1	LOPEZ, BRYAN G MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141083	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
81886	Fee-for-Service	1457467490	1457467490	1	1	LI-REPAC, DIANA PHD	10/9/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5674 STONERIDGE DR	STE 217	PLEASANTON	CA	94588	8500	01	06001	37.69154862	-121.8891352	Alameda County
81896	Fee-for-Service	1609951961	1609951961	1	1	LEE, KAREN E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	43807	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	12395 EL CAMINO REAL	STE 207	SAN DIEGO	CA	92130	3084	37	06073	32.94324259	-117.2396525	San Diego County
81904	Fee-for-Service	1952661985	1952661985	1	1	LOWENBERG-LIN, IRIS R NP	4/15/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
81938	Fee-for-Service	1588111587	1588111587	1	1	LEON, STEPHEN O NP	4/15/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
82012	Fee-for-Service	1831210442	1831210442	1	1	LOYA, CHRISTINE M LMFT	3/12/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	255 TERRACINA BLVD	SUITE 204	REDLANDS	CA	92373	4870	36	06071	34.03788441	-117.2055761	San Bernardino County
82018	Fee-for-Service	1548574056	1548574056	1	1	LA FAMILIA MEDICAL GROUP INC	7/6/2011	207R00000X	NA	Other	026	PHYSICIANS	24174	41	Internal Medicine	0	In state provider	None	6433 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4627	19	06037	34.01540058	-118.1334165	Los Angeles County
82040	Fee-for-Service	1013913300	1013913300	1	1	LIFELONG MEDICAL CARE	11/1/1992	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1860 ALCATRAZ AVE	None	BERKELEY	CA	94703	2715	01	06001	37.84890801	-122.2698934	Alameda County
82045	Fee-for-Service	1528324597	1528324597	1	1	LEE, EDWARD R MD	6/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148709	04	Otology, Laryngology, Rhinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
82094	Fee-for-Service	1356314868	1356314868	1	1	LIZER, GREGORY MD	10/1/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60165	40	Pediatrics	0	In state provider	None	1346 FOOTHILL BLVD	STE 201	LA CANADA	CA	91011	2143	19	06037	34.20780552	-118.2076252	Los Angeles County
82096	Fee-for-Service	1245632504	1245632504	1	1	LIBERSHTEYN, YEVGENIYA OD	4/27/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
82097	Fee-for-Service	1629682505	1629682505	1	1	LANUM, GABRIEL LMFT	3/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	225 AVENUE I	STE 204	REDONDO BEACH	CA	90277	5608	19	06037	33.81905278	-118.3864232	Los Angeles County
82126	Fee-for-Service	1124772314	1124772314	1	1	LYNN, SEAN LMFT	9/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1200 AVIATION BLVD	STE 102	REDONDO BEACH	CA	90278	4063	19	06037	33.86558294	-118.386439	Los Angeles County
82128	Fee-for-Service	1558449645	1558449645	1	1	LEE, HYUN MD	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84302	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
82144	Fee-for-Service	1174978977	1174978977	1	1	LO, KELLY K MD	7/1/2019	207R00000X	NA	Other	026	PHYSICIANS	156547	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
82162	Fee-for-Service	1568680601	1568680601	1	1	LEMUS, ERIKA LCSW	11/19/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
82169	Fee-for-Service	1710030994	1710030994	1	1	LOPES CUNHA, GARY J LMFT	5/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
82170	Fee-for-Service	1255307484	1255307484	1	1	LIND, CHRISTINE E MD	1/1/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	56889	08	Family Practice	0	In state provider	None	1516 MAIN ST	STE 104	RAMONA	CA	92065	5242	37	06073	33.03747003	-116.8767366	San Diego County
82177	Fee-for-Service	1588960538	1588960538	1	1	LIN, JAMIE C MD	6/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114710	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	711 W COLLEGE STREET	SUITE M88	LOS ANGELES	CA	90012	1246	19	06037	34.06541412	-118.2414102	Los Angeles County
82208	Fee-for-Service	1285619296	1285619296	1	1	LAKSHMINARAYANAN, RENUKA	11/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85598	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
82225	Fee-for-Service	1669817607	1669817607	1	1	LEIBOW, MICHAEL S PSYD	8/15/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	954 WEST FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	36	06071	34.10675048	-117.6646365	San Bernardino County
82269	Fee-for-Service	1689105124	1689105124	1	1	LIPSYC-SHARF, MARLA D MD	9/8/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	188807	None	None	0	In state provider	None	15503 VENTURA BLVD	150, 170	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
82280	Fee-for-Service	1952384968	1952384968	1	1	LONDON, JASON A MD	3/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67458	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
82331	Fee-for-Service	1548286453	1548286453	1	1	LIU, RICHARD M MD	2/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134084	04	Otology, Laryngology, Rhinology	0	In state provider	None	5565 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3021	37	06073	32.77978322	-117.0094766	San Diego County
82332	Fee-for-Service	1649791906	1649791906	1	1	LEE, WHAYOUNG MD	5/3/2021	390200000X	NA	Other	026	PHYSICIANS	164493	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
82334	Fee-for-Service	1306890389	1306890389	1	2	LOS ROBLES HOSPITAL	7/5/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	865 PATRIOT DRIVE	STE 100	MOORPARK	CA	93021	3407	56	06111	34.27758343	-118.8663357	Ventura County
82352	Fee-for-Service	1538590336	1538590336	1	1	LEE, SEUNG WON	1/8/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	20212 REDWOOD RD	104	CASTRO VALLEY	CA	94546	4324	01	06001	37.698066	-122.073924	Alameda County
82361	Fee-for-Service	1063656411	1063656411	1	1	LOGAN, ASHA T MD	10/7/2009	207R00000X	NA	Other	026	PHYSICIANS	104352	41	Internal Medicine	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
82375	Fee-for-Service	1649711821	1649711821	1	1	LANE, JENNIFER E MD	6/9/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	184250	None	None	0	In state provider	None	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
82403	Fee-for-Service	1669775110	1669775110	1	1	LONGS DRUG STORES CA LLC	4/21/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4028 LONE TREE AVE	None	ANTIOCH	CA	94509	4908	07	06013	37.98088403	-121.8056513	Contra Costa County
82406	Fee-for-Service	1205841087	1205841087	1	1	LATUNO, DENIS H MD	1/1/1994	174400000X	NA	Other	026	PHYSICIANS	52598	41	Internal Medicine	0	In state provider	None	43860 10TH ST W	None	LANCASTER	CA	93534	4848	19	06037	34.68010255	-118.1478903	Los Angeles County
82412	Fee-for-Service	1356501100	1356501100	1	1	LEE, DONG HEUN MD	6/5/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	168056	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
82429	Fee-for-Service	1023096914	1023096914	1	1	LAMMERT, GARY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	36 KLONDIKE RD	None	REPUBLIC	WA	99166	9701	00	None	48.65329167	-118.7314003	Ferry County
82475	Fee-for-Service	1578024725	1578024725	1	1	LICHTARGE, RYAN N MD	12/30/2022	207P00000X	NA	Other	026	PHYSICIANS	179244	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
82480	Fee-for-Service	1720337728	1720337728	1	1	LEE, STACY P MSW LCSW	11/8/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	74873	-	NOT APPLICABLE	0	In state provider	None	1965 LIVE OAK BLVD	None	YUBA CITY	CA	95991	8828	51	06101	39.15563037	-121.620091	Sutter County
82487	Fee-for-Service	1942389093	1942389093	1	1	LAU, EUNICE W MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69526	25	Physical Medicine and Rehabilitation	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
82516	Fee-for-Service	1194354225	1194354225	1	1	LEININGER, KURT M MD	9/14/2024	390200000X	NA	Other	026	PHYSICIANS	176758	05	Anesthesiology	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
82518	Fee-for-Service	1417480856	1417480856	1	1	LITTLE, ANTHONY R	6/15/2021	207L00000X	NA	Other	026	PHYSICIANS	162803	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
82568	Fee-for-Service	1770035024	1770035024	1	1	LANDMARK ANESTHESIA MEDICAL	12/9/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	GROUP	3630 EAST IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
82571	Fee-for-Service	1871646679	1871646679	1	1	LEDERHAUS, DISNEY &	5/3/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	255 E BONITA AVE	BLDG 9	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
82576	Fee-for-Service	1356506372	1356506372	1	1	LAURENCE, BRETT R MD	8/8/2012	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	120426	77	Infectious Disease	0	In state provider	None	77 CADILLAC DR	STE 210	SACRAMENTO	CA	95825	5480	34	06067	38.572551	-121.4181585	Sacramento County
82604	Fee-for-Service	1881836229	1881836229	1	1	LEE, MICHELLE MD	10/2/2019	208200000X	NA	General Surgery	026	PHYSICIANS	154156	24	Plastic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
82605	Fee-for-Service	1336428424	1336428424	2	1	LIVING SPINAL LLC	2/7/2015	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	7340 TRADE STREET	SUITE F	SAN DIEGO	CA	92121	2457	37	06073	32.8900117	-117.1637358	San Diego County
82624	Fee-for-Service	1306424957	1306424957	1	1	LIN, PETER MD	10/29/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	11420 WARNER AVE.	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
82641	Fee-for-Service	1619025426	1619025426	2	1	LOPEZ, DANIEL P MD	7/8/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	62426	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	625 34TH STREET	STE 100 & 200	BAKERSFIELD	CA	93301	2305	15	06029	35.39046051	-119.0092725	Kern County
82677	Fee-for-Service	1326006024	1326006024	1	1	LAKE, JEFFREY P MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	73315	02	General Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
82709	Fee-for-Service	1477505238	1477505238	1	1	LEONI, PATRICK A MD	8/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	57533	22	Pathology (M.D. only)	0	In state provider	None	3301 C STREET	SUITE 200-E	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
82755	Fee-for-Service	1962730325	1962730325	1	1	LIN, CAROL A MD	9/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106313	20	Orthopedic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
82764	Fee-for-Service	1639580228	1639580228	1	1	LAWSON, CHARLOTTE C MD	8/14/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
82771	Fee-for-Service	1851687610	1851687610	1	1	LE, YNHU T T MD	12/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150017	41	Internal Medicine	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
82795	Fee-for-Service	1942662093	1942662093	1	1	LIDSTONE, PAVEN K MD	8/4/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	161149	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
82818	Fee-for-Service	1144412446	1144412446	1	1	LEE, JENNIFER M DPM	2/23/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5020 COMMERCE DR	None	BAKERSFIELD	CA	93309	0631	15	06029	35.36787086	-119.0579597	Kern County
82829	Fee-for-Service	1538488002	1538488002	1	1	LIBBY, TIFFANY N LMFT	7/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27412 ENTERPRISE CIR W	STE. 205	TEMECULA	CA	92590	4875	33	06065	33.51594134	-117.1669025	Riverside County
82831	Fee-for-Service	1669735916	1669735916	1	1	LOUISELL, JAMES A MD	8/14/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	124140	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1595 SOQUEL DR	STE 400	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
82836	Fee-for-Service	1528019205	1528019205	1	1	LUTSKY, ZACHARY H MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84668	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
82855	Fee-for-Service	1770035024	1770035024	1	1	LANDMARK ANESTHESIA MEDICAL	5/25/2017	193400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP	3630 EAST IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
82876	Fee-for-Service	1790850790	1790850790	1	1	LINCARE, INC	9/23/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	LINCARE, INC	2515 SO. AVE. 2 1/2 EAST	STE 3	YUMA	AZ	85365	2556	00	None	32.681862	-114.5899125	Yuma County
82898	Fee-for-Service	1962543710	1962543710	1	1	LASSEN SURGERY CENTER	5/31/2012	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	103 FAIR DRIVE	None	SUSANVILLE	CA	96130	4201	18	06035	40.41378774	-120.6380058	Lassen County
82917	Fee-for-Service	1437597499	1437597499	1	1	LIU, ABBY Y MD	7/24/2017	207W00000X	NA	Ophthalmology	026	PHYSICIANS	148630	18	Ophthalmology	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
82928	Fee-for-Service	1922369230	1922369230	1	1	LAROE, CHRISTIAN O MD	6/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127420	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
82929	Fee-for-Service	1447560339	1447560339	1	1	LUGOD-MANALAD, MARY ANN M NP	7/14/2011	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	310 SANTA FE DR	STE 112	ENCINITAS	CA	92024	5182	37	06073	33.038406	-117.285354	San Diego County
82933	Fee-for-Service	1639792690	1639792690	1	1	LEE, ANTHONY T MD	9/25/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
82989	Fee-for-Service	1396066676	1396066676	1	1	LEONG, JASMINE K MD	12/23/2010	207R00000X	NA	Other	026	PHYSICIANS	67304	41	Internal Medicine	0	In state provider	PROFESSIONAL CORPORATION	1280 CORONA POINTE CT	STE 118	CORONA	CA	92879	1770	33	06065	33.87039079	-117.5408442	Riverside County
82995	Fee-for-Service	1811952328	1811952328	1	1	LE, DUNG T MD	2/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85641	08	Family Practice	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
83011	Fee-for-Service	1497044358	1497044358	1	1	LEYKIN, YAN PHD	2/21/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
83044	Fee-for-Service	1700461167	1700461167	1	1	LET'S PLAY PEDIATRIC PHYSICA	6/7/2021	2251P0200X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	L THERAPY, INC.	550 CAMINO EL ESTERO	SUITE 203	MONTEREY	CA	93940	3231	27	06053	36.59696562	-121.8887928	Monterey County
83062	Fee-for-Service	1528421898	1528421898	1	1	LIMAYE, MANEESHA R MD	8/8/2024	2080P0203X	NA	Other	026	PHYSICIANS	153155	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
83113	Fee-for-Service	1396767729	1396767729	1	2	LU, JOHN S MD	11/1/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45810	40	Pediatrics	0	In state provider	None	500 N. GARFIELD AVE.	SUITE 202	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
83233	Fee-for-Service	1821050048	1821050048	2	1	LEHRBURGER, GERALD MD	6/22/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	280 MAPLE	None	ASHLAND	OR	97520	1552	00	None	42.20644248	-122.724936	Jackson County
83313	Fee-for-Service	1336826403	1336826403	1	1	LAURA LUGO, LICENSED MARRIAG	8/23/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	945 WESTWIND DR	None	EL CENTRO	CA	92243	4365	13	06025	32.77755399	-115.5629306	Imperial County
83314	Fee-for-Service	1255490959	1255490959	1	1	LINESES, ROBERT S CRNA	10/26/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
83372	Fee-for-Service	1043253214	1043253214	2	1	LONGS DRUG STORES CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10350 FRIARS RD.	None	SAN DIEGO	CA	92120	2303	37	06073	32.791031	-117.0987856	San Diego County
83382	Fee-for-Service	1639297153	1639297153	2	1	LEE, GLORIA E	10/28/2016	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	520 S VIRGIL AVE	STE 305	LOS ANGELES	CA	90020	1425	19	06037	34.064487	-118.2870305	Los Angeles County
83400	Fee-for-Service	1619368081	1619368081	1	1	LESSMAN, RICHARD K MD INC	8/17/2015	207RN0300X	NA	Nephrology	026	PHYSICIANS	23840	41	Internal Medicine	0	In state provider	None	227 W JANSS ROAD	SUITE 110	THOUSAND OAKS	CA	91360	1848	56	06111	34.20611691	-118.883861	Ventura County
83410	Fee-for-Service	1649367186	1649367186	1	1	LOMA LINDA UNIV MEDICAL	11/1/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	LOMA LINDA UNIV COM PHA	25455 BARTON RD	STE 111A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
83417	Fee-for-Service	1942817804	1942817804	1	1	LA VISTA HEALTH	10/20/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1111 GRAND AVENUE	UNIT L	DIAMOND BAR	CA	91765	4171	19	06037	34.00172352	-117.813184	Los Angeles County
83461	Fee-for-Service	1083972426	1083972426	1	1	LIU, CORINNA Y H MD	8/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13154	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2210 E ILLINOIS	SUITE 206	FRESNO	CA	93701	2167	10	06019	36.74500687	-119.7846885	Fresno County
83469	Fee-for-Service	1649205733	1649205733	1	1	LIKAR, LAURA L MD	6/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87140	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	700 FREDERICK ST	STE 203	SANTA CRUZ	CA	95062	2239	44	06087	36.98031434	-122.004438	Santa Cruz County
83493	Fee-for-Service	1538542576	1538542576	1	1	LISKIN, LIZ S LMFT	9/18/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17326 EDWARD ROAD	None	CERRITOS	CA	90703	2444	19	06037	33.87401441	-118.0344613	Los Angeles County
83531	Fee-for-Service	1326402975	1326402975	1	1	LAM, CRYSTAL MD	8/17/2020	207L00000X	NA	Other	026	PHYSICIANS	168983	05	Anesthesiology	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
83543	Fee-for-Service	1033771845	1033771845	1	1	LINK MEDICAL TRANSPORT LLC	8/27/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	4500 SHEPARD STREET	B4	BAKERSFIELD	CA	93311	2334	15	06029	35.314551	-119.0583825	Kern County
83558	Fee-for-Service	1043578354	1043578354	1	1	LION, ELIZABETH T MD	10/12/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	151952	40	Pediatrics	0	In state provider	None	4240 HIGHLAND AVE	None	HIGHLAND	CA	92346	2764	36	06071	34.13583752	-117.194355	San Bernardino County
83615	Fee-for-Service	1245773225	1245773225	1	1	LEGACY EMANUEL HOSPITAL & HE	12/15/2022	273R00000X	NA	Other	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	ALTH CENTER	1225 NE 2ND AVE	None	PORTLAND	OR	97232	2003	00	None	45.53179918	-122.6637358	Multnomah County
83640	Fee-for-Service	1043530694	1043530694	1	1	LOCKE, ERICA A MD	7/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137301	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 E ROMIE LANE	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
83650	Fee-for-Service	1255416236	1255416236	1	1	LIU, YI Y MD	7/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	65470	08	Family Practice	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
83662	Fee-for-Service	1912633207	1912633207	1	1	LINCOLN HEIGHTS DIALYSIS	1/17/2024	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER LLC	1833 JOHNSTON STREET	None	LOS ANGELES	CA	90031	3446	19	06037	34.06551337	-118.2103	Los Angeles County
83684	Fee-for-Service	1568852622	1568852622	1	1	L.I.F.E LASTING INCOME	3/16/2015	No Taxonomy Provided	NA	None	095	PRIVATE NON-PROFIT PROPRIETARY AGENCY	-	-	NOT APPLICABLE	0	In state provider	FOR ELDERLY	5591 LAUREL RIDGE LANE	None	CAMARILLO	CA	93012	5530	56	06111	34.22865154	-118.9918237	Ventura County
83685	Fee-for-Service	1578843793	1578843793	1	1	LUND, KRISTA S DO	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	10616	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
83689	Fee-for-Service	1619368081	1619368081	1	1	LESSMAN, RICHARD K MD INC	8/17/2015	207RN0300X	NA	Nephrology	026	PHYSICIANS	23840	45	Nephrology (Renal-Kidney)	0	In state provider	None	227 W JANSS ROAD	SUITE 110	THOUSAND OAKS	CA	91360	1848	56	06111	34.20611691	-118.883861	Ventura County
83698	Fee-for-Service	1124581442	1124581442	1	1	LEE, CHRISTINE J MD	5/17/2024	208M00000X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
83713	Fee-for-Service	1235133737	1235133737	1	1	LAMBERT, EMILY D MD	11/30/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	76290	40	Pediatrics	0	In state provider	None	2800 HARRIS ST	None	EUREKA	CA	95503	4809	12	06023	40.78047245	-124.1361392	Humboldt County
83720	Fee-for-Service	1427052851	1427052851	1	1	LEYENSON, VADIM MD FAAP	9/4/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	154059	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	95 MONTGOMERY DR	104	SANTA ROSA	CA	95404	6630	49	06097	38.442357	-122.704641	Sonoma County
83721	Fee-for-Service	1033299037	1033299037	1	1	LONGSTRETH, WILLIAM T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	HARBORVIEW MEDICAL CTR	325 9TH AVE	C/O UWP MS 359110	SEATTLE	WA	98104	0000	00	None	47.60414369	-122.3235136	King County
83727	Fee-for-Service	1699901397	1699901397	1	1	LIN, STEVEN D MD	12/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107998	46	Hand Surgery	0	In state provider	None	440 STEVEN AVE	STE 150	SOLANA BEACH	CA	92075	2058	37	06073	32.99189435	-117.2615865	San Diego County
83739	Fee-for-Service	1588645048	1588645048	1	1	LAI, MARIA E MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73439	08	Family Practice	0	In state provider	None	8881 FLETCHER PKWY	STE 105	LA MESA	CA	91942	3132	37	06073	32.78442148	-117.0073814	San Diego County
83758	Fee-for-Service	1649205733	1649205733	1	1	LIKAR, LAURA L MD	6/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87140	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 FREDERICK ST	STE 203	SANTA CRUZ	CA	95062	2239	44	06087	36.98031434	-122.004438	Santa Cruz County
83777	Fee-for-Service	1265061774	1265061774	1	1	LIANG, CARMIN J DO	7/11/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21103	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
83794	Fee-for-Service	1801208707	1801208707	1	1	LEE, ERIC J DO	9/10/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17215	08	Family Practice	0	In state provider	None	1514 VALLEY VISTA DR	None	DIAMOND BAR	CA	91765	3929	19	06037	33.99491668	-117.8399137	Los Angeles County
83815	Fee-for-Service	1639849136	1639849136	1	1	LOPEZ, MICHELE MSW LCSW	6/10/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
83827	Fee-for-Service	1225273386	1225273386	1	1	LEES, SHANNON E	4/21/2009	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5395 RUFFIN RD	SUITE 102	SAN DIEGO	CA	92123	1338	37	06073	32.832387	-117.1266225	San Diego County
83829	Fee-for-Service	1275715955	1275715955	1	1	LEWIS, COLLEEN LMFT	2/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
83864	Fee-for-Service	1346510575	1346510575	1	1	LIU, LUCY H MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134583	01	General Practice	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
83877	Fee-for-Service	1669953030	1669953030	1	1	LIGOTSKI, BRIANNA R PT	7/4/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
83882	Fee-for-Service	1346088671	1346088671	1	1	LAMBERT-FLISZAR, FRANCISCA	3/13/2025	207RR0500X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	MD	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
83902	Fee-for-Service	1245773225	1245773225	1	1	LEGACY EMANUEL HOSPITAL & HE	12/15/2022	273R00000X	NA	Other	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	ALTH CENTER	1225 NE 2ND AVE	None	PORTLAND	OR	97232	2003	00	None	45.53179918	-122.6637358	Multnomah County
83918	Fee-for-Service	1487737862	1487737862	1	1	LIU, DAVE D CA	2/8/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2388 35TH AVE	STE 201	SAN FRANCISCO	CA	94116	2243	38	06075	37.74254747	-122.4928105	San Francisco County
83924	Fee-for-Service	1972957728	1972957728	1	1	LYON, ANNE H MD	5/22/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	155089	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
83930	Fee-for-Service	1043530694	1043530694	1	1	LOCKE, ERICA A MD	7/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137301	01	General Practice	0	In state provider	None	450 E ROMIE LANE	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
83938	Fee-for-Service	1518082411	1518082411	1	1	LUMA, JAYSON A MD	12/10/2019	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
83945	Fee-for-Service	1740696483	1740696483	1	1	LYNETTE VONDAL NP	3/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 3RD AVE SW	None	MINOT	ND	58701	3880	00	None	48.23336909	-101.2951165	Ward County
83971	Fee-for-Service	1568852622	1568852622	1	1	L.I.F.E LASTING INCOME	3/16/2015	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	FOR ELDERLY	5591 LAUREL RIDGE LANE	None	CAMARILLO	CA	93012	5530	56	06111	34.22865154	-118.9918237	Ventura County
83982	Fee-for-Service	1881290435	1881290435	1	1	LEE, VIVIAN E PT	7/21/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
84014	Fee-for-Service	1629010459	1629010459	2	1	LONGS DRUG STORES CA LLC	12/26/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1285 LINCOLN AVE	None	SAN JOSE	CA	95125	3016	43	06085	37.30515468	-121.8987321	Santa Clara County
84021	Fee-for-Service	1386663185	1386663185	1	1	LEE, WOO S	8/28/2014	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	85330	None	None	0	In state provider	None	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
84022	Fee-for-Service	1356369946	1356369946	1	1	LITWIN, MARK S MD	10/25/1995	208800000X	NA	Other	026	PHYSICIANS	70266	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
84025	Fee-for-Service	1104811827	1104811827	1	1	LAU, LETITIA D MD	4/29/1999	207L00000X	NA	Other	026	PHYSICIANS	67331	05	Anesthesiology	0	In state provider	None	1040 W TOWN AND COUNTRY	None	ORANGE	CA	92868	4716	30	06059	33.77652153	-117.862461	Orange County
84085	Fee-for-Service	1538181482	1538181482	1	7	LA CLINICA DE LA RAZA INC	12/23/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1146 LACEY LANE	None	CONCORD	CA	94520	4225	07	06013	37.955265	-122.0449418	Contra Costa County
84090	Fee-for-Service	1548695554	1548695554	1	1	LOU, PEK Y OD	9/12/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 E HERNDON AVE	STE 301	FRESNO	CA	93720	3326	10	06019	36.83744648	-119.7646425	Fresno County
84098	Fee-for-Service	1508018508	1508018508	1	1	LENG, LEWIS Z MD	7/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124672	13	Neurology (M.D. only)	0	In state provider	None	2100 WEBSTER ST	SUITE 115	SAN FRANCISCO	CA	94115	2374	38	06075	37.7904826	-122.4324477	San Francisco County
84107	Fee-for-Service	1821590514	1821590514	1	1	LEE, ADAM C MD	6/24/2020	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
84148	Fee-for-Service	1700171436	1700171436	1	1	LAM, CHRISTINA NP	11/5/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5755 OBERLIN DR	SUITE 100	SAN DIEGO	CA	92121	4715	37	06073	32.89290908	-117.1944873	San Diego County
84173	Fee-for-Service	1346088671	1346088671	1	1	LAMBERT-FLISZAR, FRANCISCA	3/13/2025	207RR0500X	NA	Other	026	PHYSICIANS	None	83	Rheumatology	0	In state provider	MD	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
84226	Fee-for-Service	1376617787	1376617787	1	1	LAM, TAYLOR V OD	7/5/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GARVEY OPTOMETRY	10012 GARVEY AVE	STE 12	EL MONTE	CA	91733	2087	19	06037	34.06270848	-118.050633	Los Angeles County
84248	Fee-for-Service	1164586764	1164586764	1	1	LE, DEAN ALBERT MD INC	10/3/2014	2084N0400X	NA	Neurology	026	PHYSICIANS	87113	13	Neurology (M.D. only)	0	In state provider	None	24451 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3689	30	06059	33.60848903	-117.7079742	Orange County
84251	Fee-for-Service	1396962957	1396962957	1	1	LURIE, MARK D MD INC	3/1/2002	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	28221	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3475 TORRANCE BLVD	STE A	TORRANCE	CA	90503	5800	19	06037	33.83762089	-118.3467904	Los Angeles County
84254	Fee-for-Service	1679006266	1679006266	1	1	LOH, AMANDA M MD	6/29/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	186541	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
84267	Fee-for-Service	1710952544	1710952544	1	1	LITOFF, JEROLD T MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	29343	20	Orthopedic Surgery	0	In state provider	A PROFESSIONAL CORP	2925 SYCAMORE DR	STE 202	SIMI VALLEY	CA	93065	1208	56	06111	34.288398	-118.7439175	Ventura County
84276	Fee-for-Service	1376659003	1376659003	1	1	LIU, CHIEN-YE MD	3/1/1999	207RN0300X	NA	Nephrology	026	PHYSICIANS	61514	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
84293	Fee-for-Service	1285966903	1285966903	1	1	LUK, PAMELA C	8/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110317	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
84341	Fee-for-Service	1134190879	1134190879	1	1	LI, QIAO-LING MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	79805	05	Anesthesiology	0	In state provider	None	12601 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1908	30	06059	33.77450951	-117.913014	Orange County
84370	Fee-for-Service	1255375606	1255375606	2	1	LONGS DRUG STORES CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	686 LIGHTHOUSE AVE	None	MONTEREY	CA	93940	1008	27	06053	36.61448894	-121.9024638	Monterey County
84374	Fee-for-Service	1538181482	1538181482	1	7	LA CLINICA DE LA RAZA INC	12/23/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1146 LACEY LANE	None	CONCORD	CA	94520	4225	07	06013	37.955265	-122.0449418	Contra Costa County
84384	Fee-for-Service	1508018508	1508018508	1	1	LENG, LEWIS Z MD	7/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124672	14	Neurological Surgery	0	In state provider	None	2100 WEBSTER ST	SUITE 115	SAN FRANCISCO	CA	94115	2374	38	06075	37.7904826	-122.4324477	San Francisco County
84397	Fee-for-Service	1427195916	1427195916	1	3	LUNDBERG, MARK A MD	4/18/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	64443	-	NOT APPLICABLE	0	In state provider	None	560 COHASSET ROAD	SUITE 165	CHICO	CA	95926	2460	04	06007	39.7519137	-121.8477606	Butte County
84413	Fee-for-Service	1588730881	1588730881	1	2	LRC HOMES, INC	1/26/2007	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LORI'S HOME	24402 APHENA AVE	None	MISSION VIEJO	CA	92691	4513	30	06059	33.6078199	-117.6873183	Orange County
84419	Fee-for-Service	1184672594	1184672594	1	1	LUSTIG, LAWRENCE R MD	9/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78418	04	Otology, Laryngology, Rhinology	0	In state provider	None	1001 POTRERO AVE	RM 4M	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
84459	Fee-for-Service	1336562339	1336562339	1	2	LEWIS, FLYNNE MD	1/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127989	40	Pediatrics	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	4633	07	06013	38.00771973	-122.1331484	Contra Costa County
84469	Fee-for-Service	1285750257	1285750257	1	1	LU, MINGFENG	12/21/2022	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4330 N. PERSHING AVE	B2	STOCKTON	CA	95207	6953	39	06077	37.98469498	-121.3199636	San Joaquin County
84474	Fee-for-Service	1891704169	1891704169	1	1	LIN, JEFFREY H MD	2/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103302	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
84489	Fee-for-Service	1184714073	1184714073	1	1	LISA M FRENKEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY NE	None	SEATTLE	WA	98105	3900	00	None	47.66165594	-122.2864502	King County
84499	Fee-for-Service	1366871089	1366871089	1	1	LOPEZ, STEPHANIE MD	12/28/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153494	None	None	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
84523	Fee-for-Service	1144308719	1144308719	1	1	LIEDERMAN, ERIC MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	70728	41	Internal Medicine	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
84557	Fee-for-Service	1649294414	1649294414	1	1	LUNDBERG, JOHN A MD	4/11/1995	207L00000X	NA	Other	026	PHYSICIANS	40743	05	Anesthesiology	0	In state provider	CIRCLE CITY HOSPITAL	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
84603	Fee-for-Service	1750466777	1750466777	1	1	LA, QUYEN N OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	STEIN OPTOMETRIC	7251 WARNER AVE	STE H	HUNTINGTON BEACH	CA	92647	5487	30	06059	33.71569644	-118.0024271	Orange County
84622	Fee-for-Service	1306969308	1306969308	1	1	LEUNG, SUI KEI MD	8/1/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	52914	08	Family Practice	0	In state provider	None	1045 E VALLEY BLVD	STE A210	SAN GABRIEL	CA	91776	3664	19	06037	34.08044516	-118.0846975	Los Angeles County
84671	Fee-for-Service	1730373580	1730373580	1	1	LANGEVIN, CLAUDE-JEAN MD	11/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118760	24	Plastic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
84682	Fee-for-Service	1841329638	1841329638	1	1	LOUIE, TIMOTHY J MD LTD A	7/7/1997	2084N0400X	NA	Neurology	026	PHYSICIANS	-	13	Neurology (M.D. only)	1	Border provider	NEVADA PROFESSIONAL CORP	85 KIRMAN AVE	STE 202	RENO	NV	89502	1339	00	None	39.52624763	-119.7984127	Washoe County
84688	Fee-for-Service	1376610923	1376610923	1	2	LOVATO, ESTEBAN MD	5/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75190	None	None	0	In state provider	None	10 E CHARTER WAY	None	STOCKTON	CA	95206	1357	39	06077	37.93865138	-121.2871867	San Joaquin County
84706	Fee-for-Service	1699727321	1699727321	1	1	LIU, GEORGE MD	9/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	70228	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
84707	Fee-for-Service	1144208513	1144208513	1	1	LUNG, EIRC MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
84751	Fee-for-Service	1144319062	1144319062	1	1	LONG, DENNIS R MD INC	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	47243	41	Internal Medicine	0	In state provider	None	12161 SANTA ROSALIA ST	None	GARDEN GROVE	CA	92841	3005	30	06059	33.78572561	-117.9982763	Orange County
84753	Fee-for-Service	1629554423	1629554423	1	1	LYNCH, NASIM N LMFT	4/25/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5151 N. PALM AVE	610	FRESNO	CA	93704	2211	10	06019	36.81119879	-119.808555	Fresno County
84775	Fee-for-Service	1962415141	1962415141	1	3	LUNA, LELANIE MEDINA MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	49959	40	Pediatrics	0	In state provider	None	1500 S CENTRAL AVE	STE 300	GLENDALE	CA	91204	2581	19	06037	34.12736888	-118.257777	Los Angeles County
84783	Fee-for-Service	1275508640	1275508640	1	1	LLOYD, JOHN C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2214 CANTERBURY DR	STE 210	HAYS	KS	67601	2375	00	None	38.879892	-99.2960775	Ellis County
84878	Fee-for-Service	1205281870	1205281870	1	1	LAU, DAVID S MD	1/8/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	154083	08	Family Practice	0	In state provider	None	3460 E LA PALMA AVE	None	ANAHEIM	CA	92806	9999	30	06059	33.85429451	-117.8446551	Orange County
84908	Fee-for-Service	1942229778	1942229778	1	1	LEVINE, SEYMOUR MD	2/8/2015	207RE0101X	NA	Endocrinology	026	PHYSICIANS	34469	41	Internal Medicine	0	In state provider	None	150 N ROBERTSON BLVD	STE 250	BEVERLY HILLS	CA	90211	2145	19	06037	34.06812722	-118.3837146	Los Angeles County
84910	Fee-for-Service	1437352648	1437352648	1	1	LUISTRO, JOWELL C MD	1/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99019	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
84919	Fee-for-Service	1407970684	1407970684	1	1	LUU, DARRIN D MD	2/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81858	08	Family Practice	0	In state provider	None	1125 E 17TH ST	STE N 152	SANTA ANA	CA	92701	2620	30	06059	33.76004145	-117.854838	Orange County
84925	Fee-for-Service	1356448815	1356448815	1	1	LIEN, YEONG-HAU H. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
84960	Fee-for-Service	1487648572	1487648572	2	1	LEAN, EVA K MD	4/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42436	30	Radiology	0	In state provider	None	916 SYCAMORE AVE	None	VISTA	CA	92083	7815	37	06073	33.15990889	-117.2205717	San Diego County
84964	Fee-for-Service	1730320094	1730320094	1	1	LOH, KENNETH C MD	8/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106078	02	General Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
84976	Fee-for-Service	1316980105	1316980105	2	1	LONGS DRUG STORES CA LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	50 MORAGA WAY	None	ORINDA	CA	94563	3024	07	06013	37.87856908	-122.1812686	Contra Costa County
85093	Fee-for-Service	1629662564	1629662564	1	1	LEE, BRENTON CRNA	4/20/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
85103	Fee-for-Service	1326152968	1326152968	1	1	LIGHT, CYRIL S B MD	4/30/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	76254	08	Family Practice	0	In state provider	SHARP REES-STEALY MED	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
85118	Fee-for-Service	1487732285	1487732285	1	1	LEE, DANIEL S MD	5/22/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79211	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
85124	Fee-for-Service	1609897495	1609897495	1	1	LEE, SONNY C MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73070	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
85150	Fee-for-Service	1144308750	1144308750	1	1	LUSK, LAWRENCE B MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	40960	10	Gastroenterology (M.D. only)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
85171	Fee-for-Service	1548314164	1548314164	1	1	LOMBARDI, JO ANNE C MD	12/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	47584	41	Internal Medicine	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
85200	Fee-for-Service	1770507964	1770507964	1	1	LOEST, DEBORAH G	10/31/1987	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1212 8TH AVE	None	WESTHAVEN	CA	95570	9502	12	06023	41.03774581	-124.0958824	Humboldt County
85203	Fee-for-Service	1821165820	1821165820	1	1	LE, TUYEN T MD	2/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	56152	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
85206	Fee-for-Service	1396717013	1396717013	1	1	LEWIS, DANA M DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	7088	08	Family Practice	0	In state provider	None	10052 ALTA SIERRA DR	STE A	GRASS VALLEY	CA	95949	6886	29	06057	39.14137256	-121.0701879	Nevada County
85212	Fee-for-Service	1023251501	1023251501	1	1	LICHTER, ROBERTA G PHD	1/11/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	15720 VENTURA BLVD	STE 210	ENCINO	CA	91436	2914	19	06037	34.15524484	-118.4756687	Los Angeles County
85253	Fee-for-Service	1063740520	1063740520	1	1	LAKESHORE MEDICAL CLINIC INC	8/31/2010	193400000X	NA	Other	026	PHYSICIANS	50401	41	Internal Medicine	0	In state provider	None	16770 LAKESHORE DR	STE G	LAKE ELSINORE	CA	92530	4953	33	06065	33.68662187	-117.3699069	Riverside County
85278	Fee-for-Service	1144540931	1144540931	1	1	LILAGAN, FLORDELIZA D MD	2/3/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	183598	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
85320	Fee-for-Service	1750575247	1750575247	1	1	LITAK, JASON MD	9/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118111	07	Dermatology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
85347	Fee-for-Service	1770035024	1770035024	1	9	LANDMARK ANESTHESIA MEDICAL	3/13/2025	193400000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	1001 TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
85349	Fee-for-Service	1730108614	1730108614	1	1	LIN, SHAO-LEE MD	9/1/1999	207RR0500X	NA	Other	026	PHYSICIANS	69255	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
85355	Fee-for-Service	1356738520	1356738520	1	1	LONGINO, ANDRE P LMFT	11/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
85370	Fee-for-Service	1427210079	1427210079	1	1	LAI, ELIZABETH T MD	12/29/2014	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	112834	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	399 E HIGHLAND AVE	STE 324	SAN BERNARDINO	CA	92404	3860	36	06071	34.1358627	-117.2757898	San Bernardino County
85372	Fee-for-Service	1538665880	1538665880	1	1	LIANG, LIANG MD	9/17/2024	207R00000X	NA	Other	026	PHYSICIANS	166466	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
85380	Fee-for-Service	1083909600	1083909600	1	1	LAM, STEVEN C DO	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11760	08	Family Practice	0	In state provider	None	795 E SECOND STREET	STE 5	POMONA	CA	91766	2007	19	06037	34.05845654	-117.7423951	Los Angeles County
85412	Fee-for-Service	1609897495	1609897495	1	1	LEE, SONNY C MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73070	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
85441	Fee-for-Service	1376651695	1376651695	1	1	LAI, SHIN-YI MD	1/4/2025	207P00000X	NA	Other	026	PHYSICIANS	86897	66	Emergency Medicine (Urgent Care)	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
85453	Fee-for-Service	1154409050	1154409050	1	1	LONJERS, ROBERT T MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	48902	41	Internal Medicine	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
85479	Fee-for-Service	1346460474	1346460474	1	1	LEE, STEVE C MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111551	04	Otology, Laryngology, Rhinology	0	In state provider	None	11370 ANDERSON STREET	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
85527	Fee-for-Service	1982421756	1982421756	1	1	LAU, CHARLENE LCSW	11/3/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2230 W CHAPMAN AVE	212	ORANGE	CA	92868	2316	30	06059	33.78787947	-117.8766225	Orange County
85546	Fee-for-Service	1629475900	1629475900	1	1	LINN, AUDRA E LCSW	5/25/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
85576	Fee-for-Service	1326308503	1326308503	1	1	LIN, CHIA-LEI V MD	9/27/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	186413	None	None	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
85582	Fee-for-Service	1285156026	1285156026	1	1	LIU, LUYANG MD	4/22/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159234	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
85631	Fee-for-Service	1679794192	1679794192	1	1	LYNWOOD DEVELOPMENTAL	11/3/1995	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CARE/FAIRVIEW HOUSE	3263 FLOWER ST	None	LYNWOOD	CA	90262	4226	19	06037	33.92497827	-118.2127548	Los Angeles County
85634	Fee-for-Service	1770035024	1770035024	1	9	LANDMARK ANESTHESIA MEDICAL	1/16/2025	193400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1001 TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
85674	Fee-for-Service	1972670792	1972670792	1	1	LEONORA, CARMELA M MD	4/1/1995	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	52782	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
85730	Fee-for-Service	1912935628	1912935628	1	1	LIU, SAMUEL S MD	10/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74056	45	Nephrology (Renal-Kidney)	0	In state provider	None	1900 ROYALTY DR	STE 130	POMONA	CA	91767	3052	19	06037	34.07754346	-117.7463466	Los Angeles County
85743	Fee-for-Service	1366876773	1366876773	1	1	LOISEAUX, RELYN A LMFT	11/12/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	400 CHINN ST	#2	SANTA ROSA	CA	95404	4341	49	06097	38.444616	-122.7070665	Sonoma County
85746	Fee-for-Service	1730767328	1730767328	1	1	LOPEZ, ISABELLA MD	6/7/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
85773	Fee-for-Service	1275723264	1275723264	1	1	LU, DANIEL MD	8/31/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	52794	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
85788	Fee-for-Service	1295928638	1295928638	1	1	LEE, MELANIE LCSW	10/24/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
85804	Fee-for-Service	1891895348	1891895348	1	1	LOH, JOHN C MD	7/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97749	30	Radiology	0	In state provider	None	180 ROWLAND WAY	None	NOVATO	CA	94945	5009	21	06041	38.09825699	-122.5598561	Marin County
85880	Fee-for-Service	1093944019	1093944019	1	2	LAPIDUS, RACHEL LEAH MD	6/27/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	114105	-	NOT APPLICABLE	0	In state provider	None	2001 THA ALAMEDA	None	SAN JOSE	CA	95126	1136	43	06085	37.34293689	-121.9270392	Santa Clara County
85882	Fee-for-Service	1750404422	1750404422	1	1	LEAH BRASWELL MD	3/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	None	LITTLE ROCK	AR	72202	7101	00	None	34.742745	-92.2927905	Pulaski County
85923	Fee-for-Service	1588238497	1588238497	1	1	LYON-MARTIN COMMUNITY HEALTH	5/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	SERVICES	1735 MISSION STREET	None	SAN FRANCISCO	CA	94103	2417	38	06075	37.76957692	-122.4199811	San Francisco County
85942	Fee-for-Service	1497742027	1497742027	1	1	LI, HONG MD	9/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82023	22	Pathology (M.D. only)	0	In state provider	None	2625 COFFEE RD	STE S	MODESTO	CA	95355	2050	50	06099	37.67888506	-120.9759048	Stanislaus County
85949	Fee-for-Service	1790836104	1790836104	1	1	LANGENHAN, JESSICA L MD	6/8/2009	2084P0800X	NA	Psychiatry	026	PHYSICIANS	96827	36	Psychiatry	0	In state provider	None	1430 E CHAPMAN AVE	None	ORANGE	CA	92866	2229	30	06059	33.7877945	-117.83817	Orange County
85982	Fee-for-Service	1427462159	1427462159	1	1	LE, TRUCVY H MD	7/31/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146190	01	General Practice	0	In state provider	None	100 S ANAHEIM BLVD	STE 101	ANAHEIM	CA	92805	3848	30	06059	33.83528856	-117.913627	Orange County
85985	Fee-for-Service	1699876086	1699876086	1	1	LEWIS, ROGER W. MD	6/12/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65192	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	800 DELBON AVE	None	TURLOCK	CA	95382	2005	50	06099	37.51047152	-120.839499	Stanislaus County
86002	Fee-for-Service	1245609965	1245609965	1	6	LEISURE LIVING INC	12/31/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	30822 JANLOR DR	None	WESTLAKE VILLAGE	CA	91362	4129	19	06037	34.15646108	-118.7923756	Los Angeles County
86015	Fee-for-Service	1902195746	1902195746	1	1	LAZARUS, MARK A MD	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123872	41	Internal Medicine	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
86016	Fee-for-Service	1912935628	1912935628	1	1	LIU, SAMUEL S MD	10/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74056	41	Internal Medicine	0	In state provider	None	1900 ROYALTY DR	STE 130	POMONA	CA	91767	3052	19	06037	34.07754346	-117.7463466	Los Angeles County
86040	Fee-for-Service	1437372232	1437372232	2	2	LIVI'S HOME HEALTH CARE	7/6/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1224 E BROADWAY	STE 103	GLENDALE	CA	91205	4088	19	06037	34.14615085	-118.2386531	Los Angeles County
86048	Fee-for-Service	1801137294	1801137294	1	1	LAI, WAYNE T MD	7/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114020	05	Anesthesiology	0	In state provider	None	23845 MCBEAN PARKWAY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
86060	Fee-for-Service	1407296742	1407296742	1	1	LIFETIME VALUE	11/25/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY III INC	301 E 17TH ST	None	SANTA ANA	CA	92706	2804	30	06059	33.76011145	-117.8648325	Orange County
86064	Fee-for-Service	1700467610	1700467610	1	1	LOVELESS, KATHERINE A	10/31/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	733 CEDAR STREET	None	GARBERVILLE	CA	95542	3201	12	06023	40.10148699	-123.7927018	Humboldt County
86069	Fee-for-Service	1427195189	1427195189	2	1	LOGAN, MAIYA L OD	2/20/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9186 W PICO BLVD	None	LOS ANGELES	CA	90035	1320	19	06037	34.0552227	-118.3918095	Los Angeles County
86070	Fee-for-Service	1992147425	1992147425	1	1	LAM STEPHENS, ANDREA CNP	11/22/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8850 VALLEY VIEW ST	None	BUENA PARK	CA	90620	3562	30	06059	33.833988	-118.0282915	Orange County
86100	Fee-for-Service	1982884904	1982884904	1	1	LENTZNER, JAY R MD	12/8/2008	2084P0800X	NA	Psychiatry	026	PHYSICIANS	93210	36	Psychiatry	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
86154	Fee-for-Service	1679893226	1679893226	1	1	LU, ALBERT MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116132	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
86167	Fee-for-Service	1093944019	1093944019	1	1	LAPIDUS, RACHEL LEAH MD	10/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114105	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
86180	Fee-for-Service	1861050460	1861050460	1	1	LEWIS, MARIA J PHD	9/1/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93102	0689	42	06083	34.42887662	-119.7237878	Santa Barbara County
86205	Fee-for-Service	1124173570	1124173570	1	1	LANSDOWNE, ELISA D MD	4/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84231	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
86210	Fee-for-Service	1588238497	1588238497	1	1	LYON-MARTIN COMMUNITY HEALTH	5/1/2024	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	SERVICES	1735 MISSION STREET	None	SAN FRANCISCO	CA	94103	2417	38	06075	37.76957692	-122.4199811	San Francisco County
86226	Fee-for-Service	1811978604	1811978604	1	1	LO, CHARLES Y MD	4/30/1995	208600000X	NA	General Surgery	026	PHYSICIANS	51944	02	General Surgery	0	In state provider	None	890 JACKSON ST	STE 302	SAN FRANCISCO	CA	94133	4848	38	06075	37.79566645	-122.4097018	San Francisco County
86238	Fee-for-Service	1164550885	1164550885	4	1	LIDO PHARMACY LLC	11/29/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	351 HOSPITAL RD	STE 107	NEWPORT BEACH	CA	92663	3503	30	06059	33.62579141	-117.9299554	Orange County
86251	Fee-for-Service	1770035024	1770035024	1	4	LANDMARK ANESTHESIA MEDICAL	4/8/2021	193400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
86254	Fee-for-Service	1649238130	1649238130	1	1	LIU, JIANDONG MD	12/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96949	41	Internal Medicine	0	In state provider	None	1100 LAS TABLAS ROAD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
86264	Fee-for-Service	1497778401	1497778401	1	1	LOS ANGELES COUNTY HARBOR	7/1/2005	282N00000X	NA	Hospitals	060	COUNTY HOSPITAL INPATIENT	-	-	NOT APPLICABLE	0	In state provider	UCLA MEDICAL CENTER	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
86274	Fee-for-Service	1497252324	1497252324	1	1	LEON, WILLIAM E MD	12/21/2022	207R00000X	NA	Other	026	PHYSICIANS	164603	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
86277	Fee-for-Service	1427145689	1427145689	1	1	LIVING MEDICAL EQUIPMENT	7/7/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	LIVING MEDICAL EQUIPMENT	2123 BERING DR	#K	SAN JOSE	CA	95131	2015	43	06085	37.37776382	-121.9186852	Santa Clara County
86294	Fee-for-Service	1568657757	1568657757	1	1	LI, KATY C MD	11/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98874	01	General Practice	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
86308	Fee-for-Service	1366684045	1366684045	1	1	LEE, LOIS DO	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11558	41	Internal Medicine	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
86349	Fee-for-Service	1073556833	1073556833	2	1	LONGS DRUG STORES CA LLC	8/17/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13763 MONO WAY	None	SONORA	CA	95370	8813	55	06109	37.97548548	-120.3443671	Tuolumne County
86419	Fee-for-Service	1922040732	1922040732	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11411 DEERFIELD DR	None	TRUCKEE	CA	96161	0506	29	06057	39.32041018	-120.2086806	Nevada County
86447	Fee-for-Service	1073183455	1073183455	1	1	LIBETARIO, WILLIAM M CRNA	7/1/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
86464	Fee-for-Service	1912078965	1912078965	1	1	LEE,ERIC K MD	4/1/2001	2085B0100X	NA	MRI Provider	026	PHYSICIANS	61017	30	Radiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
86478	Fee-for-Service	1295877249	1295877249	1	1	LEMMENS, HENDRIKUS MD	2/28/1995	207L00000X	NA	Other	026	PHYSICIANS	53124	05	Anesthesiology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
86484	Fee-for-Service	1770035024	1770035024	1	3	LANDMARK ANESTHESIA MEDICAL	4/8/2021	193400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
86494	Fee-for-Service	1730239682	1730239682	1	1	LEE, FENGLALY C MD	9/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90450	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	110 N VALERIA ST	STE 201	FRESNO	CA	93701	2167	10	06019	36.74388938	-119.7847725	Fresno County
86499	Fee-for-Service	1588238497	1588238497	1	1	LYON-MARTIN COMMUNITY HEALTH	5/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	SERVICES	1735 MISSION STREET	None	SAN FRANCISCO	CA	94103	2417	38	06075	37.76957692	-122.4199811	San Francisco County
86523	Fee-for-Service	1073210753	1073210753	1	1	LEGACY MD MEDICAL GROUP INC	3/15/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	222 E COLE BLVD	STE C	CALEXICO	CA	92231	3211	13	06025	32.69391949	-115.495038	Imperial County
86527	Fee-for-Service	1447665310	1447665310	1	1	LE, HAI V MD	8/1/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	160386	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
86533	Fee-for-Service	1821258153	1821258153	1	1	LUND, ANDREW D MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110847	05	Anesthesiology	0	In state provider	None	2500 GRAND RD	None	MOUNTAIN VIEW	CA	94040	4378	43	06085	37.36893518	-122.0779448	Santa Clara County
86536	Fee-for-Service	1639432610	1639432610	1	1	LICHTMAN, GREGORY T DO	10/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16553	20	Orthopedic Surgery	0	In state provider	None	11795 EDUCATION ST	STE 201	AUBURN	CA	95602	2469	31	06061	38.94433757	-121.098912	Placer County
86541	Fee-for-Service	1770035024	1770035024	1	4	LANDMARK ANESTHESIA MEDICAL	3/11/2021	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
86567	Fee-for-Service	1851704894	1851704894	1	1	LEE, ANGELA M MD	10/21/2019	207L00000X	NA	Other	026	PHYSICIANS	139581	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
86579	Fee-for-Service	1285089805	1285089805	1	1	LACHARITE-ROBERGE, ANNE-SOPH	5/30/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	176092	06	Cardiovascular Disease (M.D. only)	0	In state provider	IE MD	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
86597	Fee-for-Service	1427304526	1427304526	1	1	LEE, MICHELLE LPCC	8/1/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
86614	Fee-for-Service	1801984588	1801984588	1	1	LEONG, HOU T OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1375 N DAVIS RD	None	SALINAS	CA	93907	1991	27	06053	36.70578	-121.668822	Monterey County
86680	Fee-for-Service	1861452054	1861452054	1	1	LAW, AMY MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88515	68	Hematology	0	In state provider	None	39800 BOB HOPE DRIVE	STE C	RANCHO MIRAGE	CA	92270	3946	33	06065	33.759432	-116.408062	Riverside County
86688	Fee-for-Service	1144267907	1144267907	1	1	LI, WEI MD	12/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105970	None	None	0	In state provider	None	1420 SOUTH CENTRAL	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
86712	Fee-for-Service	1437193422	1437193422	1	1	LEE, STEPHEN C MD	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150141	34	Urology and Urological Surgery	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
86714	Fee-for-Service	1861475287	1861475287	1	1	LEUNG, JOSEPH M MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54811	10	Gastroenterology (M.D. only)	0	In state provider	None	4301 X ST	None	SACRAMENTO	CA	95817	2214	34	06067	38.5536003	-121.455135	Sacramento County
86721	Fee-for-Service	1407386444	1407386444	1	1	LOGAN MORENO, ERICKA J LMFT	8/26/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15455 SAN FERNANDO MISSO	#300	MISSION HILLS	CA	91345	1353	19	06037	34.27194157	-118.469079	Los Angeles County
86732	Fee-for-Service	1871342030	1871342030	1	1	LA DOLCE VIDA DOULA SERVICES	5/21/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	15	06029	0	0	None
86751	Fee-for-Service	1841675048	1841675048	1	1	LEE, JENNIFER P OD	7/25/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1701 LUNDY AVE	STE 120	SAN JOSE	CA	95131	1832	43	06085	37.38788073	-121.8866632	Santa Clara County
86758	Fee-for-Service	1487961926	1487961926	1	1	LIEBERT, HEATHER PSYD	4/27/2020	101Y00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
86768	Fee-for-Service	1770035024	1770035024	1	3	LANDMARK ANESTHESIA MEDICAL	3/11/2021	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
86776	Fee-for-Service	1477597508	1477597508	1	1	LEE, JAMES W MD	12/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74179	05	Anesthesiology	0	In state provider	INC	9212 MIRA ESTE CT	STE 204	SAN DIEGO	CA	92126	6337	37	06073	32.88927901	-117.1482338	San Diego County
86799	Fee-for-Service	1326081688	1326081688	2	1	LONGS DRUG STORE CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	442 LAS GALLINAS AVE	None	SAN RAFAEL	CA	94903	3618	21	06041	38.00478038	-122.5418351	Marin County
86810	Fee-for-Service	1073210753	1073210753	1	1	LEGACY MD MEDICAL GROUP INC	1/10/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	222 E COLE BLVD	STE C	CALEXICO	CA	92231	3211	13	06025	32.69391949	-115.495038	Imperial County
86873	Fee-for-Service	1750490678	1750490678	1	1	LEIGH, HOYLE MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	49276	36	Psychiatry	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
86896	Fee-for-Service	1912343674	1912343674	1	1	LIN, TASHA MD	6/17/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	141627	None	None	0	In state provider	None	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
86935	Fee-for-Service	1700187713	1700187713	1	1	LAWSON, LA SHAUN N LMFT	2/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
86964	Fee-for-Service	1861452054	1861452054	1	1	LAW, AMY MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88515	41	Internal Medicine	0	In state provider	None	39800 BOB HOPE DRIVE	STE C	RANCHO MIRAGE	CA	92270	3946	33	06065	33.759432	-116.408062	Riverside County
86967	Fee-for-Service	1902054182	1902054182	1	1	LIPSHUTZ, ANGELA K MD	1/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112586	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
86984	Fee-for-Service	1912375676	1912375676	1	1	LY, HERTHAO LCSW	12/28/2021	171M00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
86985	Fee-for-Service	1669544474	1669544474	1	1	LI, JULIA Y MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77929	36	Psychiatry	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
87003	Fee-for-Service	1861475287	1861475287	1	1	LEUNG, JOSEPH M MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54811	41	Internal Medicine	0	In state provider	None	4301 X ST	None	SACRAMENTO	CA	95817	2214	34	06067	38.5536003	-121.455135	Sacramento County
87009	Fee-for-Service	1407840705	1407840705	1	1	LIU, ALBERT T MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	67684	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
87014	Fee-for-Service	1225037336	1225037336	1	1	LEVY, LOUIS J JR MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	37491	20	Orthopedic Surgery	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
87017	Fee-for-Service	1316595283	1316595283	1	1	LA HOSPICE CENTER INC	5/27/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13609 VICTORY BLVD	SUITE 209	VAN NUYS	CA	91401	1736	19	06037	34.18671049	-118.429353	Los Angeles County
87026	Fee-for-Service	1265655773	1265655773	1	1	LE, PETER T MD	5/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85765	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
87045	Fee-for-Service	1659429728	1659429728	1	1	LIANG, WEN MD	4/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	80784	01	General Practice	0	In state provider	None	1501 TROUSDALE DRIVE	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
87063	Fee-for-Service	1700873320	1700873320	1	1	LUONG, KEVIN T MD	3/10/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71072	20	Orthopedic Surgery	0	In state provider	None	151 N SUNRISE AVE	STE 1005	ROSEVILLE	CA	95661	2930	31	06061	38.74746043	-121.2655348	Placer County
87100	Fee-for-Service	1073210753	1073210753	1	1	LEGACY MD MEDICAL GROUP INC	9/20/2024	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	222 E COLE BLVD	STE C	CALEXICO	CA	92231	3211	13	06025	32.69391949	-115.495038	Imperial County
87119	Fee-for-Service	1134288707	1134288707	1	1	LOZANO, JAMES G MD	8/1/1998	207R00000X	NA	Other	026	PHYSICIANS	55525	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
87175	Fee-for-Service	1841751088	1841751088	1	1	LE, THUYVY DO	9/22/2022	207R00000X	NA	Other	026	PHYSICIANS	19365	None	None	0	In state provider	None	2820 ALUM ROCK AVE.	SUITE 20	SAN JOSE	CA	95127	5608	43	06085	37.3631929	-121.8334108	Santa Clara County
87198	Fee-for-Service	1770569188	1770569188	1	1	LEE, THOMAS T MD	6/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66085	05	Anesthesiology	0	In state provider	None	1001 N TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
87254	Fee-for-Service	1861452054	1861452054	1	1	LAW, AMY MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88515	78	Neoplastic Diseases/Oncology	0	In state provider	None	39800 BOB HOPE DRIVE	STE C	RANCHO MIRAGE	CA	92270	3946	33	06065	33.759432	-116.408062	Riverside County
87298	Fee-for-Service	1982718615	1982718615	1	1	LE, BRIAN B CRNA	1/5/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
87300	Fee-for-Service	1932566858	1932566858	1	1	LEE, DAVID W	2/23/2019	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	10280 INDIANA AVE	None	RIVERSIDE	CA	92503	5357	33	06065	33.90600193	-117.4556267	Riverside County
87304	Fee-for-Service	1225037336	1225037336	1	1	LEVY, LOUIS J JR MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	37491	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
87305	Fee-for-Service	1316595283	1316595283	1	1	LA HOSPICE CENTER INC	5/27/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13609 VICTORY BLVD	SUITE 209	VAN NUYS	CA	91401	1736	19	06037	34.18671049	-118.429353	Los Angeles County
87307	Fee-for-Service	1316937444	1316937444	1	1	LOVRINCEVIC, MIRJANA MD	2/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145073	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
87336	Fee-for-Service	1629066618	1629066618	1	1	LESSIN, SUSAN R MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	44586	78	Neoplastic Diseases/Oncology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
87377	Fee-for-Service	1861666281	1861666281	1	1	LAI, ANDREW R MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103036	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
87390	Fee-for-Service	1073210753	1073210753	1	1	LEGACY MD MEDICAL GROUP INC	4/26/2024	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	222 E COLE BLVD	STE C	CALEXICO	CA	92231	3211	13	06025	32.69391949	-115.495038	Imperial County
87404	Fee-for-Service	1366495574	1366495574	1	1	LEE, TOMMY C MD	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	52609	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3550 Q ST	STE 301	BAKERSFIELD	CA	93301	1645	15	06029	35.391978	-119.0105025	Kern County
87411	Fee-for-Service	1457805251	1457805251	1	4	LUCID SPEECH AND LANGUAGE CL	4/11/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NIC, INC.	11870 PIERCE STREET	SUITE 150	RIVERSIDE	CA	92505	4402	33	06065	33.90095662	-117.4936969	Riverside County
87417	Fee-for-Service	1134277106	1134277106	1	1	LINDEEN, JAMES A MD	1/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74726	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
87435	Fee-for-Service	1649422924	1649422924	1	1	LY, TRAN T MD	4/1/2017	207RE0101X	NA	Endocrinology	026	PHYSICIANS	111660	67	Endocrinology	0	In state provider	None	2251 W ROSECRANS AVE	UNIT 21	COMPTON	CA	90222	3860	19	06037	33.90273823	-118.2557598	Los Angeles County
87447	Fee-for-Service	1568995181	1568995181	1	1	LEE, RICHARD C MD	4/5/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	158507	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
87466	Fee-for-Service	1013056910	1013056910	1	1	LASSEN MEDICAL GROUP -	12/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CORNING	702 SOLANO ST	None	CORNING	CA	96021	3352	52	06103	39.92794648	-122.174465	Tehama County
87492	Fee-for-Service	1265474092	1265474092	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3667 CASTRO VALLEY BLVD	None	CASTRO VALLEY	CA	94546	4403	01	06001	37.69464932	-122.0712207	Alameda County
87514	Fee-for-Service	1396348819	1396348819	1	1	LA HOSPICE	9/12/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	SUITE 164	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
87540	Fee-for-Service	1881627404	1881627404	1	1	LAVRETSKY, HELEN MD	12/11/2002	2084P0800X	NA	Psychiatry	026	PHYSICIANS	51278	36	Psychiatry	0	In state provider	None	10162 HOLLOW GLEN CIR	None	LOS ANGELES	CA	90077	2112	19	06037	34.1221474	-118.4424921	Los Angeles County
87566	Fee-for-Service	1790862431	1790862431	1	1	LEE, JENNIE M CRNA	4/5/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
87575	Fee-for-Service	1306288410	1306288410	1	1	LU, TINA CNP	2/18/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	576 E EL CAMINO REAL	None	SUNNYVALE	CA	94087	1940	43	06085	37.36249974	-122.0260401	Santa Clara County
87606	Fee-for-Service	1336227156	1336227156	1	1	LINKOWSKI, GREGORY D MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	46975	30	Radiology	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
87622	Fee-for-Service	1144326554	1144326554	1	1	LOVELL, RICHARD H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	28376	08	Family Practice	0	In state provider	None	2023 W VISTA WAY	None	VISTA	CA	92083	6030	37	06073	33.18569169	-117.2846332	San Diego County
87623	Fee-for-Service	1629066618	1629066618	1	1	LESSIN, SUSAN R MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	44586	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
87627	Fee-for-Service	1215462791	1215462791	1	1	LEV, IRINA DO	8/12/2020	207R00000X	NA	Other	026	PHYSICIANS	16959	41	Internal Medicine	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
87628	Fee-for-Service	1124709597	1124709597	1	1	LE, HANH NGUYEN CRNA	10/21/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
87635	Fee-for-Service	1972678514	1972678514	1	1	LIEDTKE, KARIN I LAC	4/8/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
87644	Fee-for-Service	1033315510	1033315510	1	1	LOKKEN, RYAN P MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119890	30	Radiology	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
87648	Fee-for-Service	1770855132	1770855132	1	1	LOS ANGELES CHRISTIAN HEALTH	4/8/2014	3336C0002X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1625 E. 4TH ST	None	LOS ANGELES	CA	90033	4201	19	06037	34.04297786	-118.2220181	Los Angeles County
87673	Fee-for-Service	1073210753	1073210753	1	1	LEGACY MD MEDICAL GROUP INC	3/15/2024	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	222 E COLE BLVD	STE C	CALEXICO	CA	92231	3211	13	06025	32.69391949	-115.495038	Imperial County
87682	Fee-for-Service	1578593521	1578593521	1	1	LOOMBA, ROHIT MD	6/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98657	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
87688	Fee-for-Service	1063522613	1063522613	1	1	LEE,DANIEL Y MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66022	10	Gastroenterology (M.D. only)	0	In state provider	None	7930 FROST ST	STE 206	SAN DIEGO	CA	92123	2766	37	06073	32.80027001	-117.1532893	San Diego County
87707	Fee-for-Service	1144681057	1144681057	1	1	LESTER, TALIA R MD	2/16/2022	2080P0006X	NA	Psychiatry	026	PHYSICIANS	150915	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
87711	Fee-for-Service	1194932335	1194932335	1	1	LEE, HANOK	2/8/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3321 W PICO BLVD	None	LOS ANGELES	CA	90019	4530	19	06037	34.0472085	-118.3162725	Los Angeles County
87713	Fee-for-Service	1083792626	1083792626	1	1	LEE, BETTY MD	5/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	46394	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
87720	Fee-for-Service	1700147527	1700147527	1	1	LIN, CHIHYI DO	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13865	41	Internal Medicine	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
87730	Fee-for-Service	1669770913	1669770913	1	1	LAGEMANN, GERRITT M MD	4/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115494	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
87735	Fee-for-Service	1730708314	1730708314	1	1	LUMAS, SHUNELLA G MD	5/29/2024	207L00000X	NA	Other	026	PHYSICIANS	187978	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
87753	Fee-for-Service	1013056910	1013056910	1	1	LASSEN MEDICAL GROUP -	12/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	CORNING	702 SOLANO ST	None	CORNING	CA	96021	3352	52	06103	39.92794648	-122.174465	Tehama County
87781	Fee-for-Service	1740724350	1740724350	1	1	LONG BEACH HEALTHCARE CENTER	11/1/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	3401 CEDAR AVE	None	LONG BEACH	CA	90807	4422	19	06037	33.82000889	-118.1953205	Los Angeles County
87803	Fee-for-Service	1396348819	1396348819	1	1	LA HOSPICE	9/12/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	SUITE 164	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
87822	Fee-for-Service	1730455239	1730455239	1	1	LI, HOJUN MD	3/7/2024	2080P0207X	NA	Hematology	026	PHYSICIANS	None	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
87865	Fee-for-Service	1649767948	1649767948	1	1	LABORATORY CORPORATION OF AM	9/15/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	ERICA	110 W CLIFF DR	SUITE 100-200	SPOKANE	WA	99204	3614	00	None	47.646162	-117.4133835	Spokane County
87874	Fee-for-Service	1114128147	1114128147	1	1	LORI D KAM AND STEPHEN K CHI	9/21/2010	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	NG ODS	2248 SUNRISE BLVD	None	RANCHO CORDOVA	CA	95670	4342	34	06067	38.620575	-121.268826	Sacramento County
87941	Fee-for-Service	1538840764	1538840764	1	1	LOR, MAI N CRNA	2/13/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4900 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5814	19	06037	34.0981225	-118.2965085	Los Angeles County
87944	Fee-for-Service	1548272198	1548272198	1	1	LAKIN, CHARLES M MD	9/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	38869	34	Urology and Urological Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
87949	Fee-for-Service	1184617813	1184617813	1	1	LEVINE, MICHAEL J MD	11/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	18859	40	Pediatrics	0	In state provider	None	914 W CENTER AVE	None	VISALIA	CA	93291	5916	54	06107	36.331182	-119.3018355	Tulare County
87957	Fee-for-Service	1205253523	1205253523	1	1	LYONS, CLAIRE MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143290	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
87960	Fee-for-Service	1962259580	1962259580	1	1	LIM, KENNETH PT	6/28/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
87962	Fee-for-Service	1194871715	1194871715	1	1	LITTLE, AMY M MD	12/30/2022	207P00000X	NA	Other	026	PHYSICIANS	183327	None	None	0	In state provider	None	10121 PINE AVENUE	None	TRUCKEE	CA	96161	4856	29	06057	39.3245308	-120.2013097	Nevada County
87967	Fee-for-Service	1174943013	1174943013	1	1	LE, WALTER V H N MD	8/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132248	41	Internal Medicine	0	In state provider	None	375 HUNTINGTON DRIVE	SUITE G	SAN MARINO	CA	91108	2357	19	06037	34.1067704	-118.1349621	Los Angeles County
87976	Fee-for-Service	1063522613	1063522613	1	1	LEE,DANIEL Y MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66022	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7930 FROST ST	STE 206	SAN DIEGO	CA	92123	2766	37	06073	32.80027001	-117.1532893	San Diego County
87990	Fee-for-Service	1881834729	1881834729	1	1	LINDBERG, KAREN R	11/2/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1687 ERRINGER ROAD	STE 109	SIMI VALLEY	CA	93065	3357	56	06111	34.268886	-118.761426	Ventura County
88029	Fee-for-Service	1588866578	1588866578	1	1	LI, WALTER L MD	5/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99014	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
88047	Fee-for-Service	1073080164	1073080164	1	1	LIPSCHULTZ, ERICA NP	9/9/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3100 SAN PABLO AVE	STE 300, 310	BERKELEY	CA	94702	2498	01	06001	37.85066636	-122.286288	Alameda County
88074	Fee-for-Service	1982165536	1982165536	1	1	LI, DAYAN MD	6/5/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	181488	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
88075	Fee-for-Service	1841225950	1841225950	1	1	LEVINE, STEVEN J MD	12/31/1989	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	53715	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2001 SANTA MONICA BLVD	STE 687W	SANTA MONICA	CA	90404	2186	19	06037	34.02891163	-118.4797466	Los Angeles County
88095	Fee-for-Service	1184634339	1184634339	1	1	LUM, FRANCIS G CRNA	6/9/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
88099	Fee-for-Service	1598708380	1598708380	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2170 FREMONT ST	None	MONTEREY	CA	93940	5213	27	06053	36.59643646	-121.859985	Monterey County
88134	Fee-for-Service	1194948984	1194948984	1	1	LUCAS, CHRISTINA NP	2/6/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	2673	-	NOT APPLICABLE	0	In state provider	None	625 STEELE LANE	STE B	SANTA ROSA	CA	95403	3127	49	06097	38.460366	-122.7242565	Sonoma County
88142	Fee-for-Service	1679872444	1679872444	1	1	LIVERANT, MITCHELL L MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131186	41	Internal Medicine	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
88150	Fee-for-Service	1225590896	1225590896	1	1	LIBERMAN, CALEB MD	3/6/2025	207L00000X	NA	Other	026	PHYSICIANS	181385	05	Anesthesiology	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
88179	Fee-for-Service	1518339530	1518339530	1	1	LUM OPTOMETRY INC	10/11/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1200 HIGHLAND AVE	None	NATIONAL CITY	CA	91950	3541	37	06073	32.67530709	-117.0977171	San Diego County
88185	Fee-for-Service	1548566599	1548566599	1	1	LEE, EDWARD H DO INC	2/18/2011	207L00000X	NA	Other	026	PHYSICIANS	11037	05	Anesthesiology	0	In state provider	None	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
88226	Fee-for-Service	1134107741	1134107741	1	1	LIN, SUSAN S MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96224	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
88241	Fee-for-Service	1376591941	1376591941	1	1	LANE REGIONAL MEDICAL CENTER	10/28/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6300 MAIN STREET	None	ZACHARY	LA	70791	0000	00	None	30.649401	-91.137519	East Baton Rouge Parish
88245	Fee-for-Service	1598120115	1598120115	1	1	LUU, CINDY MD	7/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134510	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
88279	Fee-for-Service	1043349822	1043349822	1	1	LIEBOWITZ & BROWN	9/9/2003	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRISTS, INC	421 PIONEER AVE	STE B	WOODLAND	CA	95776	4948	57	06113	38.6759259	-121.7468988	Yolo County
88302	Fee-for-Service	1467529438	1467529438	1	1	LAM, HARVEY HOCK-MO	2/8/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2303 BUENA VISTA AVE	None	ALAMEDA	CA	94501	1404	01	06001	37.76886453	-122.2411985	Alameda County
88320	Fee-for-Service	1346640604	1346640604	1	1	LI, YAN MD	4/17/2018	207R00000X	NA	Other	026	PHYSICIANS	149528	41	Internal Medicine	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
88350	Fee-for-Service	1376956086	1376956086	1	1	LYNCH, LEE M LMFT	5/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
88356	Fee-for-Service	1609861095	1609861095	1	1	LIFE CARE MEDICAL CENTER	11/20/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	715 DELMORE DRIVE	None	ROSEAU	MN	56751	1534	00	None	48.83948581	-95.7599527	Roseau County
88400	Fee-for-Service	1245647429	1245647429	1	1	LEHOANG, JENNIFER T MD	9/1/2017	390200000X	NA	Other	026	PHYSICIANS	137933	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
88402	Fee-for-Service	1144676404	1144676404	1	1	LEE, JOYCE Y MD	8/19/2019	207R00000X	NA	Other	026	PHYSICIANS	153948	41	Internal Medicine	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
88406	Fee-for-Service	1295957371	1295957371	1	1	LIN, WAYNE B MD	7/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	96829	41	Internal Medicine	0	In state provider	None	2601 E MAIN ST	SUITE 104	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
88430	Fee-for-Service	1679872444	1679872444	1	1	LIVERANT, MITCHELL L MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131186	10	Gastroenterology (M.D. only)	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
88434	Fee-for-Service	1093133571	1093133571	1	1	LEE, GLEANNA P NP	5/20/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
88459	Fee-for-Service	1619335551	1619335551	1	1	LEVARDO, ERIN A NP	4/29/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
88463	Fee-for-Service	1134418098	1134418098	1	1	LANGHAM, GEOFFREY E MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114876	05	Anesthesiology	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
88483	Fee-for-Service	1487681052	1487681052	1	1	LOWE, STEPHANIE M CNM	2/10/2014	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
88491	Fee-for-Service	1891226304	1891226304	1	1	LI, ANNA Y MD	3/13/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	157070	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
88508	Fee-for-Service	1508989856	1508989856	1	1	LAYTONVILLE VOLUNTEER	10/1/1984	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	FIRE DEPT	44290 WILLIS ROAD	None	LAYTONVILLE	CA	95454	0000	23	06045	39.6840779	-123.4841701	Mendocino County
88526	Fee-for-Service	1245289818	1245289818	2	1	LONGS DRUG STORES CA LLC	12/26/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7021 HOLLYWOOD BLVD	None	LOS ANGELES	CA	90028	6027	19	06037	34.1015647	-118.3427648	Los Angeles County
88549	Fee-for-Service	1942388533	1942388533	1	1	LUBBOCK, CRAIG A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	28405	02	General Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
88566	Fee-for-Service	1225520174	1225520174	1	1	LOPEZ, ESMARELDA CNP	1/31/2022	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	520 WEST I ST	None	LOS BANOS	CA	95616	6201	24	06047	37.06346603	-120.8593647	Merced County
88598	Fee-for-Service	1073327177	1073327177	1	1	LI, AILIN NP	2/12/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	207 SANTA ANITA ST.	STE P05	SAN GABRIEL	CA	91776	1159	19	06037	34.10072807	-118.1066296	Los Angeles County
88608	Fee-for-Service	1659442689	1659442689	1	1	LEE, EUGENE S MD	1/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71267	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
88614	Fee-for-Service	1952601510	1952601510	1	1	LA QUINTA KIDNEY CENTER LLC	3/21/2011	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	43576 WASHINGTON STREET	SUITE 101-105	LA QUINTA	CA	92253	8566	33	06065	33.73203949	-116.3037712	Riverside County
88638	Fee-for-Service	1013306364	1013306364	1	1	LADENHEIM, MARC L MD FACC	4/16/2015	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49875	06	Cardiovascular Disease (M.D. only)	0	In state provider	INC	2701 W ALAMEDA AVE	STE 607	BURBANK	CA	91505	4818	19	06037	34.15751343	-118.3303715	Los Angeles County
88644	Fee-for-Service	1609861095	1609861095	1	1	LIFE CARE MEDICAL CENTER	11/20/2010	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	715 DELMORE DRIVE	None	ROSEAU	MN	56751	1534	00	None	48.83948581	-95.7599527	Roseau County
88710	Fee-for-Service	1467744276	1467744276	1	1	LARSON, BARRETT J MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122665	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
88770	Fee-for-Service	1366932865	1366932865	1	1	LAM, JAMIE MD	7/29/2024	207P00000X	NA	Other	026	PHYSICIANS	189970	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
88784	Fee-for-Service	1366673998	1366673998	1	1	LE, MINH N OD INC	5/1/2009	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1652 E CAPITOL EXPY	None	SAN JOSE	CA	95121	1839	43	06085	37.3066751	-121.8111896	Santa Clara County
88786	Fee-for-Service	1710103718	1710103718	1	1	LARKIN, KATHLEEN S MD	1/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143947	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
88811	Fee-for-Service	1992768576	1992768576	1	1	LEUNG, YAN MD	1/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	29313	41	Internal Medicine	0	In state provider	None	1655 W BROADWAY	STE 3	ANAHEIM	CA	92802	1107	30	06059	33.8289235	-117.939537	Orange County
88820	Fee-for-Service	1578532735	1578532735	1	1	LEONI, MICHAEL K MD	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	61960	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
88839	Fee-for-Service	1730161282	1730161282	1	1	LA BARBERA, JUDITH J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	71437	42	Nuclear Medicine	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
88841	Fee-for-Service	1447288873	1447288873	1	1	LESLIE MICHAEL LEVIN, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3000 COLISEUM DR	None	HAMPTON	VA	23666	5963	00	None	37.05701869	-76.39237365	Hampton city
88882	Fee-for-Service	1033298781	1033298781	1	1	LEE, JAMES Y MD	10/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77042	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
88928	Fee-for-Service	1790830156	1790830156	1	1	LEE, LESLIE MD AMC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	61152	41	Internal Medicine	0	In state provider	None	103 N GARFIELD AVE	STE E	ALHAMBRA	CA	91801	3578	19	06037	34.0961716	-118.1275921	Los Angeles County
88929	Fee-for-Service	1013306364	1013306364	1	1	LADENHEIM, MARC L MD FACC	4/16/2015	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49875	41	Internal Medicine	0	In state provider	INC	2701 W ALAMEDA AVE	STE 607	BURBANK	CA	91505	4818	19	06037	34.15751343	-118.3303715	Los Angeles County
88933	Fee-for-Service	1639330772	1639330772	1	1	LEUNG, LOH-SHAN B MD	7/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109299	18	Ophthalmology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
88945	Fee-for-Service	1265486070	1265486070	1	1	LEON, SAMUEL O MD	10/29/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	73337	66	Emergency Medicine (Urgent Care)	0	In state provider	None	560 W GRANGEVILLE BLVD	STE C	HANFORD	CA	93230	2866	16	06031	36.34270548	-119.653191	Kings County
88971	Fee-for-Service	1427067669	1427067669	1	1	LEE, ANDREW C MD	11/10/2009	207R00000X	NA	Other	026	PHYSICIANS	81896	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	168 N BRENT STREET	#503	VENTURA	CA	93003	2892	56	06111	34.27448266	-119.2572489	Ventura County
88977	Fee-for-Service	1679685374	1679685374	1	1	LITTLE, NANCY A MD	11/30/1988	208800000X	NA	Other	026	PHYSICIANS	65454	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
89006	Fee-for-Service	1326193848	1326193848	1	1	LOS ANGELES COUNTY CCS	9/22/2006	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	MID-CITIES MTU	1417 S CENTRAL AVE	None	COMPTON	CA	90220	4102	19	06037	33.88307087	-118.2489369	Los Angeles County
89081	Fee-for-Service	1619592235	1619592235	1	1	LUONG, ANH T MD	8/25/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	179994	None	None	0	In state provider	None	555 TACHEVAH DR	SUITE 2E-107	PALM SPRINGS	CA	92262	5752	33	06065	33.83753681	-116.5424435	Riverside County
89098	Fee-for-Service	1992768576	1992768576	1	1	LEUNG, YAN MD	1/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	29313	67	Endocrinology	0	In state provider	None	1655 W BROADWAY	STE 3	ANAHEIM	CA	92802	1107	30	06059	33.8289235	-117.939537	Orange County
89106	Fee-for-Service	1578532735	1578532735	1	1	LEONI, MICHAEL K MD	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	61960	08	Family Practice	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
89197	Fee-for-Service	1952833170	1952833170	1	1	LASHIN, BASSEM M MD	8/5/2020	208M00000X	NA	Other	026	PHYSICIANS	166479	41	Internal Medicine	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
89213	Fee-for-Service	1558326363	1558326363	1	1	LUBER, SAMUEL D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
89219	Fee-for-Service	1699813824	1699813824	1	1	LODI UNIFIED SCHOOL DIST	1/10/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1305 E VINE ST	None	LODI	CA	95240	3148	39	06077	38.12334848	-121.249194	San Joaquin County
89232	Fee-for-Service	1265486070	1265486070	1	1	LEON, SAMUEL O MD	10/29/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	73337	08	Family Practice	0	In state provider	None	560 W GRANGEVILLE BLVD	STE C	HANFORD	CA	93230	2866	16	06031	36.34270548	-119.653191	Kings County
89267	Fee-for-Service	1083118020	1083118020	1	1	LIN, VIVIAN Y MD	2/4/2021	390200000X	NA	Other	026	PHYSICIANS	164755	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90809	1701	19	06037	33.808185	-118.1850575	Los Angeles County
89281	Fee-for-Service	1538181482	1538181482	1	2	LA CLINICA DE LA RAZA INC	1/21/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1360 DETROIT AVENUE	None	CONCORD	CA	94520	3522	07	06013	37.96574511	-122.0386828	Contra Costa County
89291	Fee-for-Service	1447466818	1447466818	1	1	LOYDS LIBERTY HOMES INC	3/11/1997	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7200 ALTAVILLE LN	None	BAKERSFIELD	CA	93309	2711	15	06029	35.33823857	-119.0826172	Kern County
89311	Fee-for-Service	1093188302	1093188302	1	1	LY, LINDA PHD	9/24/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8775 AERO DRIVE	STE 238	SAN DIEGO	CA	92123	1756	37	06073	32.80965551	-117.1391563	San Diego County
89314	Fee-for-Service	1194900191	1194900191	1	1	LEE, AIMEE J NP	10/24/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
89324	Fee-for-Service	1225239494	1225239494	1	1	LEWIS, LELA R MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	98062	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 N CHINA LAKE BLVD	STE B	RIDGECREST	CA	93555	3130	15	06029	35.640108	-117.6698465	Kern County
89340	Fee-for-Service	1255969762	1255969762	1	1	LIOU, CATHERINE DO	6/21/2024	208M00000X	NA	Other	026	PHYSICIANS	21569	41	Internal Medicine	0	In state provider	None	1020 29TH STREET	SUITE 570	SACRAMENTO	CA	95816	5125	34	06067	38.572803	-121.4685	Sacramento County
89345	Fee-for-Service	1609937911	1609937911	1	1	LAKE TAHOE ORTHO INSTITU	1/1/1997	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	1	Border provider	None	212 ELKS POINT RD	STE 200	ZEPHYR COVE	NV	89448	9800	00	None	38.98585115	-119.9417018	Douglas County
89353	Fee-for-Service	1528178969	1528178969	1	1	LEE, ERNY OD	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2060 PEABODY RD	STE 600	VACAVILLE	CA	95687	6696	48	06095	38.334015	-121.9704875	Solano County
89371	Fee-for-Service	1083076012	1083076012	1	1	LAU, MICHAEL X MD	1/8/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	154412	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
89373	Fee-for-Service	1205972239	1205972239	1	1	LIMAYE, ABHIJIT P MD	9/24/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
89396	Fee-for-Service	1578532735	1578532735	1	1	LEONI, MICHAEL K MD	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	61960	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
89400	Fee-for-Service	1972757516	1972757516	1	1	LITTLETON, MARIA LMFT	9/25/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	17822 BEACH BLVD	278	HUNTINGTON BEACH	CA	92647	7180	30	06059	33.70331388	-117.9890471	Orange County
89408	Fee-for-Service	1073722971	1073722971	1	1	LUM, JONATHAN T	6/12/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2702 LOW COURT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23678474	-122.0847463	Solano County
89435	Fee-for-Service	1700252285	1700252285	1	1	LAVIAN, MELODY PSYD	7/11/2023	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4153 24TH STREET	4	SAN FRANCISCO	CA	94114	3614	38	06075	37.75120501	-122.4352246	San Francisco County
89438	Fee-for-Service	1225280241	1225280241	1	1	LEIBOSHUR, NAAMA MD	1/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102565	41	Internal Medicine	0	In state provider	None	2800 BENEDICT DRIVE	None	SAN LEANDRO	CA	94577	6840	01	06001	37.71593435	-122.131151	Alameda County
89448	Fee-for-Service	1598285868	1598285868	1	1	LE, JEREMY MD	10/7/2024	2086S0129X	NA	General Surgery	026	PHYSICIANS	157926	None	None	0	In state provider	None	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
89464	Fee-for-Service	1194808394	1194808394	1	1	LAKE, DOUGLAS R MD	4/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99351	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
89465	Fee-for-Service	1790109114	1790109114	1	1	LOPEZ, CLAUDIA M LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
89468	Fee-for-Service	1386088599	1386088599	1	1	LONG, SUSAN DO	1/9/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	16648	01	General Practice	0	In state provider	None	271 TURN PIKE DR	None	FOLSOM	CA	95630	8098	34	06067	38.65509	-121.170042	Sacramento County
89492	Fee-for-Service	1104882554	1104882554	1	1	LIN, MARK A MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72763	05	Anesthesiology	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
89506	Fee-for-Service	1699813824	1699813824	1	1	LODI UNIFIED SCHOOL DIST	3/13/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	1305 E VINE ST	None	LODI	CA	95240	3148	39	06077	38.12334848	-121.249194	San Joaquin County
89559	Fee-for-Service	1093715617	1093715617	1	1	LOVE, JOHN W MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76351	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
89570	Fee-for-Service	1538181482	1538181482	1	2	LA CLINICA DE LA RAZA INC	1/21/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1360 DETROIT AVENUE	None	CONCORD	CA	94520	3522	07	06013	37.96574511	-122.0386828	Contra Costa County
89603	Fee-for-Service	1316972219	1316972219	1	1	LU, MICHAEL C MD	5/1/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55629	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10920 WILSHIRE BLVD	STE 1050	LOS ANGELES	CA	90024	6541	19	06037	34.05850474	-118.4447949	Los Angeles County
89637	Fee-for-Service	1316196397	1316196397	1	1	LAI, HOANG M MD	9/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123868	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	39755 MURRIETA HOT SPRIN	E-130	MURRIETA	CA	92563	9151	33	06065	33.55575954	-117.1627899	Riverside County
89640	Fee-for-Service	1841225893	1841225893	1	1	LAM, NHON D DC	12/8/2021	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
89659	Fee-for-Service	1730470121	1730470121	1	1	LO, DAPHNE T W MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130632	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
89663	Fee-for-Service	1528037793	1528037793	1	1	LANE, JACK C DO	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	6726	08	Family Practice	0	In state provider	None	1401 GARCES HWY	None	DELANO	CA	93215	3690	15	06029	35.76144847	-119.238912	Kern County
89671	Fee-for-Service	1508012303	1508012303	1	1	LAPOINT, JEFF M DO	8/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12291	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
89697	Fee-for-Service	1215212360	1215212360	1	1	LAM, CHAU OD	1/25/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4051 LONE TREE WAY STE E	None	ANTIOCH	CA	94531	6204	07	06013	37.97536168	-121.8003374	Contra Costa County
89701	Fee-for-Service	1811696974	1811696974	1	1	LOCATELLI, BAILEY R BIRTH DO	6/29/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	12	06023	0	0	None
89702	Fee-for-Service	1154320299	1154320299	1	1	LIGHTBRIDGE HOSPICE LLC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6155 CORNERSTONE CT EAST	SUITE 220	SAN DIEGO	CA	92121	4737	37	06073	32.89582335	-117.1880966	San Diego County
89729	Fee-for-Service	1558629675	1558629675	1	1	LANKA, VISWANATHA K MD	4/27/2020	207R00000X	NA	Other	026	PHYSICIANS	155611	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
89744	Fee-for-Service	1235368424	1235368424	1	1	LIN, JENNY J OD	6/26/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7825 ATLANTIC AVENUE	None	CUDAHY	CA	90201	5022	19	06037	33.96396181	-118.1866866	Los Angeles County
89752	Fee-for-Service	1164436820	1164436820	1	1	LIN, MICHAEL T MD	2/4/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	77571	07	Dermatology	0	In state provider	None	28049 SMYTH DR	None	VALENCIA	CA	91355	4023	19	06037	34.44339219	-118.5719935	Los Angeles County
89788	Fee-for-Service	1639161441	1639161441	1	1	LIBS, LORI DC	2/8/2015	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4410 LAMONT ST	None	SAN DIEGO	CA	92109	4515	37	06073	32.79949791	-117.2349281	San Diego County
89807	Fee-for-Service	1972538056	1972538056	1	1	LAWRENCE, PAUL C	5/12/2005	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	741 ATLANTIC AVE	None	LONG BEACH	CA	90813	4510	19	06037	33.776244	-118.1850795	Los Angeles County
89809	Fee-for-Service	1083078620	1083078620	1	1	LIGGETT, EVAN MD	3/13/2025	208600000X	NA	General Surgery	026	PHYSICIANS	192351	02	General Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
89840	Fee-for-Service	1134180946	1134180946	2	2	LEE, JEONG OK MD	2/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1801 W ROMNEYA DR	STE 606	ANAHEIM	CA	92801	1828	30	06059	33.8506615	-117.946413	Orange County
89860	Fee-for-Service	1720166820	1720166820	1	1	LEVIN, THEODORE R MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	76096	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1330 CUTTING BLVD	None	RICHMOND	CA	94804	2555	07	06013	37.92518651	-122.3564715	Contra Costa County
89901	Fee-for-Service	1033147160	1033147160	1	1	LIU, NING-AI MD	5/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77388	41	Internal Medicine	0	In state provider	None	11818 WILSHIRE BLVD	STE 200	LOS ANGELES	CA	90025	6646	19	06037	34.04781497	-118.4629576	Los Angeles County
89904	Fee-for-Service	1538145008	1538145008	1	1	LOGAN,JENNIFER DR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	80 SEYMOUR ST	None	HARTFORD	CT	06106	0000	00	None	41.75426505	-72.68071101	Capitol Planning Region
89911	Fee-for-Service	1568404374	1568404374	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2035 NOVATO BLVD	None	NOVATO	CA	94947	2191	21	06041	38.11207934	-122.5930504	Marin County
89952	Fee-for-Service	1851598726	1851598726	1	1	LADOUSIER, GENAYE M LCSW	10/26/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
89959	Fee-for-Service	1528037793	1528037793	1	1	LANE, JACK C DO	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	6726	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 GARCES HWY	None	DELANO	CA	93215	3690	15	06029	35.76144847	-119.238912	Kern County
89966	Fee-for-Service	1356960512	1356960512	1	1	LOS ANGELES CENTERS FOR ALCO	3/2/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	8919 & 8921 CALIFORNIA	None	SOUTH GATE	CA	90280	3013	19	06037	33.95350727	-118.2062649	Los Angeles County
89986	Fee-for-Service	1154320299	1154320299	1	1	LIGHTBRIDGE HOSPICE LLC	10/6/2003	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6155 CORNERSTONE CT EAST	SUITE 220	SAN DIEGO	CA	92121	4737	37	06073	32.89582335	-117.1880966	San Diego County
90031	Fee-for-Service	1851406540	1851406540	1	1	LIN, JAMES T MD INC	9/19/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86229	24	Plastic Surgery	0	In state provider	CAPITAL COSMETIC HAND &	8021 LAGUNA BLVD	# 3	ELK GROVE	CA	95758	7920	34	06067	38.422647	-121.4087805	Sacramento County
90051	Fee-for-Service	1184094849	1184094849	1	1	LANTOS, BRIAN P DO	9/27/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18551	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
90059	Fee-for-Service	1972709582	1972709582	1	1	LEDUC, JESSICA L DO	7/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
90061	Fee-for-Service	1134327067	1134327067	1	1	LAI, ELIZABETH MD	10/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121335	84	Surgery-Head and Neck	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
90071	Fee-for-Service	1609027804	1609027804	1	1	LIN, JOHN L MD	8/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106373	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
90077	Fee-for-Service	1366431348	1366431348	1	1	LEE, IVAN Y MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80771	41	Internal Medicine	0	In state provider	None	27001 CALAROGA AVE	STE 5	HAYWARD	CA	94545	4345	01	06001	37.63388965	-122.0898396	Alameda County
90081	Fee-for-Service	1588749311	1588749311	2	1	LINCARE INC	10/19/2013	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	21821 PLUMMER STREET	None	CHATSWORTH	CA	91311	4110	19	06037	34.24274637	-118.6037983	Los Angeles County
90083	Fee-for-Service	1316037922	1316037922	1	1	LACOURSIERE, DAPHNE Y MD	3/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	74138	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
90097	Fee-for-Service	1861012684	1861012684	1	1	LEE, SONNIE	8/2/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
90121	Fee-for-Service	1821033903	1821033903	1	1	LAKESIDE BEHAVIORAL	9/14/2010	261QM0801X	NA	Other	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	HEALTHCARE INC	1800 MERCY DRIVE	SUITE 302	ORLANDO	FL	32808	5646	00	None	28.567467	-81.4347855	Orange County
90157	Fee-for-Service	1275734139	1275734139	1	1	LOVEJOY, LINDA LMFT	5/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1622 4TH ST	None	SANTA ROSA	CA	95404	4020	49	06097	38.448162	-122.6995335	Sonoma County
90175	Fee-for-Service	1720353097	1720353097	1	1	LUMBRES, MADEL MD	12/21/2018	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
90188	Fee-for-Service	1033147160	1033147160	1	1	LIU, NING-AI MD	5/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77388	67	Endocrinology	0	In state provider	None	11818 WILSHIRE BLVD	STE 200	LOS ANGELES	CA	90025	6646	19	06037	34.04781497	-118.4629576	Los Angeles County
90199	Fee-for-Service	1952591703	1952591703	1	2	LEYVA, IRENE LMFT	12/9/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 N BRAND BLVD	STE 223	GLENDALE	CA	91203	2641	19	06037	34.14652066	-118.2549229	Los Angeles County
90234	Fee-for-Service	1457353567	1457353567	1	1	LUBIN, LAUREN M MD	3/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69725	40	Pediatrics	0	In state provider	None	12660 RIVERSIDE DR	STE 320	NORTH HOLLYWOOD	CA	91607	3431	19	06037	34.1575795	-118.409499	Los Angeles County
90243	Fee-for-Service	1093785198	1093785198	1	1	LIS, LEON	7/31/1989	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	57803	30	Radiology	0	In state provider	None	612 W DUARTE RD	None	ARCADIA	CA	91007	7602	19	06037	34.12647805	-118.051994	Los Angeles County
90251	Fee-for-Service	1558438408	1558438408	1	1	LITMAN, KERRY C MD	9/15/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	58632	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
90278	Fee-for-Service	1760984470	1760984470	1	1	LIN, MARK MD	7/17/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	164754	18	Ophthalmology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
90312	Fee-for-Service	1669910428	1669910428	1	1	LEE, CINDY D NP	2/4/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	19700 HESPERIAN BLVD	None	HAYWARD	CA	94541	4704	01	06001	37.66794557	-122.1184221	Alameda County
90322	Fee-for-Service	1689793945	1689793945	1	1	LAUREL HILLARY	2/10/2011	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	96	Unknown	0	In state provider	None	3113 SANDLING AVE	None	DENAIR	CA	95316	8569	50	06099	37.521495	-120.800409	Stanislaus County
90326	Fee-for-Service	1699152694	1699152694	1	1	LEDERMAN, NICOLE MD	5/4/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	162076	36	Psychiatry	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
90347	Fee-for-Service	1154683043	1154683043	1	1	LICHTMANN, DANIEL M MD	6/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128188	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
90356	Fee-for-Service	1326193996	1326193996	1	1	LOS ANGELES COUNTY CCS	8/1/2002	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	GLENDALE MTU	1700 E MOUNTAIN ST	None	GLENDALE	CA	91207	1246	19	06037	34.16432474	-118.2258678	Los Angeles County
90363	Fee-for-Service	1518458165	1518458165	1	2	LEONARD, SEAN NP	11/13/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95009094	-	NOT APPLICABLE	0	In state provider	None	13212 & 13222 CHAPMAN AV	None	GARDEN GROVE	CA	92840	4414	30	06059	33.7888215	-117.901998	Orange County
90380	Fee-for-Service	1285072918	1285072918	1	1	LEE, ALAN MD	6/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156335	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MED PLAZA	STE B265	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
90387	Fee-for-Service	1265693691	1265693691	1	1	LEE, KATHERINE B MD	4/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120778	07	Dermatology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
90436	Fee-for-Service	1396767729	1396767729	1	1	LU, JOHN S MD	1/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45810	40	Pediatrics	0	In state provider	None	4201 TORRANCE BLVD	STE 370	TORRANCE	CA	90503	4594	19	06037	33.8375955	-118.358748	Los Angeles County
90445	Fee-for-Service	1639497209	1639497209	1	1	LEONG, BENJAMIN Y MD INC	7/26/2010	208600000X	NA	General Surgery	026	PHYSICIANS	106797	None	None	0	In state provider	None	4000 14TH ST	STE 412	RIVERSIDE	CA	92501	4010	33	06065	33.97771007	-117.3818381	Riverside County
90490	Fee-for-Service	1871562496	1871562496	1	1	LENABURG, WILLIAM MD	2/14/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51103	None	None	0	In state provider	None	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	19	06037	34.13998921	-118.7070142	Los Angeles County
90512	Fee-for-Service	1588981823	1588981823	1	1	LOPEZ, JACINTA	4/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
90519	Fee-for-Service	1396277836	1396277836	1	1	LEE, DANIEL H MD	10/5/2021	207P00000X	NA	Other	026	PHYSICIANS	171922	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
90525	Fee-for-Service	1992805550	1992805550	1	2	LAU, MAY Y MD INC	1/12/2006	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	MTU CONSULTANT	4544 MAXSON RD	None	EL MONTE	CA	91732	1757	19	06037	34.08361398	-118.0027322	Los Angeles County
90539	Fee-for-Service	1558438408	1558438408	1	1	LITMAN, KERRY C MD	9/15/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	58632	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
90611	Fee-for-Service	1447282421	1447282421	1	1	LASHKARI, SAMAN MD	2/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	60443	None	None	0	In state provider	None	18375 VENTURA BLVD	SUITE 628	TARZANA	CA	91356	4218	19	06037	34.16753468	-118.5328841	Los Angeles County
90622	Fee-for-Service	1619362233	1619362233	1	1	LEE, SUH H MD	8/27/2021	207R00000X	NA	Other	026	PHYSICIANS	167877	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
90650	Fee-for-Service	1821083395	1821083395	1	1	LOWE, MARC A MD INC	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	57914	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	230 W PUEBLO ST	None	SANTA BARBARA	CA	93105	3870	42	06083	34.43081942	-119.7216759	Santa Barbara County
90659	Fee-for-Service	1699887679	1699887679	1	1	LANG, ADAM G	2/8/2015	207ZP0102X	NA	Other	026	PHYSICIANS	54339	22	Pathology (M.D. only)	0	In state provider	None	2201 MOUNT VERNON AVE	STE 110	BAKERSFIELD	CA	93306	3341	15	06029	35.38781796	-118.9673567	Kern County
90660	Fee-for-Service	1215165857	1215165857	1	1	LEWIS, CATHERINE E MD	7/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	100217	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
90684	Fee-for-Service	1386638146	1386638146	1	1	LU, VINH T MD	9/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91629	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
90796	Fee-for-Service	1336297357	1336297357	1	1	LEE, EUN K MD	12/17/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	93365	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
90837	Fee-for-Service	1518228592	1518228592	1	1	LEE, ANGELICA	7/18/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	760 POLHEMUS RD	None	SAN MATEO	CA	94402	3938	41	06081	37.52051982	-122.3386627	San Mateo County
90848	Fee-for-Service	1033123831	1033123831	1	1	LAND, JOAN B LMFT	4/23/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1370 BREA BLVD	SUITE 144	FULLERTON	CA	92835	4123	30	06059	33.88482917	-117.9236469	Orange County
90902	Fee-for-Service	1447916168	1447916168	1	1	LAYSON, MARIA S NP	1/13/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
90910	Fee-for-Service	1407947906	1407947906	1	1	LIN, XINYI CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	345 9TH ST	STE 209	OAKLAND	CA	94607	6524	01	06001	37.79975865	-122.2705956	Alameda County
90927	Fee-for-Service	1588779631	1588779631	1	1	LIN, CHAO I MD	2/21/1989	207K00000X	NA	Other	026	PHYSICIANS	45786	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
90963	Fee-for-Service	1770594616	1770594616	1	1	LIAN, TOM C MD	12/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	60506	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3130 5TH AVE	None	SAN DIEGO	CA	92103	5839	37	06073	32.73813729	-117.1603812	San Diego County
90966	Fee-for-Service	1063703890	1063703890	1	1	LEE, SCOTT H MD	1/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	123118	10	Gastroenterology (M.D. only)	0	In state provider	None	6405 DAY STREET	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
90971	Fee-for-Service	1720098171	1720098171	1	1	LONG LIFE CARDIAC CENTER	4/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	AMC	35 S GARFIELD AVE	None	ALHAMBRA	CA	91801	3830	19	06037	34.09453094	-118.1264355	Los Angeles County
91010	Fee-for-Service	1699824177	1699824177	1	1	LARSON,R JEFFERY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2301 N 44TH ST	None	PHOENIX	AZ	85008	0000	00	None	33.47325	-111.9866535	Maricopa County
91021	Fee-for-Service	1508158288	1508158288	1	1	LI, KALIE N DO	8/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14112	09	Gynecology (D.O. only)	0	In state provider	None	1100 TRANCAS STREET	SUITE 209	NAPA	CA	94558	2909	28	06055	38.32316569	-122.2981938	Napa County
91037	Fee-for-Service	1053499137	1053499137	1	1	LIANG, TSAO-YU MD	1/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85222	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
91038	Fee-for-Service	1073632402	1073632402	1	1	LIVA YATES GRITTON, M.D., IN	12/17/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	None	None	0	In state provider	C.	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
91043	Fee-for-Service	1871604686	1871604686	1	1	LEUNG, RAYMOND W P MD	4/20/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	48262	02	General Surgery	0	In state provider	None	600 N GARFIELD AVE	STE 210	MONTEREY PARK	CA	91754	1170	19	06037	34.06820797	-118.1228835	Los Angeles County
91047	Fee-for-Service	1073668521	1073668521	1	1	LOS ANGELES COUNTY CCS	9/30/1993	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	RESEDA MTU	19451 WYANDOTTE ST	None	RESEDA	CA	91335	3518	19	06037	34.20293816	-118.5572103	Los Angeles County
91058	Fee-for-Service	1184685299	1184685299	1	1	LEONG, FAH S MD	12/23/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	86652	30	Radiology	0	In state provider	None	FRESNO AND R ST	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
91062	Fee-for-Service	1811972920	1811972920	1	1	LOUIE, SAMUEL MD	6/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	47302	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
91073	Fee-for-Service	1174523344	1174523344	1	1	LEE, DANIEL D MD	7/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	2650 N TENAYA WAY	STE 301	LAS VEGAS	NV	89128	1112	00	None	36.20804839	-115.2501292	Clark County
91086	Fee-for-Service	1053471243	1053471243	1	1	LEE,JUNG-SUP MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67765	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
91105	Fee-for-Service	1992811392	1992811392	1	2	LA CLINICA DE LA RAZA INC	8/26/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	210 HOSPITAL DRIVE	None	VALLEJO	CA	94589	2517	48	06095	38.13109785	-122.238998	Solano County
91124	Fee-for-Service	1649732769	1649732769	1	2	LISTER, ALEXANDER DPM	8/4/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5120 MANZANITA AVE	SUITE 100	CARMICHAEL	CA	95608	0558	34	06067	38.659392	-121.327155	Sacramento County
91127	Fee-for-Service	1497059885	1497059885	1	1	LAO, LILIAN S MD	1/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106102	41	Internal Medicine	0	In state provider	None	3883 AIRWAY DR	#201	SANTA ROSA	CA	95403	1670	49	06097	38.483226	-122.739705	Sonoma County
91134	Fee-for-Service	1023266228	1023266228	1	1	LI, LI-QING	2/8/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	41 N GARFIELD AVE	STE 103	ALHAMBRA	CA	91801	7501	19	06037	34.09590269	-118.1274015	Los Angeles County
91140	Fee-for-Service	1932364171	1932364171	1	1	LEONARD, NATASHIA LMFT	8/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
91142	Fee-for-Service	1902935901	1902935901	1	1	LAURA'S CORSET SHOPPE INC.	11/11/2020	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	232 N BRAND BLVD	None	GLENDALE	CA	91203	2610	19	06037	34.149348	-118.2549315	Los Angeles County
91173	Fee-for-Service	1457805251	1457805251	1	1	LUCID SPEECH AND LANGUAGE CL	9/13/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	IC, INC.	31205 PAUBA ROAD	103	TEMECULA	CA	92592	6220	33	06065	33.49739729	-117.1169062	Riverside County
91180	Fee-for-Service	1003847583	1003847583	1	1	LEE, JOW-SHONE	11/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	33688	None	None	0	In state provider	None	27350 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.897402	-117.1860255	Riverside County
91209	Fee-for-Service	1386886141	1386886141	1	1	LOUIE,DEANNA M MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121476	18	Ophthalmology	0	In state provider	None	1805 N CALIFORNIA ST	STE 101	STOCKTON	CA	95204	6037	39	06077	37.9711691	-121.2894221	San Joaquin County
91236	Fee-for-Service	1598775223	1598775223	1	1	LIU, SUSIE M MD	6/30/1995	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	67248	01	General Practice	0	In state provider	None	900 WELCH RD	STE 202	PALO ALTO	CA	94304	1803	43	06085	37.43619156	-122.1779694	Santa Clara County
91248	Fee-for-Service	1770594616	1770594616	1	1	LIAN, TOM C MD	12/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	60506	36	Psychiatry	0	In state provider	None	3130 5TH AVE	None	SAN DIEGO	CA	92103	5839	37	06073	32.73813729	-117.1603812	San Diego County
91255	Fee-for-Service	1104946086	1104946086	1	1	LIEBER, COREY M MD	7/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99207	20	Orthopedic Surgery	0	In state provider	None	22 CORPORATE PLAZA DR	None	NEWPORT BEACH	CA	92660	7985	30	06059	33.607602	-117.876852	Orange County
91259	Fee-for-Service	1720098171	1720098171	1	1	LONG LIFE CARDIAC CENTER	4/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	AMC	35 S GARFIELD AVE	None	ALHAMBRA	CA	91801	3830	19	06037	34.09453094	-118.1264355	Los Angeles County
91305	Fee-for-Service	1962574426	1962574426	1	1	LOPANSRI, SUMALA MD	7/20/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33915	07	Dermatology	0	In state provider	None	1127 WILSHIRE BLVD	STE 604	LOS ANGELES	CA	90017	3901	19	06037	34.05270508	-118.2641005	Los Angeles County
91329	Fee-for-Service	1215680699	1215680699	1	1	LIVWELL HEALTHCARE SOLUTIONS	8/22/2023	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	A	594 EL CAMINO REAL	None	SANTA CLARA	CA	95050	4345	43	06085	37.35293214	-121.9385135	Santa Clara County
91355	Fee-for-Service	1619140886	1619140886	1	1	LAGLER, CHRISTINE P MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126335	18	Ophthalmology	0	In state provider	None	7300 NORTH FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
91393	Fee-for-Service	1992811392	1992811392	1	2	LA CLINICA DE LA RAZA INC	8/26/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	210 HOSPITAL DRIVE	None	VALLEJO	CA	94589	2517	48	06095	38.13109785	-122.238998	Solano County
91408	Fee-for-Service	1093831471	1093831471	1	1	LEWIS, KEITH E MD	3/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	81325	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
91419	Fee-for-Service	1306883053	1306883053	1	1	LY, CUONG P MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73873	41	Internal Medicine	0	In state provider	None	9930 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166152	-117.955521	Orange County
91428	Fee-for-Service	1871512723	1871512723	1	1	LUM, DARYL W MD	4/1/1998	207R00000X	NA	Other	026	PHYSICIANS	62800	None	None	0	In state provider	None	10000 VENICE BLVD	None	CULVER CITY	CA	90232	2720	19	06037	34.02272697	-118.3997063	Los Angeles County
91439	Fee-for-Service	1821169475	1821169475	1	1	LONGWELL, BILL J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	41238	41	Internal Medicine	0	In state provider	None	501 S SHORE CTR W	None	ALAMEDA	CA	94501	5725	01	06001	37.75884896	-122.2528366	Alameda County
91443	Fee-for-Service	1417213919	1417213919	1	1	LUI, FELIX H T MD	12/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129044	41	Internal Medicine	0	In state provider	None	2340 CLAY STREET	2ND FLOOR	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
91474	Fee-for-Service	1407201296	1407201296	1	1	LAUDENSLAGER, ADAM E MD	3/1/2019	207P00000X	NA	Other	026	PHYSICIANS	144914	66	Emergency Medicine (Urgent Care)	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
91475	Fee-for-Service	1013463579	1013463579	1	1	LEWIS, GAIL S LMFT	10/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	603 CAPITOLA AVENUE	None	CAPITOLA	CA	95010	2751	44	06087	36.9772486	-121.9533994	Santa Cruz County
91480	Fee-for-Service	1770833386	1770833386	1	1	LA BUENA VIDA PHARMACY INC	2/22/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	51-335 CESAR CHAVEZ STRE	STE 116	COACHELLA	CA	92236	1528	33	06065	33.67309459	-116.181558	Riverside County
91505	Fee-for-Service	1750434387	1750434387	1	1	LOPEZ, CARMEN LMFT	3/25/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
91522	Fee-for-Service	1598775223	1598775223	1	1	LIU, SUSIE M MD	6/30/1995	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	67248	10	Gastroenterology (M.D. only)	0	In state provider	None	900 WELCH RD	STE 202	PALO ALTO	CA	94304	1803	43	06085	37.43619156	-122.1779694	Santa Clara County
91532	Fee-for-Service	1558660399	1558660399	1	1	LENTZNER, NANCY A LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
91547	Fee-for-Service	1982067336	1982067336	1	1	LIU, ALBERT Y MD	2/14/2020	390200000X	NA	Other	026	PHYSICIANS	151883	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
91578	Fee-for-Service	1255663811	1255663811	1	1	LOERA, GLORIA A LCSW	3/1/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	85699	-	NOT APPLICABLE	0	In state provider	None	1245 E WALNUT ST	STE 117	PASADENA	CA	91106	5129	19	06037	34.14961826	-118.1246559	Los Angeles County
91607	Fee-for-Service	1508049073	1508049073	1	1	LE, HOA MD	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81891	78	Neoplastic Diseases/Oncology	0	In state provider	None	710 LAWRENCE EXPRESSWAY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
91646	Fee-for-Service	1487127858	1487127858	1	1	LEE, JONATHAN MD	6/19/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	159771	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
91656	Fee-for-Service	1639621659	1639621659	1	1	LUXOR SCIENTIFIC, LLC	1/12/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	1327 MILLER RD	F	GREENVILLE	SC	29607	5786	00	None	34.82388766	-82.29623556	Greenville County
91657	Fee-for-Service	1104487446	1104487446	1	1	LUI, ASONA J	7/3/2024	2085R0001X	NA	Other	026	PHYSICIANS	180738	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
91693	Fee-for-Service	1255466058	1255466058	1	1	LEE, YA-CHEN CNP	10/1/2020	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
91710	Fee-for-Service	1366557704	1366557704	1	1	LIAU, DEREK W MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108262	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
91720	Fee-for-Service	1548421779	1548421779	1	1	LEE, MING S MD	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121069	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
91754	Fee-for-Service	1659640811	1659640811	1	1	LEE, JAMILLE A CRNA	2/7/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
91811	Fee-for-Service	1114018686	1114018686	1	1	LOW, KYLE MD	8/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89372	20	Orthopedic Surgery	0	In state provider	None	1400 S HARBOR BLVD	None	LA HABRA	CA	90631	7577	30	06059	33.91429299	-117.9326786	Orange County
91812	Fee-for-Service	1912199266	1912199266	1	1	LI, KIT	8/8/2007	164X00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1055 N CAPITOL AVE	APT 38	SAN JOSE	CA	95133	2710	43	06085	37.38437888	-121.8583469	Santa Clara County
91829	Fee-for-Service	1497924831	1497924831	1	1	LY, JULIANNE T CRNA	4/28/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
91862	Fee-for-Service	1477585156	1477585156	1	1	LEWIS, MARGARET J AU	11/18/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
91893	Fee-for-Service	1508049073	1508049073	1	1	LE, HOA MD	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81891	68	Hematology	0	In state provider	None	710 LAWRENCE EXPRESSWAY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
91924	Fee-for-Service	1023617057	1023617057	1	1	LEMED PHARMACY III LLC	2/13/2023	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	2417 3RD AVE	STE 406	BRONX	NY	10451	6340	00	None	40.808754	-73.930662	Bronx County
91940	Fee-for-Service	1659752830	1659752830	1	1	LYZNICK, JOSEPH LMFT	1/29/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27201 TOURNEY RD	STE 200D	VALENCIA	CA	91381	1016	19	06037	34.41741018	-118.5770409	Los Angeles County
91952	Fee-for-Service	1285636704	1285636704	2	1	LIBERTY MEDICAL LLC	10/16/2015	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	2157 APPERSON DRIVE	None	SALEM	VA	24153	7235	00	None	37.266462	-80.0199045	Salem city
91982	Fee-for-Service	1184789349	1184789349	1	1	LOPEZ, TONY P MD	8/31/1982	207R00000X	NA	Other	026	PHYSICIANS	40775	01	General Practice	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
91991	Fee-for-Service	1164964409	1164964409	1	1	LYNCH, DARRAGH J PT	7/16/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
92038	Fee-for-Service	1356637359	1356637359	1	1	LOPEZ, CLAUDIA E MD	5/30/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144026	08	Family Practice	0	In state provider	None	1601 MONTE VISTA AVE	SUITE 100	CLAREMONT	CA	91711	2914	19	06037	34.112259	-117.698539	Los Angeles County
92043	Fee-for-Service	1013911551	1013911551	1	1	LINZMEYER, JENNIFER D DO	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7352	40	Pediatrics	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
92054	Fee-for-Service	1427691021	1427691021	1	1	LAIRD, HEATHER R LMFT	2/3/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
92062	Fee-for-Service	1629538160	1629538160	1	1	LIM, SUNG HYUN MD	4/19/2023	208M00000X	NA	Other	026	PHYSICIANS	177649	None	None	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
92068	Fee-for-Service	1073212338	1073212338	1	1	LEE, JIHYUNG	8/22/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
92073	Fee-for-Service	1043755754	1043755754	1	1	LIU, MONA M MD	12/18/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	146471	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
92090	Fee-for-Service	1326400144	1326400144	1	1	LANDAN, MAYA MD	11/25/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	150931	40	Pediatrics	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
92105	Fee-for-Service	1356412332	1356412332	1	1	LUETZOW, ANNETTE M MD	7/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	59197	04	Otology, Laryngology, Rhinology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
92115	Fee-for-Service	1417320433	1417320433	1	1	LUIS, SEAN A NP	5/16/2020	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
92133	Fee-for-Service	1720098270	1720098270	1	1	LIN, CHENG-I MD	11/30/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	77463	08	Family Practice	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 230	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
92141	Fee-for-Service	1881473023	1881473023	1	1	LEUNG, LAI F	10/22/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	16169 HESPERIAN BLVD	None	SAN LORENZO	CA	94580	2451	01	06001	37.67713903	-122.1254449	Alameda County
92165	Fee-for-Service	1609921204	1609921204	1	1	LARSON, BRENT R MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63652	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
92180	Fee-for-Service	1508049073	1508049073	1	1	LE, HOA MD	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81891	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPRESSWAY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
92188	Fee-for-Service	1245332220	1245332220	1	1	LAI, GARY T MD	8/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	65030	41	Internal Medicine	0	In state provider	None	2525 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.027695	-117.6498945	San Bernardino County
92191	Fee-for-Service	1215905930	1215905930	1	1	LYONS, JOHN MICHAELS MD	4/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	38565	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3838 SHERMAN DR	STE 10	RIVERSIDE	CA	92503	4083	33	06065	33.92678822	-117.4368632	Riverside County
92197	Fee-for-Service	1992328876	1992328876	1	1	LOPEZ-KLINCK, NOHEMI L LMFT	9/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
92198	Fee-for-Service	1932451168	1932451168	1	1	LUNDERGAN, WILLIAM G MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123124	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
92201	Fee-for-Service	1154529030	1154529030	1	1	LL0YD, KIMBERLY C MD	5/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	115683	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
92205	Fee-for-Service	1720037419	1720037419	1	1	LOWDER, HAROLD E MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	48264	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
92213	Fee-for-Service	1922596899	1922596899	1	1	LENDARIS, MARIA NP	7/28/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
92274	Fee-for-Service	1700176971	1700176971	1	1	LAI, BRIAN MD	9/9/2020	207LP2900X	NA	Other	026	PHYSICIANS	135483	05	Anesthesiology	0	In state provider	None	2620 E LAS POSAS ROAD	None	CAMARILLO	CA	93010	3400	56	06111	34.23720123	-119.035911	Ventura County
92280	Fee-for-Service	1477736346	1477736346	1	1	LELLESS, DESIREE T G LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18484 US HWY 18	STE 125	APPLE VALLEY	CA	92307	2371	36	06071	34.53970843	-117.2611301	San Bernardino County
92293	Fee-for-Service	1699765214	1699765214	1	1	LIN, TING-YI MD	10/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131975	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
92304	Fee-for-Service	1093728743	1093728743	1	1	LOS ANGELES COUNTY	7/1/2005	282N00000X	NA	Hospitals	060	COUNTY HOSPITAL INPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	2051 MARENGO ST	C2K100	LOS ANGELES	CA	90033	1352	19	06037	34.05627579	-118.2064774	Los Angeles County
92313	Fee-for-Service	1780808477	1780808477	1	1	LANDMARK HEARING SERVICES IN	1/17/2020	193400000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	877 W FREMONT AVE	SUITE I4	SUNNYVALE	CA	94087	2319	43	06085	37.35226149	-122.049297	Santa Clara County
92348	Fee-for-Service	1447497748	1447497748	1	1	LIN, CANDICE L NP	9/25/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
92360	Fee-for-Service	1023154721	1023154721	1	1	LYNCH, KELLY S PHD	1/3/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	23774	-	NOT APPLICABLE	0	In state provider	None	86 SOUTH 14TH STREET	None	SAN JOSE	CA	95112	2015	43	06085	37.34109735	-121.8760463	Santa Clara County
92394	Fee-for-Service	1356412332	1356412332	1	1	LUETZOW, ANNETTE M MD	7/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	59197	84	Surgery-Head and Neck	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
92412	Fee-for-Service	1376761767	1376761767	1	1	LY, CALVIN C DO	8/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10209	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
92427	Fee-for-Service	1386663987	1386663987	1	1	LOVE, PAUL H	11/5/2020	207P00000X	NA	Other	026	PHYSICIANS	61141	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
92452	Fee-for-Service	1528080470	1528080470	1	9	LA CLINICA DE LA RAZA	6/24/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1203 W 10TH ST	BUILDING A-C	ANTIOCH	CA	94509	1400	07	06013	38.01111567	-121.8217286	Contra Costa County
92468	Fee-for-Service	1598870123	1598870123	1	1	LIN, CAROLINE Y MD	8/20/2009	207R00000X	NA	Other	026	PHYSICIANS	106659	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
92475	Fee-for-Service	1528079258	1528079258	1	1	LASHIER, HARVEY M MD	5/28/1987	207W00000X	NA	Ophthalmology	026	PHYSICIANS	21384	18	Ophthalmology	0	In state provider	None	607 N CENTRAL AVE	STE 103	GLENDALE	CA	91203	1804	19	06037	34.153974	-118.2579675	Los Angeles County
92487	Fee-for-Service	1518121771	1518121771	1	1	LEE, MYUNG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
92513	Fee-for-Service	1467695320	1467695320	1	1	LAFAVE, LISA A PSYD	5/6/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
92533	Fee-for-Service	1417983552	1417983552	1	1	LOS ROBLES EMERGENCY	1/7/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS MED GROUP	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
92573	Fee-for-Service	1093860298	1093860298	1	1	LA VIDA-KPC	11/28/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	MEDICAL GROUP INC	5800 HANNUM AVE	None	CULVER CITY	CA	90230	6502	19	06037	33.98724995	-118.3858338	Los Angeles County
92587	Fee-for-Service	1902948995	1902948995	1	1	LITTLE, DIANA C LMFT	4/30/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
92604	Fee-for-Service	1750497616	1750497616	1	1	LEHFELDT, STEFANIE L MD	8/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80512	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
92618	Fee-for-Service	1649260696	1649260696	1	1	LIGHTFOOT, DAVID V MD	1/22/1987	207W00000X	NA	Ophthalmology	026	PHYSICIANS	57122	18	Ophthalmology	0	In state provider	None	1120 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4815	49	06097	38.442708	-122.7009465	Sonoma County
92649	Fee-for-Service	1033147418	1033147418	1	1	LYNCH, MELISSA J MD	1/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79894	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 N NAME UNO	None	GILROY	CA	95020	3528	43	06085	37.03498475	-121.5729235	Santa Clara County
92650	Fee-for-Service	1790733269	1790733269	1	1	LANDECK, SCOTT T MD	4/10/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84442	66	Emergency Medicine (Urgent Care)	0	In state provider	None	180 ROWLAND WAY	None	NOVATO	CA	94945	5009	21	06041	38.09825699	-122.5598561	Marin County
92653	Fee-for-Service	1558379990	1558379990	1	1	LOS ANGELES COUNTY	7/1/2000	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	SAN FERNANDO HEALTH CTR	1212 PICO ST	None	SAN FERNANDO	CA	91340	3503	19	06037	34.28357605	-118.4447788	Los Angeles County
92663	Fee-for-Service	1023854957	1023854957	1	1	LEE, BRENDA C	1/15/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
92740	Fee-for-Service	1528080470	1528080470	1	3	LA CLINICA DE LA RAZA	4/8/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	610 CROWLEY AVENUE	None	PITTSBURG	CA	94565	4763	07	06013	38.01644828	-121.9004649	Contra Costa County
92752	Fee-for-Service	1750511275	1750511275	1	1	LEE, MARSHALL K MD	11/2/2020	207LC0200X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	3181 SW SAM JACKSON PARK	None	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
92756	Fee-for-Service	1114698602	1114698602	1	1	LOMBARDI, SHELBY NP	10/1/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	201 E NOBLE AVE	None	VISALIA	CA	93277	2857	54	06107	36.326259	-119.2909725	Tulare County
92851	Fee-for-Service	1457615072	1457615072	1	1	LIU, PHILIP MD	1/16/2025	2084P0804X	NA	Psychiatry	026	PHYSICIANS	182440	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
92857	Fee-for-Service	1508960527	1508960527	1	1	LARDIZABAL, JOEL A MD	10/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92530	None	None	0	In state provider	None	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
92865	Fee-for-Service	1972668580	1972668580	1	1	LOPEZ, FREDRICK P CRNA	3/9/2006	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
92894	Fee-for-Service	1003880550	1003880550	1	1	LYNNE RUESS	10/6/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
92922	Fee-for-Service	1932608130	1932608130	1	1	LIFE ON WHEELS LLC	2/12/2018	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	550 S G ST	STE 29	ARCATA	CA	95521	2601	12	06023	40.85666085	-124.0894684	Humboldt County
92941	Fee-for-Service	1558379990	1558379990	1	1	LOS ANGELES COUNTY	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	SAN FERNANDO HEALTH CTR	1212 PICO ST	None	SAN FERNANDO	CA	91340	3503	19	06037	34.28357605	-118.4447788	Los Angeles County
92959	Fee-for-Service	1386807600	1386807600	1	1	LARA RIVERA, DEBORAH LCSW	2/11/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
92975	Fee-for-Service	1225148042	1225148042	1	1	LORBER, BRETT W MD	9/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84714	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
93002	Fee-for-Service	1790933042	1790933042	1	1	LOOMBA, ASHISH MD	1/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143844	40	Pediatrics	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
93010	Fee-for-Service	1518060417	1518060417	1	1	LEONG, TOMMY K MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	54457	08	Family Practice	0	In state provider	None	2260 E PALMDALE BLVD	STE G-I	PALMDALE	CA	93550	4952	19	06037	34.58008951	-118.0884915	Los Angeles County
93023	Fee-for-Service	1528080470	1528080470	1	3	LA CLINICA DE LA RAZA	4/8/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	610 CROWLEY AVENUE	None	PITTSBURG	CA	94565	4763	07	06013	38.01644828	-121.9004649	Contra Costa County
93032	Fee-for-Service	1497118129	1497118129	1	1	LY, PRINCETON MD	6/13/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	156336	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA #530	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
93071	Fee-for-Service	1295352060	1295352060	1	1	LODEN, CLAIRE MICHELLE NP	4/6/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	104 E OLIVE AVE	STE 100	REDLANDS	CA	92373	5255	36	06071	34.0540723	-117.1800104	San Bernardino County
93075	Fee-for-Service	1487397915	1487397915	1	1	LORENTZ, KATHRYN LMFT	11/29/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
93083	Fee-for-Service	1205934551	1205934551	1	1	LEE, ELAINE OD INC	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7375 DAY CREEK BLVD	STE 105	RANCHO CUCAMONGA	CA	91739	8024	36	06071	34.11964299	-117.5368061	San Bernardino County
93109	Fee-for-Service	1548236771	1548236771	1	1	LUAN, GORDON C MD	4/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	83256	08	Family Practice	0	In state provider	None	1236 MAIN ST	None	RAMONA	CA	92065	2125	37	06073	33.03981079	-116.8725152	San Diego County
93129	Fee-for-Service	1609953892	1609953892	1	1	LAIRD, MICHAEL T MD	3/5/1999	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	78037	20	Orthopedic Surgery	0	In state provider	None	310 S HALCYON RD	STE 101	ARROYO GRANDE	CA	93420	3863	40	06079	35.11464177	-120.5916364	San Luis Obispo County
93139	Fee-for-Service	1558592121	1558592121	1	1	LARSON, CHRISTOPHER L MD	3/30/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	116171	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
93151	Fee-for-Service	1689018533	1689018533	1	1	LANNING, BECKY N LMFT	4/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
93177	Fee-for-Service	1669690228	1669690228	1	1	LEUNG, VICKI OD	8/24/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2845 COCHRAN	D	SIMI VALLEY	CA	93065	2796	56	06111	34.280973	-118.742589	Ventura County
93192	Fee-for-Service	1407253784	1407253784	1	1	LAM, HANG T	2/5/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	301 S MOORPARK RD	None	THOUSAND OAKS	CA	91360	1008	56	06111	34.17369227	-118.8765488	Ventura County
93197	Fee-for-Service	1841559325	1841559325	1	1	LIAO, JOSEPH H MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146618	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
93230	Fee-for-Service	1194803635	1194803635	1	1	LAI, RAYMOND S DO	3/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9240	25	Physical Medicine and Rehabilitation	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
93278	Fee-for-Service	1316358179	1316358179	1	1	LA, AN D MD	7/23/2020	207L00000X	NA	Other	026	PHYSICIANS	139878	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
93307	Fee-for-Service	1083239727	1083239727	1	1	LARISSA LARSEN DERMATOLOGY,	6/17/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	None	07	Dermatology	0	In state provider	INC	2460 N PONDEROSA DR	STE A117	CAMARILLO	CA	93010	2468	56	06111	34.24276343	-119.0228383	Ventura County
93314	Fee-for-Service	1528080470	1528080470	1	9	LA CLINICA DE LA RAZA	6/24/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1203 W 10TH ST	BUILDING A-C	ANTIOCH	CA	94509	1400	07	06013	38.01111567	-121.8217286	Contra Costa County
93345	Fee-for-Service	1992725626	1992725626	1	1	LIMON, JOSE M MD	8/28/2009	207R00000X	NA	Other	026	PHYSICIANS	45442	41	Internal Medicine	0	In state provider	None	264 N HIGHLAND SPRINGS A	STE 3D	BANNING	CA	92220	3082	33	06065	33.93063	-116.946864	Riverside County
93365	Fee-for-Service	1720346034	1720346034	1	1	LEFEBVRE, RACHEL E MD	9/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149995	20	Orthopedic Surgery	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
93374	Fee-for-Service	1306056858	1306056858	2	1	LOS ANGELES COUNTY	5/23/2007	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	DEPT OF HEALTH SERVICES	335 E AVE I	None	LANCASTER	CA	93535	1916	19	06037	34.7041113	-118.1247548	Los Angeles County
93381	Fee-for-Service	1316986201	1316986201	1	1	LAKE JACKSON EMS	9/15/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10 OAK DRIVE	None	LAKE JACKSON	TX	77566	0000	00	None	29.0371237	-95.44835772	Brazoria County
93444	Fee-for-Service	1255795357	1255795357	1	1	LIN, KYAW DO	10/19/2021	208VP0000X	NA	Other	026	PHYSICIANS	16516	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
93467	Fee-for-Service	1225009350	1225009350	1	1	LETARTE,JEAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1041 NORTH ARIZOLA RD	None	CASA GRANDE	AZ	85122	0000	00	None	32.883786	-111.7146555	Pinal County
93503	Fee-for-Service	1427215250	1427215250	1	1	LOO, PATRICIA MD	3/18/2024	207R00000X	NA	Other	026	PHYSICIANS	111555	None	None	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
93525	Fee-for-Service	1144568239	1144568239	1	1	LABARGE, LORELEI E CNP	8/16/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
93546	Fee-for-Service	1316979909	1316979909	1	1	LIAO, DAVID MD	1/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74325	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
93561	Fee-for-Service	1184857658	1184857658	1	1	LI, XIN-NONG MD INC	1/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	67508	41	Internal Medicine	0	In state provider	None	6600 MERCY CT	STE 130	FAIR OAKS	CA	95628	3158	34	06067	38.666565	-121.309857	Sacramento County
93571	Fee-for-Service	1285619825	1285619825	1	1	LIU, TERRENCE E MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67388	40	Pediatrics	0	In state provider	None	15944 LOS SERRANOS COUNT	STE 220	CHINO HILLS	CA	91709	3991	36	06071	33.9635227	-117.695881	San Bernardino County
93579	Fee-for-Service	1780852509	1780852509	1	1	LEONE, SARAH LCSW	3/26/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
93626	Fee-for-Service	1346610862	1346610862	1	1	LU, JONATHAN E MD	8/9/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	158653	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
93632	Fee-for-Service	1841780889	1841780889	1	1	LEVINE, ANDREW G MD	2/1/2023	207ZP0105X	NA	Other	026	PHYSICIANS	166719	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
93654	Fee-for-Service	1720346034	1720346034	1	1	LEFEBVRE, RACHEL E MD	9/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149995	46	Hand Surgery	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
93671	Fee-for-Service	1023191517	1023191517	1	1	LANG, JULIE E MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74618	02	General Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
93680	Fee-for-Service	1427093236	1427093236	1	1	LEKHT, ZINOVY N MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51576	13	Neurology (M.D. only)	0	In state provider	None	6853 RESEDA BLVD	None	RESEDA	CA	91335	4205	19	06037	34.195401	-118.536066	Los Angeles County
93721	Fee-for-Service	1770035024	1770035024	1	8	LANDMARK ANESTHESIA MEDICAL	3/11/2021	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	16850 BEAR VALLEY	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
93723	Fee-for-Service	1134861644	1134861644	1	1	LEUNG, KRISTY H OT	3/15/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	630 S INDIAN HILL BLVD S	None	CLAREMONT	CA	91711	5461	19	06037	34.084494	-117.7191945	Los Angeles County
93733	Fee-for-Service	1598097495	1598097495	1	1	LOS ANGELES COUNTY CCS	9/1/2017	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	PACIFIC BLVD MTU	2660 E 57TH STREET	None	HUNTINGTON PARK	CA	90255	2545	19	06037	33.9910257	-118.2236447	Los Angeles County
93774	Fee-for-Service	1528238656	1528238656	1	1	LAM, ALEXANDER M MD	7/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102774	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
93777	Fee-for-Service	1598236077	1598236077	1	1	LEUNG, JOANNA LMFT	11/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
93786	Fee-for-Service	1316331788	1316331788	1	1	LI, SHARON X MD	8/28/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	168912	84	Surgery-Head and Neck	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
93796	Fee-for-Service	1104448224	1104448224	1	1	LEE, ELAINE	9/5/2023	208M00000X	NA	Other	026	PHYSICIANS	19772	None	None	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
93810	Fee-for-Service	1588002166	1588002166	1	1	LYNN-ONG, ELIZABETH T MD	10/28/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	140533	08	Family Practice	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
93832	Fee-for-Service	1508951583	1508951583	1	1	LANNIN, KATHRYN J MD	8/29/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55084	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
93861	Fee-for-Service	1609955343	1609955343	1	1	LE, TUNG B MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69926	20	Orthopedic Surgery	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
93863	Fee-for-Service	1528553211	1528553211	1	1	LA ESPERANZA MEDICAL CLINIC	11/7/2018	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC	5985 FLORENCE AVE	STE O	BELL GARDENS	CA	90201	6755	19	06037	33.96721965	-118.1580537	Los Angeles County
93870	Fee-for-Service	1427292978	1427292978	1	1	LEE, CINDY S MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124421	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
93967	Fee-for-Service	1699397513	1699397513	1	1	LOS ANGELES COUNTY	11/17/2021	No Taxonomy Provided	NA	None	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	1403 W LOMITA BLVD	2ND FLOOR	HARBOR CITY	CA	90710	2076	19	06037	33.79785936	-118.3016552	Los Angeles County
93968	Fee-for-Service	1427093236	1427093236	1	1	LEKHT, ZINOVY N MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51576	36	Psychiatry	0	In state provider	None	6853 RESEDA BLVD	None	RESEDA	CA	91335	4205	19	06037	34.195401	-118.536066	Los Angeles County
93976	Fee-for-Service	1649383381	1649383381	1	1	LIN, JACK J MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72100	13	Neurology (M.D. only)	0	In state provider	None	B 200	None	LOS ANGELES	CA	90095	0001	19	06037	33.7712871	-118.2604156	Los Angeles County
93996	Fee-for-Service	1871114785	1871114785	1	1	LI, YAN CNP	9/24/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43360 MISSION BLVD	SUITE 100	FREMONT	CA	94539	5829	01	06001	37.53249631	-121.9198141	Alameda County
94009	Fee-for-Service	1427141514	1427141514	1	1	LEMONS, STEVE L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
94011	Fee-for-Service	1770035024	1770035024	1	8	LANDMARK ANESTHESIA MEDICAL	4/8/2021	193400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	16850 BEAR VALLEY	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
94027	Fee-for-Service	1669008629	1669008629	1	1	LIU, JOY C MD	6/12/2023	207R00000X	NA	Other	026	PHYSICIANS	180577	None	None	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
94028	Fee-for-Service	1265992341	1265992341	1	1	LAM, EDDIE P MD MPH	7/15/2022	207R00000X	NA	Other	026	PHYSICIANS	176088	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
94033	Fee-for-Service	1285793869	1285793869	1	1	LONGSTRETH, GEORGE MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	26520	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
94046	Fee-for-Service	1821145459	1821145459	1	2	LU, LUCY P L OD	8/20/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4200 CHINO HILLS PKWY	STE 390	CHINO HILLS	CA	91709	5825	36	06071	33.98274451	-117.7129305	San Bernardino County
94063	Fee-for-Service	1417538034	1417538034	1	1	LOUSTAUNAU, KATHERINE F DO	7/9/2024	207R00000X	NA	Other	026	PHYSICIANS	22448	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
94108	Fee-for-Service	1306222856	1306222856	1	1	LOHANI, SAROJ MD	11/8/2023	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
94120	Fee-for-Service	1538150800	1538150800	1	1	LOVELLE O.RALLS NP	3/23/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 17TH AVE	STE 432W	SEATTLE	WA	98122	5711	00	None	47.60689769	-122.3102467	King County
94128	Fee-for-Service	1376564302	1376564302	1	1	LOUDOUN HOSPITAL CENTER	7/1/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	44045 RIVERSIDE PKWY	None	LEESBURG	VA	20176	5101	00	None	39.074004	-77.47785	Loudoun County
94136	Fee-for-Service	1689250292	1689250292	1	1	LIANG, MICHELLE MD	11/4/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
94138	Fee-for-Service	1942760756	1942760756	1	1	LEE, PETER H DO	8/21/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	22525	36	Psychiatry	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
94152	Fee-for-Service	1659448587	1659448587	1	1	LOW, ALBERT S MD	7/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80593	None	None	0	In state provider	None	441 N LAKEWVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
94164	Fee-for-Service	1750971180	1750971180	1	5	LIVE WELL FAMILY COUNSELING	11/22/2024	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	SERVICES	275 HOSPITALITY LN	SUITE #309	SAN BERNARDINO	CA	92408	3265	36	06071	34.0659135	-117.289215	San Bernardino County
94172	Fee-for-Service	1477139152	1477139152	1	1	LEI, MAN KUAN MD	4/18/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	179783	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
94198	Fee-for-Service	1528186509	1528186509	1	1	LEE, HOBART H MD	7/13/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	112663	08	Family Practice	0	In state provider	None	25455 BARTON RD	STE 204B	LOMA LINDA	CA	92354	3450	36	06071	34.04805253	-117.249534	San Bernardino County
94201	Fee-for-Service	1790105252	1790105252	1	1	LANDRITH, KINDRA N MD	8/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139776	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
94246	Fee-for-Service	1992927974	1992927974	1	1	LUCE, JOHN M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	45136	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
94266	Fee-for-Service	1093246605	1093246605	1	1	LANE-DONOVAN, COURTNEY E MD	7/29/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	160014	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
94267	Fee-for-Service	1144506114	1144506114	1	1	LAXSON, LESLIE L LCSW	6/12/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4900 CALIFORNIA AVE	STE 200	BAKERSFIELD	CA	93309	7024	15	06029	35.36440586	-119.0562732	Kern County
94269	Fee-for-Service	1437265816	1437265816	1	1	LOUDON,WILLIAM G MD	10/17/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72588	14	Neurological Surgery	0	In state provider	None	1010 W LA VETA AVENUE	SUITE 710	ORANGE	CA	92868	4306	30	06059	33.78028244	-117.8635552	Orange County
94300	Fee-for-Service	1003175746	1003175746	1	1	LEATHERWOOD, CIANNA MD	9/11/2020	207RR0500X	NA	Other	026	PHYSICIANS	130966	41	Internal Medicine	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
94302	Fee-for-Service	1124735055	1124735055	1	1	LEE MEDICAL CORPORATION	1/1/2023	2086S0120X	NA	General Surgery	022	PHYSICIANS GROUP	-	85	Surgery-Pediatric	0	In state provider	L GROUP	334 S. PATTERSON AVE.	209	SANTA BARBARA	CA	93111	2400	42	06083	34.43376368	-119.8092445	Santa Barbara County
94311	Fee-for-Service	1487751749	1487751749	1	1	LYELL, ROBERT C MD	8/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	76911	20	Orthopedic Surgery	0	In state provider	None	3798 JANES RD	STE 9	ARCATA	CA	95521	4745	12	06023	40.89649119	-124.0930501	Humboldt County
94331	Fee-for-Service	1861510760	1861510760	1	1	LEE, IRWIN H MD	5/22/2008	2085R0001X	NA	Other	026	PHYSICIANS	103038	78	Neoplastic Diseases/Oncology	0	In state provider	None	301 PROFESSIONAL CTR DR	None	ROHNERT PARK	CA	94928	2152	49	06097	38.35471913	-122.7076253	Sonoma County
94374	Fee-for-Service	1154474989	1154474989	1	1	LOPEZ-WILLIAMS, OFELIA	2/1/2001	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	INC	82013 DR CARREON BLVD	STE M	INDIO	CA	92201	5832	33	06065	33.70738152	-116.233002	Riverside County
94396	Fee-for-Service	1821203373	1821203373	1	1	LOYDS LIBERTY HOMES INC	8/3/1994	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6505 CASWELL AVE	None	BAKERSFIELD	CA	93309	0501	15	06029	35.3353162	-119.0751366	Kern County
94398	Fee-for-Service	1144501826	1144501826	1	1	LOTFY, NAWAL Y LMFT	12/14/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	415 W ROUTE 66	SUITE 202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
94401	Fee-for-Service	1487669032	1487669032	2	1	LAST FRONTIER HEALTHCARE	7/1/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1111 N NAGLE STREET	None	ALTURAS	CA	96101	3841	25	06049	41.48746641	-120.5528507	Modoc County
94411	Fee-for-Service	1427059922	1427059922	1	1	LUVINA SUCIU	3/12/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	206 2ND ST E	None	BRADENTON	FL	34208	1042	00	None	27.497223	-82.561248	Manatee County
94412	Fee-for-Service	1225115181	1225115181	1	1	LEWIS, JOHN MICHAEL	8/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	77840	01	General Practice	0	In state provider	None	3803 S BASCOM AVE	STE 104	CAMPBELL	CA	95008	7317	43	06085	37.25907527	-121.9475431	Santa Clara County
94416	Fee-for-Service	1376564302	1376564302	1	1	LOUDOUN HOSPITAL CENTER	7/1/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	44045 RIVERSIDE PKWY	None	LEESBURG	VA	20176	5101	00	None	39.074004	-77.47785	Loudoun County
94424	Fee-for-Service	1629495791	1629495791	1	1	LITVAK, FELIX MD	10/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145136	01	General Practice	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
94426	Fee-for-Service	1902072143	1902072143	1	1	LOUIE SZEGLIN ENRIQUEZ, MD,	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7700 S BROADWAY	None	LITTLETON	CO	80122	2602	00	None	39.576573	-104.9859	Arapahoe County
94437	Fee-for-Service	1649888512	1649888512	1	1	LAING, DAVID J LMFT	2/3/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
94452	Fee-for-Service	1750971180	1750971180	1	5	LIVE WELL FAMILY COUNSELING	11/22/2024	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SERVICES	275 HOSPITALITY LN	SUITE #309	SAN BERNARDINO	CA	92408	3265	36	06071	34.0659135	-117.289215	San Bernardino County
94455	Fee-for-Service	1306890389	1306890389	1	4	LOS ROBLES HOSPITAL	9/6/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2190 LYNN ROAD	SUITE 320	THOUSAND OAKS	CA	91360	8026	56	06111	34.20728091	-118.8855456	Ventura County
94459	Fee-for-Service	1942400148	1942400148	1	1	LAPORTE, KRISTIN J MD	5/20/2016	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	112246	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	333 LAWS AVE	None	UKIAH	CA	95482	6540	23	06045	39.12772164	-123.2111168	Mendocino County
94460	Fee-for-Service	1518906239	1518906239	1	1	LINDENBERG, JEFFREY A MD	4/28/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	41668	40	Pediatrics	0	In state provider	None	81 W MARCH LN	None	STOCKTON	CA	95207	5723	39	06077	37.99521006	-121.3072965	San Joaquin County
94477	Fee-for-Service	1528189115	1528189115	1	1	LEVY, PHILLIP OD	1/30/1988	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5020 BALTIMORE DR	STE B	LA MESA	CA	91941	3692	37	06073	32.77041142	-117.0256966	San Diego County
94492	Fee-for-Service	1750971180	1750971180	1	4	LIVE WELL FAMILY COUNSELING	11/19/2024	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	SERVICES	12402 INDUSTRIAL BLVD	SUITE #A9	VICTORVILLE	CA	92395	5841	36	06071	34.47628904	-117.2829923	San Bernardino County
94502	Fee-for-Service	1710047972	1710047972	1	1	LEE, KUO-WEI MD	11/14/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	89770	08	Family Practice	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
94506	Fee-for-Service	1710974365	1710974365	1	1	LANOUETTE, GREGORY W MD	7/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	60237	34	Urology and Urological Surgery	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
94509	Fee-for-Service	1841442761	1841442761	1	1	LIPSON, JOHN H MD	11/21/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	105468	08	Family Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
94512	Fee-for-Service	1588044267	1588044267	1	1	LAU, SAMANTHA L DO	10/4/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16392	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
94557	Fee-for-Service	1437265816	1437265816	1	1	LOUDON,WILLIAM G MD	10/17/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72588	40	Pediatrics	0	In state provider	None	1010 W LA VETA AVENUE	SUITE 710	ORANGE	CA	92868	4306	30	06059	33.78028244	-117.8635552	Orange County
94564	Fee-for-Service	1548204373	1548204373	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	191 WOODLAND PKWY	None	SAN MARCOS	CA	92069	3010	37	06073	33.14126811	-117.1391956	San Diego County
94589	Fee-for-Service	1003175746	1003175746	1	1	LEATHERWOOD, CIANNA MD	9/11/2020	207RR0500X	NA	Other	026	PHYSICIANS	130966	83	Rheumatology	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
94599	Fee-for-Service	1548334022	1548334022	1	1	LEE, ANDY D	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	23861 MCBEAN PKWY	STE A3	VALENCIA	CA	91355	2085	19	06037	34.39567343	-118.5542698	Los Angeles County
94656	Fee-for-Service	1396799532	1396799532	1	1	LIZASO, KNEF V MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69779	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
94659	Fee-for-Service	1417990383	1417990383	1	1	LAVERY, SARAH G MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	54840	41	Internal Medicine	0	In state provider	None	24785 STEWART ST	STE 111	LOMA LINDA	CA	92350	1721	36	06071	34.0538151	-117.2632755	San Bernardino County
94662	Fee-for-Service	1124107834	1124107834	1	1	LEE, VONG M MD	9/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82425	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
94689	Fee-for-Service	1487669032	1487669032	2	1	LAST FRONTIER HEALTHCARE	5/6/2013	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1111 N NAGLE STREET	None	ALTURAS	CA	96101	3841	25	06049	41.48746641	-120.5528507	Modoc County
94698	Fee-for-Service	1972860104	1972860104	1	1	LEE, CHUN YU MD	9/5/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	129746	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2100 WEBSTER ST	115	SAN FRANCISCO	CA	94115	2373	38	06075	37.7904826	-122.4324477	San Francisco County
94701	Fee-for-Service	1225115181	1225115181	1	1	LEWIS, JOHN MICHAEL	8/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	77840	18	Ophthalmology	0	In state provider	None	3803 S BASCOM AVE	STE 104	CAMPBELL	CA	95008	7317	43	06085	37.25907527	-121.9475431	Santa Clara County
94705	Fee-for-Service	1902442387	1902442387	1	1	LEO SALUTEM INC	1/16/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	660 PALOMAR ST	410/11	CHULA VISTA	CA	91911	2607	37	06073	32.60362445	-117.0838448	San Diego County
94711	Fee-for-Service	1053301051	1053301051	1	1	LARSON, JENNIFER P MD	3/14/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164590	None	None	0	In state provider	None	12923 INGLEWOOD AVE	STE. 1	HAWTHORNE	CA	90250	5573	19	06037	33.914961	-118.3613055	Los Angeles County
94741	Fee-for-Service	1578919650	1578919650	1	1	LUOMA, KELSEY MD	8/25/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	168406	None	None	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
94766	Fee-for-Service	1720420946	1720420946	1	1	LUU, ANDREW N MD	2/22/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	133665	20	Orthopedic Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
94768	Fee-for-Service	1205878014	1205878014	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	760 ARNEILL RD	None	CAMARILLO	CA	93010	4726	56	06111	34.225344	-119.0389335	Ventura County
94782	Fee-for-Service	1750971180	1750971180	1	4	LIVE WELL FAMILY COUNSELING	11/19/2024	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SERVICES	12402 INDUSTRIAL BLVD	SUITE #A9	VICTORVILLE	CA	92395	5841	36	06071	34.47628904	-117.2829923	San Bernardino County
94785	Fee-for-Service	1033377478	1033377478	1	1	LIEBMAN, LAWRENCE S MD	12/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154921	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
94814	Fee-for-Service	1255373080	1255373080	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3011 E SHIELDS AVE	None	FRESNO	CA	93726	6752	10	06019	36.77973233	-119.7744339	Fresno County
94828	Fee-for-Service	1932158722	1932158722	1	1	LEE, EUI J MD	12/11/2002	207RA0201X	NA	Other	026	PHYSICIANS	37293	43	Pediatric Allergy	0	In state provider	None	44215 15TH ST W	STE 111	LANCASTER	CA	93534	5503	19	06037	34.68666415	-118.1568572	Los Angeles County
94831	Fee-for-Service	1770087124	1770087124	1	1	LEE, JERRY C MD	6/7/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	165885	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
94835	Fee-for-Service	1821266966	1821266966	1	1	LUU, RICKY L MD	11/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	105345	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	STE 101	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
94855	Fee-for-Service	1780685263	1780685263	2	1	LUCKY PHARMACY INC	11/27/2007	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	416 W LAS TUNAS DRIVE	STE 100	SAN GABRIEL	CA	91776	1236	19	06037	34.10243845	-118.1046106	Los Angeles County
94857	Fee-for-Service	1487809489	1487809489	1	1	LEE, ANGELA Y NP	10/26/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
94906	Fee-for-Service	1629135405	1629135405	1	1	LURVEY, NATHANA L MD	9/11/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	70047	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1530 S OLIVE STREET	None	LOS ANGELES	CA	90015	3023	19	06037	34.03542552	-118.2652073	Los Angeles County
94951	Fee-for-Service	1619025434	1619025434	1	1	LYON, DAVID A DO	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7356	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
94954	Fee-for-Service	1114289550	1114289550	1	1	LIN, JOSHUA K Y DO	6/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13207	None	None	0	In state provider	None	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	33	06065	33.5580705	-117.1835458	Riverside County
94962	Fee-for-Service	1417995325	1417995325	1	1	LICHTI, DOUGLAS J MD	11/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134301	02	General Surgery	0	In state provider	None	726 4TH STREET	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
94977	Fee-for-Service	1487669032	1487669032	2	1	LAST FRONTIER HEALTHCARE	7/1/2011	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1111 N NAGLE STREET	None	ALTURAS	CA	96101	3841	25	06049	41.48746641	-120.5528507	Modoc County
94983	Fee-for-Service	1972860104	1972860104	1	1	LEE, CHUN YU MD	9/5/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	129746	41	Internal Medicine	0	In state provider	None	2100 WEBSTER ST	115	SAN FRANCISCO	CA	94115	2373	38	06075	37.7904826	-122.4324477	San Francisco County
94992	Fee-for-Service	1124185020	1124185020	1	1	LEE ESCHER, EMILY N LCSW	3/28/2023	101YP2500X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
94995	Fee-for-Service	1003822487	1003822487	1	1	LEGACY EMANUEL HOSPITAL	5/1/2001	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	& HEALTH CENTER	2801 N GANTENBEIN AVE	None	PORTLAND	OR	97227	1623	00	None	45.54387841	-122.6696022	Multnomah County
95002	Fee-for-Service	1649208711	1649208711	1	1	LIPSCHITZ LISA SUSAN MD	6/2/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72005	None	None	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
95013	Fee-for-Service	1245831262	1245831262	1	1	LEGACY OF TENDER CARE	3/31/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE, INC	3643 SAN FERNANDO RD	SUITE B	GLENDALE	CA	91204	2916	19	06037	34.12177211	-118.2528674	Los Angeles County
95113	Fee-for-Service	1275551251	1275551251	1	1	LIN, JAY J MD INC	9/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	31426	41	Internal Medicine	0	In state provider	None	22030 SHERMAN WAY	STE 201	CANOGA PARK	CA	91303	1885	19	06037	34.20099551	-118.6071615	Los Angeles County
95171	Fee-for-Service	1841724846	1841724846	1	1	LEE, DANIEL	11/20/2020	207R00000X	NA	Other	026	PHYSICIANS	169879	None	None	0	In state provider	None	3484 E 1ST ST	None	LOS ANGELES	CA	90063	2946	19	06037	34.0359727	-118.192576	Los Angeles County
95241	Fee-for-Service	1619025434	1619025434	1	1	LYON, DAVID A DO	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7356	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
95245	Fee-for-Service	1396232351	1396232351	1	1	LEWIS, SPENCER B MD	5/18/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	185345	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
95284	Fee-for-Service	1003822487	1003822487	1	1	LEGACY EMANUEL HOSPITAL	5/1/2001	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	& HEALTH CENTER	2801 N GANTENBEIN AVE	None	PORTLAND	OR	97227	1623	00	None	45.54387841	-122.6696022	Multnomah County
95287	Fee-for-Service	1750768677	1750768677	1	1	LAM, HELEN C MD	9/25/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	147341	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
95295	Fee-for-Service	1679787949	1679787949	1	1	LEE, SUSAN Y MD	5/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117131	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
95303	Fee-for-Service	1245831262	1245831262	1	1	LEGACY OF TENDER CARE	3/31/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE, INC	3643 SAN FERNANDO RD	SUITE B	GLENDALE	CA	91204	2916	19	06037	34.12177211	-118.2528674	Los Angeles County
95307	Fee-for-Service	1235203688	1235203688	1	2	LODI CHILDRENS CLINIC	4/22/2011	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1801 E MARCH LANE	SUITE B210	STOCKTON	CA	95210	6629	39	06077	38.00315652	-121.2868715	San Joaquin County
95308	Fee-for-Service	1841781812	1841781812	1	1	LAGRANDEUR, WESTON J MD	6/19/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	455 OCONNOR DR	SUITE 210	SAN JOSE	CA	95128	1633	43	06085	37.326654	-121.939897	Santa Clara County
95313	Fee-for-Service	1215105432	1215105432	1	1	LEE, SHARON D MD	10/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99122	None	None	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
95344	Fee-for-Service	1538181482	1538181482	1	4	LA CLINICA DE LA RAZA INC	11/24/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	663 CANAL RD	None	BAY POINT	CA	94565	3301	07	06013	38.01942274	-121.9386819	Contra Costa County
95405	Fee-for-Service	1871760686	1871760686	1	1	LARKIN, SARA E MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127631	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
95470	Fee-for-Service	1629073044	1629073044	1	1	LOPO, ALINA C MD PHD	5/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	54670	41	Internal Medicine	0	In state provider	None	18370 BURBANK BLVD	STE 412	TARZANA	CA	91356	2844	19	06037	34.17173059	-118.5331881	Los Angeles County
95491	Fee-for-Service	1023691995	1023691995	1	1	LEY, GABRIELLA A DPM	7/15/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
95497	Fee-for-Service	1831533231	1831533231	1	1	LEE, BRIAN E MD	10/14/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	133457	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
95516	Fee-for-Service	1629374061	1629374061	1	1	LEE, DAVID MD	12/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127009	30	Radiology	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
95529	Fee-for-Service	1518126259	1518126259	1	1	LEE, BRIAN M MD INC	11/1/2005	207RN0300X	NA	Nephrology	026	PHYSICIANS	86438	45	Nephrology (Renal-Kidney)	0	In state provider	None	16415 S COLORADO AVENUE	STE 410	PARAMOUNT	CA	90723	5035	19	06037	33.8853075	-118.1614695	Los Angeles County
95533	Fee-for-Service	1407238199	1407238199	1	1	LOVE, MATTHEW S OD	6/22/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	30145 ANTELOPE ROAD	SUITE 105	MENIFEE	CA	92584	8065	33	06065	33.68299914	-117.1673659	Riverside County
95548	Fee-for-Service	1932257268	1932257268	1	1	LUNDE, OTTAR V MD	12/7/2007	207R00000X	NA	Other	026	PHYSICIANS	97573	41	Internal Medicine	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
95563	Fee-for-Service	1730659103	1730659103	1	1	LIANA SHAPIRO-LEE, LICENSED	10/25/2024	103TC1900X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	191 LIGHTHOUSE AVE	SUITE A-5	MONTEREY	CA	93940	1704	27	06053	36.60947714	-121.8982943	Monterey County
95592	Fee-for-Service	1093032708	1093032708	1	1	LI, WAI PING A DO	1/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13028	67	Endocrinology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
95608	Fee-for-Service	1952615098	1952615098	1	1	LEININGER, MEGHAN C DO	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11858	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
95611	Fee-for-Service	1851734362	1851734362	1	1	LIM, CHRISTOPHER J MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136089	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
95631	Fee-for-Service	1538181482	1538181482	1	4	LA CLINICA DE LA RAZA INC	12/1/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	663 CANAL RD	None	BAY POINT	CA	94565	3301	07	06013	38.01942274	-121.9386819	Contra Costa County
95647	Fee-for-Service	1295055457	1295055457	1	1	LIN, MALINDA C MD	10/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110122	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
95651	Fee-for-Service	1194882332	1194882332	1	1	LAM, RICHARD C MD INC	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	61542	41	Internal Medicine	0	In state provider	None	27994 BRADLEY RD	STE C	SUN CITY	CA	92586	2240	33	06065	33.71392455	-117.1912253	Riverside County
95665	Fee-for-Service	1528051356	1528051356	1	1	LIEU, JEAN	10/1/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4760 SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09811852	-118.293408	Los Angeles County
95677	Fee-for-Service	1629164520	1629164520	1	1	LIU, DENNIS S MD	6/1/2002	207R00000X	NA	Other	026	PHYSICIANS	72151	41	Internal Medicine	0	In state provider	None	3301 N EASTERN AVE	None	LOS ANGELES	CA	90032	1931	19	06037	34.083765	-118.1780795	Los Angeles County
95701	Fee-for-Service	1376993063	1376993063	1	1	LARUSSA, SAMUEL J MD	6/14/2023	2085R0204X	NA	Other	026	PHYSICIANS	186634	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
95702	Fee-for-Service	1356598015	1356598015	1	1	LY, LINDA T OD	9/9/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6000 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4232	19	06037	34.11150069	-118.1888319	Los Angeles County
95745	Fee-for-Service	1184188294	1184188294	1	1	LA GLOBAL HOME HEALTH CARE	12/9/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	7100 HAYVENHURST AVE	SUITE 113	VAN NUYS	CA	91406	3835	19	06037	34.199064	-118.4923845	Los Angeles County
95752	Fee-for-Service	1245737287	1245737287	1	1	LEE, YEON H MD	11/16/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163545	None	None	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
95756	Fee-for-Service	1477666030	1477666030	1	1	LOWE, JASON T DO	2/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	8709	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
95762	Fee-for-Service	1457805251	1457805251	1	2	LUCID SPEECH AND LANGUAGE CL	9/10/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NIC, INC.	25102 JEFFERSON AVE	SUITE D	MURRIETA	CA	92562	1708	33	06065	33.55467403	-117.2033542	Riverside County
95771	Fee-for-Service	1477755288	1477755288	1	1	LIN, EDWIN Y MD	5/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	94173	78	Neoplastic Diseases/Oncology	0	In state provider	None	12462 PUTNAM ST	SUITE 303	WHITTIER	CA	90602	1049	19	06037	33.9709236	-118.0460596	Los Angeles County
95777	Fee-for-Service	1518136688	1518136688	1	1	LEE, PHOEBE H MD	10/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131101	05	Anesthesiology	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
95814	Fee-for-Service	1518126259	1518126259	1	1	LEE, BRIAN M MD INC	11/1/2005	207RN0300X	NA	Nephrology	026	PHYSICIANS	86438	41	Internal Medicine	0	In state provider	None	16415 S COLORADO AVENUE	STE 410	PARAMOUNT	CA	90723	5035	19	06037	33.8853075	-118.1614695	Los Angeles County
95838	Fee-for-Service	1790237972	1790237972	1	1	LEVINSON, LUNA C NP	1/26/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	30	06059	33.74496	-117.818857	Orange County
95908	Fee-for-Service	1205008950	1205008950	1	1	LEE, JAMES S MD	8/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90106	None	None	0	In state provider	None	18350 ROSCOE BLVD	STE 603	NORTHRIDGE	CA	91325	5607	19	06037	34.22071855	-118.5341175	Los Angeles County
95919	Fee-for-Service	1205213980	1205213980	1	1	LONG, ALEXANDER J MD	2/23/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	154017	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
95927	Fee-for-Service	1013932417	1013932417	1	1	LIPTON, MERRIE D LMFT	8/25/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	607 EAST PLAZA DRIVE	STE. 102C	SANTA MARIA	CA	93454	6945	42	06083	34.93737507	-120.4285236	Santa Barbara County
95956	Fee-for-Service	1861400962	1861400962	1	1	LIU, EDWARD M MD	10/31/1987	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	47741	30	Radiology	0	In state provider	None	6401 COYLE AVE	None	CARMICHAEL	CA	95608	0310	34	06067	38.668698	-121.3148745	Sacramento County
95961	Fee-for-Service	1588157853	1588157853	1	1	LI, YUELING MD	5/30/2023	2084P0804X	NA	Psychiatry	026	PHYSICIANS	173698	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
95962	Fee-for-Service	1215957527	1215957527	2	1	LICHTER, JULIAN MD	7/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	33711	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4033 3RD AVE	STE 300	SAN DIEGO	CA	92103	2138	37	06073	32.75053781	-117.1627168	San Diego County
96001	Fee-for-Service	1285262394	1285262394	1	1	LAMNECK, CLAIRE MD	11/17/2023	207P00000X	NA	Other	026	PHYSICIANS	186259	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
96005	Fee-for-Service	1689841686	1689841686	1	1	LAXMISAN, ARCHANA MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56078	41	Internal Medicine	0	In state provider	None	2020 GENESEE AVE	None	SAN DIEGO	CA	92123	4219	37	06073	32.7921973	-117.1571251	San Diego County
96017	Fee-for-Service	1952331035	1952331035	1	1	LOW, KENNETH C MD APC	4/11/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	38707 STIVERS ST	STE B	FREMONT	CA	94536	5337	01	06001	37.55702808	-121.9835466	Alameda County
96023	Fee-for-Service	1770044869	1770044869	1	1	LOCSO, ALYSSA OT	10/18/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
96040	Fee-for-Service	1871171553	1871171553	1	1	LEE, JOANNE JEE YEON MD	8/19/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
96044	Fee-for-Service	1700170180	1700170180	1	1	LALLAS, MATT S MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	116424	13	Neurology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
96045	Fee-for-Service	1477666030	1477666030	1	1	LOWE, JASON T DO	2/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	8709	40	Pediatrics	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
96058	Fee-for-Service	1477755288	1477755288	1	1	LIN, EDWIN Y MD	5/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	94173	41	Internal Medicine	0	In state provider	None	12462 PUTNAM ST	SUITE 303	WHITTIER	CA	90602	1049	19	06037	33.9709236	-118.0460596	Los Angeles County
96064	Fee-for-Service	1003983990	1003983990	1	1	LEWIN, BRUNO J MD	4/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	63536	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
96066	Fee-for-Service	1356566038	1356566038	1	1	LA MESA SPRING VALLEY SD	3/27/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	4750 DATE AVE	None	LA MESA	CA	91942	9214	37	06073	32.76528367	-117.0222905	San Diego County
96078	Fee-for-Service	1972597458	1972597458	1	1	LOBATO, YURIRIA S MD	4/30/1988	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	40940	30	Radiology	0	In state provider	None	2299 BACON ST	STE 5	CONCORD	CA	94520	2050	07	06013	37.98199042	-122.0349518	Contra Costa County
96119	Fee-for-Service	1750546354	1750546354	1	1	LE, KHANH, H MD	10/20/2008	207L00000X	NA	Other	026	PHYSICIANS	96418	None	None	0	In state provider	None	3630 EAST IMPERIAL HWY	None	LYNWOOD	CA	90262	2653	19	06037	33.93112671	-118.2035532	Los Angeles County
96127	Fee-for-Service	1639106461	1639106461	1	1	LEVI, ANNA PHD	3/2/2005	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	18607 VENTURA BLVD	STE 101	TARZANA	CA	91356	4144	19	06037	34.16995274	-118.5388841	Los Angeles County
96167	Fee-for-Service	1023047347	1023047347	1	1	LEE, JIMMY DPM	9/3/2019	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	624 W DUARTE RD	105	ARCADIA	CA	91007	9256	19	06037	34.12637452	-118.0527313	Los Angeles County
96242	Fee-for-Service	1629667084	1629667084	1	1	LIU, JULIE Y CNP	11/17/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18785 BROOKHURST STREET	STE 101	FOUNTAIN VALLEY	CA	92708	7300	30	06059	33.68987636	-117.9542321	Orange County
96272	Fee-for-Service	1811273675	1811273675	1	1	LOS ANGELES CENTERS FOR	8/30/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	ALCOHOL AND DRUG ABUSE	10931 STAMY ROAD	A-1 COUNSELING OFFICE	WHITTIER	CA	90604	2225	19	06037	33.933672	-118.006327	Los Angeles County
96305	Fee-for-Service	1033297668	1033297668	1	1	LOPEZ, ALFREDO R MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	36323	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
96308	Fee-for-Service	1508361296	1508361296	1	1	LELEGREN, MATTHEW J MD	5/15/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	116 S PALISADE DR	SUITE 206	SANTA MARIA	CA	93454	8904	42	06083	34.9523869	-120.4120717	Santa Barbara County
96348	Fee-for-Service	1477755288	1477755288	1	1	LIN, EDWIN Y MD	5/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	94173	68	Hematology	0	In state provider	None	12462 PUTNAM ST	SUITE 303	WHITTIER	CA	90602	1049	19	06037	33.9709236	-118.0460596	Los Angeles County
96354	Fee-for-Service	1356566038	1356566038	1	1	LA MESA SPRING VALLEY SD	7/1/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	4750 DATE AVE	None	LA MESA	CA	91942	9214	37	06073	32.76528367	-117.0222905	San Diego County
96385	Fee-for-Service	1104032911	1104032911	1	1	LAWRENCE R MILLER MD A PROFE	9/5/2021	207LP2900X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	SSIONAL CORP	8500 WILSHIRE BLVD	SUITE 1018	BEVERLY HILLS	CA	90211	3108	19	06037	34.06521956	-118.3764689	Los Angeles County
96410	Fee-for-Service	1346670197	1346670197	1	1	LOVE, GLENDA G LCSW	9/29/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	112 E F ST	STE C	TEHACHAPI	CA	93561	1740	15	06029	35.13086681	-118.4470708	Kern County
96441	Fee-for-Service	1023145067	1023145067	1	1	LIEN, CHIA-YEN MD	3/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	52578	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
96456	Fee-for-Service	1558625830	1558625830	1	1	LOEWEN, MARK J DO	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13155	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
96464	Fee-for-Service	1417174996	1417174996	1	1	LEW, WARREN L OD	8/8/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8080 PARKWAY DRIVE	None	LA MESA	CA	91942	2104	37	06073	32.77560706	-117.0231998	San Diego County
96466	Fee-for-Service	1962702449	1962702449	1	1	LIFEWORKS ACS INC	12/1/2017	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1755 W HAMMER LANE	STE 1	STOCKTON	CA	95209	2900	39	06077	38.02145403	-121.3355659	San Joaquin County
96469	Fee-for-Service	1811673791	1811673791	1	1	LISA HUMPHREYS MD MPH, PHYSI	6/28/2023	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	CIAN, INC	1300 W 7TH STREET	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
96470	Fee-for-Service	1295317477	1295317477	1	1	LU, JACKSON C DO	7/1/2024	207P00000X	NA	Other	026	PHYSICIANS	20991	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
96473	Fee-for-Service	1073512976	1073512976	1	1	LOUIS MUSSO D.O.	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5330 HWY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
96494	Fee-for-Service	1831899566	1831899566	1	1	LEWIS, SUSAN V LCSW	8/27/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
96500	Fee-for-Service	1518252816	1518252816	1	1	LIN, MARK W MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123400	01	General Practice	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
96527	Fee-for-Service	1124657218	1124657218	1	1	LARSON, STEPHANIE S MD	9/3/2024	363LX0001X	NA	Nurse Practitioner	026	PHYSICIANS	187488	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
96549	Fee-for-Service	1528015906	1528015906	1	1	LEE, DAVID W MD	8/1/2013	207RC0200X	NA	Other	026	PHYSICIANS	125875	None	None	0	In state provider	None	6311 NORTH FRESNO ST	STE 106	FRESNO	CA	93710	5290	10	06019	36.82866273	-119.7814168	Fresno County
96560	Fee-for-Service	1013910777	1013910777	1	1	LIM, MELISSA S MD	7/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74100	41	Internal Medicine	0	In state provider	None	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
96586	Fee-for-Service	1992071658	1992071658	1	1	LE, LIEN B MD	6/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127532	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
96604	Fee-for-Service	1386174878	1386174878	1	1	LAKE, MENORE G MD	6/29/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175291	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
96613	Fee-for-Service	1174601728	1174601728	1	1	LIEBERMAN, JONATHAN S MD	11/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	60174	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
96624	Fee-for-Service	1811163058	1811163058	1	1	LEE, HYUNGSUKTOMMY MD	2/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119418	02	General Surgery	0	In state provider	None	400 N PEPPER AVE	MOB SUITE 308	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
96626	Fee-for-Service	1487817797	1487817797	1	1	LAM, SHERRELL T MD	9/8/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	172867	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
96635	Fee-for-Service	1235363193	1235363193	1	1	LOPEZ-OSULLIVAN, ANA C MD	4/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114378	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
96639	Fee-for-Service	1053552455	1053552455	1	1	LAWLER, TIMOTHY DO	12/9/2022	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	12811	None	None	0	In state provider	None	2020 GENESEE AVE	None	SAN DIEGO	CA	92123	4219	37	06073	32.7921973	-117.1571251	San Diego County
96641	Fee-for-Service	1316397888	1316397888	1	1	LEVIN, SAMUEL D F OD	1/13/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
96665	Fee-for-Service	1700066776	1700066776	1	1	LIU, WEICHUNG MD	6/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95632	30	Radiology	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
96668	Fee-for-Service	1902646144	1902646144	1	1	LING, JULIE Y OD	10/24/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
96675	Fee-for-Service	1073501565	1073501565	1	1	LO, BRIAN B MD	1/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68666	41	Internal Medicine	0	In state provider	None	30131 TOWN CENTER DR	SUITE 215	LAGUNA NIGUEL	CA	92677	2033	30	06059	33.52530096	-117.7148334	Orange County
96677	Fee-for-Service	1699418616	1699418616	1	1	LOS ANGELES CHRISTIAN HEALTH	11/21/2022	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	13200 AVALON BLVD	None	LOS ANGELES	CA	90061	2227	19	06037	33.912711	-118.2652615	Los Angeles County
96705	Fee-for-Service	1285185314	1285185314	1	1	LARGUSA, KATRINA	3/3/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
96759	Fee-for-Service	1427125236	1427125236	1	1	LOZON, CRISTETA L MD	8/1/1998	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	79988	04	Otology, Laryngology, Rhinology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
96760	Fee-for-Service	1255855896	1255855896	1	1	LEE, URIM A	5/20/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
96772	Fee-for-Service	1730646894	1730646894	1	1	LANGE, SAMUEL	6/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
96787	Fee-for-Service	1801946710	1801946710	1	1	LIU, JEFF C OD	1/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
96802	Fee-for-Service	1114019486	1114019486	1	1	LABORADA, GARY G MD	6/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87019	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
96807	Fee-for-Service	1780973909	1780973909	1	1	LIEBERMAN, ALICIA MD	3/14/2025	2080P0216X	NA	Other	026	PHYSICIANS	None	83	Rheumatology	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
96816	Fee-for-Service	1417923558	1417923558	1	1	LEWIS, MARSHALL S MD	1/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	28242	20	Orthopedic Surgery	0	In state provider	None	1332 W HERNDON	STE 101	FRESNO	CA	93711	7118	10	06019	36.83737137	-119.8148304	Fresno County
96846	Fee-for-Service	1013910777	1013910777	1	1	LIM, MELISSA S MD	7/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74100	66	Emergency Medicine (Urgent Care)	0	In state provider	None	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
96850	Fee-for-Service	1104323864	1104323864	1	1	LEE, BENJAMIN MD	7/6/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	177683	None	None	0	In state provider	None	1450 SAN PABLO ST	STE 2505	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
96853	Fee-for-Service	1184040933	1184040933	1	1	LUO, YANHUI LCSW	3/16/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD RD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
96872	Fee-for-Service	1932356177	1932356177	1	1	LEE, JOHN J MD	12/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114553	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
96880	Fee-for-Service	1326622796	1326622796	1	1	LUONG, ALLEN T OD	3/27/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
96883	Fee-for-Service	1336674886	1336674886	1	1	LINARES, YENDI N MD	8/2/2018	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	148629	47	Miscellaneous	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
96892	Fee-for-Service	1144296203	1144296203	1	1	LORIN C BACHMAN M.D.	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	777 HOSPITAL WAY	None	POCATELLO	ID	83201	5175	00	None	42.87385929	-112.4189402	Bannock County
96900	Fee-for-Service	1376610923	1376610923	1	1	LOVATO, ESTEBAN MD	5/9/2006	207R00000X	NA	Other	026	PHYSICIANS	75190	None	None	0	In state provider	None	3022 INTERNATIONAL BLVD	STE 210	OAKLAND	CA	94601	2226	01	06001	37.77849802	-122.22763	Alameda County
96902	Fee-for-Service	1730205980	1730205980	1	1	LEE, JOANNE A DPM	9/21/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
96919	Fee-for-Service	1245850064	1245850064	1	1	LENOX, ALEXANDRA C DO	4/29/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	22632	15	Obstetrics (D.O. only)	0	In state provider	None	32144 AGOURA RD.	100	WESTLAKE VILLAGE	CA	91361	4031	19	06037	34.14848408	-118.8208595	Los Angeles County
96943	Fee-for-Service	1053542100	1053542100	1	1	LEWIS, AARON G MD	7/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112252	02	General Surgery	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
96945	Fee-for-Service	1447796701	1447796701	1	1	LEHN, KRISTIANA MD	11/20/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	181529	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
96947	Fee-for-Service	1952475634	1952475634	1	1	LEWIS, RICHARD A	6/26/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
96949	Fee-for-Service	1891996575	1891996575	1	1	LEMUS, MIGUEL E MD	11/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107407	66	Emergency Medicine (Urgent Care)	0	In state provider	None	14850 ROSCOE BOULEVARD	None	PANORAMA CITY	CA	91402	4677	19	06037	34.22145548	-118.4566005	Los Angeles County
97006	Fee-for-Service	1750062725	1750062725	1	1	LE, TRINI LCSW	11/14/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
97035	Fee-for-Service	1861546681	1861546681	2	1	LARRY C HUGHES MD INC A MEDI	10/4/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	CAL CORPORATION	4020 W FLORIDA AVE	None	HEMET	CA	92545	5279	33	06065	33.74543265	-117.0148924	Riverside County
97070	Fee-for-Service	1598038093	1598038093	1	1	LA PAZ REGIONAL HOSPITAL INC	8/18/2014	282NC0060X	NA	Hospitals	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	1	Border provider	None	1200 W MOHAVE RD	None	PARKER	AZ	85344	6349	00	None	34.13580083	-114.2842352	La Paz County
97076	Fee-for-Service	1740227313	1740227313	1	1	LAUCK, THOMAS MD	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81939	08	Family Practice	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
97089	Fee-for-Service	1457354235	1457354235	1	1	LORSBACH, ROBERT B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	22	Pathology (M.D. only)	2	Out of state provider	None	4301 W MARKHAM	SLOT #783	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
97092	Fee-for-Service	1396223285	1396223285	1	1	LIN, ESTHER OD	10/18/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
97108	Fee-for-Service	1497106231	1497106231	1	1	LEE, BORAM S MD	7/15/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	156711	08	Family Practice	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
97125	Fee-for-Service	1043354632	1043354632	1	1	LAZARO, HEATHER D OD	1/22/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1336 BRIDGEGATE DR	None	DIAMOND BAR	CA	91765	3955	19	06037	33.99743665	-117.8357377	Los Angeles County
97127	Fee-for-Service	1750833125	1750833125	1	1	LOWE, SUSAN L LMFT	5/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3742 TIBBETTS ST	201	RIVERSIDE	CA	92506	2641	33	06065	33.9472255	-117.3982995	Riverside County
97134	Fee-for-Service	1013910777	1013910777	1	1	LIM, MELISSA S MD	7/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74100	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
97141	Fee-for-Service	1477841484	1477841484	1	1	LEE, WILSON OD	1/7/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
97186	Fee-for-Service	1255947172	1255947172	1	1	LIFE CARE HOSPICE SERVICES	12/7/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	LLC	205 W 5TH AVE	SUITE 206	ESCONDIDO	CA	92025	4849	37	06073	33.11730822	-117.0803928	San Diego County
97217	Fee-for-Service	1134167141	1134167141	1	1	LESSIG, STEPHANIE L MD	6/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81417	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
97221	Fee-for-Service	1477816353	1477816353	1	1	LUHN, SUZANNAH C NP	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
97246	Fee-for-Service	1801944756	1801944756	1	1	LIU, NINA S MD	1/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88277	78	Neoplastic Diseases/Oncology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
97254	Fee-for-Service	1700912177	1700912177	1	1	LIM, JEAN L MD	10/11/2010	207N00000X	NA	Dermatology	026	PHYSICIANS	112666	07	Dermatology	0	In state provider	None	401 BICENTENNIAL WY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
97264	Fee-for-Service	1083781926	1083781926	1	1	LURVEY, LAWRENCE D MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	80403	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
97271	Fee-for-Service	1992952741	1992952741	1	1	LIU, WENDY Y MD	10/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109893	02	General Surgery	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
97273	Fee-for-Service	1023320496	1023320496	1	1	LASTIE, SHELIA A LMFT	5/25/2020	364SP0809X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
97279	Fee-for-Service	1740568427	1740568427	1	1	LEE, DANNY Y	3/10/2018	390200000X	NA	Other	026	PHYSICIANS	123873	41	Internal Medicine	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
97280	Fee-for-Service	1871568642	1871568642	1	1	LIM, ALBERT Y	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14694	None	None	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
97324	Fee-for-Service	1740246008	1740246008	1	1	LAMPTEY,DANIEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 5TH STREET	None	SIOUX CITY	IA	51101	0000	00	None	42.49533151	-96.40009996	Woodbury County
97331	Fee-for-Service	1982759320	1982759320	1	1	LUCAS, ROBERT M MD	12/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114459	20	Orthopedic Surgery	0	In state provider	None	3717 MT DIABLO BLVD	STE 100	LAFAYETTE	CA	94549	3588	07	06013	37.8891726	-122.1321096	Contra Costa County
97358	Fee-for-Service	1356582746	1356582746	1	1	LEWIS, JEFFREY R MD	8/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124769	41	Internal Medicine	0	In state provider	None	8536 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3153	19	06037	34.06550726	-118.3775199	Los Angeles County
97386	Fee-for-Service	1780784744	1780784744	1	1	LUCK, JAMES V JR MD	1/1/1979	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	14931	20	Orthopedic Surgery	0	In state provider	None	2400 S FLOWER STREET	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
97429	Fee-for-Service	1811082720	1811082720	1	1	LAU, CLAYTON MD	9/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92221	34	Urology and Urological Surgery	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
97473	Fee-for-Service	1255947172	1255947172	1	1	LIFE CARE HOSPICE SERVICES	12/7/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	LLC	205 W 5TH AVE	SUITE 206	ESCONDIDO	CA	92025	4849	37	06073	33.11730822	-117.0803928	San Diego County
97474	Fee-for-Service	1801552468	1801552468	1	1	LOS FELIZ FOOT AND ANKLE A P	2/20/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	ROFESSIONAL CORPORATION	1909 HILLHURST AVE	None	LOS ANGELES	CA	90027	2711	19	06037	34.105779	-118.287436	Los Angeles County
97491	Fee-for-Service	1295883270	1295883270	1	1	LYONS, JAMES P MD	4/30/1993	204D00000X	NA	Other	026	PHYSICIANS	76255	20	Orthopedic Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
97496	Fee-for-Service	1194715763	1194715763	1	1	LAWRENCE E KOWAL, MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5555 W THUNDERBIRD RD	None	GLENDALE	AZ	85306	4622	00	None	33.609294	-112.1797485	Maricopa County
97532	Fee-for-Service	1801944756	1801944756	1	1	LIU, NINA S MD	1/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88277	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
97543	Fee-for-Service	1245791409	1245791409	1	1	LION, RYAN R MD	6/29/2022	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	178251	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
97576	Fee-for-Service	1053612705	1053612705	1	1	LEHRKE, ELIZA	1/10/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
97584	Fee-for-Service	1356088629	1356088629	1	1	LOSLI, DUSTIN S CCC-SLP	7/14/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3687 MT DIABLO	SUITE 100	LAFAYETTE	CA	94549	3717	07	06013	37.8898926	-122.1304235	Contra Costa County
97592	Fee-for-Service	1518195973	1518195973	1	1	LAWREN LOVE	11/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
97600	Fee-for-Service	1740630508	1740630508	1	1	LIEBENTHAL-BAKER, PAMELA	2/12/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
97647	Fee-for-Service	1356582746	1356582746	1	1	LEWIS, JEFFREY R MD	8/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124769	10	Gastroenterology (M.D. only)	0	In state provider	None	8536 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3153	19	06037	34.06550726	-118.3775199	Los Angeles County
97696	Fee-for-Service	1598860876	1598860876	1	1	LOS PADRINOS JUVENILE	7/1/2000	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	PADRINOS JCHS INFIRMARY	7285 QUILL DR	None	DOWNEY	CA	90242	2001	19	06037	33.93429773	-118.1630661	Los Angeles County
97707	Fee-for-Service	1790947513	1790947513	1	1	LEE, WAI KIU MD	9/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111811	08	Family Practice	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
97720	Fee-for-Service	1104044825	1104044825	1	1	LERA, DONNA-MARIE LMFT	4/21/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	790 LAUREL ST	STE 114	SAN CARLOS	CA	94070	3165	41	06081	37.5039517	-122.2581492	San Mateo County
97758	Fee-for-Service	1437221272	1437221272	1	1	LAH, JOHN J MD	1/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	76371	10	Gastroenterology (M.D. only)	0	In state provider	None	15725 WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
97778	Fee-for-Service	1154852952	1154852952	1	1	LEBLANG, SPENCER A	2/5/2024	207L00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
97795	Fee-for-Service	1124486212	1124486212	1	1	LIPSKI, ELIZABETH R LMFT	3/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	427 COYOTE STREET	None	NEVADA CITY	CA	95959	2230	29	06057	39.265974	-121.017129	Nevada County
97800	Fee-for-Service	1497013239	1497013239	1	1	LEE, NATHAN C MD	6/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116282	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
97806	Fee-for-Service	1871722298	1871722298	1	1	LEE, IAN K DO	1/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	11482	01	General Practice	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
97829	Fee-for-Service	1487865226	1487865226	1	1	LONG, KRISTIN LMFT	7/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1035 SAN PABLO AVE	STE 8	ALBANY	CA	94706	2277	01	06001	37.88531142	-122.2973343	Alameda County
97834	Fee-for-Service	1003536160	1003536160	1	1	LEE, ANNE C	2/4/2023	367A00000X	NA	Certified Nurse Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	577 E ELDER ST	H	FALLBROOK	CA	92028	3079	37	06073	33.3801147	-117.2456536	San Diego County
97848	Fee-for-Service	1912111543	1912111543	1	1	LINCOLN HEIGHTS FAMILY	2/14/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	SUNRISE MEDICAL CENTER	437 N EUCLID AVE	STE A	ONTARIO	CA	91762	3456	36	06071	34.067988	-117.6521805	San Bernardino County
97849	Fee-for-Service	1851908586	1851908586	1	1	LUDWIG, TERESA T PT	1/28/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4000 DUBLIN BLVD	None	DUBLIN	CA	94568	3113	01	06001	37.70553949	-121.872609	Alameda County
97860	Fee-for-Service	1316348220	1316348220	1	1	LAWRENCE, MICHAEL A NP	1/30/2025	363LX0106X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
97863	Fee-for-Service	1588478077	1588478077	1	1	LEE, ANDREW	2/25/2025	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25050 AVENUE KEARNY	SUITE 203	VALENCIA	CA	91355	1255	19	06037	34.43517857	-118.5722781	Los Angeles County
97864	Fee-for-Service	1114927860	1114927860	1	1	LONG BEACH ADVNCD ORTHO	6/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	MEDICAL CENTER, INC	1760 TERMINO AVE	STE 208	LONG BEACH	CA	90804	2151	19	06037	33.78889871	-118.1458784	Los Angeles County
97866	Fee-for-Service	1053653105	1053653105	1	2	LA BRANT, LIA B MD	9/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126334	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
97881	Fee-for-Service	1790042885	1790042885	1	1	LINNEBUR, MEGAN R MD	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119888	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
97887	Fee-for-Service	1619153079	1619153079	1	1	LIU, WEI-CHUAN M MD	12/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101222	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	9428 VALLEY BLVD	STE 201	ROSEMEAD	CA	91770	1513	19	06037	34.0811223	-118.0635319	Los Angeles County
97896	Fee-for-Service	1093100307	1093100307	1	1	LYNDE, JENNIFER M	9/26/2022	2086S0127X	NA	General Surgery	026	PHYSICIANS	19645	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
97897	Fee-for-Service	1750646501	1750646501	1	1	LIN, FELICE MD	8/13/2019	390200000X	NA	Other	026	PHYSICIANS	127330	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2335 E KASHIAN LANE	STE 240	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
97945	Fee-for-Service	1710340559	1710340559	1	1	LAGUNA BEACH URGENT CARE, IN	4/30/2020	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	NA BEACH	32341 COAST HWY	None	LAGUNA BEACH	CA	92651	6701	30	06059	33.49286069	-117.7351651	Orange County
97948	Fee-for-Service	1306178991	1306178991	1	1	LITCHFIELD, MATT	3/13/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
97949	Fee-for-Service	1285185041	1285185041	1	1	LANIER CHIROPRACTIC PC	7/20/2017	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	23412 MOULTON PKWY	STE 100	LAGUNA HILLS	CA	92653	1732	30	06059	33.62217163	-117.7312015	Orange County
97965	Fee-for-Service	1457381816	1457381816	1	1	LUNDGREN, KATHE D	3/28/2005	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3805 UNION AVE	None	BAKERSFIELD	CA	93305	2400	15	06029	35.393868	-119.0030165	Kern County
97983	Fee-for-Service	1598860876	1598860876	1	1	LOS PADRINOS JUVENILE	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	PADRINOS JCHS INFIRMARY	7285 QUILL DR	None	DOWNEY	CA	90242	2001	19	06037	33.93429773	-118.1630661	Los Angeles County
98044	Fee-for-Service	1225564487	1225564487	1	1	LIM, ATALIE M MD	11/16/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	167226	None	None	0	In state provider	None	4240 HIGHLAND	None	HIGHLAND	CA	92346	2764	36	06071	34.13583752	-117.194355	San Bernardino County
98082	Fee-for-Service	1528525045	1528525045	1	1	LIFE HOPE LABS LLC	3/19/2021	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	5009 ROSWELL RD	None	SANDY SPRINGS	GA	30342	2223	00	None	33.89176452	-84.38116833	Fulton County
98098	Fee-for-Service	1093007676	1093007676	1	1	LONGHURST, MELISSA K CCC-SLP	6/26/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	1	Border provider	None	8313 FRITZEN AVE	None	LAS VEGAS	NV	89131	4608	00	None	36.30226278	-115.2771201	Clark County
98103	Fee-for-Service	1700953676	1700953676	1	1	LU, DONG TRIEU MD	11/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68118	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
98136	Fee-for-Service	1912111543	1912111543	1	1	LINCOLN HEIGHTS FAMILY	2/14/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	SUNRISE MEDICAL CENTER	437 N EUCLID AVE	STE A	ONTARIO	CA	91762	3456	36	06071	34.067988	-117.6521805	San Bernardino County
98149	Fee-for-Service	1447371224	1447371224	1	1	LIN, MICHAEL C MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	84329	36	Psychiatry	0	In state provider	None	2081 ARENA BLVD	SUITE 160	SACRAMENTO	CA	95834	2309	34	06067	38.647737	-121.510467	Sacramento County
98211	Fee-for-Service	1760004147	1760004147	1	1	LADY OF JOY HOSPICE INC	7/26/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4959 PALO VERDE ST	SUITE 103A-6	MONTCLAIR	CA	91763	2302	36	06071	34.08129954	-117.6966135	San Bernardino County
98230	Fee-for-Service	1780666842	1780666842	1	1	LABORATORY CORPORATION	7/12/2002	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	OF AMERICA	69-550 HIGHWAY 111	SUITE 102	RANCHO MIRAGE	CA	92270	2887	33	06065	33.7750795	-116.4496953	Riverside County
98249	Fee-for-Service	1134367204	1134367204	1	1	LIN, VICTOR DO	2/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9886	41	Internal Medicine	0	In state provider	None	975 S FAIRMONT AVENUE	None	LODI	CA	95242	3635	39	06077	38.12188356	-121.285872	San Joaquin County
98253	Fee-for-Service	1780884999	1780884999	1	1	LITTLEFIELD, PHILIP D MD	6/3/2019	207YX0901X	NA	ENT/Otolaryngology	026	PHYSICIANS	162020	04	Otology, Laryngology, Rhinology	0	In state provider	None	2020 GENESEE AVE	None	SAN DIEGO	CA	92123	4219	37	06073	32.7921973	-117.1571251	San Diego County
98256	Fee-for-Service	1841215217	1841215217	1	1	LINSEY, MICHAEL S MD	7/31/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	37688	45	Nephrology (Renal-Kidney)	0	In state provider	None	808 S FAIR OAKS AVE	None	PASADENA	CA	91105	2601	19	06037	34.131942	-118.1503315	Los Angeles County
98266	Fee-for-Service	1740608371	1740608371	1	1	LENHART, ADRIENNE L MD	3/8/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	154694	None	None	0	In state provider	None	2655 1ST STREET	360, 380	SIMI VALLEY	CA	93065	1581	56	06111	34.28400453	-118.778978	Ventura County
98276	Fee-for-Service	1306890389	1306890389	1	6	LOS ROBLES HOSPITAL	12/4/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2190 LYNN ROAD	STE 300	THOUSAND OAKS	CA	91360	8024	56	06111	34.20728091	-118.8855456	Ventura County
98282	Fee-for-Service	1740326453	1740326453	1	1	LIPSCHULTZ, MARLA D MFT	12/2/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	42672	-	NOT APPLICABLE	0	In state provider	None	2425 ENBORG LANE	None	SAN JOSE	CA	95128	2648	43	06085	37.31105733	-121.937923	Santa Clara County
98291	Fee-for-Service	1477566875	1477566875	1	1	LEE-LLACER, REYNALDO MD	8/21/2024	207R00000X	NA	Other	026	PHYSICIANS	185922	41	Internal Medicine	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
98318	Fee-for-Service	1679034466	1679034466	1	1	LEE, RICHARD W MD	7/18/2022	208M00000X	NA	Other	026	PHYSICIANS	178607	None	None	0	In state provider	None	1211 W. LA PALMA AVE.	SUITE 404	ANAHEIM	CA	92801	2806	30	06059	33.84718298	-117.933758	Orange County
98338	Fee-for-Service	1760578801	1760578801	1	1	LOVELY, LAURIE P MD	1/1/2021	174400000X	NA	Other	026	PHYSICIANS	85746	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
98347	Fee-for-Service	1649212465	1649212465	2	1	LONGS DRUG STORES CA LLC	12/15/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3999 SANTA RITA RD	None	PLEASANTON	CA	94588	3462	01	06001	37.69668269	-121.8754031	Alameda County
98405	Fee-for-Service	1437237054	1437237054	1	1	LIU, THEODORE MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	83100	07	Dermatology	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
98414	Fee-for-Service	1568795540	1568795540	1	1	LAM, CHI Y MD INC	12/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	39312	41	Internal Medicine	0	In state provider	None	223 N GARFIELD AVENUE	SUITE 206	MONTEREY PARK	CA	91754	1700	19	06037	34.0646166	-118.1228948	Los Angeles County
98423	Fee-for-Service	1912111543	1912111543	1	1	LINCOLN HEIGHTS FAMILY	2/14/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	SUNRISE MEDICAL CENTER	437 N EUCLID AVE	STE A	ONTARIO	CA	91762	3456	36	06071	34.067988	-117.6521805	San Bernardino County
98473	Fee-for-Service	1528059698	1528059698	1	1	LEE,MARK A MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62795	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
98482	Fee-for-Service	1497250815	1497250815	1	1	LUTZ, MARIE F MD	8/1/2022	207P00000X	NA	Other	026	PHYSICIANS	165436	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
98484	Fee-for-Service	1972965531	1972965531	1	1	LAD, AAKASH MD	9/9/2021	390200000X	NA	Other	026	PHYSICIANS	159171	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
98491	Fee-for-Service	1023140639	1023140639	1	1	LINDSAY KLIMES	10/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3741 W 12600 S	None	RIVERTON	UT	84065	7215	00	None	40.520232	-111.980151	Salt Lake County
98500	Fee-for-Service	1356747059	1356747059	1	1	LEADWELL CARE HOME INC	11/6/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	17256 LEADWELL STREET	None	VAN NUYS	CA	91406	2537	19	06037	34.2039065	-118.509624	Los Angeles County
98501	Fee-for-Service	1760004147	1760004147	1	1	LADY OF JOY HOSPICE INC	7/26/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4959 PALO VERDE ST	SUITE 103A-6	MONTCLAIR	CA	91763	2302	36	06071	34.08129954	-117.6966135	San Bernardino County
98507	Fee-for-Service	1710929534	1710929534	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3678 SONOMA BLVD	None	VALLEJO	CA	94590	2946	48	06095	38.12427497	-122.2552176	Solano County
98523	Fee-for-Service	1861460370	1861460370	1	1	LAW, JAMES MD	8/29/1981	207R00000X	NA	Other	026	PHYSICIANS	32750	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1310 W STEWART DR	STE 410	ORANGE	CA	92868	3855	30	06059	33.78236048	-117.8664975	Orange County
98532	Fee-for-Service	1396812210	1396812210	1	1	LEE, MARCIA M MD	4/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	74957	05	Anesthesiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
98538	Fee-for-Service	1003555772	1003555772	1	1	LAM, JOHN C MD	7/19/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	179063	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
98571	Fee-for-Service	1902669377	1902669377	1	1	LAMBA, SMITA NP	1/28/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4500 BROCKTON AVE.	SUITE 305	RIVERSIDE	CA	92501	4027	33	06065	33.97785263	-117.3836152	Riverside County
98596	Fee-for-Service	1366549016	1366549016	1	1	LAGUNA PATHOLOGY MEDICAL	9/21/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	GROUP	31872 COAST HWY	None	LAGUNA BEACH	CA	92651	6773	30	06059	33.49961197	-117.7420867	Orange County
98647	Fee-for-Service	1265978738	1265978738	1	1	LEUFROY, PAULO A PT	4/15/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12402 INDUSTRIAL BLVD	SUITE B2-B5	VICTORVILLE	CA	92395	5871	36	06071	34.47628904	-117.2829923	San Bernardino County
98653	Fee-for-Service	1912943127	1912943127	1	1	LIU, JAMES Y MD	2/4/1977	208600000X	NA	General Surgery	026	PHYSICIANS	18898	02	General Surgery	0	In state provider	None	333 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	4501	19	06037	33.9670722	-118.3439911	Los Angeles County
98683	Fee-for-Service	1952664401	1952664401	1	1	LABBAD, GABRIEL E MD	4/7/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	169121	None	None	0	In state provider	None	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	37	06073	33.14066871	-117.156095	San Diego County
98686	Fee-for-Service	1285059790	1285059790	1	1	LIFE SKILLS TRAINING AND	2/1/2015	No Taxonomy Provided	NA	None	095	PRIVATE NON-PROFIT PROPRIETARY AGENCY	-	-	NOT APPLICABLE	0	In state provider	EDUCATION PROGRAMS INC	4041 BRIDGE ST	None	FAIR OAKS	CA	95628	7503	34	06067	38.638953	-121.267593	Sacramento County
98695	Fee-for-Service	1972702728	1972702728	1	1	LIM, SUSAN S MD	9/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85550	None	None	0	In state provider	None	555 E VALLEY PKWY	None	ESCONDIDO	CA	92025	3048	37	06073	33.12542915	-117.0764725	San Diego County
98697	Fee-for-Service	1063137982	1063137982	1	1	LOPEMAN, MICHELLE LMFT	9/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4251 SO. HIGUERA ST.,	SUITE 300	SAN LUIS OBISPO	CA	93401	0000	40	06079	35.24181209	-120.6767798	San Luis Obispo County
98708	Fee-for-Service	1801458500	1801458500	1	1	LOCHTE, BRYSON C MD	4/25/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	178092	None	None	0	In state provider	None	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
98731	Fee-for-Service	1336866318	1336866318	1	1	LA MAR, KATRINA PHD	12/21/2023	390200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2131 CAPITOL AVE	SUITE 206	SACRAMENTO	CA	95816	5755	34	06067	38.573073	-121.4788005	Sacramento County
98748	Fee-for-Service	1841232675	1841232675	2	1	LONGS DRUG STORE CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7201 REGIONAL ST	None	DUBLIN	CA	94568	2325	01	06001	37.70511435	-121.9345285	Alameda County
98773	Fee-for-Service	1104258896	1104258896	1	1	LINKER, GARY LMFT	9/28/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	22 W. MICHELTORENA ST	STE D	SANTA BARBARA	CA	93101	6523	42	06083	34.4255722	-119.7090178	Santa Barbara County
98786	Fee-for-Service	1578855151	1578855151	1	1	LEKIC, TIM MD	12/26/2017	390200000X	NA	Other	026	PHYSICIANS	126265	13	Neurology (M.D. only)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
98795	Fee-for-Service	1285678011	1285678011	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1274 STABLE LN	None	YUBA CITY	CA	95993	2620	51	06101	39.14656902	-121.6457508	Sutter County
98821	Fee-for-Service	1396812210	1396812210	1	1	LEE, MARCIA M MD	4/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	74957	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
98833	Fee-for-Service	1073210753	1073210753	1	2	LEGACY MD MEDICAL GROUP INC	4/25/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1520 S IMPERIAL AVE	None	EL CENTRO	CA	92243	4241	13	06025	32.77989265	-115.5697382	Imperial County
98841	Fee-for-Service	1326218314	1326218314	1	1	LOS ANGELES COUNTY CCS	1/9/2008	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	7804 THORNLAKE AVE	None	WHITTIER	CA	90606	2312	19	06037	33.97366387	-118.0671312	Los Angeles County
98885	Fee-for-Service	1922154863	1922154863	1	1	LIVELY, HARRY R MD	5/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	56294	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	202 W WILLOW AVE	None	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
98888	Fee-for-Service	1215363387	1215363387	1	1	LANDRY, CRAIG M LCSW	12/3/2019	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
98906	Fee-for-Service	1710212113	1710212113	1	1	LEMIEUX, MELISSA H MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128031	30	Radiology	0	In state provider	None	3301 C STREET	SUITE 550	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
98952	Fee-for-Service	1134277197	1134277197	1	1	LUI, KENNY C MD	4/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69096	10	Gastroenterology (M.D. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
98955	Fee-for-Service	1851818215	1851818215	1	1	LACSON, JEREMY V PT	12/14/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
98972	Fee-for-Service	1245609965	1245609965	1	2	LEISURE LIVING INC	12/31/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5965 CALMFIELD AVE.	None	AGOURA HILLS	CA	91301	3358	19	06037	34.15930355	-118.7559222	Los Angeles County
99013	Fee-for-Service	1093208365	1093208365	1	1	LIMMER, MARGARET J PT	7/4/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
99043	Fee-for-Service	1699973727	1699973727	1	1	LE, KATHY T MD	12/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	55924	01	General Practice	0	In state provider	None	1045 N TUSTIN AVE	None	ORANGE	CA	92867	5904	30	06059	33.85389734	-117.8376042	Orange
99055	Fee-for-Service	1760412431	1760412431	1	1	LUJAN, ARLEEN G MD	11/9/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	61687	None	None	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
99093	Fee-for-Service	1538687769	1538687769	1	1	LANGE, RACHEL K	10/20/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1495 VICTOR AVENUE	SUITE D	REDDING	CA	96003	4093	45	06089	40.586022	-122.338834	Shasta County
99109	Fee-for-Service	1316155179	1316155179	1	1	LAINER, ARIK Z MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94069	30	Radiology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
99119	Fee-for-Service	1073210753	1073210753	1	2	LEGACY MD MEDICAL GROUP INC	4/26/2024	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1520 S IMPERIAL AVE	None	EL CENTRO	CA	92243	4241	13	06025	32.77989265	-115.5697382	Imperial County
99124	Fee-for-Service	1326406463	1326406463	1	1	LEE, BRIAN CPO	10/24/2018	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	3324 WEBSTER ST	None	OAKLAND	CA	94609	3105	01	06001	37.82153667	-122.2621207	Alameda County
99165	Fee-for-Service	1912126988	1912126988	1	1	LIFE OPTIONS VOCATIONAL	2/4/1993	251C00000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LA PALOMA GROUP HOME	229 N E ST	None	LOMPOC	CA	93436	6009	42	06083	34.64167358	-120.4540922	Santa Barbara County
99173	Fee-for-Service	1700868510	1700868510	1	1	LI, ALBERT Y MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69917	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6405 DAY ST	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
99177	Fee-for-Service	1154834273	1154834273	1	1	LINDBERG, ERIC R LMFT	11/27/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
99182	Fee-for-Service	1265669444	1265669444	1	1	LLANO DIALYSIS LLC	12/15/2009	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	830 REDWOOD STREET	None	VALLEJO	CA	94590	2942	48	06095	38.12279674	-122.2543699	Solano County
99194	Fee-for-Service	1396069506	1396069506	1	1	LI, JESSICA MD	3/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122821	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
99203	Fee-for-Service	1326162660	1326162660	1	1	LISING, JENNIFER G MD	12/21/2018	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
99226	Fee-for-Service	1639196215	1639196215	1	1	LEE, JASON MD	6/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	81729	05	Anesthesiology	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
99233	Fee-for-Service	1649532714	1649532714	1	1	LITWIN, TRACEY E PSYD	5/30/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
99248	Fee-for-Service	1508356130	1508356130	1	1	LALLY, PAUL M PT	12/2/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7525 METROPOLITAN DR	STE 306	SAN DIEGO	CA	92108	4404	37	06073	32.77677653	-117.1592911	San Diego County
99251	Fee-for-Service	1578903597	1578903597	1	1	LEFKOWITZ, MEGHAN M	5/11/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2801 K ST	STE 240	SACRAMENTO	CA	95816	5170	34	06067	38.572947	-121.46904	Sacramento County
99281	Fee-for-Service	1184674459	1184674459	1	1	LAI, PETER Y MD	10/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41316	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
99295	Fee-for-Service	1356383186	1356383186	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	827 OAK PARK BLVD	None	PISMO BEACH	CA	93449	3290	40	06079	35.13246961	-120.6058591	San Luis Obispo County
99313	Fee-for-Service	1740927029	1740927029	1	1	LAVINA PHARMACY INC	6/14/2022	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8251 WESTMINSTER BLVD	STE 100	WESTMINSTER	CA	92683	3370	30	06059	33.75934151	-117.985113	Orange County
99323	Fee-for-Service	1144264599	1144264599	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1039 EL CAMINO REAL	None	REDWOOD CITY	CA	94063	1690	41	06081	37.485288	-122.2313175	San Mateo County
99382	Fee-for-Service	1043269277	1043269277	1	1	LEWIN, MATTHEW R MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73541	66	Emergency Medicine (Urgent Care)	0	In state provider	None	99 MONTECILLO ROAD	None	PALO ALTO	CA	94903	3308	43	06085	38.00450116	-122.5540001	Marin County
99405	Fee-for-Service	1073210753	1073210753	1	2	LEGACY MD MEDICAL GROUP INC	9/20/2024	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1520 S IMPERIAL AVE	None	EL CENTRO	CA	92243	4241	13	06025	32.77989265	-115.5697382	Imperial County
99408	Fee-for-Service	1356337075	1356337075	1	1	LESSANI, TONIA M DO	10/23/2015	207R00000X	NA	Other	026	PHYSICIANS	6777	41	Internal Medicine	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
99412	Fee-for-Service	1427049782	1427049782	1	1	LIU, DAVID T MD	12/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95592	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
99429	Fee-for-Service	1750314621	1750314621	1	1	LAWSON, ANDREW J MD	3/31/1994	207P00000X	NA	Other	026	PHYSICIANS	79588	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
99443	Fee-for-Service	1932486362	1932486362	1	1	LAVINE, ANDRIA E LCSW	4/27/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
99444	Fee-for-Service	1205134707	1205134707	1	1	LEMOS PERNAS, KEREN MARISOL	6/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
99463	Fee-for-Service	1487017224	1487017224	1	1	LAVALLEY, CLAYTON MD	9/25/2023	207ZP0102X	NA	Other	026	PHYSICIANS	173945	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
99464	Fee-for-Service	1770679268	1770679268	1	1	LAI, KEANE K MD	11/14/2017	207ZP0104X	NA	Other	026	PHYSICIANS	90474	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
99472	Fee-for-Service	1407637044	1407637044	1	1	LA BREA RX INC	11/2/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4314 W SLAUSON AVE	1	LOS ANGELES	CA	90043	2808	19	06037	33.98885257	-118.3509655	Los Angeles County
99508	Fee-for-Service	1396209268	1396209268	1	1	LEGACY CARE HOSPICE INC	12/17/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	36923 COOK ST	STE 102-1	PALM DESERT	CA	92211	6073	33	06065	33.779753	-116.3558572	Riverside County
99515	Fee-for-Service	1649224395	1649224395	1	1	LANE, THOMAS MD	6/30/1982	207ZP0105X	NA	Other	026	PHYSICIANS	33070	22	Pathology (M.D. only)	0	In state provider	None	225 DICKINSON ST	# H720	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
99551	Fee-for-Service	1255900585	1255900585	1	1	LOPEZ, VICTORIA N MD	4/23/2024	207R00000X	NA	Other	026	PHYSICIANS	191603	41	Internal Medicine	0	In state provider	None	465 W PUTNAM AVENUE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
99559	Fee-for-Service	1972624534	1972624534	1	1	LAUER, ROGER M MD	10/4/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	22640	-	NOT APPLICABLE	0	In state provider	None	425 VERNON ST	None	OAKLAND	CA	94610	2927	01	06001	37.81680584	-122.2534611	Alameda County
99592	Fee-for-Service	1528078573	1528078573	1	1	LAC USC MEDICAL CENTER	4/28/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	LAC+USC W+C OP RM 4P81	1200 N STATE ST	None	LOS ANGELES	CA	90033	1083	19	06037	34.05855992	-118.209755	Los Angeles County
99604	Fee-for-Service	1700826740	1700826740	1	1	LEWIS, MICHAEL H MD	7/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	64666	08	Family Practice	0	In state provider	None	500 SAN PABLO AVE	STE 300	ALBANY	CA	94706	1127	01	06001	37.89781848	-122.3014067	Alameda County
99612	Fee-for-Service	1457598385	1457598385	1	1	LEVISTE, MARIA D MD INC	1/31/1992	193200000X	NA	Other	026	PHYSICIANS	39016	07	Dermatology	0	In state provider	None	1101 N PACIFIC AVE	STE 103	GLENDALE	CA	91202	3250	19	06037	34.16078708	-118.2644824	Los Angeles County
99620	Fee-for-Service	1003871088	1003871088	1	1	LEITMAN BARRY	6/1/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
99622	Fee-for-Service	1356676431	1356676431	1	1	LLOYD, CARLA R MD	7/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111474	30	Radiology	0	In state provider	None	300 PASTEUR DR	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
99629	Fee-for-Service	1528057130	1528057130	1	1	LIPSHITZ, DARREN MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65353	08	Family Practice	0	In state provider	None	1750 BRIDGEWAY	STE B106	SAUSALITO	CA	94965	1900	21	06041	37.8615467	-122.4899285	Marin County
99653	Fee-for-Service	1588687685	1588687685	1	1	LEHMAN, CHRISTOPHER R MD	2/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	65885	20	Orthopedic Surgery	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
99656	Fee-for-Service	1942257324	1942257324	1	1	LUNDEEN, TIFFANY CNM	1/7/2025	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
99667	Fee-for-Service	1336446244	1336446244	1	1	LIU, QUIN Y MD	7/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	94917	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1840	19	06037	34.07671715	-118.3799413	Los Angeles County
99694	Fee-for-Service	1073210753	1073210753	1	2	LEGACY MD MEDICAL GROUP INC	5/3/2024	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1520 S IMPERIAL AVE	None	EL CENTRO	CA	92243	4241	13	06025	32.77989265	-115.5697382	Imperial County
99705	Fee-for-Service	1669050498	1669050498	1	1	LELLELLA, MAHESH MD	8/13/2024	207R00000X	NA	Other	026	PHYSICIANS	188418	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
99725	Fee-for-Service	1518000827	1518000827	1	1	LEESCH, MARTIN K PT	12/22/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2660 WHITSON	100	SELMA	CA	93662	2622	10	06019	36.57397495	-119.6219919	Fresno County
99727	Fee-for-Service	1821175753	1821175753	1	1	LULLA, SULOCHINA H MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32025	03	Allergy	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
99745	Fee-for-Service	1013309145	1013309145	1	1	LAKHOLE, ARATHI D MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124486	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
99787	Fee-for-Service	1992998850	1992998850	1	1	LEE, ROGER CHIROPRACTIC INC	4/17/2017	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	14795 JEFFREY RD	SUITE 103	IRVINE	CA	92618	0417	30	06059	33.68748311	-117.7710103	Orange County
99796	Fee-for-Service	1396209268	1396209268	1	1	LEGACY CARE HOSPICE INC	12/17/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	36923 COOK ST	STE 102-1	PALM DESERT	CA	92211	6073	33	06065	33.779753	-116.3558572	Riverside County
99798	Fee-for-Service	1134106388	1134106388	1	1	LIN, CYNTHIA MD	10/25/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	66443	45	Nephrology (Renal-Kidney)	0	In state provider	None	515 SOUTH DR	STE 12	MOUNTAIN VIEW	CA	94040	4209	43	06085	37.36725925	-122.0837256	Santa Clara County
99814	Fee-for-Service	1215285390	1215285390	1	1	LE, THI X	12/16/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4510 VIEWRIDGE AVE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
99824	Fee-for-Service	1093924466	1093924466	1	1	LI, KEWANG K MD	10/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93477	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	23845 MCBEAN PARKWAY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
99826	Fee-for-Service	1841796018	1841796018	1	1	LE, THIEN T MD	11/10/2022	207L00000X	NA	Other	026	PHYSICIANS	175921	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
99839	Fee-for-Service	1407209737	1407209737	1	1	LI, ROSSIRENE	8/22/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVENUE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
99860	Fee-for-Service	1245551811	1245551811	1	1	LAU, ERIC N MD	6/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119478	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
99866	Fee-for-Service	1811321748	1811321748	1	1	LE, MICHAEL H MD	11/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143413	41	Internal Medicine	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
99872	Fee-for-Service	1174808224	1174808224	1	1	LIU, SANDY T MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123123	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
99901	Fee-for-Service	1457598385	1457598385	1	1	LEVISTE, MARIA D MD INC	1/31/1992	193200000X	NA	Other	026	PHYSICIANS	39016	41	Internal Medicine	0	In state provider	None	1101 N PACIFIC AVE	STE 103	GLENDALE	CA	91202	3250	19	06037	34.16078708	-118.2644824	Los Angeles County
99938	Fee-for-Service	1124056536	1124056536	1	1	LANE, KEVIN D	3/5/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	534 PINE ST	STE A	STOCKTON	CA	95204	5536	39	06077	37.97439027	-121.2897236	San Joaquin County
99953	Fee-for-Service	1336446244	1336446244	1	1	LIU, QUIN Y MD	7/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	94917	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1840	19	06037	34.07671715	-118.3799413	Los Angeles County
99970	Fee-for-Service	1184975302	1184975302	1	1	LEE, HEATHER R CRNA	6/21/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
99981	Fee-for-Service	1073210753	1073210753	1	2	LEGACY MD MEDICAL GROUP INC	2/20/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	1520 S IMPERIAL AVE	None	EL CENTRO	CA	92243	4241	13	06025	32.77989265	-115.5697382	Imperial County
100008	Fee-for-Service	1770106478	1770106478	1	1	LEE, DANIEL J DO	11/2/2023	390200000X	NA	Other	026	PHYSICIANS	20976	None	None	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 230	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
100030	Fee-for-Service	1538235031	1538235031	1	1	LIN, BING AC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1687 ERRINGER RD	STE 110	SIMI VALLEY	CA	93065	6509	56	06111	34.268886	-118.761426	Ventura County
100060	Fee-for-Service	1518033505	1518033505	1	1	LONG BEACH ARTIFICIAL	7/1/1996	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	LIMB COMPANY INC	2268 LONG BEACH BLVD	None	LONG BEACH	CA	90806	4417	19	06037	33.79839957	-118.1892452	Los Angeles County
100074	Fee-for-Service	1407835788	1407835788	1	1	LYNCH, CHRISTY MD	2/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83833	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 OLD RIVER RD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
100078	Fee-for-Service	1386250751	1386250751	1	1	LOVING HOME HEALTH SERVICES	12/9/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	20944 SHERMAN WAY	STE 205	CANOGA PARK	CA	91303	3638	19	06037	34.20095151	-118.5900435	Los Angeles County
100091	Fee-for-Service	1114942265	1114942265	1	1	LIM, CAROLYNE T MD	11/30/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	55951	40	Pediatrics	0	In state provider	None	1850 S AZUSA AVE	STE 60	HACIENDA HEIGHTS	CA	91745	6827	19	06037	33.98895597	-117.9322797	Los Angeles County
100096	Fee-for-Service	1194800284	1194800284	1	1	LUK, LESLEY J MD	2/8/2015	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	45655	04	Otology, Laryngology, Rhinology	0	In state provider	None	4201 TORRANCE BLVD	STE 390	TORRANCE	CA	90503	4541	19	06037	33.8375955	-118.358748	Los Angeles County
100115	Fee-for-Service	1093924466	1093924466	1	1	LI, KEWANG K MD	10/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93477	22	Pathology (M.D. only)	0	In state provider	None	23845 MCBEAN PARKWAY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
100140	Fee-for-Service	1376295584	1376295584	1	1	LASCANO, DANIELLE LMFT	6/21/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
100151	Fee-for-Service	1316983422	1316983422	1	1	LOVATO, VICTORIA A OD	4/29/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4566 FLORENCE AVE	STE 6	CUDAHY	CA	90201	4347	19	06037	33.97004595	-118.1858787	Los Angeles County
100160	Fee-for-Service	1174808224	1174808224	1	1	LIU, SANDY T MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123123	68	Hematology	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
100167	Fee-for-Service	1841710886	1841710886	1	1	LEDBETTER, MICHELLE NP	1/14/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2559 W ROSAMOND BLVD	STE D	ROSAMOND	CA	93560	6267	15	06029	34.86420508	-118.1771868	Kern County
100177	Fee-for-Service	1568019339	1568019339	1	1	LOWRIE, KRISTINA E PT	7/7/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1676 EAST 6TH ST	None	BEAUMONT	CA	92223	2550	33	06065	33.92948188	-116.9484306	Riverside County
100178	Fee-for-Service	1699130054	1699130054	1	1	LI, WEI-CHEN LCSW	10/22/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	80912	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVE	SUITE 150	SAN JOSE	CA	95119	1371	43	06085	37.23598537	-121.7783065	Santa Clara County
100195	Fee-for-Service	1982702056	1982702056	1	1	LI, MING MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66818	41	Internal Medicine	0	In state provider	None	25 N 14TH ST	STE 920	SAN JOSE	CA	95112	6216	43	06085	37.34293357	-121.8775187	Santa Clara County
100206	Fee-for-Service	1457469058	1457469058	1	1	LAURA ANN KOOIENGA MD	7/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	130 RAMPART WAY	STE 300B	DENVER	CO	80230	6451	00	None	39.72047057	-104.8985959	Denver County
100208	Fee-for-Service	1679598817	1679598817	1	1	LIN, STEVEN MD	10/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83420	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
100211	Fee-for-Service	1073747135	1073747135	1	1	LEE, LUANI K MD	10/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114334	45	Nephrology (Renal-Kidney)	0	In state provider	None	1400 SOUTH GRAND AVE	STE 800	LOS ANGELES	CA	90015	3048	19	06037	34.03692236	-118.2655238	Los Angeles County
100225	Fee-for-Service	1598324873	1598324873	1	1	LEE, MINDY J OT	10/19/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
100233	Fee-for-Service	1487696373	1487696373	1	1	LAI, CHI K MD	8/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90702	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
100245	Fee-for-Service	1164536702	1164536702	1	1	LAU, KATHLEEN M MD	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	51037	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
100300	Fee-for-Service	1770804668	1770804668	1	1	LEE, BRIAN J MD	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131977	05	Anesthesiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
100309	Fee-for-Service	1245666981	1245666981	1	1	LANGE, DIANNA L NP	5/8/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	800 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8359	08	06015	41.77272521	-124.1940494	Del Norte County
100356	Fee-for-Service	1760006894	1760006894	1	1	LEI, VICTOR DO	8/3/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21170	None	None	0	In state provider	None	2601 ALAMEDA AVE	412	BURBANK	CA	91505	4800	19	06037	34.15783817	-118.3293969	Los Angeles County
100358	Fee-for-Service	1942053806	1942053806	1	1	LINCARE INC	11/6/2024	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1580 OAKLAND RD	STE C105	SAN JOSE	CA	95131	2441	43	06085	37.38047183	-121.8952824	Santa Clara County
100369	Fee-for-Service	1750572491	1750572491	1	1	LEE, ANDY W DO	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11481	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1000 NUT TREE RD	None	VACAVILLE	CA	95687	1400	48	06095	38.35581953	-121.9530257	Solano County
100372	Fee-for-Service	1881679827	1881679827	1	1	LEE, JHEMON H MD	5/1/1999	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	68417	30	Radiology	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
100386	Fee-for-Service	1932270816	1932270816	1	1	LAVALLEE, MICHAEL F MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74681	01	General Practice	0	In state provider	ATTN MGA OFFICE	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
100390	Fee-for-Service	1326498536	1326498536	1	1	LEE, BRIAN R MD	9/6/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	162031	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
100393	Fee-for-Service	1033300975	1033300975	1	1	LERNER, STUART A MD AMC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32444	26	Psychiatry (child)	0	In state provider	None	3721 OCEANHILL WAY	None	MALIBU	CA	90265	5639	19	06037	34.04524254	-118.5722369	Los Angeles County
100401	Fee-for-Service	1568611549	1568611549	1	1	LIU, AIHONG MD	8/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110490	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
100483	Fee-for-Service	1730530254	1730530254	1	1	LIVINGSTON COMMUNITY HEALTH	5/7/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	16233 KING STREET	None	DELHI	CA	95315	9460	24	06047	37.43319758	-120.7809931	Merced County
100488	Fee-for-Service	1447324868	1447324868	1	1	LEE, ALEX Q MD	12/16/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76691	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
100494	Fee-for-Service	1922485747	1922485747	1	1	LASYONE, LUKAS MD	8/28/2020	207RR0500X	NA	Other	026	PHYSICIANS	146036	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
100495	Fee-for-Service	1952340325	1952340325	1	1	LIN, DEBBY A MD	6/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106077	03	Allergy	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
100497	Fee-for-Service	1679598817	1679598817	1	1	LIN, STEVEN MD	10/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83420	41	Internal Medicine	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
100505	Fee-for-Service	1932315132	1932315132	1	1	LANCASTER SCHOOL DIST	1/5/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	44711 CEDAR AVE	None	LANCASTER	CA	93534	3210	19	06037	34.69465491	-118.1390458	Los Angeles County
100510	Fee-for-Service	1366554537	1366554537	1	1	LUM, GREGORY F MD	10/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75811	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
100516	Fee-for-Service	1831207927	1831207927	1	1	LUU, ROBERT MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102624	05	Anesthesiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
100534	Fee-for-Service	1851564090	1851564090	1	1	LEW, CLARISSA G DO	10/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11066	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
100544	Fee-for-Service	1295769198	1295769198	1	2	LEE, CAROL M LCSW	8/1/2016	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	550 MAIN ST	STE C	NEWCASTLE	CA	95658	9360	31	06061	38.87380795	-121.1337733	Placer County
100557	Fee-for-Service	1558437517	1558437517	1	1	LI, NING CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	ACUPUNCTURE & HERB ALTER	500 N GARFIELD AVE	STE 210	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
100665	Fee-for-Service	1164400263	1164400263	1	1	LING, KOK T.	12/31/1991	207R00000X	NA	Other	026	PHYSICIANS	45478	45	Nephrology (Renal-Kidney)	0	In state provider	None	450 SUTTER ST	RM 935	SAN FRANCISCO	CA	94108	3997	38	06075	37.78934929	-122.4077786	San Francisco County
100674	Fee-for-Service	1932270816	1932270816	1	1	LAVALLEE, MICHAEL F MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74681	05	Anesthesiology	0	In state provider	ATTN MGA OFFICE	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
100722	Fee-for-Service	1831223486	1831223486	1	1	LIFE GUARD INTERNATIONAL INC	11/17/2014	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	1	Border provider	None	145 E RENO AVENUE	SUITE E-7	LAS VEGAS	NV	89119	1114	00	None	36.09721595	-115.1668716	Clark County
100746	Fee-for-Service	1912227562	1912227562	1	1	LO, JANE W	9/5/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	17801 PIONEER BLVD	STE F	ARTESIA	CA	90701	3962	19	06037	33.8693187	-118.0823685	Los Angeles County
100753	Fee-for-Service	1295196111	1295196111	1	1	LINDSEY, JOHN P MD	8/11/2023	208800000X	NA	Other	026	PHYSICIANS	153865	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
100770	Fee-for-Service	1730162413	1730162413	1	1	LOMELINO,TODD F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72500	08	Family Practice	0	In state provider	None	1320 LAS TABLAS RD	STE F	TEMPLETON	CA	93465	9711	40	06079	35.5544315	-120.7225935	San Luis Obispo County
100771	Fee-for-Service	1730530254	1730530254	1	1	LIVINGSTON COMMUNITY HEALTH	8/30/2018	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	16233 KING STREET	None	DELHI	CA	95315	9460	24	06047	37.43319758	-120.7809931	Merced County
100785	Fee-for-Service	1558921676	1558921676	1	1	LIFE PHARMACY INC	8/31/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1842 N TUSTIN ST	None	ORANGE	CA	92865	4605	30	06059	33.81867743	-117.8360256	Orange County
100805	Fee-for-Service	1861017881	1861017881	1	1	LA HOME HEALTHCARE, INC	7/6/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1012 E COLORADO ST	SUITE 200	GLENDALE	CA	91202	4423	19	06037	34.14262054	-118.242306	Los Angeles County
100817	Fee-for-Service	1063508786	1063508786	1	1	LEE, CHONG K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	47846	25	Physical Medicine and Rehabilitation	0	In state provider	None	3030 W OLYMPIC BLVD	STE 213	LOS ANGELES	CA	90006	6509	19	06037	34.05260995	-118.3015825	Los Angeles County
100824	Fee-for-Service	1912922352	1912922352	1	1	LUM, FRANKLIN T MD	5/1/1999	2084N0400X	NA	Neurology	026	PHYSICIANS	56091	13	Neurology (M.D. only)	0	In state provider	None	11180 WARNER AVE	STE 261	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
100840	Fee-for-Service	1578129904	1578129904	1	1	LIPARI, RACHEL K	5/23/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
100874	Fee-for-Service	1285677021	1285677021	2	1	LONGS DRUG STORE CAL LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	455 CENTER ST	None	HEALDSBURG	CA	95448	3807	49	06097	38.61383689	-122.8703363	Sonoma County
100894	Fee-for-Service	1306656962	1306656962	1	1	LOVING CARE BIRTH	1/17/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	51	06101	0	0	None
100908	Fee-for-Service	1558303362	1558303362	2	1	LONGS DRUG STORE CAL LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	124 DE ANZA BLVD	None	SAN MATEO	CA	94402	3987	41	06081	37.52072955	-122.3366221	San Mateo County
100921	Fee-for-Service	1780811786	1780811786	1	1	LANCE, SAMUEL H MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114551	24	Plastic Surgery	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
100925	Fee-for-Service	1558843441	1558843441	1	1	LEE, JEFFERSON	2/23/2024	172A00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	4949 BUCKLEY WAY	110	BAKERSFIELD	CA	93309	4881	15	06029	35.33866564	-119.0541714	Kern County
100938	Fee-for-Service	1932100062	1932100062	1	1	LIS, JULIAN G MD	7/22/1993	207P00000X	NA	Other	026	PHYSICIANS	77160	None	None	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
100941	Fee-for-Service	1184618712	1184618712	1	1	LOS GATOS PATHOLOGY MED	2/25/1989	193400000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	GROUP	815 POLLARD RD	None	LOS GATOS	CA	95032	1438	43	06085	37.26214754	-121.9701986	Santa Clara County
100960	Fee-for-Service	1972008191	1972008191	1	1	LY, ALAN A DO	7/27/2021	207P00000X	NA	Other	026	PHYSICIANS	18754	None	None	0	In state provider	None	5555 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	4000	01	06001	37.69212528	-121.8803442	Alameda County
100996	Fee-for-Service	1932600814	1932600814	1	1	LEINHOS, KARA LCSW	2/23/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
101013	Fee-for-Service	1700069721	1700069721	1	1	LOYD'S LIBERTY HOMES INC	3/2/2007	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	775 COLUMBIA AVE	None	MERCED	CA	95340	0920	24	06047	37.32381952	-120.461859	Merced County
101022	Fee-for-Service	1619363165	1619363165	1	1	LEVEY, TRISTAN B MD	8/11/2020	207L00000X	NA	Other	026	PHYSICIANS	168624	05	Anesthesiology	0	In state provider	None	CLAY AND BUCHANNAN ST	None	SAN FRANCISCO	CA	94115	0000	38	06075	37.791126	-122.4309105	San Francisco County
101032	Fee-for-Service	1548740459	1548740459	1	1	LEE, SIA CNP	3/27/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	275 W HERNDON AVE	None	CLOVIS	CA	93612	0204	10	06019	36.83766747	-119.715174	Fresno County
101038	Fee-for-Service	1154876985	1154876985	1	1	LONGS PEAK HOSPITAL	2/8/2022	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1750 E KEN PRATT BLVD	None	LONGMONT	CO	80504	5311	00	None	40.16034936	-105.0585093	Boulder County
101043	Fee-for-Service	1982668026	1982668026	1	1	LIU, HOWARD MD	8/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76177	07	Dermatology	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
101074	Fee-for-Service	1871678540	1871678540	1	1	LINDHEIM, SUSAN E MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	50276	40	Pediatrics	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
101164	Fee-for-Service	1992715320	1992715320	1	1	LOVERING, GLORIA C NP	10/12/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7050 N RECREATION AVE	SUITE 105	FRESNO	CA	93720	8001	10	06019	36.83835219	-119.7404373	Fresno County
101192	Fee-for-Service	1073708079	1073708079	1	1	LONDON, RUTHANN LMFT	1/25/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	STE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
101222	Fee-for-Service	1275208670	1275208670	1	1	LA CANADA HOME	10/25/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	1545 N VERDUGO RD	UNIT 200	GLENDALE	CA	91208	2872	19	06037	34.16921698	-118.2280083	Los Angeles County
101224	Fee-for-Service	1770740623	1770740623	1	1	LIFEHOUSE INC	5/15/1992	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2 STONEHAVEN CT	None	NOVATO	CA	94947	2039	21	06041	38.11242547	-122.6080274	Marin County
101236	Fee-for-Service	1861830051	1861830051	1	1	LANSMAN, HILLARY B DO	11/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14713	41	Internal Medicine	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
101242	Fee-for-Service	1619165115	1619165115	1	1	LABATIA, SHERIF Y MD	9/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55757	08	Family Practice	0	In state provider	None	5750 DOWNEY AVE	STE 100	LAKEWOOD	CA	90712	1411	19	06037	33.859611	-118.1511435	Los Angeles County
101261	Fee-for-Service	1316017858	1316017858	1	1	LEWIS, DAVID A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	29804	41	Internal Medicine	0	In state provider	None	2204 GRANT RD	STE 103	MOUNTAIN VIEW	CA	94040	3877	43	06085	37.37193085	-122.0779465	Santa Clara County
101277	Fee-for-Service	1295178333	1295178333	1	1	LOPEZ, DEONNAE S MD	12/18/2019	207P00000X	NA	Other	026	PHYSICIANS	162801	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
101325	Fee-for-Service	1154876985	1154876985	1	1	LONGS PEAK HOSPITAL	2/8/2022	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1750 E KEN PRATT BLVD	None	LONGMONT	CO	80504	5311	00	None	40.16034936	-105.0585093	Boulder County
101331	Fee-for-Service	1396879334	1396879334	1	1	LIAO, HSIUCHEN LMFT	9/10/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
101335	Fee-for-Service	1528012853	1528012853	1	1	LIBOON, JOHN P MD	3/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	65588	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
101346	Fee-for-Service	1205853066	1205853066	1	1	LETSON, KURT MD	7/27/2009	207L00000X	NA	Other	026	PHYSICIANS	76350	05	Anesthesiology	0	In state provider	None	1301 N ROSE DR	None	PLACENTIA	CA	92870	3802	30	06059	33.8868003	-117.8420447	Orange County
101368	Fee-for-Service	1053799296	1053799296	1	1	LUPU, SIMONA I MD	9/1/2020	207L00000X	NA	Other	026	PHYSICIANS	145724	05	Anesthesiology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
101381	Fee-for-Service	1003859844	1003859844	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2700 HOMESTEAD RD	None	SANTA CLARA	CA	95051	5353	43	06085	37.33899611	-121.9746975	Santa Clara County
101386	Fee-for-Service	1073927125	1073927125	1	1	LIN, DANG MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144920	41	Internal Medicine	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
101396	Fee-for-Service	1851580690	1851580690	1	1	LING, ARNOLD N	10/11/2006	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36706	None	None	0	In state provider	None	9604 E ARTESIA BLVD	STE 104	BELLFLOWER	CA	90706	6769	19	06037	33.87472842	-118.1288599	Los Angeles County
101408	Fee-for-Service	1932251154	1932251154	1	1	LOW, HENRY J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	71770	41	Internal Medicine	0	In state provider	None	2500 GRANT ROAD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
101409	Fee-for-Service	1477588598	1477588598	1	1	LEONARD, LISA A MD	6/7/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	79676	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1000 VALE TERRACE DR	None	VISTA	CA	92084	5218	37	06073	33.20904502	-117.2286439	San Diego County
101413	Fee-for-Service	1982704979	1982704979	1	1	LEE, LEANNE OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	MIDTOWN OPTOMETRY	1101 E MARCH LN	STE O	STOCKTON	CA	95210	4500	39	06077	38.00165171	-121.2930409	San Joaquin County
101421	Fee-for-Service	1598183840	1598183840	1	1	LONQUICH, BRIAN P MD	5/31/2021	2080P0204X	NA	Other	026	PHYSICIANS	141982	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
101447	Fee-for-Service	1255374427	1255374427	2	1	LONGS DRUG STORE CAL LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1871 EL CAMINO REAL	None	BURLINGAME	CA	94010	3220	41	06081	37.59599909	-122.3855621	San Mateo County
101489	Fee-for-Service	1235299405	1235299405	1	1	LEE, ALEXANDER T	6/30/1989	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	61138	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
101498	Fee-for-Service	1720517337	1720517337	1	1	LUCKI, JOSEPH M MD	8/28/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	172787	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
101515	Fee-for-Service	1366554933	1366554933	1	1	LIU, DENNIS M MD	4/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88792	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
101518	Fee-for-Service	1326309352	1326309352	1	1	LI, ZHIXI MD	11/8/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	128634	30	Radiology	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
101521	Fee-for-Service	1053327288	1053327288	1	1	LEE, STEPHEN K MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	52913	41	Internal Medicine	0	In state provider	None	3580 CALIFORNIA ST	STE 303	SAN FRANCISCO	CA	94118	1715	38	06075	37.78648975	-122.452943	San Francisco County
101528	Fee-for-Service	1679710156	1679710156	1	1	LIN, JAMES M MD	5/6/2010	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	105798	46	Hand Surgery	0	In state provider	None	321 E ROMIE LN	STE A	SALINAS	CA	93901	3168	27	06053	36.66081862	-121.6497217	Monterey County
101537	Fee-for-Service	1427438670	1427438670	1	1	LAI, KHA H MD	3/19/2023	207L00000X	NA	Other	026	PHYSICIANS	162212	None	None	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
101547	Fee-for-Service	1528080470	1528080470	1	2	LA CLINICA DE LA RAZA	4/8/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2000 RAILROAD AVE	None	PITTSBURG	CA	94565	3830	07	06013	38.01974062	-121.8884314	Contra Costa County
101552	Fee-for-Service	1457805251	1457805251	1	3	LUCID SPEECH AND LANGUAGE CL	9/19/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	IC, INC.	27192 NEWPORT ROAD	SUITE 1	MENIFEE	CA	92584	7387	33	06065	33.68506045	-117.1855215	Riverside County
101559	Fee-for-Service	1306891346	1306891346	1	1	LEE, WINSTON MD	11/25/2020	207RR0500X	NA	Other	026	PHYSICIANS	67889	None	None	0	In state provider	None	1140 W LA VETA AVE	#610	ORANGE	CA	92868	4223	30	06059	33.7802984	-117.8651669	Orange County
101579	Fee-for-Service	1790928141	1790928141	1	1	LINDSEY CALEY M.D.	10/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 W ANTELOPE DR	None	LAYTON	UT	84041	1142	00	None	41.091012	-111.995523	Davis County
101585	Fee-for-Service	1770669319	1770669319	1	1	LIU, JUN MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79444	None	None	0	In state provider	None	655 S MAIN ST	None	LOS ANGELES	CA	90014	2003	19	06037	34.0441643	-118.2511469	Los Angeles County
101627	Fee-for-Service	1669874467	1669874467	1	1	LUNDAHL, SHELBY MD	7/29/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	140432	None	None	0	In state provider	None	3700 SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
101658	Fee-for-Service	1902346158	1902346158	1	1	LEADING PERSONAL CARE AGENCY	4/5/2017	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	2491 ALLUVIAL AVE	None	VALENCIA	CA	93611	9587	10	06019	36.84477477	-119.6688867	Fresno County
101686	Fee-for-Service	1205136017	1205136017	1	1	LIM, ALEXANDRIA	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
101724	Fee-for-Service	1619288685	1619288685	1	1	LOTFI, KATAYOUN MD	8/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134702	67	Endocrinology	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
101725	Fee-for-Service	1316409022	1316409022	1	1	LE, DANH T MD	7/5/2023	207L00000X	NA	Other	026	PHYSICIANS	177832	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
101738	Fee-for-Service	1588812267	1588812267	1	1	LAMONTE, KAELLEN G LCSW	1/2/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 HARDING BLVD	STE 116	ROSEVILLE	CA	95678	2470	31	06061	38.75180337	-121.2682528	Placer County
101764	Fee-for-Service	1003254145	1003254145	1	1	LIEN, FRANK DO	8/7/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15755	08	Family Practice	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
101775	Fee-for-Service	1376505180	1376505180	1	1	LAZAR, MICHAEL J JR MD	2/8/2015	208800000X	NA	Other	026	PHYSICIANS	40958	34	Urology and Urological Surgery	0	In state provider	None	4710 HOEN AVE	None	SANTA ROSA	CA	95405	7887	49	06097	38.441763	-122.6647215	Sonoma County
101783	Fee-for-Service	1043684301	1043684301	1	1	LEUNG, CALVIN W H Q	1/21/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
101803	Fee-for-Service	1225110810	1225110810	1	1	LUKSICH, JASON A MD	11/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95768	18	Ophthalmology	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
101806	Fee-for-Service	1366554933	1366554933	1	1	LIU, DENNIS M MD	4/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88792	83	Rheumatology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
101813	Fee-for-Service	1093209025	1093209025	1	1	LE, STEVEN DO	10/11/2021	207R00000X	NA	Other	026	PHYSICIANS	19059	None	None	0	In state provider	None	44444 20TH ST W	None	LANCASTER	CA	93534	2714	19	06037	34.69063406	-118.1656452	Los Angeles County
101815	Fee-for-Service	1679710156	1679710156	1	1	LIN, JAMES M MD	5/6/2010	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	105798	20	Orthopedic Surgery	0	In state provider	None	321 E ROMIE LN	STE A	SALINAS	CA	93901	3168	27	06053	36.66081862	-121.6497217	Monterey County
101830	Fee-for-Service	1528080470	1528080470	1	2	LA CLINICA DE LA RAZA	4/8/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2000 RAILROAD AVE	None	PITTSBURG	CA	94565	3830	07	06013	38.01974062	-121.8884314	Contra Costa County
101832	Fee-for-Service	1427427509	1427427509	1	1	LORRAINE, COURTNEY G LCSW	4/15/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
101835	Fee-for-Service	1306136726	1306136726	1	1	LU, XIAOYING MD	2/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129062	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
101956	Fee-for-Service	1699981001	1699981001	1	1	LIN, ALEX L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	90205	25	Physical Medicine and Rehabilitation	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4167	19	06037	34.22073847	-118.532988	Los Angeles County
101986	Fee-for-Service	1770534935	1770534935	1	1	LATHIYA, NIMITTA N DO	7/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	8227	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
102003	Fee-for-Service	1932237054	1932237054	1	1	LILLEY, JOSEPH Y OD	9/19/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
102007	Fee-for-Service	1164298337	1164298337	1	1	LEGACY CARE ADHC CORPORATION	10/29/2024	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	11239 CAMINO RUIZ	STE A	SAN DIEGO	CA	92126	4601	37	06073	32.92586346	-117.1439207	San Diego County
102045	Fee-for-Service	1619186764	1619186764	1	1	LI, KEVIN M MD	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	98063	08	Family Practice	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
102054	Fee-for-Service	1700076619	1700076619	1	1	LAZZARO,NICHOLAS A MD	4/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE RD	None	MERIDIAN	ID	83646	0000	00	None	43.600527	-116.3518425	Ada County
102079	Fee-for-Service	1457307571	1457307571	1	1	LOHNER, RONALD A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	919 CONESTOGA RD	BUILDING 1, SUITE 200	ROSEMONT	PA	19010	1352	00	None	40.02531513	-75.33634992	Delaware County
102093	Fee-for-Service	1922023043	1922023043	1	1	LEE, SAMUEL K MD INC	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70695	34	Urology and Urological Surgery	0	In state provider	None	201 S ALVARADO ST	STE 622	LOS ANGELES	CA	90057	2386	19	06037	34.06417777	-118.2719543	Los Angeles County
102097	Fee-for-Service	1043402118	1043402118	1	1	LEE, JOSEPH P MD	5/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108720	40	Pediatrics	0	In state provider	None	3000 LAS POSITAS ROAD	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
102105	Fee-for-Service	1023445780	1023445780	1	1	LA CLINICA DE LA RAZA INC	4/16/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1700 28TH AVE	None	OAKLAND	CA	94601	2455	01	06001	37.78277725	-122.2270438	Alameda County
102106	Fee-for-Service	1750841979	1750841979	1	1	LIU, BENFIE DO	4/25/2022	207P00000X	NA	Other	026	PHYSICIANS	19450	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
102116	Fee-for-Service	1114105079	1114105079	1	1	LIBERSTEIN, ALLA MD INC	7/1/2008	207R00000X	NA	Other	026	PHYSICIANS	100462	41	Internal Medicine	0	In state provider	None	277 W PUTMAN AVE	None	PORTERVILLE	CA	93257	3450	54	06107	36.06075382	-118.9876346	Tulare County
102119	Fee-for-Service	1649949314	1649949314	1	1	LA CRESCENTA HOME INC	4/11/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1545 N VERDUGO RD	UNIT 201	GLENDALE	CA	91208	2871	19	06037	34.16921698	-118.2280083	Los Angeles County
102124	Fee-for-Service	1528301843	1528301843	1	1	LYNCH, ROBERT E MD	7/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134801	30	Radiology	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
102180	Fee-for-Service	1629139944	1629139944	1	1	LANG, JUDITH S LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1392	43	06085	37.23418124	-121.7818366	Santa Clara County
102192	Fee-for-Service	1487684379	1487684379	1	1	LUFKIN, ROBERT B MD	5/31/1994	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	43135	30	Radiology	0	In state provider	None	8677 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	2927	19	06037	34.06639131	-118.3808863	Los Angeles County
102233	Fee-for-Service	1184749830	1184749830	1	1	LEVESEY PEASE, CAROLYN R	4/19/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	609 E ORANGEBURG AVE	STE 201	MODESTO	CA	95350	5512	50	06099	37.66364947	-120.9857985	Stanislaus County
102258	Fee-for-Service	1215962113	1215962113	1	1	LYDEN, PATRICK D MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	48156	08	Family Practice	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
102268	Fee-for-Service	1053881193	1053881193	1	1	LE, MIEN T CRNA	7/6/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4060 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2526	19	06037	34.02390148	-118.184319	Los Angeles County
102272	Fee-for-Service	1770534935	1770534935	1	1	LATHIYA, NIMITTA N DO	7/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	8227	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
102274	Fee-for-Service	1376786657	1376786657	1	1	LEDEZMA, ALEXANDRA R LCSW	12/7/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
102333	Fee-for-Service	1124025176	1124025176	1	1	LAKE FOREST HOSPITAL	2/18/2008	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	660 N WESTMORELAND RD	None	LAKE FOREST	IL	60045	1696	00	None	42.252327	-87.865173	Lake County
102336	Fee-for-Service	1831538305	1831538305	1	1	LOWERY, PATRICIA DO	8/14/2017	390200000X	NA	Other	026	PHYSICIANS	13782	05	Anesthesiology	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
102339	Fee-for-Service	1710996160	1710996160	1	1	LEE, EDWIN R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	58886	05	Anesthesiology	0	In state provider	None	391 CYPRESS DR	None	LOS ALTOS	CA	94022	2604	43	06085	37.38185721	-122.1233493	Santa Clara County
102351	Fee-for-Service	1871164343	1871164343	1	1	LEIVA, AMY P OT	12/12/2022	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
102366	Fee-for-Service	1891779021	1891779021	1	1	LEVY, ERIC G MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	70946	08	Family Practice	0	In state provider	None	1414 S MILLER ST	STE P	SANTA MARIA	CA	93454	6915	42	06083	34.937433	-120.431561	Santa Barbara County
102391	Fee-for-Service	1023445780	1023445780	1	1	LA CLINICA DE LA RAZA INC	4/16/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1700 28TH AVE	None	OAKLAND	CA	94601	2455	01	06001	37.78277725	-122.2270438	Alameda County
102400	Fee-for-Service	1275595191	1275595191	1	1	LEANING, KATHARINE E MD	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	73830	40	Pediatrics	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
102413	Fee-for-Service	1366438574	1366438574	1	1	LIQUETE, JOHNNY A MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	49014	41	Internal Medicine	0	In state provider	None	6485 DAY ST	STE 201	RIVERSIDE	CA	92507	0926	33	06065	33.931809	-117.2789185	Riverside County
102475	Fee-for-Service	1528226073	1528226073	1	1	LANKERSHIM MEDICAL CLINIC,	12/17/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	43704	02	General Surgery	0	In state provider	INC	6056 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91606	4806	19	06037	34.18110115	-118.3843592	Los Angeles County
102488	Fee-for-Service	1982640124	1982640124	1	1	LEWIS, MARC MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	84373	05	Anesthesiology	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
102493	Fee-for-Service	1225079155	1225079155	1	1	LANNIN, W CRAIG	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	5891	18	Ophthalmology	0	In state provider	None	1950 COURT ST	None	REDDING	CA	96001	1823	45	06089	40.57884166	-122.3939309	Shasta County
102500	Fee-for-Service	1740230317	1740230317	1	1	LARKINS, MARK V MD	3/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	71942	14	Neurological Surgery	0	In state provider	None	1401 SPANOS COURT	STE 130	MODESTO	CA	95355	2815	50	06099	37.66975543	-120.9724048	Stanislaus County
102513	Fee-for-Service	1558672550	1558672550	1	1	LEE, EUNJOO	1/27/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8100 SUNLAND BLVD	None	SUN VALLEY	CA	91352	3948	19	06037	34.21771742	-118.3701303	Los Angeles County
102525	Fee-for-Service	1831402833	1831402833	1	1	LEE, JEFFREY C MD	12/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118296	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
102545	Fee-for-Service	1215962113	1215962113	1	1	LYDEN, PATRICK D MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	48156	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
102558	Fee-for-Service	1558305532	1558305532	1	1	LARSEN, DONALD W MD	3/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	58082	30	Radiology	0	In state provider	None	1510 SAN PABLO ST	STE 268	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
102579	Fee-for-Service	1518963321	1518963321	1	2	LEE, JAY K MD	10/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	85767	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2560 N PERRIS BLVD	STE F-6	PERRIS	CA	92571	3254	33	06065	33.819705	-117.2262155	Riverside County
102619	Fee-for-Service	1124025176	1124025176	1	1	LAKE FOREST HOSPITAL	12/20/2004	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	660 N WESTMORELAND RD	None	LAKE FOREST	IL	60045	1696	00	None	42.252327	-87.865173	Lake County
102651	Fee-for-Service	1073509238	1073509238	1	1	LOFFREDO, ANTHONY J MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67643	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
102652	Fee-for-Service	1225409790	1225409790	1	1	LOPEZ, LAURA LCSW	12/5/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
102662	Fee-for-Service	1356371967	1356371967	1	1	LEVINE, ALEXANDRA M MD	2/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	23375	68	Hematology	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
102666	Fee-for-Service	1487962072	1487962072	1	1	LEE, CAROLINE PHD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD ROAD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
102668	Fee-for-Service	1528234382	1528234382	1	1	LU, DAT T MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111815	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
102680	Fee-for-Service	1023445780	1023445780	1	1	LA CLINICA DE LA RAZA INC	2/5/2014	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1700 28TH AVE	None	OAKLAND	CA	94601	2455	01	06001	37.78277725	-122.2270438	Alameda County
102682	Fee-for-Service	1750368577	1750368577	1	1	LOUDEN, MARK S MD	10/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	43295	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
102692	Fee-for-Service	1649347527	1649347527	1	1	LEONARD, PATRICE A MD	9/30/1985	207RR0500X	NA	Other	026	PHYSICIANS	42695	41	Internal Medicine	0	In state provider	None	301 N PRAIRIE AVE	STE 415	INGLEWOOD	CA	90301	4507	19	06037	33.965712	-118.3439965	Los Angeles County
102717	Fee-for-Service	1285677039	1285677039	2	1	LONGS DRUG STORES CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	580 MORAGA RD	None	MORAGA	CA	94556	2211	07	06013	37.85642025	-122.1245976	Contra Costa County
102723	Fee-for-Service	1659898716	1659898716	1	1	LIU, DANIEL MD	1/19/2025	208600000X	NA	General Surgery	026	PHYSICIANS	180203	02	General Surgery	0	In state provider	None	10880 WILSHIRE BLVD	1101	LOS ANGELES	CA	90024	4112	19	06037	34.05897499	-118.4431123	Los Angeles County
102748	Fee-for-Service	1700894813	1700894813	1	1	LIANG, CARMEN W DO	4/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13547	01	General Practice	0	In state provider	None	1001 POTRERO AVE	RM 4F	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
102764	Fee-for-Service	1528226073	1528226073	1	1	LANKERSHIM MEDICAL CLINIC,	12/17/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	43704	01	General Practice	0	In state provider	INC	6056 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91606	4806	19	06037	34.18110115	-118.3843592	Los Angeles County
102770	Fee-for-Service	1891869905	1891869905	1	1	LEHMAN, CASSANDRA L PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
102805	Fee-for-Service	1386605343	1386605343	1	1	LINDENFELD, ETTA A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	41044	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
102830	Fee-for-Service	1316391519	1316391519	1	1	LOPEZ, ALEJANDRO MD	10/31/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	177105	-	NOT APPLICABLE	0	In state provider	None	7231 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90046	6724	19	06037	34.09075945	-118.347435	Los Angeles County
102832	Fee-for-Service	1215962113	1215962113	1	1	LYDEN, PATRICK D MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	48156	13	Neurology (M.D. only)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
102848	Fee-for-Service	1558305532	1558305532	1	1	LARSEN, DONALD W MD	3/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	58082	14	Neurological Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 268	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
102853	Fee-for-Service	1639412232	1639412232	1	1	LLOYD, MONIQUE I MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
102860	Fee-for-Service	1164589404	1164589404	1	1	LIM, JEAN M OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4255 CAMPUS DR	STE 112	IRVINE	CA	92612	2620	30	06059	33.64910596	-117.8394276	Orange County
102864	Fee-for-Service	1629154158	1629154158	1	1	LEVINE, LESLEY MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	47735	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
102897	Fee-for-Service	1699154807	1699154807	1	1	LEE, DAVID D	4/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14952	01	General Practice	0	In state provider	None	1201 ALHAMBRA BLVD	220	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
102900	Fee-for-Service	1154727998	1154727998	1	1	LIU, SIWEI NP	4/22/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
102906	Fee-for-Service	1528018504	1528018504	1	1	LOPEZ, JORGE R MD	8/30/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61816	01	General Practice	0	In state provider	SUITES A & B	1168 SAN GABRIEL BLVD	None	ROSEMEAD	CA	91770	4236	19	06037	34.04272643	-118.086007	Los Angeles County
102945	Fee-for-Service	1851403372	1851403372	1	1	LINCARE INC	6/30/2004	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	None	97900 SHOPPING CENTER AV	UNIT 9B	HARBOR	OR	97415	9412	00	None	42.04975626	-124.2603598	Curry County
102983	Fee-for-Service	1962539551	1962539551	1	1	LAW, ANNA C MD	12/12/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	20647	08	Family Practice	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
102994	Fee-for-Service	1174077986	1174077986	1	1	LOW FAMILY ACUPUNCTURE, INC.	12/27/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	6000 FAIRWAY DR	STE 2	ROCKLIN	CA	95677	4244	31	06061	38.79220243	-121.2621624	Placer County
103036	Fee-for-Service	1992091805	1992091805	1	1	LEE, KATHERINE Y M MD	10/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122618	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
103054	Fee-for-Service	1629057096	1629057096	1	1	LOKNA, GINA M MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63453	None	None	0	In state provider	None	2261 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3831	31	06061	38.74434897	-121.2413247	Placer County
103055	Fee-for-Service	1750434866	1750434866	1	1	LAKHA, RUMI K DO INC	11/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	5074	01	General Practice	0	In state provider	None	7136 PACIFIC BLVD	STE 225	HUNTINGTON PARK	CA	90255	4767	19	06037	33.97474083	-118.2251149	Los Angeles County
103069	Fee-for-Service	1609230994	1609230994	1	1	LIFEMED, INC.	11/6/2017	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 COURT STREET	STE E	REDDING	CA	96001	1805	45	06089	40.57812322	-122.3935669	Shasta County
103099	Fee-for-Service	1831529973	1831529973	1	1	LEBOEUF, GERALD J JR LMFT	9/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
103116	Fee-for-Service	1154959021	1154959021	1	1	LEU, JOSHUA MD	5/25/2023	207P00000X	NA	Other	026	PHYSICIANS	184027	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
103129	Fee-for-Service	1588730881	1588730881	1	1	LRC HOMES, INC	7/31/2000	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ARGUS HOME	24821 ARGUS DR	None	MISSION VIEJO	CA	92691	4613	30	06059	33.60180306	-117.679389	Orange County
103130	Fee-for-Service	1588774335	1588774335	1	1	LEVINSON, STEPHEN G MD	7/31/1990	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	44588	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2701 W ALAMEDA AVE	STE 308	BURBANK	CA	91505	4408	19	06037	34.15751343	-118.3303715	Los Angeles County
103201	Fee-for-Service	1962580456	1962580456	1	1	LISCHNER, NEAL Y MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86325	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
103214	Fee-for-Service	1710458690	1710458690	1	1	LEWIS, DINA G RCP	4/7/2023	2279G1100X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
103222	Fee-for-Service	1922165406	1922165406	1	1	LOWE, ANSON W. MD	6/30/1988	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	54277	None	None	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
103235	Fee-for-Service	1619145307	1619145307	1	1	LIFELONG MEDICAL CARE	4/1/2009	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	9933 MACARTHUR BLVD	None	OAKLAND	CA	94605	4853	01	06001	37.74646247	-122.1566447	Alameda County
103270	Fee-for-Service	1962539551	1962539551	1	1	LAW, ANNA C MD	12/12/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	20647	66	Emergency Medicine (Urgent Care)	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
103286	Fee-for-Service	1700820156	1700820156	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	27251 LA PAZ RD	None	LAGUNA NIGUEL	CA	92677	3602	30	06059	33.56713306	-117.7082763	Orange County
103301	Fee-for-Service	1972081933	1972081933	1	1	LLAMAS, JAZMIN	5/12/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
103308	Fee-for-Service	1578241295	1578241295	1	1	LITTLEPAGE, CARRIE M NP	12/19/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
103319	Fee-for-Service	1336317098	1336317098	1	1	LIBERTY DIALYSIS-CARSON	2/26/2010	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	CITY LLC	4500 SOUTH CARSON ST	None	CARSON CITY	NV	89701	5517	00	None	39.126411	-119.7724275	Consolidated Municipality of Carson City
103329	Fee-for-Service	1043471147	1043471147	1	1	LAFFERTY, JEAN M	6/26/2008	163W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	439 ALTA AVE	None	SANTA CRUZ	CA	95060	6316	44	06087	36.95440695	-122.0442484	Santa Cruz County
103405	Fee-for-Service	1508944091	1508944091	1	1	LANGER, SAMANTHA A MD	6/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	72304	84	Surgery-Head and Neck	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
103409	Fee-for-Service	1427207109	1427207109	1	1	LAITY, DOUGLAS W MD	9/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104203	41	Internal Medicine	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
103416	Fee-for-Service	1649334657	1649334657	1	1	LEE, JEANNE G MD	6/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96295	89	Surgery-Traumatic	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
103427	Fee-for-Service	1184748923	1184748923	1	1	LAMONT COMMUNITY HEALTH	7/1/1994	261QM2500X	NA	Other	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	8787 HALL RD	None	LAMONT	CA	93241	1953	15	06029	35.25969451	-118.908099	Kern County
103428	Fee-for-Service	1316265846	1316265846	1	1	LIN, AILEEN NP	4/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
103438	Fee-for-Service	1619311412	1619311412	1	1	LUGO, ROBERT A DO	12/12/2018	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	15571	39	Preventive (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
103456	Fee-for-Service	1750434866	1750434866	1	2	LAKHA, RUMI K DO INC	11/21/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5074	01	General Practice	0	In state provider	None	8534 ROSECRANS AVE	None	PARAMOUNT	CA	90723	3644	19	06037	33.9036267	-118.1503206	Los Angeles County
103462	Fee-for-Service	1891382990	1891382990	1	1	LYAPINA, ANNA CNP	9/23/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13171 MINDANAO WAY	None	MARINA DEL REY	CA	90292	6307	19	06037	33.98421001	-118.4377644	Los Angeles County
103477	Fee-for-Service	1437355260	1437355260	1	1	LYNN, RIKK N MD	1/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112258	None	None	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
103486	Fee-for-Service	1619934692	1619934692	1	1	LEVY, JENNIFER A MD	5/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91191	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
103492	Fee-for-Service	1538536230	1538536230	1	1	LEI, EDWARD LCSW	11/26/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
103494	Fee-for-Service	1952646838	1952646838	1	1	LAM, LISA S LAC	5/3/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
103497	Fee-for-Service	1780732578	1780732578	1	1	LY, SOPHEAP MD	2/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82297	41	Internal Medicine	0	In state provider	MGA OFFICE	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
103521	Fee-for-Service	1831839828	1831839828	1	1	LU, JULIA Y	5/13/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	188701	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
103525	Fee-for-Service	1841998242	1841998242	1	1	LIN, SHANSHAN	9/29/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
103596	Fee-for-Service	1295164077	1295164077	1	1	LUDOVICO, CINDY NP	9/11/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
103603	Fee-for-Service	1659397552	1659397552	1	1	LAI, TED Y MD	1/1/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	31371	04	Otology, Laryngology, Rhinology	0	In state provider	None	210 N GARFIELD AVE	STE 303	MONTEREY PARK	CA	91754	1746	19	06037	34.064181	-118.122834	Los Angeles County
103609	Fee-for-Service	1962752451	1962752451	1	1	LITTLE, JACQUELINE A	6/16/2021	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	4 HARRIS CT	STE A	MONTEREY	CA	93940	5798	27	06053	36.5799704	-121.8186278	Monterey County
103618	Fee-for-Service	1043471147	1043471147	1	1	LAFFERTY, JEAN M	6/26/2008	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	439 ALTA AVE	None	SANTA CRUZ	CA	95060	6316	44	06087	36.95440695	-122.0442484	Santa Cruz County
103622	Fee-for-Service	1760646285	1760646285	1	1	LOUI YAU, BEATRICE K MD	8/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109176	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
103645	Fee-for-Service	1487764601	1487764601	1	1	LACY, JUDITH MD	11/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96941	15	Obstetrics (D.O. only)	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
103650	Fee-for-Service	1578623740	1578623740	1	1	LEE, DONG-JOON MD	1/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	71337	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
103702	Fee-for-Service	1174756381	1174756381	1	1	LIU, JONATHAN J MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	113866	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
103714	Fee-for-Service	1598255010	1598255010	1	1	LIAO, JOSEPH MD	6/29/2023	207LP2900X	NA	Other	026	PHYSICIANS	179410	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
103733	Fee-for-Service	1730179714	1730179714	1	1	LAKEWOOD RANCH MEDICAL	9/13/2017	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	8330 LAKEWOOD RANCH BLVD	None	BRADENTON	FL	34202	5174	00	None	27.390888	-82.43335948	Manatee County
103759	Fee-for-Service	1710421284	1710421284	1	1	LENTZ, BRIAN MD	9/1/2023	207P00000X	NA	Other	026	PHYSICIANS	176753	None	None	0	In state provider	None	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
103763	Fee-for-Service	1881308898	1881308898	1	1	LEBA, NICOLE PHD	1/17/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
103786	Fee-for-Service	1609019512	1609019512	1	1	LACLAIR, WHITNEY G DO	8/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12885	09	Gynecology (D.O. only)	0	In state provider	None	1409 E BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	50	06099	37.66742737	-120.9731413	Stanislaus County
103806	Fee-for-Service	1306372834	1306372834	1	1	LEE, MICHAEL J MD	12/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	158112	01	General Practice	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
103825	Fee-for-Service	1497830350	1497830350	2	1	LINCARE INC	2/18/2021	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2326 N BATAVIA ST	SUITE 115	ORANGE	CA	92865	2020	30	06059	33.82692607	-117.8621146	Orange County
103828	Fee-for-Service	1902022544	1902022544	1	1	LIU, YA PING DC	8/1/2000	111NR0400X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	LIU'S CHIROPRACTIC	1001 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4710	19	06037	34.084575	-118.123097	Los Angeles County
103847	Fee-for-Service	1215966296	1215966296	1	1	LLOYD EDWIN PERINO M.D.	11/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1380 E MEDICAL CTR DR	None	ST GEORGE	UT	84790	2123	00	None	37.097622	-113.553828	Washington County
103869	Fee-for-Service	1205947231	1205947231	1	1	LIM, CHARLES M MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	42301	38	Geriatrics	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
103885	Fee-for-Service	1093808156	1093808156	1	1	LOESER, HELEN MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	39381	40	Pediatrics	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
103887	Fee-for-Service	1033175997	1033175997	1	1	LO, CONSTANCE W MD	12/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72854	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
103900	Fee-for-Service	1215258595	1215258595	1	1	LINCOLN, DANIEL I MD	5/16/2022	207RC0200X	NA	Other	026	PHYSICIANS	176410	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
103934	Fee-for-Service	1487764601	1487764601	1	1	LACY, JUDITH MD	11/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96941	09	Gynecology (D.O. only)	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
103938	Fee-for-Service	1578623740	1578623740	1	1	LEE, DONG-JOON MD	1/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	71337	24	Plastic Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
103974	Fee-for-Service	1336502582	1336502582	1	1	LABARDA, KRISOLITO M NP	2/10/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
104020	Fee-for-Service	1730179714	1730179714	1	1	LAKEWOOD RANCH MEDICAL	9/13/2017	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	8330 LAKEWOOD RANCH BLVD	None	BRADENTON	FL	34202	5174	00	None	27.390888	-82.43335948	Manatee County
104045	Fee-for-Service	1124557152	1124557152	1	1	LEE-KIM, JOSEPHINE MD	10/31/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
104067	Fee-for-Service	1861753303	1861753303	1	1	LAUGHMAN, LAUREN T MD	2/20/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	136600	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
104099	Fee-for-Service	1730220989	1730220989	1	1	LEANG, HELENE OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	EYE WORLD OPTOMETRY	13721 NEWPORT AVE	STE 5	TUSTIN	CA	92780	4601	30	06059	33.74113794	-117.8193349	Orange County
104116	Fee-for-Service	1902225154	1902225154	1	1	LUDWIG, STACEY M MD	2/26/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	142640	08	Family Practice	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
104151	Fee-for-Service	1265105415	1265105415	1	1	LUCEY, MEGHAN LCSW	1/3/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
104155	Fee-for-Service	1205947231	1205947231	1	1	LIM, CHARLES M MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	42301	41	Internal Medicine	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
104245	Fee-for-Service	1174136014	1174136014	1	1	LI, CATHY K OT	8/11/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2625 SHADELANDS DR.	None	WALNUT CREEK	CA	94598	2512	07	06013	37.92734436	-122.0231145	Contra Costa County
104271	Fee-for-Service	1508433012	1508433012	1	1	LOUIE, SHERENE D CNP	8/17/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2514 BERRYESSA RD	None	SAN JOSE	CA	95132	2947	43	06085	37.38738217	-121.8595232	Santa Clara County
104288	Fee-for-Service	1235203688	1235203688	1	1	LODI CHILDRENS CLINIC	1/9/2008	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL CORP	1920 TIENDA DR	STE 102	LODI	CA	95242	3930	39	06077	38.11678155	-121.2957005	San Joaquin County
104294	Fee-for-Service	1982865325	1982865325	1	1	LO, CLARA Y MD	7/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99018	78	Neoplastic Diseases/Oncology	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
104298	Fee-for-Service	1962444794	1962444794	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2790 EAST BIDWELL AVE	None	FOLSOM	CA	95630	6414	34	06067	38.655864	-121.1195205	Sacramento County
104376	Fee-for-Service	1659568723	1659568723	1	1	LEE, GARY C PHD MD INC	5/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55074	01	General Practice	0	In state provider	None	4980 BARRANCA PARKWAY	STE 202	IRVINE	CA	92604	7709	30	06059	33.67618284	-117.7940131	Orange County
104406	Fee-for-Service	1215341771	1215341771	1	1	LEE, JAMIE S OD	12/2/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
104466	Fee-for-Service	1417156068	1417156068	1	1	LYONS, JOHN M MD	8/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104484	10	Gastroenterology (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92307	1027	37	06073	32.89687721	-117.2418677	San Diego County
104481	Fee-for-Service	1649787789	1649787789	1	1	LOTT, KRYSTAL A NP	6/27/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	30	06059	33.74496	-117.818857	Orange County
104487	Fee-for-Service	1629470190	1629470190	1	1	LOS ANGELES ATHLETIC	2/1/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	ALTERNATIVE PROGRAM	8450 HIGUERA STREET	None	CULVER CITY	CA	90232	2520	19	06037	34.02211096	-118.37947	Los Angeles County
104489	Fee-for-Service	1841483187	1841483187	2	1	LONGS DRUG STORES CA LLC	12/24/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3020 GREEN VALLEY RD	STE B	CAMERON PARK	CA	95682	7658	09	06017	38.69790614	-121.0029435	El Dorado County
104495	Fee-for-Service	1437898533	1437898533	1	1	LIN, INGRID Y MD	2/26/2025	2080P0006X	NA	Psychiatry	026	PHYSICIANS	63539	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
104516	Fee-for-Service	1205914371	1205914371	1	1	LANDE, ARTHUR E MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	38851	40	Pediatrics	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
104549	Fee-for-Service	1851955801	1851955801	1	1	LOPEZ, KATRINA LMFT	3/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	244 CALIFORNIA	STE 300	SAN FRANCISCO	CA	94111	4302	38	06075	37.79331375	-122.3995607	San Francisco County
104570	Fee-for-Service	1215469283	1215469283	1	1	LUM HO, RACHEL L MD	8/25/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169392	40	Pediatrics	0	In state provider	None	625 W CITRACADO PKWY	STE 200	ESCONDIDO	CA	92025	6428	37	06073	33.09166731	-117.0784699	San Diego County
104582	Fee-for-Service	1982865325	1982865325	1	1	LO, CLARA Y MD	7/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99018	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
104583	Fee-for-Service	1619949443	1619949443	1	1	LEE, ANNA E H MD	4/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79537	40	Pediatrics	0	In state provider	None	27800 MEDICAL CENTER RD	STE 204	MISSION VIEJO	CA	92691	6408	30	06059	33.55952733	-117.6645199	Orange County
104595	Fee-for-Service	1457989931	1457989931	1	1	LEUNG, JESSICA MD	3/18/2025	207L00000X	NA	Other	026	PHYSICIANS	188394	05	Anesthesiology	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
104632	Fee-for-Service	1780012260	1780012260	1	1	LAKESIDE HOSPICE CARE, INC	6/27/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	800 N HARBOR BLVD	STE A	LA HABRA	CA	90631	3165	30	06059	33.939387	-117.9330415	Orange County
104664	Fee-for-Service	1518026129	1518026129	1	1	LEONIDO, TEODORO R M MD	10/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	64246	36	Psychiatry	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
104774	Fee-for-Service	1316475189	1316475189	1	1	LI, JONATHAN Z MD	8/1/2024	390200000X	NA	Other	026	PHYSICIANS	159167	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
104836	Fee-for-Service	1457761082	1457761082	1	1	LEONG, QI QUAN MD	6/5/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	184705	77	Infectious Disease	0	In state provider	None	2250 HAYES ST	STE 302	SAN FRANCISCO	CA	94117	1078	38	06075	37.77302042	-122.45342	San Francisco County
104837	Fee-for-Service	1598053894	1598053894	1	1	LASHIN, SAHAR E MD	12/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127149	41	Internal Medicine	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
104840	Fee-for-Service	1992811392	1992811392	1	1	LA CLINICA DE LA RAZA INC	11/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	415 GEORGIA ST	None	VALLEJO	CA	94590	6004	48	06095	38.10107165	-122.2562086	Solano County
104857	Fee-for-Service	1043099468	1043099468	1	1	LUIS DELGADO, ALBERTO PT	12/29/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
104869	Fee-for-Service	1083064091	1083064091	1	1	LIANG, GEOFFREY DO	12/27/2020	207R00000X	NA	Other	026	PHYSICIANS	17086	None	None	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
104882	Fee-for-Service	1174554646	1174554646	1	1	LACKMAN, VERNON H MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	67735	41	Internal Medicine	0	In state provider	None	27141 HIDAWAY AVE	None	CANYON COUNTRY	CA	91351	4131	19	06037	34.41483	-118.469039	Los Angeles County
104886	Fee-for-Service	1184033631	1184033631	1	1	LAURIA WHITE, CARMELLA M LCS	2/20/2025	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
104899	Fee-for-Service	1881969038	1881969038	1	1	LUU, BRIAN MD	4/22/2019	390200000X	NA	Other	026	PHYSICIANS	138386	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
104924	Fee-for-Service	1780012260	1780012260	1	1	LAKESIDE HOSPICE CARE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	800 N HARBOR BLVD	STE A	LA HABRA	CA	90631	3165	30	06059	33.939387	-117.9330415	Orange County
104928	Fee-for-Service	1518015445	1518015445	1	1	LEE, MICHELLE P MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86103	05	Anesthesiology	0	In state provider	ATTN MGA OFFICE	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
105000	Fee-for-Service	1205066446	1205066446	1	1	LIEBENTHAL, JENNIFER A MD	10/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130578	13	Neurology (M.D. only)	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
105001	Fee-for-Service	1730449596	1730449596	1	1	LEW, ROBERT D MD	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136684	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
105005	Fee-for-Service	1174815005	1174815005	1	1	LEE, JESSE W MD	9/16/2021	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	123480	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
105015	Fee-for-Service	1427005024	1427005024	1	1	LOS ALAMITOS RADIOLOGY	6/27/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP INC	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3101	30	06059	33.80318353	-118.0666665	Orange County
105017	Fee-for-Service	1194709535	1194709535	1	1	LING, DAVID MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	29051	None	None	0	In state provider	None	2031 W ALAMEDA AVE	STE 214	BURBANK	CA	91506	2959	19	06037	34.15972797	-118.3237055	Los Angeles County
105024	Fee-for-Service	1780119701	1780119701	1	1	LEE, HENRY MD	4/17/2022	207R00000X	NA	Other	026	PHYSICIANS	173675	None	None	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
105045	Fee-for-Service	1639527674	1639527674	1	1	LINCOLN PHARMACY INC	6/27/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	831 STERLING PARKWAY	STE 120	LINCOLN	CA	95648	8691	31	06061	38.869632	-121.29417	Placer County
105047	Fee-for-Service	1154032712	1154032712	1	1	LENCHNER, RICHARD LMFT	6/5/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	133177	-	NOT APPLICABLE	0	In state provider	None	20933 DEVONSHIRE ST STE	None	CHATSWORTH	CA	91311	2369	19	06037	34.25727951	-118.589886	Los Angeles County
105071	Fee-for-Service	1780002311	1780002311	1	1	LE, JENNIE U V N MD	8/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142307	40	Pediatrics	0	In state provider	None	341 MAGNOLIA AVE	STE 201	CORONA	CA	92879	3332	33	06065	33.85291987	-117.5664344	Riverside County
105084	Fee-for-Service	1326079369	1326079369	1	1	LEW, HOMER K DO AMC	4/22/2005	193400000X	NA	Other	026	PHYSICIANS	7156	41	Internal Medicine	0	In state provider	None	23521 PASEO DE VALENCIA	STE 108	LAGUNA HILLS	CA	92653	3137	30	06059	33.61113028	-117.7126684	Orange County
105092	Fee-for-Service	1508241779	1508241779	1	1	LICUANAN, BRIAN F PHD	11/19/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1090 THIRD ST	STE 1	SOUTH LAKE TAHOE	CA	96150	3485	09	06017	38.91492536	-119.9966528	El Dorado County
105125	Fee-for-Service	1992811392	1992811392	1	1	LA CLINICA DE LA RAZA INC	11/1/2002	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	415 GEORGIA ST	None	VALLEJO	CA	94590	6004	48	06095	38.10107165	-122.2562086	Solano County
105129	Fee-for-Service	1871571612	1871571612	1	1	LEE, PRISCILLA NP	9/15/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
105132	Fee-for-Service	1114935574	1114935574	1	1	LOPEZ, CARLOS G MD	5/7/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	140744	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
105138	Fee-for-Service	1497834147	1497834147	1	1	LEE, ALEXANDER C MD	9/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	87178	18	Ophthalmology	0	In state provider	None	720 E ROMIE LN	None	SALINAS	CA	93901	4208	27	06053	36.65902767	-121.6422856	Monterey County
105154	Fee-for-Service	1922030204	1922030204	1	1	LEE, RICHARD H	4/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73448	None	None	0	In state provider	None	1300 N VERMONT AVE	STE 901	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
105162	Fee-for-Service	1861540478	1861540478	1	1	LIEBERMAN, BETSY M LMFT	4/26/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
105168	Fee-for-Service	1164865358	1164865358	1	1	LIANG, EMILY H MD	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133700	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
105187	Fee-for-Service	1114246360	1114246360	1	1	LEE, JAE S MD	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13074	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
105241	Fee-for-Service	1497208359	1497208359	1	1	LEYVA, YANI E PHD	8/16/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
105244	Fee-for-Service	1881866820	1881866820	1	1	LESTARI, IRENE OT	7/18/2022	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3687 MT DIABLO	SUITE 100	LAFAYETTE	CA	94549	3717	07	06013	37.8898926	-122.1304235	Contra Costa County
105271	Fee-for-Service	1477840734	1477840734	1	1	LIANG, SHANNON N MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141133	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95816	2307	34	06067	38.552211	-121.449429	Sacramento County
105336	Fee-for-Service	1164908422	1164908422	1	1	LEE, YOO JIN MD	7/29/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
105372	Fee-for-Service	1669770053	1669770053	1	1	LARSEN, SCOTT A	10/28/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2300 CALIFORNIA ST	1ST FL	SAN FRANCISCO	CA	94115	2753	38	06075	37.78910083	-122.4323944	San Francisco County
105382	Fee-for-Service	1932393428	1932393428	1	1	LUCAS, MIKAEL L MD	10/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106922	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
105413	Fee-for-Service	1992811392	1992811392	1	1	LA CLINICA DE LA RAZA INC	5/28/2003	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	415 GEORGIA ST	None	VALLEJO	CA	94590	6004	48	06095	38.10107165	-122.2562086	Solano County
105451	Fee-for-Service	1235721119	1235721119	1	1	LE, NGA T	2/20/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
105457	Fee-for-Service	1265929582	1265929582	1	1	LANDON, ROBERT	7/25/2024	207L00000X	NA	Other	026	PHYSICIANS	163630	05	Anesthesiology	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
105469	Fee-for-Service	1972835452	1972835452	2	1	LEUNG, L ERIC MD APC	2/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	35631	18	Ophthalmology	0	In state provider	None	929 CLAY ST	STE 503	SAN FRANCISCO	CA	94108	1500	38	06075	37.79398652	-122.4083496	San Francisco County
105470	Fee-for-Service	1881924918	1881924918	1	1	LONG, SYDNEY B T MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143874	03	Allergy	0	In state provider	None	7471 N FRESNO STREET	None	FRESNO	CA	93720	2457	10	06019	36.84632065	-119.783885	Fresno County
105473	Fee-for-Service	1164865358	1164865358	1	1	LIANG, EMILY H MD	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133700	03	Allergy	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
105485	Fee-for-Service	1942241534	1942241534	1	1	LEVY, ADAM V MD	8/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	1707 W CHARLESTON BLVD	STE 120	LAS VEGAS	NV	89102	2352	00	None	36.15879353	-115.1643015	Clark County
105531	Fee-for-Service	1659309037	1659309037	1	1	LI, DAN MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86068	41	Internal Medicine	0	In state provider	None	888 S HILL RD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
105545	Fee-for-Service	1144223702	1144223702	1	1	LITTLETON HOSPITAL	7/20/2009	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	ASSOCIATION	600 ST JOHNSBURY ROAD	None	LITTLETON	NH	03561	3442	00	None	44.31676937	-71.82435231	Grafton County
105572	Fee-for-Service	1871988006	1871988006	1	1	LAHUE, SARA MD	6/4/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	148432	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
105574	Fee-for-Service	1356427272	1356427272	1	1	LING, BENJAMIN MD	12/31/1985	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	37385	20	Orthopedic Surgery	0	In state provider	None	2021 SMITH FLAT ROAD	#A	PLACERVILLE	CA	95667	6561	09	06017	38.73372676	-120.7534336	El Dorado County
105602	Fee-for-Service	1528545928	1528545928	1	1	LEE, ZIN RCP	11/12/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
105609	Fee-for-Service	1083771158	1083771158	2	1	LARINO-TIONKO, CARMELA OD	5/22/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	18800 E AMAR RD	SUITE A5	WALNUT	CA	91789	7100	19	06037	34.02857448	-117.8910187	Los Angeles County
105623	Fee-for-Service	1124654272	1124654272	1	1	LIEN, IRVIN C MD	7/3/2023	208M00000X	NA	Other	026	PHYSICIANS	180133	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
105627	Fee-for-Service	1912201476	1912201476	1	1	LEE, ANNA LMFT	11/6/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	93402	-	NOT APPLICABLE	0	In state provider	None	2821 OCEANSIDE BLVD	None	OCEANSIDE	CA	90254	4800	37	06073	33.20170851	-117.3402045	San Diego County
105628	Fee-for-Service	1215354238	1215354238	1	1	LIU, SU Y MD	7/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142887	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
105641	Fee-for-Service	1902220924	1902220924	1	1	LILA PHARMACY INC	6/17/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16137 FOOTHILL BLVD	None	FONTANA	CA	92335	3374	36	06071	34.10653119	-117.453131	San Bernardino County
105651	Fee-for-Service	1043470735	1043470735	1	1	LATIF, SYED R MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	124616	01	General Practice	0	In state provider	None	2800 L ST	None	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
105692	Fee-for-Service	1598882599	1598882599	1	1	LITSCH, SIMONE A MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89254	36	Psychiatry	0	In state provider	None	2081 ARENA BLVD	SUITE 160	SACRAMENTO	CA	95834	2309	34	06067	38.647737	-121.510467	Sacramento County
105703	Fee-for-Service	1992811392	1992811392	1	1	LA CLINICA DE LA RAZA INC	3/4/2005	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	415 GEORGIA ST	None	VALLEJO	CA	94590	6004	48	06095	38.10107165	-122.2562086	Solano County
105771	Fee-for-Service	1427412154	1427412154	1	1	LINSTADT, HANNA M MD	9/1/2021	207P00000X	NA	Other	026	PHYSICIANS	150848	None	None	0	In state provider	None	6501 COYLE AVENUE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
105772	Fee-for-Service	1467543918	1467543918	2	1	LE, DE HIEU MD	11/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	35088	01	General Practice	0	In state provider	None	312 13TH STREET	None	OAKLAND	CA	94612	3917	01	06001	37.80237169	-122.2683109	Alameda County
105773	Fee-for-Service	1700892932	1700892932	1	1	LONDON, DAMON MD	12/1/1997	207P00000X	NA	Other	026	PHYSICIANS	61156	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
105778	Fee-for-Service	1013956671	1013956671	1	1	LAWRENCE, ALLEN L MD	4/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	22501	41	Internal Medicine	0	In state provider	None	4312 WOODMAND AVE	STE 102	SHERMAN OAKS	CA	91423	4823	19	06037	34.148637	-118.4312035	Los Angeles County
105784	Fee-for-Service	1679139828	1679139828	1	1	LEE, MOSES DO	1/9/2025	207P00000X	NA	Other	026	PHYSICIANS	19409	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
105792	Fee-for-Service	1568424919	1568424919	1	1	LIU, YONG Q MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72252	41	Internal Medicine	0	In state provider	None	181 ANDRIEUX ST	STE 202	SONOMA	CA	95476	6920	49	06097	38.28809911	-122.4613026	Sonoma County
105798	Fee-for-Service	1073542668	1073542668	1	1	LU, DAVID MD	11/30/1992	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	51945	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
105810	Fee-for-Service	1023417953	1023417953	1	1	LA VIE HOSPICE & HOME HEALTH	12/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	46560 FREMONT BLVD	UNIT 115	FREMONT	CA	94538	6484	01	06001	37.4834786	-121.9457844	Alameda County
105811	Fee-for-Service	1093491193	1093491193	1	1	LIN, ANGELA M OD	8/28/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4151 FOOTHILL ROAD	None	SANTA BARBARA	CA	93110	1110	42	06083	34.45144647	-119.7604485	Santa Barbara County
105814	Fee-for-Service	1609134006	1609134006	1	1	LAINE, VICTORIA M MD	9/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131124	None	None	0	In state provider	None	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
105838	Fee-for-Service	1144223702	1144223702	1	1	LITTLETON HOSPITAL	7/20/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	ASSOCIATION	600 ST JOHNSBURY ROAD	None	LITTLETON	NH	03561	3442	00	None	44.31676937	-71.82435231	Grafton County
105855	Fee-for-Service	1467529826	1467529826	1	1	LEVIN, JONATHAN M MD	3/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	50155	02	General Surgery	0	In state provider	None	165 ROWLAND WAY	STE 312	NOVATO	CA	94945	5059	21	06041	38.09824386	-122.559872	Marin County
105856	Fee-for-Service	1356545925	1356545925	1	1	LE, THONG D MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111231	05	Anesthesiology	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
105866	Fee-for-Service	1518920602	1518920602	2	1	LEE, VICTOR W DPM	11/12/2015	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3150 ALMADEN EXPRESSWAY	STE 205	SAN JOSE	CA	95118	1253	43	06085	37.276537	-121.8777357	Santa Clara County
105885	Fee-for-Service	1568880870	1568880870	1	1	LEVENE, SARAH LMFT	10/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
105894	Fee-for-Service	1427160597	1427160597	1	1	LAC, QUYEN C OD	5/25/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6134 PACIFIC BLVD	None	HUNTINGTON PARK	CA	90255	2923	19	06037	33.98457344	-118.2251414	Los Angeles County
105895	Fee-for-Service	1114369147	1114369147	1	1	LINCOLN, SONYA Y LCSW	1/3/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9113 FOOTHILL BLVD	STE 130	RANCHO CUCAMONGA	CA	91730	6565	36	06071	34.10651347	-117.606528	San Bernardino County
105936	Fee-for-Service	1033517610	1033517610	1	1	LONGEVITY HOSPICE CARE	5/5/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	229 N CENTRAL AVE	SUITE 607	GLENDALE	CA	91203	3531	19	06037	34.14910181	-118.2579537	Los Angeles County
105953	Fee-for-Service	1861447997	1861447997	1	1	LEE, BARTOLOME C III MD	10/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83830	05	Anesthesiology	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
105955	Fee-for-Service	1811148620	1811148620	1	1	LIAO, KEVIN S H DO	1/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	10734	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
105958	Fee-for-Service	1801383328	1801383328	1	1	LOPEZ, MICHAEL A MD	9/26/2024	207RA0201X	NA	Other	026	PHYSICIANS	173720	03	Allergy	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
105972	Fee-for-Service	1003243916	1003243916	1	1	LI, YING LAC	3/26/2018	106H00000X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1832 CRENSHAW BLVD	None	LOS ANGELES	CA	90019	6038	19	06037	34.04105875	-118.3303901	Los Angeles County
106004	Fee-for-Service	1265457295	1265457295	1	1	LIU, DENNIS MD	4/28/1999	207L00000X	NA	Other	026	PHYSICIANS	42212	05	Anesthesiology	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
106006	Fee-for-Service	1821607045	1821607045	1	1	LECHNER, MATTHIAS A MD	8/6/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
106029	Fee-for-Service	1659385664	1659385664	1	1	LUBENS, PERRY R MD	6/1/1998	2084N0402X	NA	Neurology	026	PHYSICIANS	32989	79	Neurology-Child	0	In state provider	None	2865 ATLANTIC AVE	STE 105	LONG BEACH	CA	90806	7415	19	06037	33.809418	-118.185058	Los Angeles County
106042	Fee-for-Service	1194012294	1194012294	1	1	LOS REYES CLINICA MEDICA	7/30/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	URGENCIAS, INC	7934 SEVILLE AVE	None	WALNUT PARK	CA	90255	6804	19	06037	33.96586903	-118.2223523	Los Angeles County
106060	Fee-for-Service	1700892932	1700892932	1	1	LONDON, DAMON MD	12/1/1997	207P00000X	NA	Other	026	PHYSICIANS	61156	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
106068	Fee-for-Service	1376661561	1376661561	1	1	LUO, AILEEN P	5/16/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
106081	Fee-for-Service	1295293496	1295293496	1	1	LANKFORD, JOSEPH C MD	3/13/2024	208800000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
106097	Fee-for-Service	1023417953	1023417953	1	1	LA VIE HOSPICE & HOME HEALTH	12/14/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	46560 FREMONT BLVD	UNIT 115	FREMONT	CA	94538	6484	01	06001	37.4834786	-121.9457844	Alameda County
106109	Fee-for-Service	1063815165	1063815165	1	1	LIFE FAMILY MEDICINE CLINIC	1/28/2016	111N00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	7275 E SOUTHGATE DR	SUITE 102	SACRAMENTO	CA	95823	2610	34	06067	38.493576	-121.436559	Sacramento County
106120	Fee-for-Service	1942541826	1942541826	1	1	LA DIGESTIVE HEALTH AND	7/28/2014	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	102671	10	Gastroenterology (M.D. only)	0	In state provider	WELLNESS INC	8631 W 3RD STREET	SUITE 445E	LOS ANGELES	CA	90048	6160	19	06037	34.07361928	-118.3803143	Los Angeles County
106145	Fee-for-Service	1962528190	1962528190	1	1	LEE, CHAN W CRNA	5/16/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
106147	Fee-for-Service	1356845473	1356845473	1	1	LEVITTE, REBECCA L MD	3/3/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	165580	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
106171	Fee-for-Service	1982874301	1982874301	1	1	LY, KEVIN S MD	6/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97342	05	Anesthesiology	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
106175	Fee-for-Service	1346274024	1346274024	1	1	LOMAN, JANE V MD	7/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95685	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	RM 1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
106193	Fee-for-Service	1689235616	1689235616	1	1	LIZAGUB, TATE LMFT	9/26/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15455 SAN FERNANDO MISSO	#300	MISSION HILLS	CA	91345	1353	19	06037	34.27194157	-118.469079	Los Angeles County
106196	Fee-for-Service	1639564396	1639564396	1	1	LOPEZ, CARMINA LMFT	6/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA U	802	SAN DIEGO	CA	92108	3102	37	06073	32.76632791	-117.1616245	San Diego County
106205	Fee-for-Service	1083846166	1083846166	1	1	LAL, RAYHAN A MD	6/7/2019	207RE0101X	NA	Endocrinology	026	PHYSICIANS	123327	67	Endocrinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
106218	Fee-for-Service	1952350381	1952350381	1	1	LEVENBERG, STEVEN E DO	6/21/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	5003	01	General Practice	0	In state provider	None	8109 LA PLZ	None	COTATI	CA	94931	4244	49	06097	38.32659528	-122.7075717	Sonoma County
106222	Fee-for-Service	1033517610	1033517610	1	1	LONGEVITY HOSPICE CARE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	229 N CENTRAL AVE	SUITE 607	GLENDALE	CA	91203	3531	19	06037	34.14910181	-118.2579537	Los Angeles County
106246	Fee-for-Service	1417180050	1417180050	1	1	LATEINER, RACHEL DPM	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
106250	Fee-for-Service	1487915120	1487915120	1	1	LEMUS-RANGEL, RAFAEL MD	11/6/2012	208600000X	NA	General Surgery	026	PHYSICIANS	107205	02	General Surgery	0	In state provider	A MEDICAL CORPORATION	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
106259	Fee-for-Service	1134355514	1134355514	1	1	LAPINE FERRILL, LARISSA K	6/30/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4211 B VALLEY VIEW AVE	None	NORCO	CA	92860	3502	33	06065	33.943446	-117.5498725	Riverside County
106264	Fee-for-Service	1164467205	1164467205	1	1	LIN AND WILSON RADIOLOGY	10/31/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP, INC	725 S ORANGE AVE	None	WEST COVINA	CA	91790	2614	19	06037	34.07079634	-117.9445034	Los Angeles County
106362	Fee-for-Service	1639503717	1639503717	1	1	LOERA, ESTHER B LCSW	6/3/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
106363	Fee-for-Service	1114107505	1114107505	1	1	LIFE HEARING INC	9/11/2015	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1635 E LINCOLN AVE	None	ORANGE	CA	92865	1929	30	06059	33.83499747	-117.8370225	Orange County
106364	Fee-for-Service	1255890380	1255890380	1	1	LIU, LAWRENCE W MD	4/5/2023	207R00000X	NA	Other	026	PHYSICIANS	178663	None	None	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
106396	Fee-for-Service	1063815165	1063815165	1	1	LIFE FAMILY MEDICINE CLINIC	1/28/2016	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	INC	7275 E SOUTHGATE DR	SUITE 102	SACRAMENTO	CA	95823	2610	34	06067	38.493576	-121.436559	Sacramento County
106400	Fee-for-Service	1730498734	1730498734	1	1	LEININGER, APRIL R LCSW	7/10/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
106409	Fee-for-Service	1992319024	1992319024	1	1	LAMOTHE, DANY MD	11/2/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	170799	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
106427	Fee-for-Service	1700964442	1700964442	1	1	LI,MORRIS M MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64210	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
106450	Fee-for-Service	1558445262	1558445262	1	1	LOUIS M. BLAKE-INADA, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	21601 76TH AVE W	None	EDMONDS	WA	98026	7507	00	None	47.803239	-122.335652	Snohomish County
106472	Fee-for-Service	1447781315	1447781315	1	1	LEIGHT, TERRA OD	9/12/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1845 W REDLANDS BLVD	101	REDLANDS	CA	92373	3124	36	06071	34.06287653	-117.215955	San Bernardino County
106480	Fee-for-Service	1508939216	1508939216	1	1	LEE, ELIZABETH W L MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63238	08	Family Practice	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
106563	Fee-for-Service	1750589065	1750589065	1	1	LEE, EUN SEON AC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	ALL GRACE WELL-BEING CLI	7851 WALKER ST	# 203	LA PALMA	CA	90623	1747	30	06059	33.848253	-118.037309	Orange County
106567	Fee-for-Service	1376750117	1376750117	1	1	LAURELS MEDICAL SERVICE	4/14/2004	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	CHARIOT	4617 CARRIGAN LN	None	CARMICHAEL	CA	95608	2243	34	06067	38.65122	-121.3313895	Sacramento County
106574	Fee-for-Service	1861903627	1861903627	1	1	LAM, CAROL T NP	12/16/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
106595	Fee-for-Service	1659353316	1659353316	1	1	LAUGHRUN, DAVID R MD	3/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	72466	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
106606	Fee-for-Service	1245609965	1245609965	1	4	LEISURE LIVING INC	12/31/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6156 HEDGEWALL DR	None	WESTLAKE VILLAGE	CA	91362	4129	19	06037	34.16409145	-118.7932157	Los Angeles County
106646	Fee-for-Service	1104246768	1104246768	1	1	LEE, STEPHANIE S MD	10/18/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	140401	40	Pediatrics	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
106652	Fee-for-Service	1750306593	1750306593	1	1	LAI, ALBERT MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70155	13	Neurology (M.D. only)	0	In state provider	None	300 UCLA MEDICAL PLZ	# B200	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
106711	Fee-for-Service	1740929694	1740929694	1	1	LACTATION CONSULTANTS OF AME	7/1/2024	174N00000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
106713	Fee-for-Service	1750608204	1750608204	1	1	LEVITT, LAURA C MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141214	05	Anesthesiology	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
106735	Fee-for-Service	1629064894	1629064894	1	1	LIEBOWITZ, HOWARD MD	3/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37685	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
106771	Fee-for-Service	1538787346	1538787346	1	1	LOZADA, MARYFLORIEL L RCP	7/25/2020	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
106782	Fee-for-Service	1942254925	1942254925	1	1	LOS ROBLES HOSPITAL	12/1/1977	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	& MEDICAL CENTER	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1899	56	06111	34.2064445	-118.8824085	Ventura County
106795	Fee-for-Service	1316026248	1316026248	1	1	LIN, KAO-HONG MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	36380	40	Pediatrics	0	In state provider	None	728 PACIFIC AVE	STE 403	SAN FRANCISCO	CA	94133	4449	38	06075	37.79687859	-122.4074282	San Francisco County
106832	Fee-for-Service	1194821868	1194821868	1	1	LONG, JAMES M MD	10/11/1996	207RH0003X	NA	Oncology	026	PHYSICIANS	50016	78	Neoplastic Diseases/Oncology	0	In state provider	None	1100 TRANCAS ST	STE 256	NAPA	CA	94558	2908	28	06055	38.32316569	-122.2981938	Napa County
106862	Fee-for-Service	1073630505	1073630505	1	1	LONG BEACH UNIFIED SD	2/21/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1515 HUGHES WAY	None	LONG BEACH	CA	90810	1865	19	06037	33.82864601	-118.2137447	Los Angeles County
106863	Fee-for-Service	1306682547	1306682547	1	1	LANGFORD, JESSICA LMFT	7/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
106881	Fee-for-Service	1659353316	1659353316	1	1	LAUGHRUN, DAVID R MD	3/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	72466	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
106901	Fee-for-Service	1568929438	1568929438	1	1	LAL, RETA	8/21/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95011067	-	NOT APPLICABLE	0	In state provider	None	1349 AND 1343 W. MAIN ST	A & B	MERCED	CA	95340	4438	24	06047	37.30624009	-120.4963217	Merced County
106905	Fee-for-Service	1578641395	1578641395	1	1	LOWE, FREDERICK M MD	7/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32443	41	Internal Medicine	0	In state provider	None	1617 BROADWAY ST	None	VALLEJO	CA	94590	2406	48	06095	38.12454745	-122.2499877	Solano County
106913	Fee-for-Service	1306972229	1306972229	1	1	LEVINE, DANIEL A MD	2/8/2015	2084N0400X	NA	Neurology	026	PHYSICIANS	30720	13	Neurology (M.D. only)	0	In state provider	None	9744 WILSHIRE BLVD	#400	BEVERLY HILLS	CA	90212	1814	19	06037	34.06705247	-118.408077	Los Angeles County
106945	Fee-for-Service	1295198117	1295198117	1	1	LE, BAONHAN MD	11/3/2019	207R00000X	NA	Other	026	PHYSICIANS	158857	41	Internal Medicine	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
106965	Fee-for-Service	1730388752	1730388752	1	1	LU, DAVID B MD INC	5/27/2010	193400000X	NA	Other	026	PHYSICIANS	77795	05	Anesthesiology	0	In state provider	None	301 VICTORIA STREET	None	COSTA MESA	CA	92627	1995	30	06059	33.65258952	-117.9121545	Orange County
107013	Fee-for-Service	1063806529	1063806529	1	1	LOPEZ, MARIA E LCSW	1/17/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
107057	Fee-for-Service	1417315805	1417315805	1	1	LANE, ANDREW PT	12/9/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
107070	Fee-for-Service	1942254925	1942254925	1	1	LOS ROBLES HOSPITAL	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	& MEDICAL CENTER	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1899	56	06111	34.2064445	-118.8824085	Ventura County
107078	Fee-for-Service	1184744377	1184744377	1	1	LAHIDJI, SAM F MD	9/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110844	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
107087	Fee-for-Service	1770035024	1770035024	1	5	LANDMARK ANESTHESIA MEDICAL	3/11/2021	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5000 SAN BERNARDINO	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
107105	Fee-for-Service	1376707653	1376707653	1	1	LUNNY, PETER M DO	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12202	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
107109	Fee-for-Service	1275690430	1275690430	1	1	LANSBERG, MAARTEN G MD	7/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75890	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
107111	Fee-for-Service	1053816306	1053816306	1	1	LI, DESIREE MD	2/24/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	163532	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
107120	Fee-for-Service	1194821868	1194821868	1	1	LONG, JAMES M MD	10/11/1996	207RH0003X	NA	Oncology	026	PHYSICIANS	50016	68	Hematology	0	In state provider	None	1100 TRANCAS ST	STE 256	NAPA	CA	94558	2908	28	06055	38.32316569	-122.2981938	Napa County
107139	Fee-for-Service	1588860076	1588860076	1	1	LYONS, JONATHAN J MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108465	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
107149	Fee-for-Service	1629177506	1629177506	1	1	LEW, JAMES D MD	3/1/2001	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	56316	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	440 AIRPORT BLVD	STE A	SALINAS	CA	93905	3302	27	06053	36.66527366	-121.616758	Monterey County
107174	Fee-for-Service	1023315447	1023315447	1	1	LEE, KRISTEN OD A	9/21/2011	193400000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	21739 AVALON BLVD	None	CARSON	CA	90745	3302	19	06037	33.830361	-118.263757	Los Angeles County
107179	Fee-for-Service	1518250026	1518250026	1	1	LAM, TERESA S MD	10/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123115	40	Pediatrics	0	In state provider	None	25845 BARTON ROAD	SUITE F	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
107201	Fee-for-Service	1073834180	1073834180	1	1	LEYKING, RANDALL W DPM	3/28/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
107206	Fee-for-Service	1457571895	1457571895	1	1	LIN, GRACE MD	1/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88927	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
107228	Fee-for-Service	1265945794	1265945794	1	1	LISTER, JESSICA LCSW	11/13/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2667 CAMINO DEL RIO SOUT	SUITE 306	SAN DIEGO	CA	92108	3765	37	06073	32.76979794	-117.1355701	San Diego County
107245	Fee-for-Service	1407900954	1407900954	1	1	LOCKYER, JO A PT	5/29/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
107289	Fee-for-Service	1245467463	1245467463	1	1	LABRECHE, PETER T MD	1/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116920	02	General Surgery	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
107297	Fee-for-Service	1093728909	1093728909	1	1	LIM, MARGIE D MD	2/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	61477	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
107304	Fee-for-Service	1457535197	1457535197	1	1	LEWIS, ROCHUNDA P	2/13/2008	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
107306	Fee-for-Service	1518026483	1518026483	1	1	LOVY, MICHAEL R MD	11/14/2018	207RR0500X	NA	Other	026	PHYSICIANS	87946	01	General Practice	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
107337	Fee-for-Service	1801257902	1801257902	1	1	LEFFLER, TAMI L MSW LCSW	4/26/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
107341	Fee-for-Service	1811390644	1811390644	1	1	LOTA, APRIL R LCSW	1/8/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12139 MOUNT VERNON AVE	SUITE 200A	GRAND TERRACE	CA	92313	5547	36	06071	34.033185	-117.313583	San Bernardino County
107378	Fee-for-Service	1770035024	1770035024	1	5	LANDMARK ANESTHESIA MEDICAL	4/8/2021	193400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5000 SAN BERNARDINO	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
107410	Fee-for-Service	1194285965	1194285965	1	1	LEE, SO L MD	10/1/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176429	08	Family Practice	0	In state provider	None	955 W IMPERIAL HWY	SUITE 110	BREA	CA	92821	3812	30	06059	33.91745451	-117.9133065	Orange County
107417	Fee-for-Service	1730234261	1730234261	1	1	LOS ANGELES COUNTY CCS	5/28/2004	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	PALMDALE MTU	37005 HILLCREST DR	None	PALMDALE	CA	93552	5347	19	06037	34.55286785	-118.0366542	Los Angeles County
107444	Fee-for-Service	1629177506	1629177506	1	1	LEW, JAMES D MD	3/1/2001	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	56316	08	Family Practice	0	In state provider	None	440 AIRPORT BLVD	STE A	SALINAS	CA	93905	3302	27	06053	36.66527366	-121.616758	Monterey County
107462	Fee-for-Service	1558303370	1558303370	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1125 BRANHAM LANE	None	SAN JOSE	CA	95118	3702	43	06085	37.26265839	-121.8781017	Santa Clara County
107471	Fee-for-Service	1104022078	1104022078	1	1	LIMON, JOSE MD PROFESSIONAL	3/27/2009	193400000X	NA	Other	026	PHYSICIANS	45442	41	Internal Medicine	0	In state provider	MEDICAL CORPORATION	264 N HIGHLAND SPRINGS	SUITE 3-D	BANNING	CA	92220	3082	33	06065	33.93063	-116.946864	Riverside County
107482	Fee-for-Service	1982614038	1982614038	1	1	LARRAGOITI, NOEMI D	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10145 VALLEY VIEW ST	None	CYPRESS	CA	90630	4602	30	06059	33.81489	-118.0283595	Orange County
107515	Fee-for-Service	1699880625	1699880625	1	1	LOMA LINDA HLTH PHARMACY	10/1/1993	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	#A-2	11382 MOUNTAIN VIEW AVE	None	LOMA LINDA	CA	92354	3878	36	06071	34.04644696	-117.2436991	San Bernardino County
107517	Fee-for-Service	1124189717	1124189717	1	1	LEE, JANE C MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	60526	40	Pediatrics	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
107540	Fee-for-Service	1942794557	1942794557	1	1	LUPO, BRIAN L CRNA	7/8/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
107550	Fee-for-Service	1154660918	1154660918	1	1	LIN, JOSEPH A MD	10/17/2024	208C00000X	NA	General Surgery	026	PHYSICIANS	153659	02	General Surgery	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
107562	Fee-for-Service	1295750974	1295750974	1	1	LINDA VU MD, A MEDICAL	6/19/2017	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	511 E GARVEY AVE	SUITE 201	MONTEREY PARK	CA	91755	1974	19	06037	34.06262048	-118.114902	Los Angeles County
107612	Fee-for-Service	1003892894	1003892894	1	1	LOPEZ, CARLOS MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	56141	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	STE P312	RANCHO MIRAGE	CA	92270	7010	33	06065	33.763572	-116.4056895	Riverside County
107648	Fee-for-Service	1659497535	1659497535	1	1	LEE, ALAN I MD	10/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105008	40	Pediatrics	0	In state provider	None	17264 FOOTHILL BLVD	STE A & B	FONTANA	CA	92336	9051	36	06071	34.10678654	-117.4277541	San Bernardino County
107650	Fee-for-Service	1134105091	1134105091	1	1	LEARY, JOYCE C MD	6/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92613	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
107659	Fee-for-Service	1184203630	1184203630	1	1	LEE, HEATHER M DO	8/16/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	22204	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
107692	Fee-for-Service	1346771938	1346771938	1	1	LINDA D. MURPHY	8/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	None	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
107697	Fee-for-Service	1336791375	1336791375	1	1	LI, JIANYIN H LCSW	1/8/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
107716	Fee-for-Service	1932129186	1932129186	1	1	LEV, DIANA A MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80853	08	Family Practice	0	In state provider	None	1400 S GRAND AVE	STE 101	LOS ANGELES	CA	90015	3048	19	06037	34.03692236	-118.2655238	Los Angeles County
107721	Fee-for-Service	1942714498	1942714498	1	1	LL BANKS LLC	4/3/2018	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1755 W HAMMER LN	STE 7B	STOCKTON	CA	95209	2900	39	06077	38.02145403	-121.3355659	San Joaquin County
107759	Fee-for-Service	1891802013	1891802013	2	1	LALEZARI, BAHMAN MD	11/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	51462	01	General Practice	0	In state provider	None	4944 W PICO BLVD	None	LOS ANGELES	CA	90019	4228	19	06037	34.04790155	-118.3443429	Los Angeles County
107769	Fee-for-Service	1215503172	1215503172	1	1	LAKSHUMANAN, CHITRA CCC-SLP	12/30/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3687 MT DIABLO	SUITE 100	LAFAYETTE	CA	94549	3717	07	06013	37.8898926	-122.1304235	Contra Costa County
107812	Fee-for-Service	1659506301	1659506301	1	1	LEICESTER, KIMBERLY PHD	2/14/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
107841	Fee-for-Service	1154660918	1154660918	1	1	LIN, JOSEPH A MD	10/17/2024	208C00000X	NA	General Surgery	026	PHYSICIANS	153659	34	Urology and Urological Surgery	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
107844	Fee-for-Service	1659903284	1659903284	1	1	LARRACAS, KRISTYL B CNP	4/10/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
107849	Fee-for-Service	1295750974	1295750974	1	1	LINDA VU MD, A MEDICAL	6/19/2017	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CORPORATION	511 E GARVEY AVE	SUITE 201	MONTEREY PARK	CA	91755	1974	19	06037	34.06262048	-118.114902	Los Angeles County
107851	Fee-for-Service	1770614059	1770614059	1	1	LAL, NIRAJ MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	41784	None	None	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
107866	Fee-for-Service	1770654683	1770654683	1	1	LEHMER, RANDY R MD	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51225	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
107885	Fee-for-Service	1821014879	1821014879	1	1	LEE, TAE Y MD	3/1/1995	207RN0300X	NA	Nephrology	026	PHYSICIANS	50000	45	Nephrology (Renal-Kidney)	0	In state provider	None	3300 E SOUTH ST	STE 110	LONG BEACH	CA	90805	4550	19	06037	33.86018093	-118.1537163	Los Angeles County
107900	Fee-for-Service	1386859122	1386859122	1	1	LOS ANGELES HEMATOLOGY/	2/1/1997	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	ONCOLOGY MEDICAL GROUP	222 W EULALIA ST	STE 100C	GLENDALE	CA	91204	2850	19	06037	34.12653215	-118.257121	Los Angeles County
107926	Fee-for-Service	1184618175	1184618175	2	1	LINSON, PATRICK W MD	4/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	83054	30	Radiology	0	In state provider	None	916 SYCAMORE AVE	None	VISTA	CA	92083	7815	37	06073	33.15990889	-117.2205717	San Diego County
107932	Fee-for-Service	1467454686	1467454686	1	1	LADENHEIM, ERIC MD	12/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	84737	02	General Surgery	0	In state provider	None	6057 N 1ST ST	STE 105	FRESNO	CA	93710	5468	10	06019	36.824193	-119.7723865	Fresno County
107943	Fee-for-Service	1912052275	1912052275	1	1	LEE, LESLIE MD APMC	3/6/2017	193200000X	NA	Other	026	PHYSICIANS	61152	41	Internal Medicine	0	In state provider	None	150 S RAYMOND AVE	None	ALHAMBRA	CA	91801	3166	19	06037	34.08926073	-118.1450118	Los Angeles County
107953	Fee-for-Service	1144488115	1144488115	1	1	LEE, LUCY C MD	6/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109298	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
107992	Fee-for-Service	1144454604	1144454604	1	1	LIN, LUKE T MD	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122379	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
107998	Fee-for-Service	1245570035	1245570035	1	1	LEA, SHAUN M CRNA	3/13/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2615 CHESTER AVENUE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
107999	Fee-for-Service	1033613690	1033613690	1	1	LIU, YAO MD	7/19/2021	207R00000X	NA	Other	026	PHYSICIANS	165331	None	None	0	In state provider	None	1250 16TH STREET	2100	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
108036	Fee-for-Service	1023152196	1023152196	1	1	LAVERY, ADRIAN MD	10/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116763	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
108042	Fee-for-Service	1881942407	1881942407	1	1	LUNA, NATALIA MSW LCSW	9/28/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
108053	Fee-for-Service	1457641250	1457641250	1	1	LOS ANGELES CENTERS FOR ALCO	2/26/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	HOL AND DRUG ABUSE	1084-1092 NEW YORK DR	None	ALTADENA	CA	91001	3118	19	06037	34.17840347	-118.1281905	Los Angeles County
108075	Fee-for-Service	1598758658	1598758658	1	1	LYONS, LISA L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2345 RICE ST	#160	SAINT PAUL	MN	55113	3741	00	None	45.011619	-93.106068	Ramsey County
108094	Fee-for-Service	1265509111	1265509111	1	1	LI, CINDY Y DO	1/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7655	07	Dermatology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
108104	Fee-for-Service	1316072572	1316072572	1	1	LIBOVA, OLGA A CNM	1/21/2016	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
108196	Fee-for-Service	1316039365	1316039365	1	1	LIU, DEBORAH R MD	3/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82919	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
108215	Fee-for-Service	1891375325	1891375325	1	1	LALLOS BRANDL, FRANCESCA LP	9/9/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CC	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
108228	Fee-for-Service	1497240220	1497240220	1	1	LEE, JOHN K MD	4/7/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	167333	None	None	0	In state provider	None	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
108242	Fee-for-Service	1497768782	1497768782	1	1	LOS ANGELES CO	4/28/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	AVHC FAMILY PLANNING	335 E AVENUE K6	STE B	LANCASTER	CA	93535	4645	19	06037	34.6694985	-118.125468	Los Angeles County
108243	Fee-for-Service	1104295831	1104295831	1	1	LY, JONATHAN H	10/25/2023	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
108279	Fee-for-Service	1073011169	1073011169	1	1	LAO, STEPHANIE MD	9/8/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	152054	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1220 HEMLOCK WAY	200	SANTA ANA	CA	92707	3655	30	06059	33.70975375	-117.8842792	Orange County
108280	Fee-for-Service	1720496128	1720496128	1	1	LAW, TRINEL C	8/7/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	217 W CERRITOS AVE	None	ANAHEIM	CA	92805	6549	30	06059	33.81058193	-117.9065445	Orange County
108304	Fee-for-Service	1083637086	1083637086	1	1	LEWIS, JOHN W MD	9/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
108346	Fee-for-Service	1033502869	1033502869	1	1	LEE, JENNIFER DO	5/5/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	17453	15	Obstetrics (D.O. only)	0	In state provider	None	215 JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
108359	Fee-for-Service	1154498012	1154498012	1	1	LU, SHARON S MD	4/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78929	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
108407	Fee-for-Service	1386931947	1386931947	1	1	LEFTWICH, LISA A	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
108410	Fee-for-Service	1225365810	1225365810	1	1	LIN, TIFFANY F MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123482	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
108411	Fee-for-Service	1871510370	1871510370	2	1	LEE, SU K MD	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48044	08	Family Practice	0	In state provider	None	17895 COLIMA RD	None	LA PUENTE	CA	91748	1729	19	06037	33.99004717	-117.913584	Los Angeles County
108418	Fee-for-Service	1457421489	1457421489	1	1	LOEFFLER, CURTIS R DC	6/1/2001	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	912 E ACACIA AVE	None	HEMET	CA	92543	4526	33	06065	33.74395753	-116.96274	Riverside County
108431	Fee-for-Service	1235146135	1235146135	1	1	LOMA LINDA UNIVERSITY	7/1/1980	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
108465	Fee-for-Service	1134162928	1134162928	2	1	LONGS DRUG STORE CAL LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3500 PALMER DR	None	CAMERON PARK	CA	95682	8202	09	06017	38.66132066	-120.9657099	El Dorado County
108466	Fee-for-Service	1750543922	1750543922	1	1	LEE, DEBORA OD	10/6/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
108472	Fee-for-Service	1164420469	1164420469	1	1	LUDINGTON, KATHERINE MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66026	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
108473	Fee-for-Service	1558398719	1558398719	1	1	LO, STEPHEN HC MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65887	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
108481	Fee-for-Service	1982737516	1982737516	1	1	LAINEZ, GLORIA C LMFT	2/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
108486	Fee-for-Service	1316039365	1316039365	1	1	LIU, DEBORAH R MD	3/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82919	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
108531	Fee-for-Service	1700262094	1700262094	1	1	LEONE, BRANDY PT	3/20/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
108573	Fee-for-Service	1326082777	1326082777	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3939 STATE ST	None	SANTA BARBARA	CA	93105	3113	42	06083	34.44032755	-119.7532819	Santa Barbara County
108577	Fee-for-Service	1578770913	1578770913	1	1	LAI, EDGAR MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99426	30	Radiology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
108620	Fee-for-Service	1699935460	1699935460	1	1	LIANG, LIANG MD	12/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105249	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
108632	Fee-for-Service	1033502869	1033502869	1	1	LEE, JENNIFER DO	5/5/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	17453	09	Gynecology (D.O. only)	0	In state provider	None	215 JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
108639	Fee-for-Service	1609401397	1609401397	1	1	LEWIS, BRANDON PT	3/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 W HOSPITALITY LN	103	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
108645	Fee-for-Service	1467612663	1467612663	1	1	LENG, JODY C MD	3/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109173	05	Anesthesiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
108677	Fee-for-Service	1801278072	1801278072	1	1	LEAKS, CYNTHIA L CRNA	8/22/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
108714	Fee-for-Service	1801093554	1801093554	1	1	LY, ANDREW D MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88872	13	Neurology (M.D. only)	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92658	6100	30	06059	33.62421676	-117.9309656	Orange County
108749	Fee-for-Service	1588858187	1588858187	1	1	LEPAGE, CHRISTOPHER A PHD	2/1/2011	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7098	34	06067	38.56554	-121.4664615	Sacramento County
108758	Fee-for-Service	1922103654	1922103654	1	1	LIGONS, SANAA I DO	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	8792	08	Family Practice	0	In state provider	None	5000 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
108764	Fee-for-Service	1245609965	1245609965	1	3	LEISURE LIVING INC	12/31/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5608 ROCK CREEK RD	None	AGOURA HILLS	CA	91301	3358	19	06037	34.152768	-118.7627035	Los Angeles County
108781	Fee-for-Service	1619260569	1619260569	1	1	LANGSTON, DANIEL E NP	7/12/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
108842	Fee-for-Service	1730405473	1730405473	1	1	LOE, STEPHANIE A MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118803	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
108845	Fee-for-Service	1386363711	1386363711	1	1	LAM, SOPHIA OD	12/2/2022	152WC0802X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
108848	Fee-for-Service	1851618151	1851618151	1	1	LARSON, LINDSAY A DO	9/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11427	08	Family Practice	0	In state provider	None	MCMF 450 E SPRING STREET	SUITE 1	LONG BEACH	CA	90806	1625	19	06037	33.8099218	-118.1872346	Los Angeles County
108860	Fee-for-Service	1396095881	1396095881	1	1	LAKE TAHOE PODIATRY	7/22/2013	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	A PROFESSIONAL PODIATRIC	2229 BARTON AVE	None	SOUTH LAKE TAHOE	CA	96150	3411	09	06017	38.9176846	-119.9962881	El Dorado County
108900	Fee-for-Service	1093810699	1093810699	1	1	LE, TAM H MD	7/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87631	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	701 E 28TH ST	STE 212	LONG BEACH	CA	90806	2774	19	06037	33.80803441	-118.1847137	Los Angeles County
108903	Fee-for-Service	1932257748	1932257748	1	1	LANDAU, MICHAEL A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36537	36	Psychiatry	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
108912	Fee-for-Service	1043363740	1043363740	1	1	LOMAN, GEOFFREY J MD	9/30/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	46052	08	Family Practice	0	In state provider	None	168 N BRENT ST	STE 502	VENTURA	CA	93003	2840	56	06111	34.27448266	-119.2572489	Ventura County
108915	Fee-for-Service	1932163532	1932163532	1	1	LEPORT, PETER C MD	11/1/1983	174400000X	NA	Other	026	PHYSICIANS	47193	02	General Surgery	0	In state provider	None	11160 WARNER AVE	STE 421	FOUNTAIN VALLEY	CA	92708	4056	30	06059	33.71630854	-117.934317	Orange County
108916	Fee-for-Service	1588264055	1588264055	1	1	LAUBER, LACY L CNM	3/2/2022	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
108927	Fee-for-Service	1336402916	1336402916	1	1	LAIWALLA, DEEPA Z DO	4/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	13409	09	Gynecology (D.O. only)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
108970	Fee-for-Service	1528086303	1528086303	1	1	LE, TRANG DANG T MD	8/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84741	08	Family Practice	0	In state provider	None	477 EL CAMINO REAL	None	ENCINITAS	CA	92024	0000	37	06073	33.05700866	-117.262449	San Diego County
108989	Fee-for-Service	1770590820	1770590820	1	1	LUNDIE, GRANT MD	7/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85262	05	Anesthesiology	0	In state provider	None	3931 MACARTHUR BLVD	STE 105	NEWPORT BEACH	CA	92660	3012	30	06059	33.65770891	-117.8628645	Orange County
108993	Fee-for-Service	1003890971	1003890971	1	1	LEVENSON, HENRY MD	11/1/2001	2084N0400X	NA	Neurology	026	PHYSICIANS	34680	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
109078	Fee-for-Service	1033152863	1033152863	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	43418 STATE HIGHWAY 74	None	HEMET	CA	92544	5219	33	06065	33.74788133	-116.9031212	Riverside County
109099	Fee-for-Service	1023050838	1023050838	2	1	LONGS DRUG STORE CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	40365 WINCHESTER RD	None	TEMECULA	CA	92591	5520	33	06065	33.53162948	-117.1507503	Riverside County
109108	Fee-for-Service	1144583733	1144583733	1	1	LEE, LISA X MD	2/26/2020	207RH0000X	NA	Hematology	026	PHYSICIANS	156461	68	Hematology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
109131	Fee-for-Service	1780765420	1780765420	2	1	LE, LING NP	9/14/2011	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6120 N VINELAND	None	NORTH HOLLYWOOD	CA	91606	4914	19	06037	34.1819583	-118.3702737	Los Angeles County
109143	Fee-for-Service	1477796092	1477796092	1	1	LEE, JI YOUNG MD	1/7/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	162571	None	None	0	In state provider	None	2505 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.02139448	-121.347738	San Joaquin County
109178	Fee-for-Service	1376780866	1376780866	1	1	LEMESHKO, SERGY V MD	1/16/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	190419	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
109185	Fee-for-Service	1093810699	1093810699	1	1	LE, TAM H MD	7/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87631	34	Urology and Urological Surgery	0	In state provider	None	701 E 28TH ST	STE 212	LONG BEACH	CA	90806	2774	19	06037	33.80803441	-118.1847137	Los Angeles County
109198	Fee-for-Service	1629242615	1629242615	1	1	LEE, JENNIFER H MD	10/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109364	41	Internal Medicine	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
109214	Fee-for-Service	1336402916	1336402916	1	1	LAIWALLA, DEEPA Z DO	4/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	13409	15	Obstetrics (D.O. only)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
109225	Fee-for-Service	1215558341	1215558341	1	1	LOS ANGELES FOOD ALLERGY INS	4/20/2021	207KA0200X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	TITUTE, INC	800 S CENTRAL AVE	303	GLENDALE	CA	91204	4388	19	06037	34.13654729	-118.2578243	Los Angeles County
109239	Fee-for-Service	1609810050	1609810050	2	1	LONGS DRUG STORES CA LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1401 WASHINGTON AVE	None	SAN LEANDRO	CA	94577	3647	01	06001	37.72370148	-122.1561373	Alameda County
109243	Fee-for-Service	1376670513	1376670513	1	1	LEMBKE, ANNA MD	2/1/2001	2084P0800X	NA	Psychiatry	026	PHYSICIANS	62241	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
109248	Fee-for-Service	1770659906	1770659906	1	1	LEIB, REBECCA M PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6216A HIGHWAY 9	None	FELTON	CA	95018	9713	44	06087	37.05161695	-122.0731877	Santa Cruz County
109268	Fee-for-Service	1639270846	1639270846	1	1	LOMA LINDA UNIV SCHOOL	9/30/1998	1223S0112X	NA	Dental Provider	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	OF DENTISTRY	24871 TAYLOR ST	None	LOMA LINDA	CA	92354	2809	36	06071	34.0509747	-117.2620074	San Bernardino County
109314	Fee-for-Service	1366485195	1366485195	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	155 W LOS ANGELES AVE	None	MOORPARK	CA	93021	1822	56	06111	34.27896953	-118.8842985	Ventura County
109354	Fee-for-Service	1811148760	1811148760	1	1	LANDAY, MELANIE F MD	3/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	91323	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
109389	Fee-for-Service	1619392289	1619392289	1	1	LAURA BIEDERMAN MD	7/19/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
109447	Fee-for-Service	1528240389	1528240389	1	1	LENNON, TINA S MD	12/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109760	05	Anesthesiology	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
109513	Fee-for-Service	1568953842	1568953842	1	1	LEWIS, ALICE-GRAY DO	12/10/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19060	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
109526	Fee-for-Service	1285363176	1285363176	1	1	LALEHZARIAN, AARON DPM	2/3/2025	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	74000 COUNTRY CLUB DR.	STE E-4	PALM DESERT	CA	92260	1678	33	06065	33.75805952	-116.373249	Riverside County
109541	Fee-for-Service	1790591758	1790591758	1	1	LENAE'S LACTATION INC.	1/1/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	24	06047	0	0	None
109542	Fee-for-Service	1326464488	1326464488	1	1	LARKSPUR OPTOMETRY INC	2/5/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2620 LARKSPUR LANE	SUITE L	REDDING	CA	96002	1043	45	06089	40.5690659	-122.3555361	Shasta County
109549	Fee-for-Service	1609273317	1609273317	1	2	LIFEBRITE LABORATORIES, LLC	9/1/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	9 CORPORATE BLVD NE	SUITE 150	ATLANTA	GA	30329	1908	00	None	33.836607	-84.3322905	DeKalb County
109553	Fee-for-Service	1104965383	1104965383	1	1	LIAO, JIMMY K MD	4/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	66300	41	Internal Medicine	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
109605	Fee-for-Service	1023067329	1023067329	1	1	LAI, FRANK C MC	4/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67706	34	Urology and Urological Surgery	0	In state provider	None	205 SOUTH DR	None	MOUNTAIN VIEW	CA	94040	4323	43	06085	37.36723252	-122.0797125	Santa Clara County
109625	Fee-for-Service	1447639182	1447639182	1	1	LIU, VIRGINIA B MD	9/15/2021	2084N0402X	NA	Neurology	026	PHYSICIANS	147340	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
109632	Fee-for-Service	1134767940	1134767940	1	1	LUNA-NGUYEN, JENNIFER K LCSW	6/17/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
109635	Fee-for-Service	1629180542	1629180542	2	1	LORX INC	3/9/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9970 LIVE OAK BLVD	None	LIVE OAK	CA	95953	2334	51	06101	39.27558931	-121.6611497	Sutter County
109640	Fee-for-Service	1699702795	1699702795	2	1	LOPEZ, FRANK E MD	11/30/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	76384	41	Internal Medicine	0	In state provider	None	2790 S ELM AVE	None	FRESNO	CA	93706	5435	10	06019	36.700533	-119.7908665	Fresno County
109655	Fee-for-Service	1841326386	1841326386	1	1	LIN, JAN J MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88751	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
109665	Fee-for-Service	1659142610	1659142610	1	1	LINA, ABIGAIL A CNP	1/29/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2500 H ST	None	BAKERSFIELD	CA	93301	2818	15	06029	35.38232703	-119.0211171	Kern County
109688	Fee-for-Service	1053473728	1053473728	1	1	LO, ALVIN K OD	6/5/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	17134 COLIMA ROAD	SUITE B & C	HACIENDA HEIGHTS	CA	91745	6737	19	06037	33.99066696	-117.9330037	Los Angeles County
109720	Fee-for-Service	1770516213	1770516213	1	1	LICINIO, JULIO MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50445	36	Psychiatry	0	In state provider	None	300 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
109743	Fee-for-Service	1710916234	1710916234	1	1	LOWE, MICHAEL A MD	4/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84235	66	Emergency Medicine (Urgent Care)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
109761	Fee-for-Service	1144270497	1144270497	1	1	LIN, DAVID D MD	11/4/2008	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	80049	20	Orthopedic Surgery	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3194	07	06013	37.9141514	-122.0422089	Contra Costa County
109769	Fee-for-Service	1891370854	1891370854	1	1	LYONS HUBER MANAGEMENT	3/12/2021	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	15630 18TH AVE	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
109816	Fee-for-Service	1932594165	1932594165	1	1	LIBAW, JUSTIN S MD	9/11/2020	207L00000X	NA	Other	026	PHYSICIANS	149025	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
109828	Fee-for-Service	1558687798	1558687798	1	1	LUONG, PAUL N MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109848	41	Internal Medicine	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
109875	Fee-for-Service	1629575014	1629575014	1	1	LAM, VICKY MD	8/28/2022	207P00000X	NA	Other	026	PHYSICIANS	175867	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
109902	Fee-for-Service	1104031269	1104031269	1	1	LIMA-VIEIRA, GINA B LCSW	9/17/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	384 E OLIVE AVE	STE 1	TURLOCK	CA	95380	4051	50	06099	37.49658844	-120.8452043	Stanislaus County
109926	Fee-for-Service	1689614992	1689614992	1	1	LEE, SHU MAY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	63819	41	Internal Medicine	0	In state provider	None	1800 SULLIVAN AVE	RM 105	DALY CITY	CA	94015	2227	41	06081	37.68077723	-122.4728941	San Mateo County
109927	Fee-for-Service	1699702795	1699702795	2	1	LOPEZ, FRANK E MD	11/30/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	76384	40	Pediatrics	0	In state provider	None	2790 S ELM AVE	None	FRESNO	CA	93706	5435	10	06019	36.700533	-119.7908665	Fresno County
109932	Fee-for-Service	1750971180	1750971180	1	3	LIVE WELL FAMILY COUNSELING	12/27/2021	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SERVICES	41593 WINCHESTER RD	215	TEMECULA	CA	92590	4860	33	06065	33.52030169	-117.1659061	Riverside County
109961	Fee-for-Service	1528420122	1528420122	1	1	LI, JANET T DO	9/3/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15913	08	Family Practice	0	In state provider	None	18406 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.2206967	-118.5342638	Los Angeles County
109966	Fee-for-Service	1780892117	1780892117	1	1	LIU, HONGGUANG MD	4/4/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	120683	None	None	0	In state provider	None	1825 SONOMA ST	None	REDDING	CA	96001	2519	45	06089	40.5756004	-122.3928987	Shasta County
109982	Fee-for-Service	1427614254	1427614254	1	1	LE, ANN T MD MPH	12/5/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181643	None	None	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
110001	Fee-for-Service	1306813183	1306813183	1	1	LIN, JIIN T MD	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	46675	41	Internal Medicine	0	In state provider	None	39271 MISSION BLVD	STE 205	FREMONT	CA	94539	3039	01	06001	37.56248629	-121.9589239	Alameda County
110021	Fee-for-Service	1487836995	1487836995	1	1	LLOYD, JESSICA E MD	10/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103708	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
110056	Fee-for-Service	1891370854	1891370854	1	1	LYONS HUBER MANAGEMENT	3/12/2021	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	15630 18TH AVE	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
110091	Fee-for-Service	1396859476	1396859476	1	1	LIU, CONNIE C OD	12/26/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2248 D ST	None	LA VERNE	CA	91750	5403	19	06037	34.10030594	-117.7702602	Los Angeles County
110110	Fee-for-Service	1730418849	1730418849	1	1	LONDON, NIKOLAS JS MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	100888	18	Ophthalmology	0	In state provider	None	12630 MONTE VISTA ROAD	STE 104	POWAY	CA	92064	2526	37	06073	32.99533582	-117.0560031	San Diego County
110127	Fee-for-Service	1962445734	1962445734	2	1	LONGS DRUG STORE CA, INC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	560 CENTER AVE	None	MARTINEZ	CA	94553	4600	07	06013	37.99247265	-122.1185812	Contra Costa County
110211	Fee-for-Service	1689936007	1689936007	1	1	LILIENSTEIN, ALIA A C MD	9/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136775	01	General Practice	0	In state provider	None	2500 MILVIA ST	None	BERKELEY	CA	94705	2636	01	06001	37.86338897	-122.2698455	Alameda County
110218	Fee-for-Service	1750971180	1750971180	1	3	LIVE WELL FAMILY COUNSELING	12/27/2021	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	SERVICES	41593 WINCHESTER RD	215	TEMECULA	CA	92590	4860	33	06065	33.52030169	-117.1659061	Riverside County
110232	Fee-for-Service	1487625190	1487625190	1	1	LONG BEACH DIALYSIS	12/2/1998	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER LLC	1045 ATLANTIC AVE	STE 108	LONG BEACH	CA	90813	3414	19	06037	33.780267	-118.1850795	Los Angeles County
110270	Fee-for-Service	1013147453	1013147453	1	1	LYNX, MATTHEW D MD	7/14/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	170819	None	None	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
110280	Fee-for-Service	1841376969	1841376969	1	1	LIU, JONATHAN C H MD	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97174	89	Surgery-Traumatic	0	In state provider	None	5533 W HILLSDALE	STE C	VISALIA	CA	93291	5138	54	06107	36.329238	-119.35251	Tulare County
110297	Fee-for-Service	1538885587	1538885587	1	1	LAMANUZZI, JESSI NP	4/23/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	19526C HILLSDALE DR	None	SONORA	CA	95370	9230	55	06109	37.97673368	-120.3246964	Tuolumne County
110323	Fee-for-Service	1407174980	1407174980	1	1	LEAPS AND BOUNDS PEDIATRIC	12/14/2022	225X00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RAPY	4211 B VALLEY VIEW AVE	None	NORCO	CA	92860	3502	33	06065	33.943446	-117.5498725	Riverside County
110325	Fee-for-Service	1760429393	1760429393	1	1	LAI, ERIC C DC	8/3/2020	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1017 S FAIR OAKS AVE	None	PASADENA	CA	91105	2621	19	06037	34.12830178	-118.1503497	Los Angeles County
110357	Fee-for-Service	1639344005	1639344005	1	1	LONG, MEGAN J MD	5/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111832	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1301 N ROSE DRIVE	None	ORANGE	CA	92870	3802	30	06059	33.8868003	-117.8420447	Orange
110362	Fee-for-Service	1891752283	1891752283	1	1	LUCERO, MICHAEL E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	690 N COFCO CENTER CT	STE 290	PHOENIX	AZ	85008	6474	00	None	33.455502	-111.990321	Maricopa County
110367	Fee-for-Service	1003182593	1003182593	1	1	LI, FENG MD	1/25/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	162022	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
110392	Fee-for-Service	1225009301	1225009301	1	1	LUSTBERG, ALEXANDER MD	10/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86284	10	Gastroenterology (M.D. only)	0	In state provider	None	1210 SONOMA AVE	STE B	SANTA ROSA	CA	95405	6648	49	06097	38.440404	-122.6983185	Sonoma County
110418	Fee-for-Service	1831727296	1831727296	1	1	LIU, NANCY F MD	9/14/2023	207R00000X	NA	Other	026	PHYSICIANS	186064	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
110421	Fee-for-Service	1003930983	1003930983	1	1	LICHTMAN, JOSHUA M DO	12/5/2007	2084P0800X	NA	Psychiatry	026	PHYSICIANS	8909	36	Psychiatry	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
110457	Fee-for-Service	1295073757	1295073757	1	1	LA ROCQUE, ANGELA K LVN	1/22/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8741 WEST SHIELDS AVENUE	None	FRESNO	CA	93723	9280	10	06019	36.77866172	-119.948154	Fresno County
110461	Fee-for-Service	1457585903	1457585903	1	1	LU, DANIEL C MD	5/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91813	14	Neurological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
110469	Fee-for-Service	1548337918	1548337918	1	1	LOHR, JASON L MD	11/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122084	01	General Practice	0	In state provider	None	25455 BARTON ROAD	SUITE 108A	LOMA LINDA	CA	92354	3130	36	06071	34.04805253	-117.249534	San Bernardino County
110488	Fee-for-Service	1750578357	1750578357	1	1	LEROY, ANDREE M MD	4/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	25	Physical Medicine and Rehabilitation	0	In state provider	None	2080 CENTURY PARK EAST	300	LOS ANGELES	CA	90067	2006	19	06037	34.05887194	-118.4122914	Los Angeles County
110494	Fee-for-Service	1407282510	1407282510	1	1	LE, TRIET M DO	9/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14016	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	15975 HARBOR BLVD	None	FOUNTAIN VALLEY	CA	92708	1303	30	06059	33.73140379	-117.9200162	Orange County
110496	Fee-for-Service	1992911036	1992911036	1	1	LIM, JENNIFER J DO	7/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8655	40	Pediatrics	0	In state provider	None	11234 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
110508	Fee-for-Service	1750971180	1750971180	1	3	LIVE WELL FAMILY COUNSELING	12/27/2021	106H00000X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	SERVICES	41593 WINCHESTER RD	215	TEMECULA	CA	92590	4860	33	06065	33.52030169	-117.1659061	Riverside County
110519	Fee-for-Service	1518074947	1518074947	1	1	LEE, CHRISTOPHER J MD	1/29/2020	208600000X	NA	General Surgery	026	PHYSICIANS	68836	02	General Surgery	0	In state provider	None	3304 RENNER DR	None	FORTUNA	CA	95540	7102	12	06023	40.58239308	-124.1360417	Humboldt County
110521	Fee-for-Service	1538181482	1538181482	1	5	LA CLINICA DE LA RAZA INC	12/1/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2400 LISA LANE	None	PLEASANT HILL	CA	94523	3902	07	06013	37.94511904	-122.0512768	Contra Costa County
110529	Fee-for-Service	1023269388	1023269388	1	1	LANDIS, CLIFFORD LMFT	11/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	518 S SCHOOL ST	# 205	UKIAH	CA	95482	5479	23	06045	39.14644789	-123.2079137	Mendocino County
110539	Fee-for-Service	1952745473	1952745473	1	1	LO, CHRISTOPHER C MD	5/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148351	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
110574	Fee-for-Service	1275703969	1275703969	1	1	LOBO, BJORN M MD	12/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129324	14	Neurological Surgery	0	In state provider	None	25751 MCBEAN PKWY	SUITE 305	VALENCIA	CA	91355	3701	19	06037	34.39972502	-118.5511766	Los Angeles County
110576	Fee-for-Service	1457755209	1457755209	1	1	LAM, GARY K DPM A	11/26/2018	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	PROFESSIONAL CORP	410 16TH AVE	None	SAN FRANCISCO	CA	94118	2812	38	06075	37.78027337	-122.4750574	San Francisco County
110579	Fee-for-Service	1396944161	1396944161	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	645 MARKET ST	None	SAN DIEGO	CA	92101	7032	37	06073	32.71148155	-117.1587645	San Diego County
110591	Fee-for-Service	1609212042	1609212042	1	1	LANIAKEA, BENJAMIN H MD	6/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134882	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
110609	Fee-for-Service	1407174980	1407174980	1	1	LEAPS AND BOUNDS PEDIATRIC	12/14/2022	225X00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RAPY	4211 B VALLEY VIEW AVE	None	NORCO	CA	92860	3502	33	06065	33.943446	-117.5498725	Riverside County
110652	Fee-for-Service	1659695393	1659695393	1	1	LU, PETER L MD	6/9/2017	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	700 CHILDRENS DRIVE	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
110656	Fee-for-Service	1851549463	1851549463	1	1	LUI, ALBEN C MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105866	13	Neurology (M.D. only)	0	In state provider	None	1515 NEWELL AVENUE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
110670	Fee-for-Service	1225035025	1225035025	1	1	LEE, CHRISTINA D MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	62993	08	Family Practice	0	In state provider	None	14642 NEWPORT AVE	STE 101	TUSTIN	CA	92780	6058	30	06059	33.73082212	-117.8293987	Orange County
110673	Fee-for-Service	1356442974	1356442974	1	1	LOWE, GIDEON H III MD	1/1/1979	207W00000X	NA	Ophthalmology	026	PHYSICIANS	33638	18	Ophthalmology	0	In state provider	None	1300 N VERMONT AVE	# 605	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
110717	Fee-for-Service	1629636444	1629636444	1	1	LABASTIDE, ANGELE S MD	10/27/2022	207R00000X	NA	Other	026	PHYSICIANS	181009	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
110745	Fee-for-Service	1295073757	1295073757	1	1	LA ROCQUE, ANGELA K LVN	1/22/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8741 WEST SHIELDS AVENUE	None	FRESNO	CA	93723	9280	10	06019	36.77866172	-119.948154	Fresno County
110756	Fee-for-Service	1144741125	1144741125	1	1	LEE, HELEN OD	2/5/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
110762	Fee-for-Service	1649271677	1649271677	1	1	LUEKEN, ROBERT J MD	12/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	5330 SOUTH HIGHWAY	95	FORT MOHAVE	AZ	86426	9225	00	None	35.048484	-114.5851493	Mohave County
110802	Fee-for-Service	1003267493	1003267493	1	1	LAUREN BROGIS	10/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 S MAIN ST	None	MOSCOW	ID	83843	3056	00	None	46.728594	-117.0013525	Latah County
110810	Fee-for-Service	1538181482	1538181482	1	5	LA CLINICA DE LA RAZA INC	11/24/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2400 LISA LANE	None	PLEASANT HILL	CA	94523	3902	07	06013	37.94511904	-122.0512768	Contra Costa County
110828	Fee-for-Service	1467447896	1467447896	1	1	LARNER, DOUGLAS S CNP	5/14/2020	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
110834	Fee-for-Service	1467685289	1467685289	1	1	LE, THO D MD	12/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111431	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
110843	Fee-for-Service	1265880744	1265880744	1	1	LASOFSKY, BRIAN S NP	1/25/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
110851	Fee-for-Service	1124262787	1124262787	1	1	LOWELL, TORRES GEORGE M DO	8/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9294	None	None	0	In state provider	None	11500 BROOKSHIRE AVENUE	None	DOWNEY	CA	90241	4917	19	06037	33.93500365	-118.1321119	Los Angeles County
110868	Fee-for-Service	1740622679	1740622679	1	1	LIN, LUKE MD	7/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134942	41	Internal Medicine	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
110884	Fee-for-Service	1306293824	1306293824	1	1	LEE, ELLEN	2/8/2022	207L00000X	NA	Other	026	PHYSICIANS	18971	None	None	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
110893	Fee-for-Service	1558463968	1558463968	1	1	LESEUR, HARRY D PHARM D	12/1/1999	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	271 MAIN STREET	SUITE A	CHESTER	CA	96020	0827	32	06063	40.3078407	-121.2307857	Plumas County
110896	Fee-for-Service	1407174980	1407174980	1	1	LEAPS AND BOUNDS PEDIATRIC	12/14/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RAPY	4211 B VALLEY VIEW AVE	None	NORCO	CA	92860	3502	33	06065	33.943446	-117.5498725	Riverside County
110929	Fee-for-Service	1629156799	1629156799	1	1	LUM, GEORGE H MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	70165	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
110986	Fee-for-Service	1285053454	1285053454	1	1	LEE, ANDREW MD	4/15/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	140487	30	Radiology	0	In state provider	None	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	39	06077	37.744011	-121.4349725	San Joaquin County
111026	Fee-for-Service	1891119640	1891119640	1	1	LEMMONS, LISA PSYD	4/4/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	334 SHAW AVE	SUITE 100	CLOVIS	CA	93612	3839	10	06019	36.80839352	-119.7049776	Fresno County
111033	Fee-for-Service	1386824183	1386824183	1	1	LACHICA, MIGUEL PT	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
111037	Fee-for-Service	1477971331	1477971331	1	1	LEE, HAE SEUNG MD	10/12/2023	207RE0101X	NA	Endocrinology	026	PHYSICIANS	171672	None	None	0	In state provider	None	4201 TORRANCE BLVD	STE. 750	TORRANCE	CA	90503	4504	19	06037	33.8375955	-118.358748	Los Angeles County
111045	Fee-for-Service	1649650631	1649650631	1	1	LEE, ALBERT S DO	4/11/2024	2088P0231X	NA	Other	026	PHYSICIANS	-	34	Urology and Urological Surgery	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
111061	Fee-for-Service	1235213810	1235213810	1	1	LONGWOOD ENTERPRISES LLC	1/1/1979	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4853 W WASHINGTON BLVD	None	LOS ANGELES	CA	90016	1501	19	06037	34.03995353	-118.3452567	Los Angeles County
111070	Fee-for-Service	1336598796	1336598796	1	1	LU, YI MD	10/7/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	160796	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
111101	Fee-for-Service	1902895030	1902895030	1	1	LAMBERTY, NORMAN L	10/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146076	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
111174	Fee-for-Service	1174753032	1174753032	1	1	LIU, LILY DPM	5/13/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
111184	Fee-for-Service	1255408084	1255408084	1	1	LOERA, GLADYS E MD	6/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85551	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
111191	Fee-for-Service	1891182325	1891182325	1	1	LOH, STEVE DO	10/16/2019	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	17046	25	Physical Medicine and Rehabilitation	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
111207	Fee-for-Service	1154584316	1154584316	1	1	LIAKHOVETSKI, OLEG MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103798	41	Internal Medicine	0	In state provider	None	4955 VAN NUYS BLVD	STE 502	SHERMAN OAKS	CA	91403	1817	19	06037	34.160805	-118.4487295	Los Angeles County
111235	Fee-for-Service	1134553308	1134553308	1	1	LIWANAG, EMILY S LMFT	9/18/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1605 HOPE ST	STE 350	SOUTH PASADENA	CA	91030	2628	19	06037	34.11679363	-118.150088	Los Angeles County
111338	Fee-for-Service	1104842319	1104842319	1	1	LUONG, HELEN H T MD	11/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	55269	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1174 N EUCLID ST	None	ANAHEIM	CA	92801	1900	30	06059	33.849621	-117.941612	Orange County
111342	Fee-for-Service	1861114688	1861114688	1	1	LEROSE, DANIELLE I NP	10/13/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
111343	Fee-for-Service	1215558341	1215558341	1	2	LOS ANGELES FOOD ALLERGY INS	10/8/2021	207KA0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	TITUTE, INC.	201 S BUENA VISTA ST	310	BURBANK	CA	91505	4569	19	06037	34.15978726	-118.3289164	Los Angeles County
111357	Fee-for-Service	1225659907	1225659907	1	1	LASKO, KEITH MD	1/13/2024	390200000X	NA	Other	026	PHYSICIANS	187588	None	None	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
111361	Fee-for-Service	1518377852	1518377852	1	1	LEE, KRISTINA MD	10/11/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	142556	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
111385	Fee-for-Service	1134698418	1134698418	1	1	LINCARE PHARMACY SERVICES IN	6/1/2021	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	2001 NE 46TH ST	SUITE 150	KANSAS CITY	MO	64116	2051	00	None	39.17577296	-94.55700456	Clay County
111427	Fee-for-Service	1912268483	1912268483	1	1	LEE, RICHARD K MD	7/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127010	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
111457	Fee-for-Service	1124205059	1124205059	1	1	LI, KARIN C MD	9/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96828	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
111475	Fee-for-Service	1417367715	1417367715	1	1	LEE, LISA M CNP	4/15/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
111477	Fee-for-Service	1184644734	1184644734	1	1	LEE, HAK SOON MD	4/23/1999	174400000X	NA	Other	026	PHYSICIANS	33849	05	Anesthesiology	0	In state provider	None	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
111487	Fee-for-Service	1073640314	1073640314	1	1	LECHNER, JASON T LMFT	6/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
111501	Fee-for-Service	1144370859	1144370859	1	1	LEE, GORTON MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78145	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
111518	Fee-for-Service	1609851252	1609851252	1	1	LIN, DORIS MD	8/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	52008	08	Family Practice	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
111530	Fee-for-Service	1710324710	1710324710	1	1	LOU, MAY MD	7/1/2019	390200000X	NA	Other	026	PHYSICIANS	134470	41	Internal Medicine	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
111584	Fee-for-Service	1104904689	1104904689	1	1	LAU, ALBERT S MD	4/16/2008	208M00000X	NA	Other	026	PHYSICIANS	93241	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
111604	Fee-for-Service	1477639912	1477639912	1	1	LINCARE INC	2/11/2003	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	42207 6TH ST W	STE 101	LANCASTER	CA	93534	7181	19	06037	34.650117	-118.141279	Los Angeles County
111609	Fee-for-Service	1649835174	1649835174	1	1	LIFETIME HOME HEALTH CARE	7/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	600 W BROADWAY	SUITE 360	GLENDALE	CA	91204	1040	19	06037	34.14678282	-118.2666498	Los Angeles County
111643	Fee-for-Service	1053354225	1053354225	2	1	LONGS DRUG STORES CA LLC	12/15/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	42520 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	4471	33	06065	33.7375529	-116.4087046	Riverside County
111650	Fee-for-Service	1528043932	1528043932	1	1	LE, STACEY QUYNH-THY OD	8/31/1993	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	STANTON OPTOMETRY	7038 KATELLA AVE	None	STANTON	CA	90680	2805	30	06059	33.8027637	-118.0101193	Orange County
111652	Fee-for-Service	1609275171	1609275171	1	1	LEE, KIM MD	4/22/2019	390200000X	NA	Other	026	PHYSICIANS	139160	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
111669	Fee-for-Service	1386703999	1386703999	1	1	LIU, LES I MD	12/1/1997	207R00000X	NA	Other	026	PHYSICIANS	55434	41	Internal Medicine	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
111736	Fee-for-Service	1992269757	1992269757	1	1	LOS ANGELES CHRISTIAN HEALTH	9/8/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTERS	325 E 7TH ST	None	LOS ANGELES	CA	90014	2209	19	06037	34.04209386	-118.2486813	Los Angeles County
111779	Fee-for-Service	1841722758	1841722758	1	1	LIU, MICHAEL Y MD	7/17/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	157500	None	None	0	In state provider	None	3828 SCHAUFELE AVENUE	SUITE 200	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
111783	Fee-for-Service	1689977001	1689977001	1	1	LONGS DRUG STORES CA LLC	6/30/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	19701 VANOWEN ST	None	WINNETKA	CA	91306	3927	19	06037	34.1938475	-118.562724	Los Angeles County
111800	Fee-for-Service	1154750560	1154750560	1	1	LOMPOC VALLEY MEDICAL CENTER	9/19/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	303 SOUTH C STREET	None	LOMPOC	CA	93436	7305	42	06083	34.63525845	-120.451628	Santa Barbara County
111806	Fee-for-Service	1609851252	1609851252	1	1	LIN, DORIS MD	8/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	52008	66	Emergency Medicine (Urgent Care)	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
111831	Fee-for-Service	1326479270	1326479270	1	1	LONG, DEBORA S CNM	12/1/2014	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
111834	Fee-for-Service	1457697799	1457697799	1	1	LOMELINO, MICHELE OD	9/20/2022	152W00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	350 N WIGET LANE	SUITE 200	WALNUT CREEK	CA	94598	3058	07	06013	37.92948925	-122.0275099	Contra Costa County
111842	Fee-for-Service	1710921549	1710921549	2	1	LONGS DRUG STORE CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2514 BERRYESSA RD	None	SAN JOSE	CA	95132	2947	43	06085	37.38738217	-121.8595232	Santa Clara County
111871	Fee-for-Service	1881004836	1881004836	1	1	LUU, KEVIN D MD	9/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150032	40	Pediatrics	0	In state provider	None	4785 N FIRST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
111889	Fee-for-Service	1699235085	1699235085	1	1	LO, JOCELYN R MD	9/1/2022	207R00000X	NA	Other	026	PHYSICIANS	178325	None	None	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
111924	Fee-for-Service	1184999559	1184999559	1	1	LAZAR, LINDA J DO	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15282	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
111957	Fee-for-Service	1568406080	1568406080	1	1	LIU, CHARLES Y	9/16/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65677	None	None	0	In state provider	None	1510 SAN PABLO ST	# 268	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
111971	Fee-for-Service	1265449169	1265449169	1	1	LEISTIKOW, BRUCE N MD	11/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	80992	70	Clinic (mixed specialty)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
111981	Fee-for-Service	1740692961	1740692961	1	1	LABRECQUE, DAVID	3/8/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
112016	Fee-for-Service	1730509852	1730509852	1	1	LI, BETTY A MD	8/20/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	143616	None	None	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
112027	Fee-for-Service	1992269757	1992269757	1	1	LOS ANGELES CHRISTIAN HEALTH	9/8/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTERS	325 E 7TH ST	None	LOS ANGELES	CA	90014	2209	19	06037	34.04209386	-118.2486813	Los Angeles County
112103	Fee-for-Service	1356429914	1356429914	1	1	LUNDSTROM, ROBERT J MD	8/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	25484	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
112130	Fee-for-Service	1568477446	1568477446	1	1	LANCASTER CARD MED GRP	8/1/2001	174400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	43860 N 10 ST W	None	LANCASTER	CA	93534	4848	19	06037	34.68010255	-118.1478903	Los Angeles County
112160	Fee-for-Service	1508211202	1508211202	1	1	LIU, VICTORIA D MD	11/7/2021	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	151230	None	None	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
112198	Fee-for-Service	1093758708	1093758708	1	1	LACY, JOHN G MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	79003	22	Pathology (M.D. only)	0	In state provider	None	19951 MARINER AVE	STE 150	TORRANCE	CA	90503	1738	19	06037	33.85129396	-118.3504889	Los Angeles County
112218	Fee-for-Service	1255473211	1255473211	1	1	LEVINSON WICKHAM, TERRILL S	1/2/2019	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PHD	1210 NEVADA ST	STE 101	REDLANDS	CA	92374	2895	36	06071	34.069554	-117.2174405	San Bernardino County
112229	Fee-for-Service	1902835770	1902835770	1	1	LEIDIG,GILBERT A JR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	ONE CENTURIAN DR	STE 200	NEWARK	DE	19713	2150	00	None	39.69604971	-75.65624854	New Castle County
112232	Fee-for-Service	1386776839	1386776839	1	1	LEE, LINDA H MD	8/21/2008	1223S0112X	NA	Dental Provider	026	PHYSICIANS	96160	02	General Surgery	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
112242	Fee-for-Service	1861405664	1861405664	1	1	LIN, HENRY C OD	12/5/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	525 W MAIN ST	STE 2	EL CENTRO	CA	92243	7906	13	06025	32.79280049	-115.555473	Imperial County
112251	Fee-for-Service	1952326381	1952326381	1	1	LESSER, ANDREW J MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	35072	01	General Practice	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
112284	Fee-for-Service	1285923623	1285923623	1	2	LEWIS, MARSHALL S MD APC	1/20/2015	193200000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1332 W HERNDON AVE	STE 101	FRESNO	CA	93711	7118	10	06019	36.83737137	-119.8148304	Fresno County
112303	Fee-for-Service	1982829198	1982829198	1	2	LIRA HOME HEALTH, INC	1/8/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6767 FOREST LAWN DRIVE	SUITE 215	LOS ANGELES	CA	90068	1051	19	06037	34.14408052	-118.3399531	Los Angeles County
112310	Fee-for-Service	1548468192	1548468192	1	1	LI DE WANG, FENG LING CA	3/12/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1223 HIGUERA ST	STE 203	SAN LUIS OBISPO	CA	93401	3165	40	06079	35.28310108	-120.6574301	San Luis Obispo County
112328	Fee-for-Service	1093133027	1093133027	1	1	LASAM, GLENMORE U MD	7/14/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	171671	None	None	0	In state provider	None	415 E HARDING WAY	STE D	STOCKTON	CA	95204	6118	39	06077	37.96819912	-121.2900761	San Joaquin County
112342	Fee-for-Service	1104049998	1104049998	1	1	LOURENCO, KATHLEEN M LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
112343	Fee-for-Service	1740592989	1740592989	1	1	LEUNKAM, SERAPHINE	10/31/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
112364	Fee-for-Service	1316908023	1316908023	1	1	LURIE, HUGH NP	9/3/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
112381	Fee-for-Service	1023196102	1023196102	1	1	LEONG, WAYNE C MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	78793	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
112415	Fee-for-Service	1568477446	1568477446	1	1	LANCASTER CARD MED GRP	8/1/2001	174400000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	43860 N 10 ST W	None	LANCASTER	CA	93534	4848	19	06037	34.68010255	-118.1478903	Los Angeles County
112424	Fee-for-Service	1114511201	1114511201	1	1	LION HEART HOSPICE INC	8/5/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8949 RESEDA BLVD	227	NORTHRIDGE	CA	91324	5809	19	06037	34.233255	-118.536109	Los Angeles County
112448	Fee-for-Service	1669662102	1669662102	1	1	LANDINI, JENNY L LCSW	3/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
112500	Fee-for-Service	1891283362	1891283362	1	1	LIBBY, JOANNA M MD	7/30/2021	207R00000X	NA	Other	026	PHYSICIANS	165434	None	None	0	In state provider	None	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	19	06037	34.06704253	-118.3835029	Los Angeles County
112509	Fee-for-Service	1952507477	1952507477	1	1	LEE KUMAR, AMY T MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108897	41	Internal Medicine	0	In state provider	None	16200 SAND CANYON AVE	None	IRVINE	CA	92618	3714	30	06059	33.6617581	-117.7736362	Orange County
112521	Fee-for-Service	1518126259	1518126259	1	2	LEE, BRIAN M MD INC	11/18/2009	207RN0300X	NA	Nephrology	026	PHYSICIANS	86438	45	Nephrology (Renal-Kidney)	0	In state provider	None	3625 MARTIN LUTHER KING	BLVD STE 5	LYNWOOD	CA	90262	3509	19	06037	33.93044131	-118.2021564	Los Angeles County
112541	Fee-for-Service	1952326381	1952326381	1	1	LESSER, ANDREW J MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	35072	66	Emergency Medicine (Urgent Care)	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
112572	Fee-for-Service	1285923623	1285923623	1	2	LEWIS, MARSHALL S MD APC	1/20/2015	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	None	1332 W HERNDON AVE	STE 101	FRESNO	CA	93711	7118	10	06019	36.83737137	-119.8148304	Fresno County
112573	Fee-for-Service	1215343710	1215343710	1	1	LIM, ROBERT H PHD	6/27/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
112583	Fee-for-Service	1396183521	1396183521	1	1	LY, ALAYNA F DO	10/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15827	01	General Practice	0	In state provider	None	3000 Q ST	FL 3	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
112585	Fee-for-Service	1447741038	1447741038	1	1	LIN, ESTHER MD	4/29/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164604	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 220	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
112618	Fee-for-Service	1629381108	1629381108	1	1	LESMONI INC	10/10/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3042 CLEVELAND PL	None	ANTIOCH	CA	94509	5359	07	06013	37.99047915	-121.8356346	Contra Costa County
112635	Fee-for-Service	1114040896	1114040896	1	1	LIVERMORE VALLEY JUSD	6/15/1998	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	685 E JACK LONDON BLVD	None	LIVERMORE	CA	94551	1855	01	06001	37.68899247	-121.791726	Alameda County
112637	Fee-for-Service	1952668725	1952668725	1	1	LARRALDE, MARK J MD	8/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155791	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
112711	Fee-for-Service	1700473808	1700473808	1	1	LIMAR HOSPICE INC	12/8/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1619 W GARVEY AVE N	STE 207	WEST COVINA	CA	91790	2156	19	06037	34.07272709	-117.9404871	Los Angeles County
112713	Fee-for-Service	1114511201	1114511201	1	1	LION HEART HOSPICE INC	8/5/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8949 RESEDA BLVD	227	NORTHRIDGE	CA	91324	5809	19	06037	34.233255	-118.536109	Los Angeles County
112715	Fee-for-Service	1598296238	1598296238	1	1	LEE, CHANG SUP MD	7/6/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	172874	None	None	0	In state provider	None	1450 SAN PABLO ST	STE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
112743	Fee-for-Service	1407437650	1407437650	1	1	LATIF, IKRAMAH DO	2/28/2025	207R00000X	NA	Other	026	PHYSICIANS	21327	41	Internal Medicine	0	In state provider	None	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
112764	Fee-for-Service	1093293490	1093293490	1	1	LAWRENCE, CHRISTINA M CRNA	9/20/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
112839	Fee-for-Service	1336140656	1336140656	1	1	LAUGHLIN, DONELLE A MD	9/18/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65672	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
112847	Fee-for-Service	1376645150	1376645150	1	1	LEVIN, JONATHAN MD	8/24/2020	174400000X	NA	Other	026	PHYSICIANS	60920	25	Physical Medicine and Rehabilitation	0	In state provider	None	7855 SANTA MONICA BLVD	None	LOS ANGELES	CA	90046	5344	19	06037	34.0908873	-118.36044	Los Angeles County
112859	Fee-for-Service	1285923623	1285923623	1	2	LEWIS, MARSHALL S MD APC	1/20/2015	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	1332 W HERNDON AVE	STE 101	FRESNO	CA	93711	7118	10	06019	36.83737137	-119.8148304	Fresno County
112875	Fee-for-Service	1871036822	1871036822	1	1	LEWIS, LAURA MD	7/15/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	153343	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
112895	Fee-for-Service	1801367503	1801367503	1	1	LOTZ, STANLEY L RCP	11/14/2020	2279C0205X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
112922	Fee-for-Service	1114040896	1114040896	1	1	LIVERMORE VALLEY JUSD	1/24/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	685 E JACK LONDON BLVD	None	LIVERMORE	CA	94551	1855	01	06001	37.68899247	-121.791726	Alameda County
112955	Fee-for-Service	1083792865	1083792865	1	1	LIM, DAVID B MD	10/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	78324	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
112982	Fee-for-Service	1194131854	1194131854	1	1	LIN, CHARLES S MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
112999	Fee-for-Service	1700473808	1700473808	1	1	LIMAR HOSPICE INC	12/8/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1619 W GARVEY AVE N	STE 207	WEST COVINA	CA	91790	2156	19	06037	34.07272709	-117.9404871	Los Angeles County
113019	Fee-for-Service	1063979755	1063979755	1	1	LIEN, HEIDI C PT	1/23/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9230 MARYSVILLE RD	None	OREGON HOUSE	CA	95962	9705	58	06115	39.36447161	-121.2501344	Yuba County
113022	Fee-for-Service	1306852504	1306852504	1	1	LIN, EDWARD P MD	8/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108805	None	None	0	In state provider	None	2320 BATH STREET	SUITE 208	SANTA BARBARA	CA	93105	5322	42	06083	34.43082689	-119.7223032	Santa Barbara County
113028	Fee-for-Service	1164878948	1164878948	1	1	LO, DANIELLE M MD	7/14/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	168982	None	None	0	In state provider	None	1850 S AZUSA AVE	SUITE 107	HACIENDA HEIGHTS	CA	91745	6813	19	06037	33.98895597	-117.9322797	Los Angeles County
113031	Fee-for-Service	1265936132	1265936132	1	1	LEI, NAN YE DO	10/8/2021	208M00000X	NA	Other	026	PHYSICIANS	17890	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
113033	Fee-for-Service	1124070420	1124070420	1	1	LE, MIMI Q MD	6/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88869	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	6719 ALVARADO RD	STE 201	SAN DIEGO	CA	92120	5257	37	06073	32.77684978	-117.055137	San Diego County
113055	Fee-for-Service	1962936781	1962936781	1	1	LI, HE H MD	10/4/2022	207LP2900X	NA	Other	026	PHYSICIANS	157581	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
113059	Fee-for-Service	1710532452	1710532452	1	1	LIN, SHENG Y PT	5/18/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
113061	Fee-for-Service	1447714373	1447714373	1	1	LA VETA HEALTHCARE INC	5/1/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1835 W LA VETA AVENUE	None	ORANGE	CA	92868	4132	30	06059	33.78034869	-117.8721459	Orange County
113064	Fee-for-Service	1093133035	1093133035	1	1	LUTTON, HEATHER C MD	8/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149886	40	Pediatrics	0	In state provider	None	1510 FLORIDA AVE	SUITE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
113074	Fee-for-Service	1295099356	1295099356	1	1	LU, SHUN S DPM	3/11/2019	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1520 N MOUNTAIN AVE	#E122	ONTARIO	CA	91762	1128	36	06071	34.085925	-117.669564	San Bernardino County
113075	Fee-for-Service	1992064976	1992064976	1	1	LEE, DAVID P MD MPH	5/3/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	141487	10	Gastroenterology (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
113102	Fee-for-Service	1831143056	1831143056	1	1	LAZARUS, JOYCE P MD	4/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87020	41	Internal Medicine	0	In state provider	None	1711 W TEMPLE ST	STE 5605	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
113127	Fee-for-Service	1336140656	1336140656	1	1	LAUGHLIN, DONELLE A MD	9/18/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65672	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
113141	Fee-for-Service	1578787958	1578787958	1	1	LUXON, KAREN LMFT	3/17/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	505 NORTH TUSTIN AVENUE	SUITE 265	SANTA ANA	CA	78611	3112	30	06059	33.74962094	-117.8341227	Orange County
113150	Fee-for-Service	1780843953	1780843953	1	1	LIANG, FEN MD	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124673	41	Internal Medicine	0	In state provider	None	31700 TEMECULA PARKWAY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
113176	Fee-for-Service	1134250103	1134250103	1	1	LAM, JONATHAN J MD	10/5/2009	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	92006	20	Orthopedic Surgery	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
113205	Fee-for-Service	1154636793	1154636793	1	1	LOS ANGELES COUNTY	12/27/2010	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	HIGH DESERT HLTH SYSTEMS	44900 60TH ST W	None	LANCASTER	CA	93536	7618	19	06037	34.6976943	-118.2365888	Los Angeles County
113214	Fee-for-Service	1740252048	1740252048	1	1	LEVINE, MICHAEL M MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	39575	45	Nephrology (Renal-Kidney)	0	In state provider	None	8635 W 3RD ST	STE 485W	LOS ANGELES	CA	90048	6121	19	06037	34.07361928	-118.3803143	Los Angeles County
113217	Fee-for-Service	1841337946	1841337946	1	1	LAUFER, MICHAEL D MD	3/31/1989	207P00000X	NA	Other	026	PHYSICIANS	59661	02	General Surgery	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
113220	Fee-for-Service	1376566299	1376566299	1	1	LAWSON, AMY L MD	4/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55268	40	Pediatrics	0	In state provider	None	3700 CALIFORNIA ST	5TH FLOOR	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
113243	Fee-for-Service	1366599607	1366599607	1	1	LEE, TZIELAN C MD	8/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66221	83	Rheumatology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
113260	Fee-for-Service	1679720841	1679720841	1	1	LIND, KAREN R MD	5/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129703	None	None	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
113272	Fee-for-Service	1285139485	1285139485	1	1	LOUIE, MATTHEW N MD	8/31/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	167458	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
113281	Fee-for-Service	1285749903	1285749903	1	1	LOCKE, DOUGLAS A LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
113283	Fee-for-Service	1841230109	1841230109	1	1	LOMA LINDA UNIVERSITY	10/1/1988	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	PHYSICIANS MEDICAL GROUP	11370 ANDERSON ST	STE 3150	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
113285	Fee-for-Service	1376779264	1376779264	1	1	LEE, DAHMI MD	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125043	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
113299	Fee-for-Service	1427091750	1427091750	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 N CARPENTER RD	STE 30	MODESTO	CA	95351	1301	50	06099	37.64783423	-121.0305477	Stanislaus County
113310	Fee-for-Service	1720056781	1720056781	1	1	LEE, FRANCIS S MD	11/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	64245	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	12555 GARDEN GROVE BLVD	STE 303	GARDEN GROVE	CA	92843	1903	30	06059	33.77450946	-117.913041	Orange County
113320	Fee-for-Service	1124070420	1124070420	1	1	LE, MIMI Q MD	6/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88869	41	Internal Medicine	0	In state provider	None	6719 ALVARADO RD	STE 201	SAN DIEGO	CA	92120	5257	37	06073	32.77684978	-117.055137	San Diego County
113390	Fee-for-Service	1831143056	1831143056	1	1	LAZARUS, JOYCE P MD	4/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87020	38	Geriatrics	0	In state provider	None	1711 W TEMPLE ST	STE 5605	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
113432	Fee-for-Service	1821553553	1821553553	1	1	LOYALTY HOSPICE SERVICES, IN	8/1/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	1700 E LINCOLN AVE	204	ANAHEIM	CA	92805	4347	30	06059	33.84008418	-117.8937053	Orange County
113440	Fee-for-Service	1831387620	1831387620	2	1	LAUREL CANYON URGENT MEDICAL	12/16/1982	193400000X	NA	Other	026	PHYSICIANS	29900	08	Family Practice	0	In state provider	GROUP INC	8020 LAUREL CANYON BLVD	None	NORTH HOLLYWOOD	CA	91605	1427	19	06037	34.216398	-118.396503	Los Angeles County
113458	Fee-for-Service	1932682283	1932682283	1	2	LANG, TIFFANI LCSW	8/1/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	560 COHASSET ROAD	STE 165	CHICO	CA	95926	2460	04	06007	39.7519137	-121.8477606	Butte County
113479	Fee-for-Service	1609341866	1609341866	1	1	LOPEZDUFF, IMANI	2/10/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	48	06095	0	0	None
113508	Fee-for-Service	1164861969	1164861969	1	1	LAO, MICHAEL MD	2/5/2019	208800000X	NA	Other	026	PHYSICIANS	160251	34	Urology and Urological Surgery	0	In state provider	None	44151 15TH ST WEST	STE 409	LANCASTER	CA	93534	5504	19	06037	34.68551775	-118.1568686	Los Angeles County
113511	Fee-for-Service	1427265354	1427265354	1	1	LITTIG, DAVID H	4/17/2002	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1645 DONLON ST	ST 102	VENTURA	CA	93003	5667	56	06111	34.25714805	-119.2376516	Ventura County
113515	Fee-for-Service	1144263401	1144263401	2	1	LONGS DRUG STORES CA LLC	11/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	347 ALISAL ST	None	SALINAS	CA	93901	4302	27	06053	36.67449068	-121.6431963	Monterey County
113534	Fee-for-Service	1366599607	1366599607	1	1	LEE, TZIELAN C MD	8/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66221	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
113536	Fee-for-Service	1114194057	1114194057	1	1	LEE, JOHN K MD	2/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	109268	68	Hematology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365 420 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
113547	Fee-for-Service	1932700283	1932700283	1	1	LUI, CHRISTOPHER PT	4/29/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
113582	Fee-for-Service	1902241755	1902241755	1	1	LIVE LIFE HOME HEALTH LLC	7/16/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	79440 CORPORATE CTR DR	SUITE 107-C OFFICE C	LA QUINTA	CA	92253	7241	33	06065	33.70937862	-116.2788139	Riverside County
113586	Fee-for-Service	1497833990	1497833990	1	1	LWIN, TINT MD	8/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95005	41	Internal Medicine	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
113603	Fee-for-Service	1659450534	1659450534	2	1	LINCARE INC	3/15/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	9420 W PERSHING AVE	None	VISALIA	CA	93291	8857	54	06107	36.339282	-119.396493	Tulare County
113633	Fee-for-Service	1639257272	1639257272	1	1	LIAO, YULAN MD	12/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80137	36	Psychiatry	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
113647	Fee-for-Service	1023424710	1023424710	1	1	LAMA TAMANG, TSERING G MD	8/14/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	148535	68	Hematology	0	In state provider	None	4900 CALIFORNIA AVE	STE 200	BAKERSFIELD	CA	93309	7024	15	06029	35.36440586	-119.0562732	Kern County
113650	Fee-for-Service	1841642295	1841642295	1	1	LEE, REBECCA Y OD	11/6/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	388 9TH STREET	SUITE 157	OAKLAND	CA	94607	4290	01	06001	37.80019425	-122.2715222	Alameda County
113666	Fee-for-Service	1801402805	1801402805	1	1	LEONG, JOY R RCP	10/22/2020	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
113672	Fee-for-Service	1407440472	1407440472	1	1	LEUNG, AUSTIN C PT	3/10/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	957 FAULKNERROAD	105	SANTA PAULA	CA	93060	9129	56	06111	34.33481551	-119.0867489	Ventura County
113674	Fee-for-Service	1457469884	1457469884	1	1	LA VERNE FAMILY MEDICAL CENT	2/27/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ER INC	2100 FOOTHILL BLVD	SUITE A	LA VERNE	CA	91750	2905	19	06037	34.11308422	-117.764666	Los Angeles County
113684	Fee-for-Service	1003832346	1003832346	1	1	LEE, DAVID MD	7/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80947	None	None	0	In state provider	None	7911 LAGUNA BLVD	None	ELK GROVE	CA	95758	7920	34	06067	38.422971	-121.410873	Sacramento County
113685	Fee-for-Service	1114959020	1114959020	1	1	LEE, CHRISTINA J MD	3/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	68416	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	19582 BEACH BLVD	STE 206	HUNTINGTON BEACH	CA	92648	5950	30	06059	33.67831649	-117.9885198	Orange County
113717	Fee-for-Service	1639148406	1639148406	1	1	LOMBARDI, VINCENT A MD	11/24/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	88699	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
113721	Fee-for-Service	1821553553	1821553553	1	1	LOYALTY HOSPICE SERVICES, IN	8/1/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	1700 E LINCOLN AVE	204	ANAHEIM	CA	92805	4347	30	06059	33.84008418	-117.8937053	Orange County
113725	Fee-for-Service	1831387620	1831387620	2	1	LAUREL CANYON URGENT MEDICAL	12/16/1982	193400000X	NA	Other	026	PHYSICIANS	29900	40	Pediatrics	0	In state provider	GROUP INC	8020 LAUREL CANYON BLVD	None	NORTH HOLLYWOOD	CA	91605	1427	19	06037	34.216398	-118.396503	Los Angeles County
113751	Fee-for-Service	1801180377	1801180377	1	1	LINGAD, MARILEN	8/1/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	38656 MEDICAL CENTER DR	SUITE B	PALMDALE	CA	93551	4483	19	06037	34.58533737	-118.1437927	Los Angeles County
113771	Fee-for-Service	1205998036	1205998036	1	1	LYONS, KATHERINE M PSYD	8/5/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
113772	Fee-for-Service	1487698668	1487698668	1	1	LAMBERT, CHRISTOPHER V	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	32409	66	Emergency Medicine (Urgent Care)	0	In state provider	None	PUEBLO AT BATH	None	SANTA BARBARA	CA	93105	0000	42	06083	34.430526	-119.72196	Santa Barbara County
113806	Fee-for-Service	1750608303	1750608303	1	1	LONGACRE, MATTHEW D MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111961	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
113819	Fee-for-Service	1508893983	1508893983	1	1	LOWENSTEIN, DANIEL H MD	6/30/1986	2084N0400X	NA	Neurology	026	PHYSICIANS	53866	13	Neurology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	# 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
113822	Fee-for-Service	1972895142	1972895142	1	1	LEBASTCHI, AMIR H MD	10/7/2020	208800000X	NA	Other	026	PHYSICIANS	169779	34	Urology and Urological Surgery	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
113827	Fee-for-Service	1114194057	1114194057	1	1	LEE, JOHN K MD	2/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	109268	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365 420 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
113859	Fee-for-Service	1275950115	1275950115	1	1	LEMOR, DANIEL MD	8/1/2019	207WX0120X	NA	Ophthalmology	026	PHYSICIANS	156391	18	Ophthalmology	0	In state provider	None	4036 WHITTIER BLVD	SUITE 202	LOS ANGELES	CA	90023	2561	19	06037	34.02390455	-118.1847825	Los Angeles County
113869	Fee-for-Service	1376636233	1376636233	1	1	LEWIS, WILLIAM R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	23261	14	Neurological Surgery	0	In state provider	None	757 PACIFIC ST	None	MONTEREY	CA	93940	2819	27	06053	36.59463401	-121.8978403	Monterey County
113939	Fee-for-Service	1659556991	1659556991	1	1	LIN, YANN-BOR MD	11/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	3001 ST ROSE PKWY	None	HENDERSON	NV	89113	3612	00	None	36.00555274	-115.1163108	Clark County
113947	Fee-for-Service	1467889410	1467889410	1	1	LARIOS-GARCIA, GUADALUPE LC	7/16/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	420 DOWNEY	None	MODESTO	CA	95354	1301	50	06099	37.64547549	-120.987999	Stanislaus County
113950	Fee-for-Service	1437191269	1437191269	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3471 LAKE TAHOE BLVD	None	SOUTH LAKE TAHOE	CA	96150	8948	09	06017	38.94625984	-119.9641274	El Dorado County
113984	Fee-for-Service	1720708902	1720708902	1	1	LEE, JESSICA Y	10/14/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	15201 BEACH BLVD	A	WESTMINSTER	CA	92683	9268	30	06059	33.7416537	-117.9896279	Orange County
113990	Fee-for-Service	1164467205	1164467205	1	2	LIN AND WILSON RADIOLOGY	10/31/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP, INC	301 VICTORIA ST	None	COSTA MESA	CA	92627	1995	30	06059	33.65258952	-117.9121545	Orange County
114015	Fee-for-Service	1831387620	1831387620	2	1	LAUREL CANYON URGENT MEDICAL	12/16/1982	193400000X	NA	Other	026	PHYSICIANS	29900	66	Emergency Medicine (Urgent Care)	0	In state provider	GROUP INC	8020 LAUREL CANYON BLVD	None	NORTH HOLLYWOOD	CA	91605	1427	19	06037	34.216398	-118.396503	Los Angeles County
114082	Fee-for-Service	1932214624	1932214624	1	1	LA PEER SURGERY CENTER, LLC	7/2/2021	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	8920 WILSHIRE BLVD	SUITE 101	BEVERLY HILLS	CA	90211	2007	19	06037	34.06703599	-118.3863456	Los Angeles County
114097	Fee-for-Service	1992805550	1992805550	1	1	LAU, MAY Y MD INC	11/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75371	66	Emergency Medicine (Urgent Care)	0	In state provider	None	320 S GARFIELD AVE	STE 288	ALHAMBRA	CA	91801	6815	19	06037	34.09184212	-118.1245127	Los Angeles County
114098	Fee-for-Service	1558311050	1558311050	1	1	LOMBARD, JANE C MD	2/18/1987	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	55024	01	General Practice	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
114119	Fee-for-Service	1114194057	1114194057	1	1	LEE, JOHN K MD	2/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	109268	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365 420 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
114145	Fee-for-Service	1407813678	1407813678	1	1	LAN, ANDREW J MD	11/28/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	78731	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
114156	Fee-for-Service	1376636233	1376636233	1	1	LEWIS, WILLIAM R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	23261	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 PACIFIC ST	None	MONTEREY	CA	93940	2819	27	06053	36.59463401	-121.8978403	Monterey County
114188	Fee-for-Service	1679635254	1679635254	1	1	LIN, ANDREW Y MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77882	41	Internal Medicine	0	In state provider	None	500 E REMINGTON DR	STE 30	SUNNYVALE	CA	94087	2612	43	06085	37.35898474	-122.0281716	Santa Clara County
114197	Fee-for-Service	1538188826	1538188826	1	1	LASHER, STEPHEN A MD	1/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83050	41	Internal Medicine	0	In state provider	None	CASTRO AND DUBOCE ST	STE 160 & 175	SAN FRANCISCO	CA	94112	0000	38	06075	37.769049	-122.43582	San Francisco County
114219	Fee-for-Service	1942442033	1942442033	1	1	LOVDOKKEN, MARIE A PHD	5/30/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
114225	Fee-for-Service	1699105098	1699105098	1	1	LE, NATASHA M	7/3/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	25201 PASEO DE ALICIA	STE 110	LAGUNA HILLS	CA	92653	4627	30	06059	33.60176857	-117.6901093	Orange County
114250	Fee-for-Service	1205227584	1205227584	1	1	LISE, CHRISTIAN Q LMFT	4/4/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4193 FLAT ROCK DR STE 20	None	RIVERSIDE	CA	92505	7113	33	06065	33.90361212	-117.4930456	Riverside County
114251	Fee-for-Service	1700387867	1700387867	1	1	LEARD, STEPHANIE OT	12/28/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	77564 COUNTRY CLUB DR.	SUITE 401B	PALM DESERT	CA	92211	6246	33	06065	33.75833451	-116.3114325	Riverside County
114265	Fee-for-Service	1699163097	1699163097	1	1	LY, NHA T CRNA	10/14/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 MAPLE STREET	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
114277	Fee-for-Service	1003829128	1003829128	1	1	LENZ, SUZANNE PHD	6/1/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	24050 MADISON ST	200	TORRANCE	CA	90505	6015	19	06037	33.80594851	-118.348558	Los Angeles County
114291	Fee-for-Service	1124480611	1124480611	1	1	LUJAN HERNANDEZ, JORGE R MD	6/3/2022	2086S0122X	NA	General Surgery	026	PHYSICIANS	177535	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
114308	Fee-for-Service	1992150932	1992150932	1	1	LEWIS, MIRANDA M MD	9/23/2022	207P00000X	NA	Other	026	PHYSICIANS	151126	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
114310	Fee-for-Service	1396846317	1396846317	1	1	LE, THU H MD	4/4/2025	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	45	Nephrology (Renal-Kidney)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
114311	Fee-for-Service	1477583060	1477583060	1	1	LENZ, LAWRENCE J MD	7/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	26130	None	None	0	In state provider	None	600 W I ST	STE C	LOS BANOS	CA	93635	3460	24	06047	37.06305336	-120.8610993	Merced County
114321	Fee-for-Service	1871140996	1871140996	1	1	LIBERTY HOSPICE CARE	7/22/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14407 GILMORE ST	SUITE 202B	VAN NUYS	CA	91401	1400	19	06037	34.18767148	-118.4468805	Los Angeles County
114322	Fee-for-Service	1598932287	1598932287	1	1	LAMB, MARGARET LCSW	12/8/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
114331	Fee-for-Service	1578126702	1578126702	1	1	LEITNER, STEFANO MD	6/14/2024	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	177366	39	Preventive (M.D. only)	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
114338	Fee-for-Service	1548646011	1548646011	1	2	LIN, BRUCE HORNG J MD PC	7/19/2016	193400000X	NA	Other	026	PHYSICIANS	88657	None	None	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
114342	Fee-for-Service	1750068862	1750068862	1	1	LS RX LLC	7/19/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	602 MAIN ST	None	BRAWLEY	CA	92227	2548	13	06025	32.97860652	-115.531893	Imperial County
114350	Fee-for-Service	1841683406	1841683406	1	1	LIUO, KO G NP	4/15/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
114356	Fee-for-Service	1659443133	1659443133	1	1	LEBOWITZ, STEPHEN H MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	25406	41	Internal Medicine	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
114364	Fee-for-Service	1467633909	1467633909	1	1	LIEBERT, NEIL LMFT	9/27/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
114368	Fee-for-Service	1477549459	1477549459	1	1	LIM, MICHAEL H MD	3/1/1999	207L00000X	NA	Other	026	PHYSICIANS	61364	None	None	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
114381	Fee-for-Service	1497147144	1497147144	1	1	LEWIS, KEVIN C MD	3/7/2024	208800000X	NA	Other	026	PHYSICIANS	192343	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
114386	Fee-for-Service	1992805550	1992805550	1	1	LAU, MAY Y MD INC	11/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75371	40	Pediatrics	0	In state provider	None	320 S GARFIELD AVE	STE 288	ALHAMBRA	CA	91801	6815	19	06037	34.09184212	-118.1245127	Los Angeles County
114391	Fee-for-Service	1275637324	1275637324	1	1	LOMA LINDA UNIV MED CTR	4/1/1985	3336H0001X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MOUNTAIN VIEW PHARMACEU	11255 MOUNTAIN VIEW AVE	None	LOMA LINDA	CA	92354	3864	36	06071	34.04936109	-117.243598	San Bernardino County
114392	Fee-for-Service	1245488592	1245488592	1	1	LEE, JEFFREY K MD	6/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110583	01	General Practice	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
114398	Fee-for-Service	1235666264	1235666264	1	1	LEBOWITZ, JONATHAN MD	6/28/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
114399	Fee-for-Service	1720614696	1720614696	1	1	LADENHEIM, MAYA MD	12/9/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	189539	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
114415	Fee-for-Service	1215257340	1215257340	1	1	LEE, SARAH J MD	9/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121866	79	Neurology-Child	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
114429	Fee-for-Service	1982034195	1982034195	1	1	LOGAN, ANNA L PHD	12/17/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
114443	Fee-for-Service	1699766188	1699766188	1	1	LEE, KEITH JONATHAN MD	10/31/1987	207R00000X	NA	Other	026	PHYSICIANS	52059	01	General Practice	0	In state provider	None	3160 RED HILL AVE	None	COSTA MESA	CA	92626	3402	30	06059	33.68024793	-117.8734988	Orange County
114453	Fee-for-Service	1215371216	1215371216	1	1	LEWIS, JEFFREY B MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139881	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
114458	Fee-for-Service	1699352708	1699352708	1	1	LEE, JENNIFER DO	10/30/2024	207R00000X	NA	Other	026	PHYSICIANS	21097	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
114481	Fee-for-Service	1134102452	1134102452	1	1	LIMPIADO, PAT MAY P MD	4/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51311	08	Family Practice	0	In state provider	None	1405 CALIFORNIA AVE	None	DOS PALOS	CA	93620	2300	24	06047	36.98665246	-120.6290163	Merced County
114499	Fee-for-Service	1063154730	1063154730	1	1	LEVEL UP PHYSICAL THERAPY, I	11/6/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12568 VALLEY VIEW ST	None	GARDEN GROVE	CA	92845	2006	30	06059	33.78049752	-118.0307808	Orange County
114514	Fee-for-Service	1326432667	1326432667	1	1	LAKLOUK, ISRAA A MD	4/19/2023	207ZP0102X	NA	Other	026	PHYSICIANS	152056	None	None	0	In state provider	None	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
114557	Fee-for-Service	1073740221	1073740221	1	1	LEE, LINA K LMFT	4/30/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1000 S GARFIELD AVENUE	None	ALHAMBRA	CA	91801	4709	19	06037	34.084557	-118.123042	Los Angeles County
114584	Fee-for-Service	1528592870	1528592870	1	1	LEE, MICHELLE E DO	9/1/2020	207P00000X	NA	Other	026	PHYSICIANS	18224	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 WALKER STREET	None	LA PALMA	CA	90623	1722	30	06059	33.84755382	-118.0373024	Orange County
114610	Fee-for-Service	1871140996	1871140996	1	1	LIBERTY HOSPICE CARE	7/22/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14407 GILMORE ST	SUITE 202B	VAN NUYS	CA	91401	1400	19	06037	34.18767148	-118.4468805	Los Angeles County
114631	Fee-for-Service	1790273381	1790273381	1	1	LAVELLE, KRISTEN C MD	6/8/2023	207RE0101X	NA	Endocrinology	026	PHYSICIANS	166166	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
114649	Fee-for-Service	1639753445	1639753445	1	1	LO, KA W	2/10/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185886	08	Family Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
114676	Fee-for-Service	1083696637	1083696637	1	1	LIGHTFOOTE, JOHNSON B MD	11/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	39456	30	Radiology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
114725	Fee-for-Service	1245211184	1245211184	1	1	LINDSEY, CALANDRA D DO	1/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	9313	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
114728	Fee-for-Service	1639672421	1639672421	1	1	LU, STACEY OD	7/31/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4560 E CESAR E CHAVEZ	None	LOS ANGELES	CA	90022	1117	19	06037	34.04057653	-118.167318	Los Angeles County
114738	Fee-for-Service	1346656576	1346656576	1	1	LAM, LILY NP	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
114821	Fee-for-Service	1164846689	1164846689	1	1	LOCKE, JESSICA B LCSW	4/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	73369	-	NOT APPLICABLE	0	In state provider	None	710 E 111TH PLACE	None	LOS ANGELES	CA	90059	1518	19	06037	33.93454026	-118.2626368	Los Angeles County
114840	Fee-for-Service	1083067748	1083067748	1	1	LE REVE RENDEROS, AMY L LMFT	4/29/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
114865	Fee-for-Service	1043673775	1043673775	1	1	LE, CUONG B MD	11/9/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158835	08	Family Practice	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
114881	Fee-for-Service	1063469245	1063469245	1	1	LUDDER, SATNAM S MD	10/31/1984	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	39939	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 222	CONCORD	CA	94520	1813	07	06013	37.98507961	-122.034189	Contra Costa County
114884	Fee-for-Service	1568989325	1568989325	1	1	LOPEZ, CHRISTIAN O PT	4/20/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
114903	Fee-for-Service	1962471292	1962471292	1	1	LEON, JOSE RICARDO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36705	41	Internal Medicine	0	In state provider	None	450 4TH AVE	STE 209	CHULA VISTA	CA	91910	4428	37	06073	32.63513513	-117.0820663	San Diego County
114933	Fee-for-Service	1659837144	1659837144	1	1	LAMB, CHELSEA L LMFT	6/19/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
114963	Fee-for-Service	1083696637	1083696637	1	1	LIGHTFOOTE, JOHNSON B MD	11/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	39456	08	Family Practice	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
114977	Fee-for-Service	1033229695	1033229695	1	1	LINGRAPHICARE AMERICA, INC	3/13/2024	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	700 ALEXANDER PARK	SUITE 101	PRINCETON	NJ	08540	6351	00	None	40.32041278	-74.63502489	Mercer County
114988	Fee-for-Service	1306890389	1306890389	1	3	LOS ROBLES HOSPITAL	11/30/2012	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	401 ROLLING OAKS DR	None	THOUSAND OAKS	CA	91361	1050	56	06111	34.17439717	-118.8691161	Ventura County
115071	Fee-for-Service	1801966718	1801966718	1	1	LIVELY, DANIEL M MD	7/22/2008	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	51791	41	Internal Medicine	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
115079	Fee-for-Service	1821157520	1821157520	1	1	LYNN, LISA	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PKWY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
115119	Fee-for-Service	1538294798	1538294798	1	1	LOUIE, MICHAEL K	6/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98215	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
115192	Fee-for-Service	1962471292	1962471292	1	1	LEON, JOSE RICARDO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36705	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 4TH AVE	STE 209	CHULA VISTA	CA	91910	4428	37	06073	32.63513513	-117.0820663	San Diego County
115206	Fee-for-Service	1336277847	1336277847	1	1	LUPTON, KATHERINE L MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98097	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
115211	Fee-for-Service	1780248302	1780248302	1	1	LOGGINS, TIFFANY N PSYD	5/16/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
115231	Fee-for-Service	1881603769	1881603769	1	1	LONG, CARLIN S MD	5/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	41350	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
115258	Fee-for-Service	1922360874	1922360874	1	1	LUNG, LINN M MD	6/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141792	66	Emergency Medicine (Urgent Care)	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
115264	Fee-for-Service	1073576468	1073576468	1	1	LALANI, NAZNIN	7/13/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3630 EAST IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
115277	Fee-for-Service	1306890389	1306890389	1	3	LOS ROBLES HOSPITAL	11/30/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	401 ROLLING OAKS DR	None	THOUSAND OAKS	CA	91361	1050	56	06111	34.17439717	-118.8691161	Ventura County
115294	Fee-for-Service	1518321454	1518321454	1	1	LI, MENGJIE DO	2/24/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16036	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
115384	Fee-for-Service	1891739595	1891739595	1	1	LILLIE, DUSTIN M MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81968	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
115389	Fee-for-Service	1588734982	1588734982	1	1	LANEY, LORNA L CNP	12/10/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	29610 RANCHO CALIFORNIA	None	TEMECULA	CA	92591	5283	33	06065	33.50455159	-117.1462052	Riverside County
115409	Fee-for-Service	1770519621	1770519621	1	1	LOUIE, MARTIN D MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	41284	08	Family Practice	0	In state provider	None	3878 43RD ST	None	SAN DIEGO	CA	92105	2604	37	06073	32.749092	-117.1020575	San Diego County
115415	Fee-for-Service	1417932807	1417932807	1	1	LE, DIANA	4/1/2003	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	KHANH PHARMACY	4575 EL CAJON BLVD	STE C	SAN DIEGO	CA	92115	4390	37	06073	32.75550844	-117.0958574	San Diego County
115422	Fee-for-Service	1649347816	1649347816	1	1	LU, HELEN K MD	8/1/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	75083	01	General Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
115447	Fee-for-Service	1194412692	1194412692	1	1	LOGO, DAWNESHIA DOULA	11/20/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
115456	Fee-for-Service	1164408621	1164408621	1	1	LAMMERS, CATHLEEN R MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53841	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
115465	Fee-for-Service	1356398077	1356398077	1	1	LOSKOTA, WILLIAM J MD	10/11/1991	207L00000X	NA	Other	026	PHYSICIANS	38563	05	Anesthesiology	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
115476	Fee-for-Service	1477620490	1477620490	1	1	LENTZ, SCOTT E MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65034	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
115477	Fee-for-Service	1962471292	1962471292	1	1	LEON, JOSE RICARDO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36705	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	450 4TH AVE	STE 209	CHULA VISTA	CA	91910	4428	37	06073	32.63513513	-117.0820663	San Diego County
115490	Fee-for-Service	1316031735	1316031735	1	1	LIN, JAMES C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1319 PUNAHOU ST	None	HONOLULU	HI	96826	1001	00	None	21.30030321	-157.8342762	Honolulu County
115495	Fee-for-Service	1336277847	1336277847	1	1	LUPTON, KATHERINE L MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98097	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
115527	Fee-for-Service	1659356962	1659356962	1	1	LOWERY, MATHEW MD.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 E BOULDER ST	None	COLORADO SPGS	CO	80909	5533	00	None	38.8388119	-104.7995065	El Paso County
115530	Fee-for-Service	1255779187	1255779187	1	1	LAKEWOOD HOME HEALTH &	2/9/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	539 N GLENOAKS BLVD	STE 301F	BURBANK	CA	91502	3209	19	06037	34.18652984	-118.310858	Los Angeles County
115536	Fee-for-Service	1104116045	1104116045	1	1	LEWMAN, NATALIE M DO	10/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
115557	Fee-for-Service	1740619006	1740619006	1	1	LEE, EUN J LAC	1/2/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	13141 CENTURY BLVD	None	GARDEN GROVE	CA	92843	1211	30	06059	33.77204537	-117.9423678	Orange County
115558	Fee-for-Service	1134345630	1134345630	1	1	LOU, YANQIN MD	9/21/2010	207L00000X	NA	Other	026	PHYSICIANS	68741	05	Anesthesiology	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
115601	Fee-for-Service	1831519115	1831519115	1	1	LAM, RICHARD MD	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143551	41	Internal Medicine	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
115620	Fee-for-Service	1275980609	1275980609	1	1	LIVELY, KATHARINE LMFT	6/10/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	572 RIO LINDO AVE	STE 203	CHICO	CA	95926	1851	04	06007	39.75508407	-121.8487933	Butte County
115626	Fee-for-Service	1295883155	1295883155	1	1	LEWIS, RICHARD E MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	60815	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
115646	Fee-for-Service	1780072868	1780072868	1	1	LIGHTNING, ALEXANDRIA NP	10/28/2021	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
115676	Fee-for-Service	1639474265	1639474265	1	1	LIGHTHOUSE DIALYSIS LLC	6/30/2011	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1345 W BUSH STREET	None	LEMOORE	CA	93245	0000	16	06031	36.29824054	-119.7997515	Kings County
115688	Fee-for-Service	1801038237	1801038237	1	1	LEITNER, ANDREW T MD	2/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112734	05	Anesthesiology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
115693	Fee-for-Service	1770519621	1770519621	1	1	LOUIE, MARTIN D MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	41284	02	General Surgery	0	In state provider	None	3878 43RD ST	None	SAN DIEGO	CA	92105	2604	37	06073	32.749092	-117.1020575	San Diego County
115701	Fee-for-Service	1427341155	1427341155	1	1	LINKER, DEBRA T MD	9/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123223	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
115721	Fee-for-Service	1811209703	1811209703	1	1	LIANG, MARGARET I MD	9/29/2022	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	129492	None	None	0	In state provider	None	8700 BEVERLY BLVD	# 3611	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
115744	Fee-for-Service	1932259306	1932259306	1	1	LOWENSTEIN, ADAM MD	6/24/2010	174400000X	NA	Other	026	PHYSICIANS	87853	24	Plastic Surgery	0	In state provider	None	1110 COAST VILLAGE CIR	None	SANTA BARBARA	CA	93108	2711	42	06083	34.42093191	-119.6475139	Santa Barbara County
115754	Fee-for-Service	1558439281	1558439281	1	1	LABARBERA, MARIANNE C MD	10/7/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	50947	None	None	0	In state provider	None	2331 A MONTPELIER DR	STE 20	SAN JOSE	CA	95116	1688	43	06085	37.3649965	-121.8479359	Santa Clara County
115766	Fee-for-Service	1487923322	1487923322	1	1	LE, QUYNH-HOA T DO	11/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12032	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
115783	Fee-for-Service	1891851325	1891851325	1	1	LIU, CHIA-SHANG J MD	4/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116834	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
115792	Fee-for-Service	1821676081	1821676081	1	1	LEE, MOSES S DO	10/25/2024	208M00000X	NA	Other	026	PHYSICIANS	22221	41	Internal Medicine	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
115808	Fee-for-Service	1679950349	1679950349	1	1	LOPEZ, KIMBERLY CNM	2/2/2025	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
115811	Fee-for-Service	1881617652	1881617652	1	1	LAC, PETER T M MD	6/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91135	41	Internal Medicine	0	In state provider	None	1011 E. DEVONSHIRE AVE	#201	HEMET	CA	92543	3033	33	06065	33.75118151	-116.9615025	Riverside County
115814	Fee-for-Service	1063723211	1063723211	1	1	LEE, DENNIS J MD	7/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112770	34	Urology and Urological Surgery	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
115836	Fee-for-Service	1326624073	1326624073	1	1	LIANG, SHUANG AN MD	8/28/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	192339	40	Pediatrics	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
115858	Fee-for-Service	1659448462	1659448462	1	1	LUNA, ELISE N MD	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74620	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
115864	Fee-for-Service	1609876895	1609876895	1	1	LAWSON, DONALD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4300 ALTON ROAD	None	MIAMI BEACH	FL	33140	2800	00	None	25.81334191	-80.139276	Miami-Dade County
115886	Fee-for-Service	1003867912	1003867912	1	1	LIN, ALEXANDER M MD	5/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80259	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
115912	Fee-for-Service	1295883155	1295883155	1	1	LEWIS, RICHARD E MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	60815	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
115927	Fee-for-Service	1750440400	1750440400	1	1	LIEU, KIET V MD	3/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82427	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
115992	Fee-for-Service	1932971678	1932971678	1	1	LAWSON, CAITLIN NP	1/30/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1313 E HERNDON AVE	101B/203-206	FRESNO	CA	93720	3306	10	06019	36.834984	-119.7641925	Fresno County
115994	Fee-for-Service	1285175695	1285175695	1	1	LALANI, NAINA MD	9/1/2020	207R00000X	NA	Other	026	PHYSICIANS	158556	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
116022	Fee-for-Service	1659578805	1659578805	1	1	LANDAU, BRIAN LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
116029	Fee-for-Service	1215011283	1215011283	1	1	LEGGETT, WILLIAM C MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92010	41	Internal Medicine	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
116043	Fee-for-Service	1427391747	1427391747	1	1	LAGOS-JARAMILLO, VERONICA I	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135400	41	Internal Medicine	0	In state provider	MD	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
116071	Fee-for-Service	1154689248	1154689248	1	1	LIU, JOSEPH N MD	8/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157220	20	Orthopedic Surgery	0	In state provider	None	25455 BARTON RD	101B 102B 104B 106B	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
116095	Fee-for-Service	1114709037	1114709037	1	1	LANCASTER URGENT CARE INC	3/14/2024	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1331 W AVENUE J	SUITE 101	LANCASTER	CA	93534	2942	19	06037	34.68946152	-118.155699	Los Angeles County
116099	Fee-for-Service	1881617652	1881617652	1	1	LAC, PETER T M MD	6/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91135	45	Nephrology (Renal-Kidney)	0	In state provider	None	1011 E. DEVONSHIRE AVE	#201	HEMET	CA	92543	3033	33	06065	33.75118151	-116.9615025	Riverside County
116103	Fee-for-Service	1255410957	1255410957	1	1	LAM, EDUARDO D MD	1/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93915	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
116112	Fee-for-Service	1225010069	1225010069	1	1	LASLETT, LAWRENCE MD	7/26/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	34496	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
116114	Fee-for-Service	1063561348	1063561348	1	1	LEE, TAEK-CHOON J MD	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81323	66	Emergency Medicine (Urgent Care)	0	In state provider	ATTN MGA OFFICE	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
116117	Fee-for-Service	1316238561	1316238561	1	1	LIM, MICHELLE J MD	8/14/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	135787	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
116133	Fee-for-Service	1023219466	1023219466	1	1	L&N, INC	4/25/2005	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	NEAL'S HOME	25247 CALAROGA AVE	None	HAYWARD	CA	94545	2503	01	06001	37.64475041	-122.0990704	Alameda County
116150	Fee-for-Service	1437268505	1437268505	1	1	LANDMAN, JAMIE MD	12/3/2010	174400000X	NA	Other	026	PHYSICIANS	88840	34	Urology and Urological Surgery	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
116187	Fee-for-Service	1528033925	1528033925	1	1	LASHGARI, ALI R MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	78121	07	Dermatology	0	In state provider	None	1111 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3131	15	06029	35.64171	-117.669847	Kern County
116200	Fee-for-Service	1295883155	1295883155	1	1	LEWIS, RICHARD E MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	60815	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
116218	Fee-for-Service	1801830633	1801830633	2	1	LONGS DRUG STORES CA LLC	12/8/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8101 GREENBACK LANE	None	FAIR OAKS	CA	95628	2502	34	06067	38.679237	-121.261662	Sacramento County
116221	Fee-for-Service	1992186662	1992186662	1	1	LAU, DEANNA DO	5/26/2021	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	18785	None	None	0	In state provider	None	121 SOTOYOME ST	None	SANTA ROSA	CA	95405	4823	49	06097	38.44224	-122.70195	Sonoma County
116238	Fee-for-Service	1922358506	1922358506	1	1	LEE, YIHSIN	2/10/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
116271	Fee-for-Service	1164774691	1164774691	1	1	LAM, JOHN K MD PC	11/8/2012	2086S0127X	NA	General Surgery	026	PHYSICIANS	122862	89	Surgery-Traumatic	0	In state provider	None	W 5TH AVE & ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.741948	-121.848921	Butte County
116276	Fee-for-Service	1770582967	1770582967	2	1	LAVIAN, DAVID MD	8/14/2011	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	46370	08	Family Practice	0	In state provider	None	14600 SHERMAN WY	STE 215	VAN NUYS	CA	91405	5050	19	06037	34.20025916	-118.4500763	Los Angeles County
116287	Fee-for-Service	1881661767	1881661767	1	1	LI, BENJAMIN K MD	5/1/1998	207L00000X	NA	Other	026	PHYSICIANS	60762	05	Anesthesiology	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
116297	Fee-for-Service	1083436356	1083436356	1	1	LOI THANH MAI OD INC	1/1/2025	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	16106 BELLFLOWER BLVD	None	BELLFLOWER	CA	90706	4606	19	06037	33.8880183	-118.1252595	Los Angeles County
116313	Fee-for-Service	1770035024	1770035024	1	7	LANDMARK ANESTHESIA MEDICAL	4/8/2021	193400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4929 VAN NUYS	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
116393	Fee-for-Service	1215965322	1215965322	1	1	LEE, TAI K MD	8/5/2008	207L00000X	NA	Other	026	PHYSICIANS	69722	05	Anesthesiology	0	In state provider	None	15107 VANOWEN STREET	None	VAN NUYS	CA	91405	4597	19	06037	34.19395645	-118.463265	Los Angeles County
116397	Fee-for-Service	1700875150	1700875150	1	1	LU, DENNIS C MD	6/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100729	18	Ophthalmology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
116404	Fee-for-Service	1740821172	1740821172	1	1	LAMBOY, ALLISON N NP	11/25/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
116406	Fee-for-Service	1124595368	1124595368	1	1	LUCENT OPTOMETRY MONTCLAIR I	1/5/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	471 N CENTRAL AVE	None	UPLAND	CA	91786	4219	36	06071	34.099308	-117.689689	San Bernardino County
116463	Fee-for-Service	1023169513	1023169513	1	1	LECHLEITNER, RITA L MD	10/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	63237	02	General Surgery	0	In state provider	None	2581 SAMARITAN DR	None	SAN JOSE	CA	95124	4112	43	06085	37.25305684	-121.9507351	Santa Clara County
116487	Fee-for-Service	1689723900	1689723900	1	1	LEE, HERBERT K MD	10/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79550	25	Physical Medicine and Rehabilitation	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
116513	Fee-for-Service	1285931782	1285931782	1	1	LI, WALTER CHUNG KAY PT	3/24/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	Y/ DELANO THERAPY SERVIC	1004 14TH AVE	A	DELANO	CA	93215	2246	15	06029	35.77449518	-119.2451571	Kern County
116518	Fee-for-Service	1538203583	1538203583	1	1	LANDIS, BRADLEY MD	7/31/1985	208800000X	NA	Other	026	PHYSICIANS	42058	34	Urology and Urological Surgery	0	In state provider	None	1300 N VERMONT	STE 1003	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
116540	Fee-for-Service	1568753903	1568753903	1	1	LYDIA WASHER	2/26/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 GENE GEORGE BLVD	None	SPRINGDALE	AR	72762	0845	00	None	36.162234	-94.190292	Washington County
116552	Fee-for-Service	1174813364	1174813364	1	1	LE, HUNG Q MD	8/28/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	134679	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
116553	Fee-for-Service	1376863951	1376863951	1	1	LA JOLLA ENDOSCOPY CTR	12/1/1999	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	9850 GENESEE AVE	STE 980	LA JOLLA	CA	92037	1234	37	06073	32.882913	-117.226341	San Diego County
116554	Fee-for-Service	1962550947	1962550947	1	1	LEVIN, BARRY MD	1/31/1987	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	60642	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
116596	Fee-for-Service	1770035024	1770035024	1	7	LANDMARK ANESTHESIA MEDICAL	3/11/2021	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4929 VAN NUYS	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
116610	Fee-for-Service	1134279995	1134279995	1	1	LEE, OLIVIA L MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108933	18	Ophthalmology	0	In state provider	None	100 STEIN PLAZA	RM 1340	LOS ANGELES	CA	90074	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
116622	Fee-for-Service	1184004772	1184004772	1	1	LE, HAI D MD	2/26/2018	163WG0000X	NA	Other	026	PHYSICIANS	151243	01	General Practice	0	In state provider	None	1524 MCHENRY AVE	SUITE 370	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
116643	Fee-for-Service	1336108596	1336108596	1	1	LOPEZ, ALVARO B MD	6/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	45652	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
116650	Fee-for-Service	1275735987	1275735987	1	1	LOKSH, ANNA MD	7/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85108	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	B186 CHS	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
116651	Fee-for-Service	1093748766	1093748766	1	1	LAMBERT, SCOTT R MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	53052	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
116657	Fee-for-Service	1699194001	1699194001	1	1	LOICA-MERSA, SILVA MD	8/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138111	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
116718	Fee-for-Service	1134328735	1134328735	1	1	LIM, KELLIE J MD	8/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106613	03	Allergy	0	In state provider	None	7471 N FRESNO ST	None	FRESNO	CA	93720	2457	10	06019	36.84632065	-119.783885	Fresno County
116741	Fee-for-Service	1518068931	1518068931	1	1	LAI, THUAN DUC	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43047	01	General Practice	0	In state provider	None	1359 N FRESNO ST	None	FRESNO	CA	93703	3837	10	06019	36.76061876	-119.7815093	Fresno County
116778	Fee-for-Service	1992776108	1992776108	1	1	LUA, JESUS MD	3/19/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	50698	08	Family Practice	0	In state provider	None	360 E 7TH STREET	A	UPLAND	CA	91786	6701	36	06071	34.08880374	-117.6465151	San Bernardino County
116779	Fee-for-Service	1457512071	1457512071	1	1	LEE, ROBERT Y MD	4/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107544	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
116781	Fee-for-Service	1700889128	1700889128	1	1	LY UYEN T MD	5/1/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	76278	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
116804	Fee-for-Service	1700809829	1700809829	1	1	LEGACY SALMON CREEK HOSP	8/27/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2211 NE 139TH ST	None	VANCOUVER	WA	98686	2742	00	None	45.720117	-122.647986	Clark County
116816	Fee-for-Service	1164459400	1164459400	1	1	LOMBARD, MATTHEW R MD	5/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	75012	01	General Practice	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
116840	Fee-for-Service	1023402286	1023402286	1	1	LEE, JAY KYUNG MD APC	12/22/2014	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	85767	None	None	0	In state provider	None	7724 CALIFORNIA AVE	None	RIVERSIDE	CA	92504	2509	33	06065	33.94557281	-117.4180549	Riverside County
116858	Fee-for-Service	1093057499	1093057499	2	1	LIM, GRACE X MD	12/27/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	143319	None	None	0	In state provider	None	117 W BUNNY AVE	None	SANTA MARIA	CA	93458	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
116859	Fee-for-Service	1659349496	1659349496	1	1	LIN, CAROLINE L MD	9/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94027	05	Anesthesiology	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
116867	Fee-for-Service	1194768077	1194768077	1	2	LEW, CLARKE R MD	5/24/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	54668	-	NOT APPLICABLE	0	In state provider	None	3535 W COMMONWEALTH AVE	None	FULLERTON	CA	92833	2821	30	06059	33.8700505	-117.9749565	Orange County
116868	Fee-for-Service	1639180375	1639180375	1	1	LYDON, EDWARD J	2/8/2015	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	LYDONS ORTHOTIC SERVICE	1200 WESTERN ST	STE B	FAIRFIELD	CA	94533	2474	48	06095	38.27426233	-122.008423	Solano County
116872	Fee-for-Service	1831623974	1831623974	1	1	LOBUGLIO, MARISA LMFT	6/19/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	134923	-	NOT APPLICABLE	0	In state provider	None	6022 VARIEL AVENUE	None	WOODLAND HILLS	CA	91367	3719	19	06037	34.180029	-118.592771	Los Angeles County
116881	Fee-for-Service	1346571643	1346571643	1	1	LILLY, MATTHEW N MD	11/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127216	36	Psychiatry	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
116933	Fee-for-Service	1114459575	1114459575	1	1	LE, DUC P MD	7/21/2022	207L00000X	NA	Other	026	PHYSICIANS	160485	None	None	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
116945	Fee-for-Service	1851142558	1851142558	1	1	LANDEGGER, LUKAS MD	10/3/2024	207YX0901X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
116974	Fee-for-Service	1366721680	1366721680	1	1	LANDA, KATRINA N MD	7/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122931	01	General Practice	0	In state provider	None	58471 29 PALMS HWY	#303	YUCCA VALLEY	CA	92284	5818	36	06071	34.13270029	-116.3881647	San Bernardino County
116978	Fee-for-Service	1588762694	1588762694	1	1	LIU, JINGYAN RCP	12/16/2022	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
116990	Fee-for-Service	1770024093	1770024093	1	1	LOWE, ASHLEY C NP	9/10/2023	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	320 SANTA FE DRIVE	SUITE 305	ENCINITAS	CA	92024	2526	37	06073	33.038847	-117.285579	San Diego County
116998	Fee-for-Service	1962685222	1962685222	1	1	LARSEN, MICHAEL C MD	6/1/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	97376	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
117016	Fee-for-Service	1861824872	1861824872	1	1	LOPEZ, MIGUEL A CRNA	6/9/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11911 CENTRAL AVE	None	CHINO	CA	91710	1906	36	06071	34.03704117	-117.6893971	San Bernardino County
117018	Fee-for-Service	1942241187	1942241187	1	1	LIN, DAVID MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86588	None	None	0	In state provider	None	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
117028	Fee-for-Service	1417507294	1417507294	1	1	LUCE, JILL CRNA	2/21/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
117030	Fee-for-Service	1518068931	1518068931	1	1	LAI, THUAN DUC	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43047	41	Internal Medicine	0	In state provider	None	1359 N FRESNO ST	None	FRESNO	CA	93703	3837	10	06019	36.76061876	-119.7815093	Fresno County
117045	Fee-for-Service	1447414396	1447414396	1	1	LEE, RICHARD J MD	2/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101616	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
117050	Fee-for-Service	1366995433	1366995433	1	1	LOCHER, MICHAEL MD	11/12/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	147992	36	Psychiatry	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
117053	Fee-for-Service	1295187185	1295187185	1	1	LIN, JOSEPHINE, OD	7/11/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3605 HOSPITAL RD	None	ATWATER	CA	95301	5173	24	06047	37.36678073	-120.576731	Merced County
117055	Fee-for-Service	1649613647	1649613647	1	1	LEE, SUN YOUNG MD	1/31/2022	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	133520	None	None	0	In state provider	None	1450 SAN PABLO ST	STE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
117068	Fee-for-Service	1700889128	1700889128	1	1	LY UYEN T MD	5/1/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	76278	01	General Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
117075	Fee-for-Service	1770661449	1770661449	1	1	LEMIEUX, JULIE MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	58085	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95616	6325	57	06113	38.5399459	-121.7284328	Yolo County
117078	Fee-for-Service	1124257480	1124257480	1	1	LEE, JUNE S MD	11/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	50043	40	Pediatrics	0	In state provider	None	7501 HOSPITAL DR	STE 203	SACRAMENTO	CA	95823	5405	34	06067	38.464776	-121.416912	Sacramento County
117093	Fee-for-Service	1700809829	1700809829	1	1	LEGACY SALMON CREEK HOSP	8/27/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2211 NE 139TH ST	None	VANCOUVER	WA	98686	2742	00	None	45.720117	-122.647986	Clark County
117096	Fee-for-Service	1538248679	1538248679	1	1	LIN, HOWARD C MD	11/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	81607	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
117117	Fee-for-Service	1679767800	1679767800	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2100 COLUMBUS PKWY	None	BENICIA	CA	94510	5402	48	06095	38.08140041	-122.1925109	Solano County
117127	Fee-for-Service	1205415437	1205415437	1	1	LIFESTYLE HOSPICE INC	11/3/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2600 FOOTHILL BLVD	SUITE 110	LA CRESCENTA	CA	91214	4578	19	06037	34.22121465	-118.2352382	Los Angeles County
117153	Fee-for-Service	1720472277	1720472277	1	1	LEE, BRYAN MD	11/30/2018	207R00000X	NA	Other	026	PHYSICIANS	152378	41	Internal Medicine	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
117155	Fee-for-Service	1083972483	1083972483	1	1	LAKHERA, YOGITA MD	1/22/2014	207RN0300X	NA	Nephrology	026	PHYSICIANS	125173	45	Nephrology (Renal-Kidney)	0	In state provider	None	9834 GENESEE AVE	SUITE 312	LA JOLLA	CA	92037	1214	37	06073	32.884074	-117.225855	San Diego County
117166	Fee-for-Service	1184895799	1184895799	1	1	LENNON, MAZAIRA LCSW	2/22/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1652 WEST AVE J	None	LANCASTER	CA	93534	2814	19	06037	34.6893627	-118.1602957	Los Angeles County
117187	Fee-for-Service	1538659321	1538659321	1	1	LIAO, SHERRY MD	9/27/2022	208M00000X	NA	Other	026	PHYSICIANS	164018	None	None	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
117188	Fee-for-Service	1033677489	1033677489	1	1	LEBLANG, STEPHANIE E MD	10/10/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	188698	None	None	0	In state provider	None	2185 CITRACADA PARKWAY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
117193	Fee-for-Service	1215176995	1215176995	1	1	LIMAGE RUSSO, MAGDALA CRNA	6/24/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
117194	Fee-for-Service	1568715324	1568715324	1	1	LIM, HENGKY NP	6/22/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43112 N 15 WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
117213	Fee-for-Service	1841645488	1841645488	1	1	LIPKIN, SAMUEL H MD	8/24/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	153932	36	Psychiatry	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
117305	Fee-for-Service	1558627059	1558627059	1	1	LEWIN, SARA E MD	7/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	127107	10	Gastroenterology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
117330	Fee-for-Service	1871595710	1871595710	1	1	LIN, DANNY Y MD	6/12/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72782	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	RM 1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
117377	Fee-for-Service	1447405204	1447405204	1	1	LIU, MINGHSUN MD PHD PC	12/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85950	None	None	0	In state provider	None	11103 VENICE BLVD	None	LOS ANGELES	CA	90034	6914	19	06037	34.01379685	-118.4159354	Los Angeles County
117384	Fee-for-Service	1164583753	1164583753	1	1	LUK, LINCOLN	6/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	43123	22	Pathology (M.D. only)	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	3011	19	06037	33.94909549	-118.3481595	Los Angeles County
117416	Fee-for-Service	1205415437	1205415437	1	1	LIFESTYLE HOSPICE INC	11/3/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2600 FOOTHILL BLVD	SUITE 110	LA CRESCENTA	CA	91214	4578	19	06037	34.22121465	-118.2352382	Los Angeles County
117417	Fee-for-Service	1124051354	1124051354	1	1	LANDMARK IMAGING MEDICAL	10/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP INC	11620 WILSHIRE BLVD	STE 100	LOS ANGELES	CA	90025	6801	19	06037	34.05024415	-118.4598908	Los Angeles County
117420	Fee-for-Service	1124081807	1124081807	1	1	LANDAY, MICHAEL J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
117425	Fee-for-Service	1538397765	1538397765	1	1	LONGORIA, JAVIER A MD	5/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115684	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
117444	Fee-for-Service	1083972483	1083972483	1	1	LAKHERA, YOGITA MD	1/22/2014	207RN0300X	NA	Nephrology	026	PHYSICIANS	125173	41	Internal Medicine	0	In state provider	None	9834 GENESEE AVE	SUITE 312	LA JOLLA	CA	92037	1214	37	06073	32.884074	-117.225855	San Diego County
117460	Fee-for-Service	1396767653	1396767653	1	1	LUI, PAUL D MD	7/29/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	55528	02	General Surgery	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
117497	Fee-for-Service	1891740940	1891740940	1	1	LAM, KHOI A MD	8/25/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75007	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
117499	Fee-for-Service	1497149504	1497149504	1	1	LYONS, MATTHEW J DO	8/6/2019	207L00000X	NA	Other	026	PHYSICIANS	17257	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
117500	Fee-for-Service	1265629638	1265629638	1	1	LEE, ARTHUR T MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96664	20	Orthopedic Surgery	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
117501	Fee-for-Service	1811481914	1811481914	1	1	LIN, DANA DPM	5/5/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2131 SAN JOAQUIN HILLS	None	NEWPORT BEACH	CA	92660	6507	30	06059	33.61632004	-117.8687553	Orange County
117507	Fee-for-Service	1912467630	1912467630	1	1	LIN, GWEN D MD	9/21/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	180106	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
117516	Fee-for-Service	1174689715	1174689715	1	1	LOUIS & MARY JO WONG	12/13/1984	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2200 W 3RD ST	STE 390	LOS ANGELES	CA	90057	2386	19	06037	34.06329642	-118.2739484	Los Angeles County
117520	Fee-for-Service	1811927981	1811927981	1	1	LYCHE, KIP D MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	62357	10	Gastroenterology (M.D. only)	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
117548	Fee-for-Service	1841480159	1841480159	1	1	LONG, COREY M MD	8/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109270	None	None	0	In state provider	None	3901 LONE TREE WY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
117560	Fee-for-Service	1033388517	1033388517	1	2	LUON W PENG DO INC	12/29/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	45	Nephrology (Renal-Kidney)	0	In state provider	None	3731 E 3RD ST	None	LOS ANGELES	CA	90063	2401	19	06037	34.03338991	-118.1883007	Los Angeles County
117617	Fee-for-Service	1639108772	1639108772	1	1	LEARY, MARK MD	11/17/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	60430	None	None	0	In state provider	None	1001 POTRERO AVE	RM 7M	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
117618	Fee-for-Service	1285732859	1285732859	1	1	LOGAN, JOY L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
117619	Fee-for-Service	1902193360	1902193360	1	1	LANGUB, JOSEPH MD	10/4/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	125467	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
117661	Fee-for-Service	1316472046	1316472046	2	1	LOMIBAO, MADALINE A	5/2/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8788 ELK GROVE BLVD	BLDG 3, STE 12E	ELK GROVE	CA	95624	1766	34	06067	38.408382	-121.3770645	Sacramento County
117669	Fee-for-Service	1558833970	1558833970	1	1	LIANG, ERIC CCC-SLP	5/16/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
117676	Fee-for-Service	1104906411	1104906411	1	1	LU, DAVID S MD INC	1/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	66695	None	None	0	In state provider	None	4201 TORRANCE BLVD	SUITE 530	TORRANCE	CA	90503	4509	19	06037	33.8375955	-118.358748	Los Angeles County
117677	Fee-for-Service	1235284811	1235284811	1	1	LOS ANGELES COUNTY CCS	9/15/1993	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	LA PUENTE MTU	800 TONOPAH AVE	None	LA PUENTE	CA	91744	2460	19	06037	34.04505913	-117.9675733	Los Angeles County
117681	Fee-for-Service	1881208445	1881208445	1	1	LITTON, HANNAH J AU	9/1/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
117735	Fee-for-Service	1235161449	1235161449	1	1	LIU, JOHN C MD	3/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	88822	14	Neurological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
117748	Fee-for-Service	1396767653	1396767653	1	1	LUI, PAUL D MD	7/29/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	55528	34	Urology and Urological Surgery	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
117777	Fee-for-Service	1144288069	1144288069	1	1	LAZAR, ANTHONY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SW IOWA CARDIOLOGY ASSOC	1223 S. GEAR AVE.,	SUITE 109	WEST BURLINGTON	IA	82655	0000	00	None	40.809789	-91.1727495	Des Moines County
117809	Fee-for-Service	1851515142	1851515142	1	1	LINARES, ERNEST A	4/15/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
117810	Fee-for-Service	1033200902	1033200902	1	1	LIVONI, JOHN MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	34484	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
117822	Fee-for-Service	1679567051	1679567051	1	1	LE, THANH U T MD	4/30/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55016	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	143 E MAIN ST	None	LOS GATOS	CA	95030	6903	43	06085	37.22117263	-121.9775316	Santa Clara County
117878	Fee-for-Service	1831843564	1831843564	1	1	LLAMAS, ANGELICA CRNA	10/7/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
117904	Fee-for-Service	1093959991	1093959991	1	1	LAZAR, JANET S MFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	53954	-	NOT APPLICABLE	0	In state provider	None	15305 RAYEN STREET	None	NORTH HILLS	CA	91343	5117	19	06037	34.23191048	-118.4657625	Los Angeles County
117905	Fee-for-Service	1194049379	1194049379	1	1	LOOPER, LOUIS A AU	2/11/2022	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 MORNING STAR	None	SONORA	CA	95370	5193	55	06109	37.98487014	-120.3706904	Tuolumne County
117909	Fee-for-Service	1205280146	1205280146	1	1	LEUNG, ALISON	12/27/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
117912	Fee-for-Service	1255499174	1255499174	1	1	LILAC HOLDINGS LLC	1/18/2007	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6061 BANBURY ST	None	SAN DIEGO	CA	92139	3624	37	06073	32.6710696	-117.0601576	San Diego County
117917	Fee-for-Service	1164034476	1164034476	1	1	LAKHOVSKY, MIHAL PT	3/8/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
117929	Fee-for-Service	1750466728	1750466728	1	1	LEE, BOO W MD	12/31/1981	207R00000X	NA	Other	026	PHYSICIANS	38393	41	Internal Medicine	0	In state provider	None	2040 FOREST AVE	STE 3	SAN JOSE	CA	95128	4800	43	06085	37.3270506	-121.9347674	Santa Clara County
117946	Fee-for-Service	1720152333	1720152333	1	1	LAPUNZINA, PAUL M MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85362	08	Family Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
117950	Fee-for-Service	1770035024	1770035024	1	6	LANDMARK ANESTHESIA MEDICAL	3/11/2021	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1350 W COVINA BLVD	None	SAN DIMAS	CA	91723	3245	19	06037	34.09906108	-117.8343639	Los Angeles County
117959	Fee-for-Service	1225689276	1225689276	1	1	LEE, JOSEPHINE LMFT	6/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
117972	Fee-for-Service	1215339437	1215339437	2	1	LOS ROBLES HEALTHCARE LLC	10/22/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11838 BERNARDO PLAZA CT	STE 260B	SAN DIEGO	CA	92128	2434	37	06073	33.02037119	-117.0760729	San Diego County
117976	Fee-for-Service	1891010120	1891010120	1	1	LIN, MICHAEL C MD	4/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100504	30	Radiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
117995	Fee-for-Service	1356573570	1356573570	1	1	LI, ANDREW MD	9/1/2019	208200000X	NA	General Surgery	026	PHYSICIANS	113865	24	Plastic Surgery	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
118021	Fee-for-Service	1255658076	1255658076	1	1	LIPANA, LAWRENCE EIDREF S MD	9/12/2019	207L00000X	NA	Other	026	PHYSICIANS	128220	05	Anesthesiology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
118039	Fee-for-Service	1538299334	1538299334	1	1	LEE, BENJAMIN C MD	8/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95001	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
118049	Fee-for-Service	1427224203	1427224203	1	1	LOH, SHAUN MD	10/26/2010	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	102669	30	Radiology	0	In state provider	None	975 SEREN DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
118052	Fee-for-Service	1366584419	1366584419	1	1	LIU, BEN LAC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	BEN LIU ACUPUNCTURE	328 10TH ST	STE 220	OAKLAND	CA	94607	4214	01	06001	37.80038524	-122.2698559	Alameda County
118056	Fee-for-Service	1346296407	1346296407	1	1	LITT, LAWRENCE MD	12/1/1982	207L00000X	NA	Other	026	PHYSICIANS	42550	05	Anesthesiology	0	In state provider	U C MEDICAL CENTER	513 PARNASSUS AVE	# S436	SAN FRANCISCO	CA	94143	2205	38	06075	37.76344756	-122.4581992	San Francisco County
118110	Fee-for-Service	1679567051	1679567051	1	1	LE, THANH U T MD	4/30/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55016	08	Family Practice	0	In state provider	None	143 E MAIN ST	None	LOS GATOS	CA	95030	6903	43	06085	37.22117263	-121.9775316	Santa Clara County
118117	Fee-for-Service	1184702268	1184702268	1	1	LEVINE, PETER L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32777	40	Pediatrics	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
118122	Fee-for-Service	1821392507	1821392507	1	1	LY, LUONG T MD INC	2/15/2011	193400000X	NA	Other	026	PHYSICIANS	86007	77	Infectious Disease	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
118133	Fee-for-Service	1730101619	1730101619	1	1	LOHMAN, BRUCE E MD	2/28/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	30389	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
118163	Fee-for-Service	1114036142	1114036142	1	1	LEE, KEITH L M MD	7/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75624	34	Urology and Urological Surgery	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
118197	Fee-for-Service	1205280146	1205280146	1	1	LEUNG, ALISON	12/27/2024	207P00000X	NA	Other	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
118207	Fee-for-Service	1790103885	1790103885	1	1	LIGHTFOOT-SIORDIA, CATRISSA	12/20/2018	207L00000X	NA	Other	026	PHYSICIANS	155707	05	Anesthesiology	0	In state provider	L MD	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
118218	Fee-for-Service	1750466728	1750466728	1	1	LEE, BOO W MD	12/31/1981	207R00000X	NA	Other	026	PHYSICIANS	38393	40	Pediatrics	0	In state provider	None	2040 FOREST AVE	STE 3	SAN JOSE	CA	95128	4800	43	06085	37.3270506	-121.9347674	Santa Clara County
118230	Fee-for-Service	1255750568	1255750568	1	1	LEE, BONNY MD	8/1/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	162786	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
118237	Fee-for-Service	1770035024	1770035024	1	6	LANDMARK ANESTHESIA MEDICAL	4/8/2021	193400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1350 W COVINA BLVD	None	SAN DIMAS	CA	91723	3245	19	06037	34.09906108	-117.8343639	Los Angeles County
118262	Fee-for-Service	1568669976	1568669976	1	1	LEUNG, PETER W MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10615	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
118263	Fee-for-Service	1215339437	1215339437	2	1	LOS ROBLES HEALTHCARE LLC	10/22/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11838 BERNARDO PLAZA CT	STE 260B	SAN DIEGO	CA	92128	2434	37	06073	33.02037119	-117.0760729	San Diego County
118273	Fee-for-Service	1922092527	1922092527	1	1	LAGRO, RONALD MD	11/30/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	71290	08	Family Practice	0	In state provider	None	824 PINE ST	None	MOUNT SHASTA	CA	96067	2137	47	06093	41.31718861	-122.3207167	Siskiyou County
118286	Fee-for-Service	1518166016	1518166016	1	1	LO, YUE MAN ONNA MD	6/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101813	08	Family Practice	0	In state provider	None	3325 CHANATE ROAD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
118295	Fee-for-Service	1659451797	1659451797	1	1	LIAO, SOLOMON S MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61444	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
118309	Fee-for-Service	1396170296	1396170296	1	1	LOPEZ, CESAR LCSW	2/28/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12440 FIRESTONE BLVD	3001	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
118313	Fee-for-Service	1013664598	1013664598	1	1	LEVIN, JANE LCSW	12/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4199 CAMPUS DR	SUITE 550, OFFICE 57	IRVINE	CA	92612	4684	30	06059	33.650775	-117.838296	Orange County
118322	Fee-for-Service	1801017876	1801017876	1	1	LEPP, NATHAN T. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
118411	Fee-for-Service	1265498570	1265498570	1	1	LENZ, ANITA I MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	38207	08	Family Practice	0	In state provider	None	9041 MAGNOLIA AVE	SUITE 206	RIVERSIDE	CA	92503	3956	33	06065	33.92541585	-117.4378266	Riverside County
118421	Fee-for-Service	1730101619	1730101619	1	1	LOHMAN, BRUCE E MD	2/28/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	30389	38	Geriatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
118423	Fee-for-Service	1265466189	1265466189	1	1	LITTLE COMPANY OF MARY ANCIL	6/2/2021	261QR0200X	NA	Mammography/MRI Provider	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	MARY OUTPATIENT IMAGING	5215 TORRANCE BLVD	STE 110	TORRANCE	CA	90503	4009	19	06037	33.83760237	-118.3692467	Los Angeles County
118436	Fee-for-Service	1649378597	1649378597	1	1	LUEKEMEYER, DENNIS C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1509 UNION AVE	None	MOBERLY	MO	65270	9407	00	None	39.42392494	-92.41605198	Randolph County
118451	Fee-for-Service	1003850199	1003850199	1	1	LAKSHMANAN, VIJAYALAKSHM	7/31/1983	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	38209	40	Pediatrics	0	In state provider	None	623 W DUARTE RD	STE 2	ARCADIA	CA	91007	7336	19	06037	34.12648672	-118.0522757	Los Angeles County
118487	Fee-for-Service	1629010442	1629010442	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 S TWIN OAKS VLY RD	None	SAN MARCOS	CA	92078	4333	37	06073	33.13063641	-117.1648887	San Diego County
118491	Fee-for-Service	1952465908	1952465908	2	1	LYNCH, CRISTAL M MD	4/7/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	48358	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
118507	Fee-for-Service	1053962597	1053962597	1	1	LIMQUECO, LAUDIMIR A NP	1/7/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
118518	Fee-for-Service	1912502469	1912502469	1	1	LEVIER, ANTOINETTE CNP	4/22/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	491 E ALESSANDRO BLVD	None	RIVERSIDE	CA	92508	6071	33	06065	33.91628714	-117.3230954	Riverside County
118546	Fee-for-Service	1407413412	1407413412	1	1	LUNG, BRANDON E MD	8/18/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	182097	20	Orthopedic Surgery	0	In state provider	None	18133 VENTURA BLVD	102	TARZANA	CA	91356	3641	19	06037	34.1657808	-118.5283188	Los Angeles County
118567	Fee-for-Service	1407037468	1407037468	1	1	LEWIS, JENNIFER	3/2/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
118617	Fee-for-Service	1073092730	1073092730	1	1	LIU, XIAOQING RCP	9/11/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
118626	Fee-for-Service	1093871725	1093871725	1	1	LLAURADO, RAYMOND J MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	56140	02	General Surgery	0	In state provider	None	220 S PALISADE DR	STE 102	SANTA MARIA	CA	93454	5931	42	06083	34.95143521	-120.412098	Santa Barbara County
118634	Fee-for-Service	1669552691	1669552691	2	1	LANGER, DEANA K	6/23/2017	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	7230 MEDICAL CENTER DR	SUITE 104	WEST HILLS	CA	91307	4001	19	06037	34.20172814	-118.6294322	Los Angeles County
118637	Fee-for-Service	1801258819	1801258819	1	1	LEVOY, EMILY MD	5/15/2024	208M00000X	NA	Other	026	PHYSICIANS	168017	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
118699	Fee-for-Service	1265498570	1265498570	1	1	LENZ, ANITA I MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	38207	01	General Practice	0	In state provider	None	9041 MAGNOLIA AVE	SUITE 206	RIVERSIDE	CA	92503	3956	33	06065	33.92541585	-117.4378266	Riverside County
118700	Fee-for-Service	1346386323	1346386323	1	1	LOWRIE, LEA M	2/25/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
118724	Fee-for-Service	1437248846	1437248846	1	1	LEKAWA, SAJEE D	4/22/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	77604	41	Internal Medicine	0	In state provider	None	1095A IRVINE BLVD	None	TUSTIN	CA	92780	3526	30	06059	33.74821163	-117.8097851	Orange County
118725	Fee-for-Service	1477168656	1477168656	1	1	LINCOLN RETIREMENT VILLA LLC	2/3/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	41040 LINCOLN ST	None	FREMONT	CA	94538	4316	01	06001	37.53404345	-121.956634	Alameda County
118732	Fee-for-Service	1982947131	1982947131	1	1	LEE, PEI LIM B MD	9/1/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	142953	10	Gastroenterology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
118906	Fee-for-Service	1780797381	1780797381	1	1	LE, HUAN A MD	11/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76373	41	Internal Medicine	0	In state provider	ADVANCED LUNG & SLEEP	5507 EL CAJON BLVD	STE C	SAN DIEGO	CA	92115	3624	37	06073	32.75824665	-117.0763619	San Diego County
118916	Fee-for-Service	1083673735	1083673735	1	1	LLEWELLYN, GEORGE K MD	12/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80609	07	Dermatology	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
118924	Fee-for-Service	1801258819	1801258819	1	1	LEVOY, EMILY MD	5/15/2024	208M00000X	NA	Other	026	PHYSICIANS	168017	41	Internal Medicine	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
118927	Fee-for-Service	1225186042	1225186042	1	1	LANE, RAYMOND L MD	1/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	50951	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
118938	Fee-for-Service	1215964077	1215964077	1	1	LANE ENGLAND	11/24/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
118977	Fee-for-Service	1194899781	1194899781	1	1	LARSON, ERIC W MD	10/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81578	08	Family Practice	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
118980	Fee-for-Service	1417907015	1417907015	1	1	LITOW, JEFFREY MD	2/28/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	18732	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1000 W 9TH ST	None	LOS ANGELES	CA	90015	1377	19	06037	34.04745182	-118.2658125	Los Angeles County
118983	Fee-for-Service	1144394743	1144394743	1	1	LAI, KATHERINE W DO	1/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8498	25	Physical Medicine and Rehabilitation	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
118986	Fee-for-Service	1659349777	1659349777	1	1	LU, YEN-YING J CRNA	1/1/2002	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
119054	Fee-for-Service	1205904059	1205904059	1	1	LATTUPALLY, SHIRISHA PT	7/20/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
119068	Fee-for-Service	1649559006	1649559006	1	1	LAM, JOANNE H PSYD	3/2/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
119107	Fee-for-Service	1821032970	1821032970	1	1	LANDGRAF, ROBERT L DO	10/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	7022	08	Family Practice	0	In state provider	None	2560 N TEXAS ST	None	FAIRFIELD	CA	94533	1649	48	06095	38.27539711	-122.0340414	Solano County
119116	Fee-for-Service	1073708616	1073708616	1	1	LUCIANI, KATHRYN LMFT	9/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	320 WESTERN AVE	None	PETALUMA	CA	94952	2519	49	06097	38.23314321	-122.6432398	Sonoma County
119119	Fee-for-Service	1871535328	1871535328	1	1	LIU, INGRID MD	7/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	43687	08	Family Practice	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
119131	Fee-for-Service	1033278759	1033278759	1	1	LIN, LISA C	1/17/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
119136	Fee-for-Service	1780629717	1780629717	1	1	LIMB, CHARLES J MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136123	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
119138	Fee-for-Service	1790205375	1790205375	1	1	LANGER, STEPHANIE K MD	9/8/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159191	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
119139	Fee-for-Service	1619316080	1619316080	1	1	LOPEZ, ANNA M LMFT	11/3/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14201 KENTWOOD BLVD	STE 2	VICTORVILLE	CA	92392	2472	36	06071	34.508862	-117.327461	San Bernardino County
119146	Fee-for-Service	1518992551	1518992551	1	1	LUM. LYNETTE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7435 W TALCOTT AVE	None	CHICAGO	IL	60631	3707	00	None	41.98844808	-87.81251188	Cook County
119193	Fee-for-Service	1780797381	1780797381	1	1	LE, HUAN A MD	11/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76373	29	Pulmonary Diseases (M.D. only)	0	In state provider	ADVANCED LUNG & SLEEP	5507 EL CAJON BLVD	STE C	SAN DIEGO	CA	92115	3624	37	06073	32.75824665	-117.0763619	San Diego County
119203	Fee-for-Service	1528063484	1528063484	1	1	LAI, TSU H MD	2/28/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	39956	01	General Practice	0	In state provider	None	18523 CORWIN RD	STE B	APPLE VALLEY	CA	92307	2300	36	06071	34.54095703	-117.2601143	San Bernardino County
119221	Fee-for-Service	1598800559	1598800559	1	1	LEE, PATRICIA K MD	3/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96603	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
119292	Fee-for-Service	1710325402	1710325402	1	1	LINFESTY, DANIEL C MD	1/3/2022	207R00000X	NA	Other	026	PHYSICIANS	171215	None	None	0	In state provider	None	7551 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
119315	Fee-for-Service	1992249858	1992249858	1	1	LAO, JUSTIN PT	7/5/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	328 COMMERCIAL ROAD	SUITE 108	SAN BERNARDINO	CA	92408	3766	36	06071	34.05583518	-117.2779712	San Bernardino County
119325	Fee-for-Service	1801250089	1801250089	1	1	LINDEN, OLIVIA E MD	4/26/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	153946	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
119339	Fee-for-Service	1215120902	1215120902	1	1	LEE, JENNY J MD	7/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105683	02	General Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
119346	Fee-for-Service	1396039830	1396039830	1	1	LUNDBOHM, ADRIAN C LMFT	10/23/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
119351	Fee-for-Service	1376829887	1376829887	1	1	LE, TON T CRNA	4/26/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	RMC MOB2	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
119353	Fee-for-Service	1790708576	1790708576	1	1	LUSTIG, ROBERT H MD	8/22/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	49990	40	Pediatrics	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
119363	Fee-for-Service	1598212391	1598212391	1	1	LANGUAGE TO LEARNING, INC.	12/21/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1700 CAMERON AVE	108	WEST COVINA	CA	91790	2718	19	06037	34.06970547	-117.943734	Los Angeles County
119374	Fee-for-Service	1194745356	1194745356	1	1	LANG, KATHRYN E MD	9/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92529	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
119388	Fee-for-Service	1831192418	1831192418	1	1	LARSEN, MELISSA E MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	80218	None	None	0	In state provider	None	102 SAN MIGUEL AVE	None	SALINAS	CA	93901	3057	27	06053	36.65895947	-121.6556795	Monterey County
119391	Fee-for-Service	1376722017	1376722017	1	1	LO, EDDIE MD	8/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	102816	20	Orthopedic Surgery	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
119403	Fee-for-Service	1841395993	1841395993	1	2	LOHARUKA, PRABHU MD	4/10/2020	207R00000X	NA	Other	026	PHYSICIANS	46415	41	Internal Medicine	0	In state provider	None	4201 TORRANCE	380	TORRANCE	CA	90503	4504	19	06037	33.8375955	-118.358748	Los Angeles County
119406	Fee-for-Service	1871535328	1871535328	1	1	LIU, INGRID MD	7/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	43687	41	Internal Medicine	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
119420	Fee-for-Service	1821528225	1821528225	1	1	LIANG, CONAN MD	8/4/2022	207R00000X	NA	Other	026	PHYSICIANS	160248	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
119421	Fee-for-Service	1063426278	1063426278	1	1	LEE, GARY A OD	11/30/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10614 LOWER AZUSA RD	None	EL MONTE	CA	91731	1210	19	06037	34.09235767	-118.0371362	Los Angeles County
119426	Fee-for-Service	1780629717	1780629717	1	1	LIMB, CHARLES J MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136123	04	Otology, Laryngology, Rhinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
119478	Fee-for-Service	1386404309	1386404309	1	1	LITTLE, RACHAEL M LMFT	5/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
119516	Fee-for-Service	1003469172	1003469172	1	1	LARECY, DANEEN A LCSW	4/9/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23945 SUNNYMEAD BLVD.	3	MORENO VALLEY	CA	92553	3025	33	06065	33.93897472	-117.2450469	Riverside County
119517	Fee-for-Service	1467128173	1467128173	1	1	LEE, MATTHEW OD	9/10/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	34420 FREMONT BLVD	SUITE E	FREMONT	CA	94555	3323	01	06001	37.57486959	-122.040298	Alameda County
119530	Fee-for-Service	1710044482	1710044482	1	1	LAFFAN, ANGELA NP	5/17/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
119540	Fee-for-Service	1750607644	1750607644	1	1	LE, NAM Q DO	11/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12155	41	Internal Medicine	0	In state provider	None	1125 SIR FRANCIS DRAKE	None	KENTFIELD	CA	94904	1418	21	06041	37.95899686	-122.5520873	Marin County
119543	Fee-for-Service	1598316713	1598316713	1	1	LEE, YONG K LAC	7/29/2021	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	S	3858 CHICAGO AVE	None	RIVERSIDE	CA	92507	5354	33	06065	33.974064	-117.348474	Riverside County
119550	Fee-for-Service	1457786170	1457786170	1	1	LESLIE-JONES, TIKESHA PHD	7/21/2021	103TH0004X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
119593	Fee-for-Service	1891013819	1891013819	1	1	LEE, MICHAEL OD	5/8/2012	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2366 EL CAMINO REAL	SUITE 5	SANTA CLARA	CA	95050	4070	43	06085	37.35228252	-121.9674105	Santa Clara County
119628	Fee-for-Service	1023185428	1023185428	1	1	LA JOLLA RADIOLOGY MED	11/1/1987	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP - THERAPY	916 SYCAMORE AVE	None	VISTA	CA	92081	7815	37	06073	33.15990889	-117.2205717	San Diego County
119633	Fee-for-Service	1619147519	1619147519	1	1	LABORICO, ALISHA C MD	10/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102433	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
119639	Fee-for-Service	1609136050	1609136050	1	1	LEE, NHI T MD	1/10/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165888	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
119645	Fee-for-Service	1982700035	1982700035	1	2	LOMIS, THOMAS J MD INC	6/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	83600	78	Neoplastic Diseases/Oncology	0	In state provider	None	5901 OLYMPIC BLVD	SUITE 105	LOS ANGELES	CA	90036	4680	19	06037	34.05764121	-118.3603115	Los Angeles County
119650	Fee-for-Service	1912203373	1912203373	1	1	LOPEZ ARREDONDO, YAHAIRA L M	3/14/2019	207R00000X	NA	Other	026	PHYSICIANS	158470	41	Internal Medicine	0	In state provider	D	3155 KEARNEY ST	100	FREMONT	CA	94538	2268	01	06001	37.5490951	-121.974815	Alameda County
119657	Fee-for-Service	1558835991	1558835991	1	1	LEVINSON, MICHELLE NP	3/16/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
119687	Fee-for-Service	1437635109	1437635109	1	1	LARSON, KRICHELLE A CRNA	10/24/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
119707	Fee-for-Service	1821256710	1821256710	1	1	LIEBL, MAX E MD	9/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119951	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
119721	Fee-for-Service	1700306222	1700306222	1	1	LAKSHMI NAIR MD FACC INC	8/21/2017	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	27206 CALAROGA AVE	115	HAYWARD	CA	94545	4300	01	06001	37.632357	-122.0868765	Alameda County
119753	Fee-for-Service	1912924432	1912924432	1	1	LONG, THOMAS V MD	11/1/1992	207R00000X	NA	Other	026	PHYSICIANS	73457	None	None	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
119794	Fee-for-Service	1356904510	1356904510	1	1	LUU, THAIPHI H MD	7/29/2024	208800000X	NA	Other	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
119804	Fee-for-Service	1568622355	1568622355	1	1	LEMKER, ERICH S MD	7/6/2009	208600000X	NA	General Surgery	026	PHYSICIANS	95116	02	General Surgery	0	In state provider	None	255 N HOWARD	None	FRESNO	CA	93710	0000	10	06019	36.8364201	-119.7835108	Fresno County
119816	Fee-for-Service	1114107505	1114107505	1	2	LIFE HEARING INC	9/11/2015	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	18672 FLORIDA ST	SUITE 202A	HUNTINGTON BEACH	CA	92648	7601	30	06059	33.691185	-117.9910425	Orange County
119819	Fee-for-Service	1487732095	1487732095	1	1	LARACH, JUAN C MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	60426	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1604 UNION ST	None	SAN FRANCISCO	CA	94123	4507	38	06075	37.79834855	-122.4258054	San Francisco County
119824	Fee-for-Service	1083086888	1083086888	1	1	LESTER, LIANE LMFT	2/19/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
119834	Fee-for-Service	1376521641	1376521641	1	1	LORAN, MATTHEW J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
119838	Fee-for-Service	1891314548	1891314548	1	1	LYLE, DAVID C MD	8/1/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
119841	Fee-for-Service	1194753301	1194753301	1	1	LEWIS, GREGORY M MD	8/7/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	168694	18	Ophthalmology	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
119882	Fee-for-Service	1124882675	1124882675	1	1	LOWI-TENG, ALEXIA NP	3/1/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	39159 PASEO PADRE PKWY	STE 121	FREMONT	CA	94538	1600	01	06001	37.5531875	-121.9805141	Alameda County
119886	Fee-for-Service	1205934700	1205934700	1	1	LIM, MICHAEL YAM WAI MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61866	41	Internal Medicine	0	In state provider	None	885 RUSSELL BLVD	STE A	DAVIS	CA	95616	3426	57	06113	38.54642506	-121.7615001	Yolo County
119897	Fee-for-Service	1144368887	1144368887	1	1	LAUREL MEDICAL CENTER	4/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	13680 VAN NUYS BLVD	None	PACOIMA	CA	91331	3616	19	06037	34.25957089	-118.4310033	Los Angeles County
119933	Fee-for-Service	1508390204	1508390204	1	1	LIM, AMANDA D MD	2/28/2023	103TC2200X	NA	Mental Health Outpatient Services	026	PHYSICIANS	157246	None	None	0	In state provider	None	1686 BARTON ROAD	None	REDLANDS	CA	92373	7761	36	06071	34.04833901	-117.2120103	San Bernardino County
119962	Fee-for-Service	1346726239	1346726239	1	1	LIFELONG MEDICAL CARE	10/30/2018	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 SAN PABLO AVE	None	OAKLAND	CA	94612	1121	01	06001	37.81631446	-122.2752306	Alameda County
119983	Fee-for-Service	1760529275	1760529275	2	1	LANGSFORD, STEPHEN G OD	2/4/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1545 W 5TH ST	STE 100	OXNARD	CA	93030	6510	56	06111	34.19757729	-119.1961091	Ventura County
120016	Fee-for-Service	1497798755	1497798755	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7525 EADS AVE	None	LA JOLLA	CA	92037	4806	37	06073	32.84052686	-117.2750588	San Diego County
120031	Fee-for-Service	1700146339	1700146339	1	1	LANDSMAN, NICHOLAS A MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129489	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
120054	Fee-for-Service	1306890389	1306890389	1	1	LOS ROBLES HOSPITAL	1/1/1994	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	& MEDICAL CENTER	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1899	56	06111	34.2064445	-118.8824085	Ventura County
120059	Fee-for-Service	1629049473	1629049473	1	1	LARSON, JON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2102 N COUNTRY CLUB RD	STE B	TUCSON	AZ	85716	2831	00	None	32.247675	-110.9261655	Pima County
120071	Fee-for-Service	1386127470	1386127470	1	1	LEZIN, SARA M NP	1/9/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
120073	Fee-for-Service	1427345487	1427345487	1	1	LINDBACK, SARAH MEGAN MD	8/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117823	40	Pediatrics	0	In state provider	None	15725 POMERADO RD	SUITE #203	POWAY	CA	92064	2058	37	06073	33.00037882	-117.0580735	San Diego County
120078	Fee-for-Service	1821013863	1821013863	1	1	LIN, RICHARD C MD	3/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	79892	18	Ophthalmology	0	In state provider	None	300 PASTEUR DRIVE	MC:500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
120096	Fee-for-Service	1700288578	1700288578	1	1	LAU, JACKIE H PT	6/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1819 W VALLEY BLVD.	UNIT B	ALHAMBRA	CA	91803	2344	19	06037	34.07738758	-118.1436791	Los Angeles County
120105	Fee-for-Service	1639387491	1639387491	1	1	LOPEZ, MERRICK R MD	7/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98514	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
120120	Fee-for-Service	1922839539	1922839539	1	1	LOPEZ, ABRAHAM PT	3/13/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
120122	Fee-for-Service	1447334818	1447334818	1	1	LIN, HENRY N MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74372	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
120172	Fee-for-Service	1205934700	1205934700	1	1	LIM, MICHAEL YAM WAI MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61866	01	General Practice	0	In state provider	None	885 RUSSELL BLVD	STE A	DAVIS	CA	95616	3426	57	06113	38.54642506	-121.7615001	Yolo County
120177	Fee-for-Service	1982929378	1982929378	1	1	LIU, JUDY F MD	11/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127472	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
120180	Fee-for-Service	1568460715	1568460715	1	1	LITVAN, IRENE MD	10/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54862	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
120187	Fee-for-Service	1508922857	1508922857	1	1	LAU, GEORGE S MD	1/1/1994	207R00000X	NA	Other	026	PHYSICIANS	52510	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
120269	Fee-for-Service	1487678041	1487678041	1	1	LI, JOHN JEFFREY MD	7/1/2008	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	85389	77	Infectious Disease	0	In state provider	None	7230 MEDICAL CENTER DR	# 203	WEST HILLS	CA	91307	4007	19	06037	34.20172814	-118.6294322	Los Angeles County
120271	Fee-for-Service	1326033804	1326033804	1	1	LUCKEY, DOMINIQUE L MD	2/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	69874	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 402	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
120296	Fee-for-Service	1285688275	1285688275	1	1	LOUIS WILLIAMS CHIROPRACTIC	8/29/2019	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	29645 RANCHO CALIFORNIA	218	TEMECULA	CA	92591	6200	33	06065	33.50627123	-117.1431728	Riverside County
120305	Fee-for-Service	1508872912	1508872912	1	1	LOS ANGELES COUNTY	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	WILMINGTON SUBCENTER	1325 BROAD AVE	None	WILMINGTON	CA	90744	2604	19	06037	33.78954418	-118.2615913	Los Angeles County
120330	Fee-for-Service	1871868174	1871868174	1	1	LINDE, BRIAN J MD	12/11/2023	2083P0500X	NA	Adult Primary Care	026	PHYSICIANS	186770	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
120331	Fee-for-Service	1528130366	1528130366	1	1	LEWIS, LINDA A MD	10/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82990	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
120336	Fee-for-Service	1710315353	1710315353	1	1	LA JOLLA EMERGENCY	1/1/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SPECIALISTS	9888 GENESEE AVENUE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
120345	Fee-for-Service	1306890389	1306890389	1	1	LOS ROBLES HOSPITAL	12/1/1997	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	& MEDICAL CENTER	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1899	56	06111	34.2064445	-118.8824085	Ventura County
120348	Fee-for-Service	1235750761	1235750761	1	1	LEE & ELEANOR POSNER	6/24/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	11323 CALVERT ST	None	NORTH HOLLYWOOD	CA	91606	4217	19	06037	34.18126348	-118.3777438	Los Angeles County
120362	Fee-for-Service	1033643143	1033643143	1	1	LAU, VINCENT DO	8/11/2021	207L00000X	NA	Other	026	PHYSICIANS	18878	None	None	0	In state provider	None	525 NORTH GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
120366	Fee-for-Service	1316989296	1316989296	1	1	LIANG, JIAN YING J MD	3/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75263	08	Family Practice	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
120367	Fee-for-Service	1043371321	1043371321	1	1	LIM, MICHAEL D LCSW	12/11/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
120371	Fee-for-Service	1306205448	1306205448	1	1	LE, HUYKIEN C DO	9/13/2021	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	19056	None	None	0	In state provider	None	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
120377	Fee-for-Service	1356375059	1356375059	1	1	LI, MARK W MD	2/28/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	44985	41	Internal Medicine	0	In state provider	None	2440 S HACIENDA BLVD	STE 105	HACIENDA HEIGHTS	CA	91745	4763	19	06037	33.9911773	-117.9688954	Los Angeles County
120384	Fee-for-Service	1629017512	1629017512	1	1	LEVAN, ANN MARIE T MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	44196	30	Radiology	0	In state provider	None	16453 COLORADO AVE	None	PARAMOUNT	CA	90723	5011	19	06037	33.8848803	-118.1614216	Los Angeles County
120386	Fee-for-Service	1669666186	1669666186	1	1	LOPEZ, JAIRO E MD	5/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96832	02	General Surgery	0	In state provider	None	400 NORTH PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
120388	Fee-for-Service	1811180953	1811180953	1	1	LO, EDMUND MD	6/16/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	63461	41	Internal Medicine	0	In state provider	None	123 N GARFIELD AVE	STE A	ALHAMBRA	CA	91801	3564	19	06037	34.09636542	-118.127778	Los Angeles County
120397	Fee-for-Service	1497831325	1497831325	1	1	LILLO, MARK R	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	41175	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
120407	Fee-for-Service	1639405590	1639405590	1	1	LINDEMAN, ANDREW J LMFT	2/24/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
120408	Fee-for-Service	1447334818	1447334818	1	1	LIN, HENRY N MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74372	40	Pediatrics	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
120418	Fee-for-Service	1780306621	1780306621	1	1	LOPEZ, SUSAN LMFT	2/3/2025	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1742 OREGON STREET	None	REDDING	CA	96001	1717	45	06089	40.5808265	-122.3932989	Shasta County
120435	Fee-for-Service	1659662807	1659662807	1	1	LEE, STEVEN MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141286	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
120438	Fee-for-Service	1437170024	1437170024	1	1	LEE HWONG, LISA J MD	10/1/2000	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	84844	30	Radiology	0	In state provider	None	115 MALL DR	None	HANFORD	CA	93230	3576	16	06031	36.32396253	-119.6688834	Kings County
120485	Fee-for-Service	1992763668	1992763668	1	1	LEIBOWICH, SHLOMO MD	1/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	54679	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
120496	Fee-for-Service	1497060875	1497060875	1	1	LIAO, YUANBING OD	6/16/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3028 CASTRO VALLEY BLVD	None	CASTRO VALLEY	CA	94546	5510	01	06001	37.69553812	-122.0816554	Alameda County
120515	Fee-for-Service	1821197567	1821197567	1	1	LOFTHOUSE, WILLIAM E MD	10/11/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	8564	-	NOT APPLICABLE	0	In state provider	None	2060 CAMPUS DRIVE	None	YREKA	CA	96097	9538	47	06093	41.7050458	-122.6481121	Siskiyou County
120529	Fee-for-Service	1063857258	1063857258	1	1	LEUNG, TERESA K DO	12/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	13781	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
120534	Fee-for-Service	1215376603	1215376603	1	1	LI, TONI PSYD	8/2/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
120536	Fee-for-Service	1831266659	1831266659	1	1	LATINO, FRANK MD	1/1/1982	207RH0003X	NA	Oncology	026	PHYSICIANS	20897	41	Internal Medicine	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
120546	Fee-for-Service	1457478729	1457478729	1	1	LU, JI MD	8/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106827	22	Pathology (M.D. only)	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
120547	Fee-for-Service	1326793506	1326793506	1	1	LIU, ELISE Y PT	1/10/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 W. PROVIDENCE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
120565	Fee-for-Service	1528413663	1528413663	1	1	LASCANO, DANNY MD	3/15/2021	208600000X	NA	General Surgery	026	PHYSICIANS	162012	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
120589	Fee-for-Service	1508872912	1508872912	1	1	LOS ANGELES COUNTY	7/1/2000	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	WILMINGTON SUBCENTER	1325 BROAD AVE	None	WILMINGTON	CA	90744	2604	19	06037	33.78954418	-118.2615913	Los Angeles County
120609	Fee-for-Service	1952780777	1952780777	1	1	LIMA, ALEXIS D MD	7/1/2019	207P00000X	NA	Other	026	PHYSICIANS	151122	66	Emergency Medicine (Urgent Care)	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
120622	Fee-for-Service	1679664627	1679664627	1	1	LE, TRANG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	640 ULUKAHIKI ST	None	KAILUA	HI	96734	4454	00	None	21.38090913	-157.758388	Honolulu County
120643	Fee-for-Service	1457764466	1457764466	1	1	LIEBER, BETTY LUE LMFT	8/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17664 GREENRIDGE ROAD	None	HIDDEN VALLEY LAK	CA	95467	8275	17	06033	38.81569667	-122.565964	Lake County
120661	Fee-for-Service	1356375059	1356375059	1	1	LI, MARK W MD	2/28/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	44985	10	Gastroenterology (M.D. only)	0	In state provider	None	2440 S HACIENDA BLVD	STE 105	HACIENDA HEIGHTS	CA	91745	4763	19	06037	33.9911773	-117.9688954	Los Angeles County
120664	Fee-for-Service	1790957520	1790957520	1	1	LEE, UNA J MD	8/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10689	34	Urology and Urological Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 140	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
120670	Fee-for-Service	1598463044	1598463044	1	1	LOVING, VERONICA R	3/13/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	65 SHORELINE CT	None	RICHMOND	CA	94804	4587	07	06013	37.91130493	-122.3427913	Contra Costa County
120683	Fee-for-Service	1578118147	1578118147	1	1	LEVY, CYNTHIA M LMFT	5/13/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 E. THOUSAND OAKS BLV	176	THOUSAND OAKS	CA	91360	5713	56	06111	34.17902886	-118.8749335	Ventura County
120714	Fee-for-Service	1437666898	1437666898	1	1	LARGE, ARLETTE A LCSW	9/4/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1026 N ST	None	EUREKA	CA	95501	2047	12	06023	40.79881636	-124.1563278	Humboldt County
120719	Fee-for-Service	1316127624	1316127624	1	1	LIOU, ROBERT D MD	9/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106614	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
120746	Fee-for-Service	1710960307	1710960307	1	1	LEAVY, BENJAMIN R MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70315	None	None	0	In state provider	None	7911 LAGUNA BLVD	None	ELK GROVE	CA	95758	7920	34	06067	38.422971	-121.410873	Sacramento County
120777	Fee-for-Service	1285906917	1285906917	1	1	LAW, STEPHEN P	1/16/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
120785	Fee-for-Service	1801272075	1801272075	1	1	LUZ, JILLIAN E LMFT	2/6/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1605 HOPE ST	STE 350	SOUTH PASADENA	CA	91030	2628	19	06037	34.11679363	-118.150088	Los Angeles County
120837	Fee-for-Service	1831705714	1831705714	1	1	LI, JAMIE C NP	8/8/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
120884	Fee-for-Service	1346015005	1346015005	1	1	LINARES, PAULINE	1/25/2024	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1601 W 17TH ST	UNIT E2	SANTA ANA	CA	92706	0000	30	06059	33.7600735	-117.890325	Orange County
120897	Fee-for-Service	1528143849	1528143849	1	1	LE, HOP N MD	3/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	62311	24	Plastic Surgery	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
120908	Fee-for-Service	1750360699	1750360699	1	1	LODI PODIATRY GROUP	9/28/2023	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1300 W LODI AVE	STE W	LODI	CA	95242	3038	39	06077	38.13001447	-121.289931	San Joaquin County
120911	Fee-for-Service	1588997704	1588997704	1	1	LILIENSTEIN, JORDAN T MD	8/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	124428	02	General Surgery	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
120916	Fee-for-Service	1881771624	1881771624	1	1	LEGG, JILL J MD	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	62719	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	# 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
120919	Fee-for-Service	1124281423	1124281423	1	1	LUU, JANE T MD	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115343	01	General Practice	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
120925	Fee-for-Service	1104855428	1104855428	1	1	LEE, ALBERT Y MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40109	40	Pediatrics	0	In state provider	None	2699 ATLANTIC AVE	None	LONG BEACH	CA	90806	2710	19	06037	33.805971	-118.1850555	Los Angeles County
120944	Fee-for-Service	1437359445	1437359445	1	1	LAFEMINA, MICHAEL J MD	4/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98656	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
120959	Fee-for-Service	1598463044	1598463044	1	1	LOVING, VERONICA R	3/13/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	65 SHORELINE CT	None	RICHMOND	CA	94804	4587	07	06013	37.91130493	-122.3427913	Contra Costa County
120980	Fee-for-Service	1487082566	1487082566	1	1	LANGAS, ASHLEY P	2/5/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 CRAVEN RD	None	SAN MARCOS	CA	92078	4201	37	06073	33.12746646	-117.17028	San Diego County
121052	Fee-for-Service	1447637392	1447637392	1	1	LEE, DAVID C H CRNA	6/9/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
121053	Fee-for-Service	1316075062	1316075062	1	1	LASALLE MEDICAL ASSOC	4/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	16455 MAIN ST	STE 1	HESPERIA	CA	92345	3500	36	06071	34.42186386	-117.3038021	San Bernardino County
121057	Fee-for-Service	1255638672	1255638672	1	1	LEE, KRISTEN J	3/2/2011	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	50 E FOOTHILL BLVD	STE 100	ARCADIA	CA	91006	2314	19	06037	34.15096965	-118.0295442	Los Angeles County
121073	Fee-for-Service	1295860187	1295860187	1	1	LEDESMA, HARVEY D OD	12/15/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRY INC	490 ALABAMA ST	STE 107	REDLANDS	CA	92373	8089	36	06071	34.058763	-117.2087625	San Bernardino County
121101	Fee-for-Service	1477015899	1477015899	1	1	LEE, WILLIAM G MD	7/5/2022	2086S0120X	NA	General Surgery	026	PHYSICIANS	177785	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
121103	Fee-for-Service	1437380284	1437380284	1	1	LEE DONNER	4/18/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 E 149TH ST	None	BRONX	NY	10451	5504	00	None	40.817538	-73.9240965	Bronx County
121111	Fee-for-Service	1699087833	1699087833	1	1	LIN, CHUNRONG MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125591	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
121114	Fee-for-Service	1508811514	1508811514	1	1	LAI, PAUL P DO	5/2/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	7294	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
121123	Fee-for-Service	1548473762	1548473762	1	1	LORRETTA KNAUSS	2/8/2015	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	GOLETA VALLEY OPTICAL	5124 HOLLISTER AVE	None	SANTA BARBARA	CA	93111	2526	42	06083	34.43501264	-119.8031898	Santa Barbara County
121141	Fee-for-Service	1285923623	1285923623	1	1	LEWIS, MARSHALL S MD APC	1/20/2015	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	None	2619 F ST	None	BAKERSFIELD	CA	93301	1815	15	06029	35.38353323	-119.0235023	Kern County
121168	Fee-for-Service	1386226553	1386226553	1	1	LIWAY PROFESSIONAL CORPORATI	4/29/2021	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	78 S ROSEMEAD BLVD	None	PASADENA	CA	91107	3959	19	06037	34.14485189	-118.0732813	Los Angeles County
121188	Fee-for-Service	1275567158	1275567158	1	1	LASK, GARY P MD	1/1/1994	207N00000X	NA	Dermatology	026	PHYSICIANS	35542	41	Internal Medicine	0	In state provider	None	200 UCLA MEDICAL PLZ	BLDG 465	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
121232	Fee-for-Service	1366030975	1366030975	1	1	LYONS HOWARD, DESIREE L PT	9/26/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3191 MISSION INN AVE	B	RIVERSIDE	CA	92507	4187	33	06065	33.98015514	-117.3677324	Riverside County
121233	Fee-for-Service	1437359445	1437359445	1	1	LAFEMINA, MICHAEL J MD	4/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98656	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
121285	Fee-for-Service	1407275423	1407275423	1	1	LEONOR, PAUL MD	8/1/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	141042	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
121318	Fee-for-Service	1134200793	1134200793	1	1	LEPROWSE,CONRAD R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	914 S SCHEUBER RD	None	CENTRALIA	WA	98531	0000	00	None	46.71220956	-122.9870103	Lewis County
121366	Fee-for-Service	1245234780	1245234780	1	1	LEON, GINGER L DO	5/24/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	8311	08	Family Practice	0	In state provider	None	436 S RIVERSIDE AVE	None	RIALTO	CA	92376	6523	36	06071	34.093089	-117.3703775	San Bernardino County
121374	Fee-for-Service	1477670131	1477670131	1	1	LEUNG, ALVA L S LCSW	11/3/2014	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
121392	Fee-for-Service	1861640146	1861640146	1	2	LITTLEFIELD, MATTHEW	1/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
121401	Fee-for-Service	1699087833	1699087833	1	1	LIN, CHUNRONG MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125591	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
121412	Fee-for-Service	1336378199	1336378199	1	1	LACALLE, EDUARDO J MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124841	66	Emergency Medicine (Urgent Care)	0	In state provider	None	222 WEST 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
121413	Fee-for-Service	1033137096	1033137096	1	1	LO, LOUISE C MD	2/20/2004	2080P0207X	NA	Hematology	026	PHYSICIANS	65779	40	Pediatrics	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
121420	Fee-for-Service	1952459935	1952459935	1	1	LEE-WALLINE, WAI-MING MD	5/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71673	18	Ophthalmology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
121430	Fee-for-Service	1285923623	1285923623	1	1	LEWIS, MARSHALL S MD APC	1/20/2015	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	2619 F ST	None	BAKERSFIELD	CA	93301	1815	15	06029	35.38353323	-119.0235023	Kern County
121434	Fee-for-Service	1144414293	1144414293	1	1	LIU, JOY DO INC	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9350	08	Family Practice	0	In state provider	None	1600 CREEKSIDE DR	STE 3200	FOLSOM	CA	95630	3447	34	06067	38.669994	-121.147488	Sacramento County
121441	Fee-for-Service	1598098345	1598098345	1	1	LEE, CHENG L MD	4/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109363	08	Family Practice	0	In state provider	None	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
121445	Fee-for-Service	1417099052	1417099052	1	1	LAMONT SCHOOL DIST	5/22/1994	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	7915 BURGUNDY AVE	None	LAMONT	CA	93241	1350	15	06029	35.2632355	-118.9163385	Kern County
121456	Fee-for-Service	1780065508	1780065508	1	1	LALA, VASIMAHMED DO	6/28/2022	207R00000X	NA	Other	026	PHYSICIANS	19207	None	None	0	In state provider	None	8635 W 3RD ST	695W	LOS ANGELES	CA	90048	6162	19	06037	34.07361928	-118.3803143	Los Angeles County
121459	Fee-for-Service	1902505746	1902505746	1	1	LIME RIDGE HEALTHCARE LLC	5/1/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1050 SAN MIGUEL RD	None	CONCORD	CA	94518	2094	07	06013	37.9570997	-122.0265937	Contra Costa County
121486	Fee-for-Service	1316422942	1316422942	1	1	LAZO, CAROL LPCC	10/8/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
121497	Fee-for-Service	1750971180	1750971180	1	1	LIVE WELL FAMILY COUNSELING	5/25/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SERVICES	41593 WINCHESTER	200	TEMECULA	CA	92590	4860	33	06065	33.52030169	-117.1659061	Riverside County
121500	Fee-for-Service	1790843373	1790843373	1	1	LUI, VERNON K. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9660 S 1300 E	None	SANDY	UT	84094	3762	00	None	40.57617253	-111.8531739	Salt Lake County
121512	Fee-for-Service	1144367111	1144367111	1	1	LAU, JONATHAN B DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	7545	None	None	0	In state provider	None	4929 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
121536	Fee-for-Service	1174032999	1174032999	1	1	LEE, JIYANG MD	6/4/2020	207R00000X	NA	Other	026	PHYSICIANS	152149	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
121550	Fee-for-Service	1063493567	1063493567	1	1	LOPEZ-SEMINARIO, NICOLE	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90742	None	None	0	In state provider	None	3 MEDICAL PLAZA	STE 250	ROSEVILLE	CA	95661	3089	31	06061	38.76566391	-121.2457432	Placer County
121559	Fee-for-Service	1912584350	1912584350	1	1	LOPES, GABRIELLA MD	7/12/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
121561	Fee-for-Service	1629302526	1629302526	1	1	LE, ROSE T NP	12/30/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
121600	Fee-for-Service	1962758748	1962758748	1	1	LUU, HONG G OD	8/27/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6767 N FRESNO STREET	None	FRESNO	CA	93710	3709	10	06019	36.83686637	-119.7813437	Fresno County
121602	Fee-for-Service	1649456682	1649456682	1	1	LY, CONG T DO	8/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10687	66	Emergency Medicine (Urgent Care)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
121637	Fee-for-Service	1891871869	1891871869	1	1	LEE, THOMAS C MD	12/1/1997	207RH0000X	NA	Hematology	026	PHYSICIANS	72388	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
121667	Fee-for-Service	1558449033	1558449033	1	1	LAMPENFELD, MYLES E MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	44388	30	Radiology	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
121687	Fee-for-Service	1699087833	1699087833	1	1	LIN, CHUNRONG MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125591	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
121700	Fee-for-Service	1740289032	1740289032	1	1	LEE, GILBERT HAE-GIL MD	7/31/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66690	08	Family Practice	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
121716	Fee-for-Service	1285923623	1285923623	1	1	LEWIS, MARSHALL S MD APC	1/20/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2619 F ST	None	BAKERSFIELD	CA	93301	1815	15	06029	35.38353323	-119.0235023	Kern County
121719	Fee-for-Service	1285175588	1285175588	1	1	LUCHETTE, MATTHEW F MD	9/13/2024	2080P0203X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
121723	Fee-for-Service	1780115535	1780115535	1	1	LEE, ALBERT MD	9/28/2021	207L00000X	NA	Other	026	PHYSICIANS	160081	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
121762	Fee-for-Service	1255310140	1255310140	1	1	LAI, JENNIFER WAU-YIN MD	1/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88655	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
121766	Fee-for-Service	1538181482	1538181482	1	1	LA CLINICA DE LA RAZA INC	9/1/2004	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2000 SIERRA ROAD	None	CONCORD	CA	94518	2905	07	06013	37.95249193	-122.0369734	Contra Costa County
121787	Fee-for-Service	1770895559	1770895559	1	1	LIU, JOSEPH P MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130982	None	None	0	In state provider	None	1516 COTNER AVE	None	LOS ANGELES	CA	90025	3303	19	06037	34.04905416	-118.4477438	Los Angeles County
121821	Fee-for-Service	1194917682	1194917682	1	1	LYOVIN, ANDREI PSYD	8/14/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
121828	Fee-for-Service	1053347450	1053347450	1	1	LAFATA, JOHN A MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32987	41	Internal Medicine	0	In state provider	None	2067 W VISTA WAY	STE 200	VISTA	CA	92083	6033	37	06073	33.18505594	-117.285958	San Diego County
121837	Fee-for-Service	1336362490	1336362490	1	1	LISA MARIE SATURNINO MD	11/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1665 BONANZA DR	None	PARK CITY	UT	84060	5127	00	None	40.66209063	-111.5005335	Summit County
121848	Fee-for-Service	1780782755	1780782755	1	1	LEUNG, ALVINA Y MD	3/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	78148	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
121855	Fee-for-Service	1952331217	1952331217	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	29985 CANYON HILLS RD	None	LAKE ELSINORE	CA	92532	2576	33	06065	33.66798508	-117.2631808	Riverside County
121856	Fee-for-Service	1558353029	1558353029	1	1	LEE, CHENG-HONG J	7/16/1995	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	18371 PIONEER BLVD	None	ARTESIA	CA	90701	5532	19	06037	33.86501824	-118.0822695	Los Angeles County
121877	Fee-for-Service	1437293750	1437293750	1	1	LI, JOB R MD	8/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	40142	41	Internal Medicine	0	In state provider	None	808 E VALLEY BLVD	None	SAN GABRIEL	CA	91776	3607	19	06037	34.08013723	-118.0900484	Los Angeles County
121886	Fee-for-Service	1417017781	1417017781	1	1	LIN, HUI CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1425 BROADWAY	STE 8	BURLINGAME	CA	94010	3468	41	06081	37.5846779	-122.3658869	San Mateo County
121887	Fee-for-Service	1689126427	1689126427	1	1	LANDER, THESLA M LMFT	5/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
121888	Fee-for-Service	1801824941	1801824941	1	1	LEWIS, MICHAEL I MD	1/31/1990	174400000X	NA	Other	026	PHYSICIANS	42166	01	General Practice	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
121897	Fee-for-Service	1669903274	1669903274	1	1	LOPEZ, CHRISTINA N LMFT	8/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17059 MAIN ST	None	HESPERIA	CA	92345	6067	36	06071	34.4199033	-117.2908045	San Bernardino County
121929	Fee-for-Service	1891871869	1891871869	1	1	LEE, THOMAS C MD	12/1/1997	207RH0000X	NA	Hematology	026	PHYSICIANS	72388	68	Hematology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
121945	Fee-for-Service	1588722201	1588722201	1	1	LORINE LAGATTA	8/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3300 NACOGDOCHES RD	STE 110	SAN ANTONIO	TX	78217	3368	00	None	29.52826083	-98.43418366	Bexar County
121957	Fee-for-Service	1558449033	1558449033	1	1	LAMPENFELD, MYLES E MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	44388	41	Internal Medicine	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
121990	Fee-for-Service	1740289032	1740289032	1	1	LEE, GILBERT HAE-GIL MD	7/31/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66690	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
122000	Fee-for-Service	1629150511	1629150511	1	1	LI, VICTOR MD	9/17/2009	207LP2900X	NA	Other	026	PHYSICIANS	77617	05	Anesthesiology	0	In state provider	PRIME PAIN MEDICINE INST	3143 PAUL SWEET RD	None	SANTA CRUZ	CA	95065	1521	44	06087	36.98906826	-121.9854242	Santa Cruz County
122033	Fee-for-Service	1548584816	1548584816	1	1	LEHR, LEONARD K MD INC	8/4/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	25608	None	None	0	In state provider	None	7601 HOSPITAL DRIVE	SUITE 202	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
122055	Fee-for-Service	1538181482	1538181482	1	1	LA CLINICA DE LA RAZA INC	8/21/2006	261QD0000X	NA	Dental Clinic	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	2000 SIERRA ROAD	None	CONCORD	CA	94518	2905	07	06013	37.95249193	-122.0369734	Contra Costa County
122058	Fee-for-Service	1215400429	1215400429	1	1	LIMA, FRANK W PT	3/1/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
122063	Fee-for-Service	1235671793	1235671793	1	1	LYU, KEZIAH PSYD	2/3/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
122064	Fee-for-Service	1609909464	1609909464	1	1	LEWAK, ANDREA R LMFT	3/23/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
122069	Fee-for-Service	1952960239	1952960239	1	1	LAWRENCE, DYLAN S MD	11/4/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
122075	Fee-for-Service	1841617420	1841617420	1	1	LEW, KRISTEN MD	9/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128750	41	Internal Medicine	0	In state provider	None	6109 W RAMSEY ST	None	BANNING	CA	92220	3051	33	06065	33.92940576	-116.9437965	Riverside County
122077	Fee-for-Service	1518457985	1518457985	2	1	LEBEAU, JACOB F DO	6/8/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17758	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
122084	Fee-for-Service	1437618931	1437618931	1	1	LOURENZO, LESLIE PT	1/28/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	350 JOHN MUIR PKWY	250	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
122108	Fee-for-Service	1184107195	1184107195	1	1	LOZICK, VELIA R OT	12/19/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3525 LOMA VISTA RD	SUITE C	VENTURA	CA	93003	3165	56	06111	34.27680789	-119.2480851	Ventura County
122125	Fee-for-Service	1972551679	1972551679	1	1	LINFOOT, JOHN A MD	1/1/1979	207RE0101X	NA	Endocrinology	026	PHYSICIANS	6915	41	Internal Medicine	0	In state provider	None	350 30TH ST	STE 208	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
122136	Fee-for-Service	1023229325	1023229325	1	1	LEVINE, NICHOLAS B MD	8/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143668	14	Neurological Surgery	0	In state provider	None	45 RIVER PARK PLACE WEST	STE 104	FRESNO	CA	93720	1565	10	06019	36.85901695	-119.7893872	Fresno County
122155	Fee-for-Service	1790404986	1790404986	1	1	LAM, CINDY OD	10/6/2023	152WC0802X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
122168	Fee-for-Service	1407432073	1407432073	1	1	LEE, SARAH S DO	9/17/2024	208M00000X	NA	Other	026	PHYSICIANS	21034	41	Internal Medicine	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
122189	Fee-for-Service	1194787457	1194787457	1	1	LAWSON, BARRY MD	4/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	12040 NO EAST 128TH ST	None	KIRKLAND	WA	98034	3013	00	None	47.71493427	-122.1792761	King County
122197	Fee-for-Service	1245609965	1245609965	1	5	LEISURE LIVING INC	12/31/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	30821 CATARINA DR	None	WESTLAKE VILLAGE	CA	91362	4129	19	06037	34.16085206	-118.7925055	Los Angeles County
122201	Fee-for-Service	1154950285	1154950285	1	1	LINDBERG, WESLEY MD	5/23/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	1401 GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
122214	Fee-for-Service	1336384031	1336384031	1	1	LEE, CATHERINE MD	10/5/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	111958	None	None	0	In state provider	None	18040 SHERMAN WAY	SUITE 304	RESEDA	CA	91335	4656	19	06037	34.20103048	-118.526787	Los Angeles County
122215	Fee-for-Service	1891871869	1891871869	1	1	LEE, THOMAS C MD	12/1/1997	207RH0000X	NA	Hematology	026	PHYSICIANS	72388	78	Neoplastic Diseases/Oncology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
122222	Fee-for-Service	1275018871	1275018871	1	1	LAB24 LLC	8/27/2019	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	475 KNOLLCREST DRIVE	None	REDDING	CA	96002	0101	45	06089	40.57256839	-122.3631672	Shasta County
122245	Fee-for-Service	1558449033	1558449033	1	1	LAMPENFELD, MYLES E MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	44388	78	Neoplastic Diseases/Oncology	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
122253	Fee-for-Service	1619343829	1619343829	1	1	LY, HOANHA T OD	8/8/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2101 STONE BLVD	STE 150	WEST SACRAMENTO	CA	95624	4406	57	06113	38.56318049	-121.5379228	Yolo County
122258	Fee-for-Service	1821416009	1821416009	1	1	LEWICKI, ALEKSANDR G MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138846	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
122266	Fee-for-Service	1588652515	1588652515	1	1	LYONS, PAUL E MD	7/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	89077	08	Family Practice	0	In state provider	None	555 TACHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
122289	Fee-for-Service	1396176814	1396176814	2	1	LAURENT, BRET CP	1/13/2014	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2345 S BROADWAY	#E	SANTA MARIA	CA	93454	7840	42	06083	34.91787028	-120.4361185	Santa Barbara County
122307	Fee-for-Service	1013337641	1013337641	1	1	LEONARD, ROBERT MD	5/1/2020	207P00000X	NA	Other	026	PHYSICIANS	158526	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2701 S BRISTOL ST	None	SANTA ANA	CA	92704	6201	30	06059	33.71114199	-117.8853958	Orange County
122311	Fee-for-Service	1225556814	1225556814	1	1	LOPEZ-ALEJANDRE, LUIS M LCSW	9/2/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
122330	Fee-for-Service	1841255072	1841255072	1	1	LIBBY, JOCELYN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1615 DELAWARE ST	None	LONGVIEW	WA	98632	2367	00	None	46.1309207	-122.9408931	Cowlitz County
122335	Fee-for-Service	1467885277	1467885277	1	1	LASATER, JESSICA PSYD	8/16/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	32251	-	NOT APPLICABLE	0	In state provider	None	18700 OXNARD STREET	None	TARZANA	CA	91356	1413	19	06037	34.18014349	-118.5410025	Los Angeles County
122344	Fee-for-Service	1538181482	1538181482	1	1	LA CLINICA DE LA RAZA INC	7/26/2010	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	2000 SIERRA ROAD	None	CONCORD	CA	94518	2905	07	06013	37.95249193	-122.0369734	Contra Costa County
122389	Fee-for-Service	1972753291	1972753291	1	1	LAU, FRANCIS W MD INC	11/25/2008	207L00000X	NA	Other	026	PHYSICIANS	91625	05	Anesthesiology	0	In state provider	None	23845 MCBEAN PARKWAY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
122390	Fee-for-Service	1386033090	1386033090	1	1	LEON GUERRERO, SHANTI MD	3/28/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	155088	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
122403	Fee-for-Service	1730216565	1730216565	1	1	LEE, TIMOTHY MD	3/7/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	96022	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
122406	Fee-for-Service	1275997066	1275997066	1	1	LUMALU, JACQUELINE S CRNA	11/19/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
122412	Fee-for-Service	1619952918	1619952918	1	1	LANCIERS, SOPHIE MD	6/20/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
122417	Fee-for-Service	1831375880	1831375880	1	1	LAKSHMANAN, ASHWINI MD	6/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99352	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
122419	Fee-for-Service	1356725808	1356725808	1	1	LYNDEE VENOSTA MARRIAGE & FA	1/19/2021	106H00000X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5871 PINE AVE	SUITE 230	CHINO HILLS	CA	91709	6545	36	06071	33.94767013	-117.6754339	San Bernardino County
122423	Fee-for-Service	1306803101	1306803101	1	1	LAU, SEAN K MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68037	22	Pathology (M.D. only)	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
122463	Fee-for-Service	1518963693	1518963693	1	1	LIFELONG MEDICAL CARE	7/1/1996	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	BERKELEY PRIMARY CARE	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
122478	Fee-for-Service	1003540329	1003540329	1	1	LEISURE HEALTHCARE, LLC	8/1/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	330 MISSION RD	None	GLENDALE	CA	91205	3328	19	06037	34.12701464	-118.251778	Los Angeles County
122486	Fee-for-Service	1255011409	1255011409	1	1	LUNA'S CARE LLC	9/26/2023	347C00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2384 E MAIN ST	None	STOCKTON	CA	95205	6552	39	06077	37.95497317	-121.2554741	San Joaquin County
122489	Fee-for-Service	1154950285	1154950285	1	1	LINDBERG, WESLEY MD	5/23/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	1401 GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
122513	Fee-for-Service	1376627356	1376627356	1	1	LOVOLD, JEFFREY A MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	61962	41	Internal Medicine	0	In state provider	THE PERMANENTE MED GROUP	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
122544	Fee-for-Service	1083076749	1083076749	1	1	LEE, JENNY J MD	10/11/2023	207RA0201X	NA	Other	026	PHYSICIANS	186020	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
122554	Fee-for-Service	1972062834	1972062834	1	1	LAU, NICOLE W MD	7/1/2022	207P00000X	NA	Other	026	PHYSICIANS	176400	None	None	0	In state provider	None	6501 COYLE AVENUE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
122557	Fee-for-Service	1255374054	1255374054	1	1	LAGUNA HONDA HOSPITAL	1/1/1966	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1499	38	06075	37.74791027	-122.4587116	San Francisco County
122574	Fee-for-Service	1023139797	1023139797	1	1	LUZ, BRADFORD R PHD	7/10/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
122576	Fee-for-Service	1992703458	1992703458	1	1	LIN, MATTHEW Y C MD INC	6/8/1989	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	32175	20	Orthopedic Surgery	0	In state provider	None	500 N GARFIELD AVE	STE 204	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
122590	Fee-for-Service	1629867387	1629867387	1	1	LYNN-MCDONOUGH, VALERIE	5/2/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
122626	Fee-for-Service	1023437530	1023437530	1	1	LYN, RAQUEL L MD	8/31/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	156681	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
122630	Fee-for-Service	1538181482	1538181482	1	1	LA CLINICA DE LA RAZA INC	9/1/2004	261QD0000X	NA	Dental Clinic	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2000 SIERRA ROAD	None	CONCORD	CA	94518	2905	07	06013	37.95249193	-122.0369734	Contra Costa County
122656	Fee-for-Service	1922189802	1922189802	1	1	LEPLER, ELLIOT C MD	8/24/2004	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	36082	40	Pediatrics	0	In state provider	None	515 SOUTH DR	STE 21	MOUNTAIN VIEW	CA	94040	4209	43	06085	37.36725925	-122.0837256	Santa Clara County
122688	Fee-for-Service	1134301591	1134301591	1	1	LEE-YIP, THERESA M OD	6/27/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
122706	Fee-for-Service	1356725808	1356725808	1	1	LYNDEE VENOSTA MARRIAGE & FA	8/26/2019	106H00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5871 PINE AVE	SUITE 230	CHINO HILLS	CA	91709	6545	36	06071	33.94767013	-117.6754339	San Bernardino County
122732	Fee-for-Service	1265661177	1265661177	1	1	LAI, JASMINE MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	113482	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4004 BEYER BLVD	None	SAN DIEGO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
122743	Fee-for-Service	1255419883	1255419883	1	1	LOPATO, LESLIE M MD	10/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	42620	36	Psychiatry	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
122752	Fee-for-Service	1518963693	1518963693	1	1	LIFELONG MEDICAL CARE	3/1/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	BERKELEY PRIMARY CARE	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
122758	Fee-for-Service	1013196609	1013196609	1	1	LUDWIN, STEVEN M MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117398	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
122848	Fee-for-Service	1518074731	1518074731	1	1	LIU, JAMES H MD	2/12/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	64811	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1730 S SAN GABRIEL BLVD	STE C	SAN GABRIEL	CA	91776	3928	19	06037	34.077654	-118.0907045	Los Angeles County
122857	Fee-for-Service	1659535094	1659535094	1	1	LEWINSKI, MARY K MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109633	77	Infectious Disease	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
122943	Fee-for-Service	1508128679	1508128679	1	1	LIM, BECKY A MD	1/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119156	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
122946	Fee-for-Service	1437349263	1437349263	1	1	LOFLAND, JENNIFER S CRNA	10/14/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
122957	Fee-for-Service	1427453414	1427453414	1	1	LANG, JORDAN A MD	3/16/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	178591	None	None	0	In state provider	None	830 2ND ST	STE A	SANTA ROSA	CA	95404	4620	49	06097	38.440746	-122.7085605	Sonoma County
122989	Fee-for-Service	1245327139	1245327139	1	1	LOARIE, AMY L PHD	8/25/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1660 E ROSEVILLE PARKWAY	BUILDING C	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
122994	Fee-for-Service	1356725808	1356725808	1	1	LYNDEE VENOSTA MARRIAGE & FA	8/26/2019	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5871 PINE AVE	SUITE 230	CHINO HILLS	CA	91709	6545	36	06071	33.94767013	-117.6754339	San Bernardino County
123001	Fee-for-Service	1326023979	1326023979	1	1	LEBERTHON, BRIAN J MD	1/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	79934	68	Hematology	0	In state provider	AMC	1135 S SUNSET AVE	STE 207	WEST COVINA	CA	91790	3908	19	06037	34.06215064	-117.9453997	Los Angeles County
123039	Fee-for-Service	1518963693	1518963693	1	1	LIFELONG MEDICAL CARE	7/1/1996	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	BERKELEY PRIMARY CARE	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
123043	Fee-for-Service	1255368726	1255368726	1	1	LOW, RANDALL MD	6/30/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32525	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	728 PACIFIC AVE	STE 501	SAN FRANCISCO	CA	94133	4449	38	06075	37.79687859	-122.4074282	San Francisco County
123062	Fee-for-Service	1083619100	1083619100	1	1	LIN, PAUL S MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	51128	09	Gynecology (D.O. only)	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
123067	Fee-for-Service	1609819465	1609819465	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	60 CABRILLO HWY N	None	HALF MOON BAY	CA	94019	1664	41	06081	37.46927467	-122.4347359	San Mateo County
123121	Fee-for-Service	1497145916	1497145916	1	1	LAKHANI, ABDULLAH H MD	12/13/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	50260	None	None	0	In state provider	None	7257 FRESNO	FIRST FLOOR	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
123133	Fee-for-Service	1982799888	1982799888	1	1	LUNDEBERG, PATRICIA M MD	12/1/2001	207P00000X	NA	Other	026	PHYSICIANS	56317	08	Family Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
123143	Fee-for-Service	1659535094	1659535094	1	1	LEWINSKI, MARY K MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109633	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
123145	Fee-for-Service	1780003590	1780003590	1	1	LANG, JASON W MD	8/1/2019	207L00000X	NA	Other	026	PHYSICIANS	142354	05	Anesthesiology	0	In state provider	None	CLAY AND BUCHANNAN ST	None	SAN FRANCISCO	CA	94115	0000	38	06075	37.791126	-122.4309105	San Francisco County
123152	Fee-for-Service	1386170785	1386170785	1	1	LOPEZ, JUAN D MD	12/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	158651	01	General Practice	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
123174	Fee-for-Service	1275638389	1275638389	1	1	LINDENFELD, PAUL N MD	1/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101117	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
123180	Fee-for-Service	1922187624	1922187624	1	1	LEE, YU-TE MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65351	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
123198	Fee-for-Service	1457794364	1457794364	1	1	LE, CATHERINE N MD	8/21/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	141737	41	Internal Medicine	0	In state provider	None	8635 W 3RD ST	STE 485W	LOS ANGELES	CA	90048	6121	19	06037	34.07361928	-118.3803143	Los Angeles County
123230	Fee-for-Service	1730121542	1730121542	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	257 MOUNT HERMON RD	None	SCOTTS VALLEY	CA	95066	4037	44	06087	37.04734356	-122.0319835	Santa Cruz County
123232	Fee-for-Service	1699742189	1699742189	1	1	LEE, LANCE J MD	5/1/2002	2084N0400X	NA	Neurology	026	PHYSICIANS	61300	None	None	0	In state provider	None	435 ARDEN AVE	STE 560	GLENDALE	CA	91203	1142	19	06037	34.15848148	-118.2628845	Los Angeles County
123260	Fee-for-Service	1447389325	1447389325	1	1	LYNCH, JOSEPHINE J M LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
123268	Fee-for-Service	1124015656	1124015656	1	1	LIU, FANGLUO MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	53049	None	None	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
123271	Fee-for-Service	1346224540	1346224540	1	1	LIBAO, RICHARD MD	10/31/1991	207L00000X	NA	Other	026	PHYSICIANS	55784	05	Anesthesiology	0	In state provider	None	1720 TERMINO AVE	None	LONG BEACH	CA	90804	2104	19	06037	33.78889871	-118.1458784	Los Angeles County
123282	Fee-for-Service	1356725808	1356725808	1	1	LYNDEE VENOSTA MARRIAGE & FA	8/26/2019	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5871 PINE AVE	SUITE 230	CHINO HILLS	CA	91709	6545	36	06071	33.94767013	-117.6754339	San Bernardino County
123292	Fee-for-Service	1326023979	1326023979	1	1	LEBERTHON, BRIAN J MD	1/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	79934	78	Neoplastic Diseases/Oncology	0	In state provider	AMC	1135 S SUNSET AVE	STE 207	WEST COVINA	CA	91790	3908	19	06037	34.06215064	-117.9453997	Los Angeles County
123382	Fee-for-Service	1326675489	1326675489	1	1	LEE, PRESTON MD	10/16/2023	207R00000X	NA	Other	026	PHYSICIANS	187834	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
123393	Fee-for-Service	1003844622	1003844622	1	1	LEE, DAVID D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	202 N DIVISION ST	None	AUBURN	WA	98001	4939	00	None	47.308698	-122.2297715	King County
123395	Fee-for-Service	1285676015	1285676015	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8915 TOWNE CENTRE DR	None	SAN DIEGO	CA	92122	5650	37	06073	32.86767898	-117.2071838	San Diego County
123406	Fee-for-Service	1477263911	1477263911	1	1	LUTZ, EMMA NP	2/21/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95022110	-	NOT APPLICABLE	0	In state provider	None	12 & 16 RITTER STREET	None	SAN RAFAEL	CA	94901	3323	21	06041	37.97151013	-122.5251246	Marin County
123409	Fee-for-Service	1659315091	1659315091	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	30640 RANCHO CALIF RD	None	TEMECULA	CA	92591	3276	33	06065	33.510087	-117.1255905	Riverside County
123429	Fee-for-Service	1578625307	1578625307	1	1	LEE, GARY A OD APC	9/24/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11930 GARVEY AVE	None	EL MONTE	CA	91732	3514	19	06037	34.0627107	-118.0209423	Los Angeles County
123434	Fee-for-Service	1013985738	1013985738	1	1	LYNN, MICHAEL S MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61071	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
123436	Fee-for-Service	1336343482	1336343482	1	1	LEONG, LELAND D	6/15/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	30400 CAMINO CAPISTRANO	None	SAN JUAN CAPISTRA	CA	92675	1300	30	06059	33.5224708	-117.6686181	Orange County
123465	Fee-for-Service	1972765774	1972765774	1	1	LOGAN, STACEY M MD	10/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115496	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
123467	Fee-for-Service	1205941994	1205941994	1	1	LEUNG, ALEX C PHD	5/27/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	16412 LOS GATOS BLVD	None	LOS GATOS	CA	95032	5525	43	06085	37.23046706	-121.9654506	Santa Clara County
123470	Fee-for-Service	1023677309	1023677309	1	1	LOPEZ, ARACELI LMFT	9/2/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
123486	Fee-for-Service	1457794364	1457794364	1	1	LE, CATHERINE N MD	8/21/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	141737	77	Infectious Disease	0	In state provider	None	8635 W 3RD ST	STE 485W	LOS ANGELES	CA	90048	6121	19	06037	34.07361928	-118.3803143	Los Angeles County
123489	Fee-for-Service	1740245034	1740245034	1	1	LEIB, STEVEN J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41608	08	Family Practice	0	In state provider	None	6222 HIGHWAY 9	None	FELTON	CA	95018	9713	44	06087	37.05175537	-122.0732255	Santa Cruz County
123491	Fee-for-Service	1720091747	1720091747	1	1	LU, JING MD	9/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88108	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 N GARFIELD AVE	STE 205	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
123497	Fee-for-Service	1588744056	1588744056	1	1	LYNCH, NATHALIE	9/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82921	40	Pediatrics	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
123511	Fee-for-Service	1609840008	1609840008	1	1	LACOMIS,JOAN M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5230 CENTER AVE	None	PITTSBURGH	PA	15232	0000	00	None	40.45554129	-79.93971305	Allegheny County
123587	Fee-for-Service	1013203165	1013203165	1	1	LURVEY, ROBERT B MD	7/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123987	34	Urology and Urological Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
123590	Fee-for-Service	1629235783	1629235783	1	1	LIN, JEFF F H MD	10/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131018	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	23526 HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5802661	-121.9165234	Monterey County
123635	Fee-for-Service	1225044662	1225044662	1	1	LOS ANGELES COUNTY	4/28/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	WILMINGTON FAM PLANNING	1325 BROAD AVE	None	WILMINGTON	CA	90744	2604	19	06037	33.78954418	-118.2615913	Los Angeles County
123636	Fee-for-Service	1265413165	1265413165	2	1	LA, ANHTU H MD	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82125	None	None	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
123689	Fee-for-Service	1053510099	1053510099	1	1	LIN, ERIC L MD	12/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82296	20	Orthopedic Surgery	0	In state provider	None	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
123705	Fee-for-Service	1194296244	1194296244	1	1	LEBLEUCHATEAU, INC	8/21/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1911 GRISMER AVE	None	BURBANK	CA	91504	3623	19	06037	34.19591031	-118.3257523	Los Angeles County
123710	Fee-for-Service	1760976070	1760976070	1	1	LOPEZ, MICHAEL A PHD	10/11/2022	225400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
123739	Fee-for-Service	1770650590	1770650590	1	1	LIU, GRACE DO	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7719	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
123742	Fee-for-Service	1740447796	1740447796	1	1	LEE, WENDY Y MD	6/8/2010	390200000X	NA	Other	026	PHYSICIANS	105010	41	Internal Medicine	0	In state provider	None	11000 OLSON DR	STE 100	RANCHO CORDOVA	CA	95670	5605	34	06067	38.595123	-121.2820155	Sacramento County
123751	Fee-for-Service	1548204977	1548204977	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1558 TRANCAS ST.	None	NAPA	CA	94558	2916	28	06055	38.32222673	-122.3035952	Napa County
123757	Fee-for-Service	1578133948	1578133948	1	1	LEISS, JORY	3/29/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
123758	Fee-for-Service	1679354609	1679354609	1	1	LOPEZ, KATRINA NP	2/14/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
123777	Fee-for-Service	1497864177	1497864177	1	1	LUU, VAN K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	43051	08	Family Practice	0	In state provider	None	9500 BOLSA AVE	STE M	WESTMINSTER	CA	92683	5943	30	06059	33.74475113	-117.9634694	Orange County
123801	Fee-for-Service	1831692656	1831692656	1	1	LEAVITT, WILLIAM K LMFT	8/9/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1201 S VICTORY BLVD	STE 206	BURBANK	CA	91502	2552	19	06037	34.16527115	-118.3059384	Los Angeles County
123802	Fee-for-Service	1316203144	1316203144	1	1	LAN N VU	3/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7026 OLD KATY RD	STE 276	HOUSTON	TX	77024	2187	00	None	29.78388299	-95.44503208	Harris County
123804	Fee-for-Service	1962961284	1962961284	1	1	LIANG, JOANNE MD	6/28/2022	390200000X	NA	Other	026	PHYSICIANS	178738	None	None	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
123811	Fee-for-Service	1043265556	1043265556	1	1	LAZERE, ANDREW MD	10/27/1969	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	20742	30	Radiology	0	In state provider	None	28 MONARCH BAY PLAZA	None	SOUTH LAGUNA	CA	92677	0000	30	06059	33.48609173	-117.7247508	Orange County
123820	Fee-for-Service	1558550129	1558550129	1	1	LAKE SIDE DIAGNOSTICS CENTER	4/7/2009	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED	10701 RIVERSIDE DRIVE	STE 16	TOLUCA LAKE	CA	91602	2385	19	06037	34.15226651	-118.36386	Los Angeles County
123823	Fee-for-Service	1013071471	1013071471	1	1	LEE, FUE DC	4/1/1999	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	7206 FLORIN MALL DR	None	SACRAMENTO	CA	95823	2785	34	06067	38.494692	-121.435011	Sacramento County
123831	Fee-for-Service	1093972192	1093972192	1	1	LEE, LOUIS C MD	10/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121405	02	General Surgery	0	In state provider	None	1668 DOMINICAN WAY	None	SANTA CRUZ	CA	95065	1522	44	06087	36.99025828	-121.9810944	Santa Cruz County
123833	Fee-for-Service	1659354686	1659354686	1	1	LEE, LOREN L OD	1/31/1987	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	619 S FIRST AVE	None	ARCADIA	CA	91006	3834	19	06037	34.13273103	-118.0282278	Los Angeles County
123874	Fee-for-Service	1669775763	1669775763	1	1	LIN, DAVID MEDICAL CLINIC	1/31/2014	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	INC	3925 N ROSEMEAD BLVD	SUITE 101	ROSEMEAD	CA	91770	1933	19	06037	34.07930385	-118.0732531	Los Angeles County
123884	Fee-for-Service	1134688070	1134688070	1	1	LEE, JULIE J MD	4/25/2024	207R00000X	NA	Other	026	PHYSICIANS	178105	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
123960	Fee-for-Service	1558523928	1558523928	1	1	LEE, DAVID W MD DO	12/27/2018	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	115258	25	Physical Medicine and Rehabilitation	0	In state provider	None	680 LANGSDORF DR	SUITE 103	FULLERTON	CA	92831	3702	30	06059	33.87673088	-117.8824577	Orange County
123968	Fee-for-Service	1699303172	1699303172	1	1	LAO, AARON-JAMES DO	11/21/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20952	None	None	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
123970	Fee-for-Service	1518973940	1518973940	1	1	LOS ANGELES COUNTY	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	BELLFLOWER HEALTH CENTER	10005 E FLOWER AVE	None	BELLFLOWER	CA	90706	0000	19	06037	33.8821593	-118.1206122	Los Angeles County
123971	Fee-for-Service	1558474395	1558474395	1	1	LUQUE, HECTOR F DO	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	6465	41	Internal Medicine	0	In state provider	None	850 S ATLANTIC BLVD	STE 101	MONTEREY PARK	CA	91754	4727	19	06037	34.05097684	-118.1379979	Los Angeles County
123994	Fee-for-Service	1235584749	1235584749	1	1	LEE, MICHAEL J MD	4/20/2021	261QR0200X	NA	Mammography/MRI Provider	026	PHYSICIANS	151930	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
124027	Fee-for-Service	1275146144	1275146144	1	1	LAVELLA HOSPICE INC	8/31/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	STE 107A	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
124032	Fee-for-Service	1497225965	1497225965	1	1	LABAJO, MARIA CELESTE L NP	12/7/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
124034	Fee-for-Service	1619107430	1619107430	1	1	LUGG, REBECCA LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
124046	Fee-for-Service	1043777618	1043777618	1	1	LOPEZ, STEPHANIE PSYD	4/27/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
124107	Fee-for-Service	1194084517	1194084517	1	1	LEE, ON-TAT MD	7/8/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	138659	18	Ophthalmology	0	In state provider	None	1617 SAINT MARKS PLZ	STE D	STOCKTON	CA	95207	6478	39	06077	37.98864819	-121.3268062	San Joaquin County
124113	Fee-for-Service	1881798346	1881798346	1	1	LANCE, JEFFREY M PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1560 E CHEVY CHASE DR	STE 250	GLENDALE	CA	91206	4157	19	06037	34.15290734	-118.2302295	Los Angeles County
124128	Fee-for-Service	1932668894	1932668894	1	1	LEE, STEVEN DO	10/14/2022	207R00000X	NA	Other	026	PHYSICIANS	19434	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
124135	Fee-for-Service	1851686828	1851686828	1	1	LEE, DIANA H DO	8/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11529	05	Anesthesiology	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
124166	Fee-for-Service	1659695971	1659695971	1	1	LAM, GABRIEL LCSW	2/15/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	510 W. MAIN STREET	SUITE 110	EL CENTRO	CA	92243	4371	13	06025	32.79286045	-115.555059	Imperial County
124177	Fee-for-Service	1457398406	1457398406	1	1	LAI, JOHN O MD	10/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78359	41	Internal Medicine	0	In state provider	None	1580 VALENCIA ST	STE 605	SAN FRANCISCO	CA	94110	4415	38	06075	37.74746923	-122.4202583	San Francisco County
124182	Fee-for-Service	1861999005	1861999005	1	1	LEE, JONGSERK R DO	6/26/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	17556	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
124196	Fee-for-Service	1649874546	1649874546	1	1	LE HEALTHCARE	4/19/2024	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	15420 CRENSHAW BLVD	None	GARDENA	CA	90249	4524	19	06037	33.8903685	-118.3264725	Los Angeles County
124213	Fee-for-Service	1265049233	1265049233	1	1	LEAN, MELANIE L PSYD	4/26/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
124259	Fee-for-Service	1558474395	1558474395	1	1	LUQUE, HECTOR F DO	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	6465	01	General Practice	0	In state provider	None	850 S ATLANTIC BLVD	STE 101	MONTEREY PARK	CA	91754	4727	19	06037	34.05097684	-118.1379979	Los Angeles County
124260	Fee-for-Service	1518973940	1518973940	1	1	LOS ANGELES COUNTY	7/1/2000	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	BELLFLOWER HEALTH CENTER	10005 E FLOWER AVE	None	BELLFLOWER	CA	90706	0000	19	06037	33.8821593	-118.1206122	Los Angeles County
124262	Fee-for-Service	1578539508	1578539508	1	1	LEE, HEE YOUNG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36830	05	Anesthesiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
124301	Fee-for-Service	1407436207	1407436207	1	1	LU, MONIQUE A MD	10/18/2023	207R00000X	NA	Other	026	PHYSICIANS	20945	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
124316	Fee-for-Service	1275146144	1275146144	1	1	LAVELLA HOSPICE INC	8/31/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	STE 107A	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
124324	Fee-for-Service	1447292545	1447292545	1	1	LEE, SINJIN MD	11/24/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	108586	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3080 BRISTOL STREET	SUITE 600	COSTA MESA	CA	92626	7341	30	06059	33.68480996	-117.8854767	Orange County
124327	Fee-for-Service	1548585375	1548585375	1	1	LOTFIPOUR, ASHLEY K MD	3/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115433	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
124345	Fee-for-Service	1811931173	1811931173	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2140 GRASS VALLEY HWY	None	AUBURN	CA	95603	2522	31	06061	38.93320477	-121.0915392	Placer County
124400	Fee-for-Service	1144269820	1144269820	1	1	LIN, HELEN Y MD	1/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130579	41	Internal Medicine	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
124404	Fee-for-Service	1013513522	1013513522	1	1	LOGAN, SHAWNTEL R NP	9/25/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11234 ANDERSON ST	SUITE 7100	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
124444	Fee-for-Service	1053446625	1053446625	1	1	LAU, ALVIN H MD	7/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98872	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
124486	Fee-for-Service	1649874546	1649874546	1	1	LE HEALTHCARE	4/19/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	15420 CRENSHAW BLVD	None	GARDENA	CA	90249	4524	19	06037	33.8903685	-118.3264725	Los Angeles County
124531	Fee-for-Service	1356758635	1356758635	1	1	LEE, GRACE M CNP	10/4/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
124586	Fee-for-Service	1265512982	1265512982	1	1	LY, PHUONG C MD	2/13/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53516	08	Family Practice	0	In state provider	None	710 N EUCLID ST	None	ANAHEIM	CA	92801	4122	30	06059	33.8420837	-117.9415765	Orange County
124587	Fee-for-Service	1154724052	1154724052	1	1	LARSON, BRETT PA	5/4/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	51996	-	NOT APPLICABLE	0	In state provider	None	2101 E 1ST ST	None	SANTA ANA	CA	92705	4007	30	06059	33.74575646	-117.836901	Orange County
124616	Fee-for-Service	1124557434	1124557434	3	1	LPS PHARMACY INC	3/30/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1647 N. HACIENDA BLVD.	None	LA PUENTE	CA	91744	1137	19	06037	34.04917664	-117.9454719	Los Angeles County
124627	Fee-for-Service	1447302666	1447302666	1	1	LIU, AMON Y MD	5/22/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84543	30	Radiology	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
124650	Fee-for-Service	1225293343	1225293343	1	1	LEE, JIN S MD	5/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107777	05	Anesthesiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
124652	Fee-for-Service	1003961525	1003961525	1	1	LOS ANGELES COUNTY CCS	11/14/1994	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	NORTH HOLLYWOOD MTU	12827 SATICOY ST	None	NORTH HOLLYWOOD	CA	91605	3506	19	06037	34.20639436	-118.41311	Los Angeles County
124656	Fee-for-Service	1831149475	1831149475	1	1	LEE, KENNETH S MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	53421	40	Pediatrics	0	In state provider	None	5800 HANNUM AVE	None	CULVER CITY	CA	90230	6502	19	06037	33.98724995	-118.3858338	Los Angeles County
124732	Fee-for-Service	1053446625	1053446625	1	1	LAU, ALVIN H MD	7/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98872	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
124735	Fee-for-Service	1487459475	1487459475	1	1	LYON, TINA M	2/18/2025	172V00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
124741	Fee-for-Service	1508052341	1508052341	1	1	LIM, EDUARDO MED CORP	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	49674	68	Hematology	0	In state provider	None	201 S ALVARDO ST	STE 505	LOS ANGELES	CA	90057	2385	19	06037	34.06417777	-118.2719543	Los Angeles County
124742	Fee-for-Service	1457574717	1457574717	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3340 N TEXAS ST	None	FAIRFIELD	CA	94533	9758	48	06095	38.29154988	-122.0337627	Solano County
124769	Fee-for-Service	1730525999	1730525999	1	1	LI, YI MD	7/27/2020	207RR0500X	NA	Other	026	PHYSICIANS	162759	83	Rheumatology	0	In state provider	None	8329 BRIMHALL RD	SUITE 801	BAKERSFIELD	CA	93312	2243	15	06029	35.366706	-119.0959425	Kern County
124774	Fee-for-Service	1548337454	1548337454	1	1	LOZANO, CHRISTOPHER S MD	11/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90978	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
124785	Fee-for-Service	1568407468	1568407468	1	1	LCPS ACQUISITION LLC	8/8/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	1	Border provider	None	6825 W GALVESTON ST	STE 3	CHANDLER	AZ	85226	2517	00	None	33.31215	-111.960063	Maricopa County
124806	Fee-for-Service	1326545880	1326545880	1	1	LUTTIO, ISAAC N MD	8/27/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174115	None	None	0	In state provider	None	3612 DALE RD	None	MODESTO	CA	95356	0500	50	06099	37.69097901	-121.0498748	Stanislaus County
124813	Fee-for-Service	1679192587	1679192587	1	1	LASKY, JAMES A MD	6/4/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	1401 GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
124815	Fee-for-Service	1316027444	1316027444	1	1	LANE, KAREN T MD	10/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80533	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	#120	LOS ANGELES	CA	90024	7002	19	06037	34.06527974	-118.4462792	Los Angeles County
124829	Fee-for-Service	1750519237	1750519237	1	1	LO, RUBY C MD MPH	8/3/2022	2086S0129X	NA	General Surgery	026	PHYSICIANS	178062	None	None	0	In state provider	None	1668 DOMINICAN WAY	None	SANTA CRUZ	CA	95065	1522	44	06087	36.99025828	-121.9810944	Santa Cruz County
124843	Fee-for-Service	1730291808	1730291808	1	1	LOMBARDY, LESLIE LMFT	3/12/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
124854	Fee-for-Service	1861990418	1861990418	1	1	LAUREN H. FELIPE, O.D. INC.	3/1/2025	193400000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14709 PRAIRIE AVE	None	LAWNDALE	CA	90260	1831	19	06037	33.89785517	-118.3439175	Los Angeles County
124897	Fee-for-Service	1548202740	1548202740	1	1	LAI, ANNIE PO WAH MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	64759	None	None	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
124906	Fee-for-Service	1396880365	1396880365	1	1	LEE, RYAN K M D INC	4/17/2012	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	79984	None	None	0	In state provider	None	1420 SOUTH CENTRAL AVE	None	GLENDALE	CA	91204	2851	19	06037	34.12811155	-118.2577764	Los Angeles County
124912	Fee-for-Service	1003860909	1003860909	1	1	LAVKAN, AHMET H MD	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55377	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
124926	Fee-for-Service	1205246741	1205246741	1	1	LEWIS, JONATHAN D MD	3/25/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
124944	Fee-for-Service	1831149475	1831149475	1	1	LEE, KENNETH S MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	53421	08	Family Practice	0	In state provider	None	5800 HANNUM AVE	None	CULVER CITY	CA	90230	6502	19	06037	33.98724995	-118.3858338	Los Angeles County
124966	Fee-for-Service	1922528017	1922528017	1	1	LEE, HAE J	12/7/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	217 W CERRITOS AVE	None	ANAHEIM	CA	92805	6549	30	06059	33.81058193	-117.9065445	Orange County
124971	Fee-for-Service	1326081191	1326081191	2	1	LONGS DRUG STORES CA LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2662 DEL MAR HEIGHTS RD.	None	DEL MAR	CA	92014	3100	37	06073	32.94924349	-117.245776	San Diego County
124976	Fee-for-Service	1689681546	1689681546	1	1	LANUM, DAVID A MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	61543	08	Family Practice	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
124986	Fee-for-Service	1790371722	1790371722	1	1	LUAR HOSPICE CARE INC	9/21/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1619 W GARVEY AVE N	SUITE 102	WEST COVINA	CA	91790	2146	19	06037	34.07272709	-117.9404871	Los Angeles County
125003	Fee-for-Service	1710337894	1710337894	1	1	LIPSUN, DARYL OD	6/27/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 E SANTA BARBARA ST	SUITE C	SANTA PAULA	CA	93060	2675	56	06111	34.35269772	-119.069955	Ventura County
125015	Fee-for-Service	1770525917	1770525917	1	1	LU, CHUANYI MD	3/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73318	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
125018	Fee-for-Service	1053446625	1053446625	1	1	LAU, ALVIN H MD	7/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98872	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
125029	Fee-for-Service	1508052341	1508052341	1	1	LIM, EDUARDO MED CORP	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	49674	78	Neoplastic Diseases/Oncology	0	In state provider	None	201 S ALVARDO ST	STE 505	LOS ANGELES	CA	90057	2385	19	06037	34.06417777	-118.2719543	Los Angeles County
125100	Fee-for-Service	1679192587	1679192587	1	1	LASKY, JAMES A MD	6/4/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	1401 GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
125101	Fee-for-Service	1316027444	1316027444	1	1	LANE, KAREN T MD	10/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80533	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	#120	LOS ANGELES	CA	90024	7002	19	06037	34.06527974	-118.4462792	Los Angeles County
125108	Fee-for-Service	1265441521	1265441521	1	1	LEVIN, DAVID R DPM	10/31/1993	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	18055 BUSHARD ST	None	FOUNTAIN VALLEY	CA	92708	5760	30	06059	33.700788	-117.9629595	Orange County
125120	Fee-for-Service	1891122255	1891122255	1	1	LEITCH, JUDITH LCSW	1/16/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
125158	Fee-for-Service	1679659551	1679659551	1	1	LITOFE, TIMOTHY A MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
125160	Fee-for-Service	1558531384	1558531384	1	1	LAI, JAY H MD	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101700	08	Family Practice	0	In state provider	None	1020 29TH STREET	SUITE 480	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
125183	Fee-for-Service	1295950962	1295950962	1	1	LOGALBO, MATHEW J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5300 TALLMAN AVE NW	STE 4	SEATTLE	WA	98107	3932	00	None	47.6671795	-122.3799151	King County
125198	Fee-for-Service	1003860909	1003860909	1	1	LAVKAN, AHMET H MD	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55377	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
125200	Fee-for-Service	1568549491	1568549491	1	1	LEVIS, JOEL T MD	6/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76319	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
125208	Fee-for-Service	1801944764	1801944764	1	1	LASSER, KENNETH H MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35502	22	Pathology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
125228	Fee-for-Service	1730197062	1730197062	1	1	LEE, JAW-CHYI MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70318	66	Emergency Medicine (Urgent Care)	0	In state provider	None	12601 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1908	30	06059	33.77450951	-117.913014	Orange County
125240	Fee-for-Service	1306093927	1306093927	1	1	LAU, CINDY-HEUNG M NP	5/30/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
125244	Fee-for-Service	1457521239	1457521239	1	1	LA MAESTRA FAMILY CLINIC	4/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	LA MAESTRA COMMUNITY PHA	4171 FAIRMOUNT AVE	STE B	SAN DIEGO	CA	92105	1609	37	06073	32.75269063	-117.1008386	San Diego County
125273	Fee-for-Service	1790371722	1790371722	1	1	LUAR HOSPICE CARE INC	9/21/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1619 W GARVEY AVE N	SUITE 102	WEST COVINA	CA	91790	2146	19	06037	34.07272709	-117.9404871	Los Angeles County
125303	Fee-for-Service	1770525917	1770525917	1	1	LU, CHUANYI MD	3/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73318	90	Pathology-Forensic	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
125310	Fee-for-Service	1639547391	1639547391	1	1	LIM, DOROTHY A C CRNA	12/14/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
125320	Fee-for-Service	1447465513	1447465513	1	1	LUMAN, JENIFER C MD	10/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131482	66	Emergency Medicine (Urgent Care)	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
125358	Fee-for-Service	1790362093	1790362093	1	1	LUONG, ETHAN B MD	9/15/2023	207P00000X	NA	Other	026	PHYSICIANS	184728	None	None	0	In state provider	None	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	39	06077	38.12188356	-121.285872	San Joaquin County
125377	Fee-for-Service	1902936792	1902936792	1	1	LOPEZ, MARIVEL R LMFT	8/13/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
125384	Fee-for-Service	1831178250	1831178250	1	1	LANE, STEVEN R MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	60899	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	# AC9	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
125403	Fee-for-Service	1295787984	1295787984	1	1	LANDAU, EARL K MD	11/23/2010	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	28197	30	Radiology	0	In state provider	None	1400 S GRAND AVE	#608	LOS ANGELES	CA	90015	3068	19	06037	34.03692236	-118.2655238	Los Angeles County
125414	Fee-for-Service	1255590527	1255590527	1	2	LEE, JULIANNE O MD	10/24/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	97817	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
125475	Fee-for-Service	1427330174	1427330174	1	1	LAMAS, LORENA LCSW	2/9/2021	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	809 S ATLANTIC BLVD	203	MONTEREY PARK	CA	91754	4757	19	06037	34.05248855	-118.1371554	Los Angeles County
125501	Fee-for-Service	1558440545	1558440545	1	1	LIPPMAN, ARTHUR L MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	14483	05	Anesthesiology	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93942	5902	27	06053	36.5785911	-121.9150013	Monterey County
125542	Fee-for-Service	1285923623	1285923623	1	3	LEWIS, MARSHALL S MD APC	1/20/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	None	1031 N DEMAREE ST	None	VISALIA	CA	93291	4117	54	06107	36.338409	-119.3322735	Tulare County
125558	Fee-for-Service	1396742904	1396742904	1	1	LOPATEGUI, JEAN R MD	12/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	50833	22	Pathology (M.D. only)	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
125561	Fee-for-Service	1457592917	1457592917	1	1	LOPEZ, ELIZABETH A CRNA	7/26/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
125568	Fee-for-Service	1790960128	1790960128	1	1	LUE, JAMES MD	10/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91550	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
125575	Fee-for-Service	1225531049	1225531049	1	1	LEVITTE, STEVEN MD	6/4/2024	390200000X	NA	Other	026	PHYSICIANS	165068	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
125591	Fee-for-Service	1639131386	1639131386	1	1	LARRY D. SMITH, D.O.	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	810 JASMINE ST	None	OMAK	WA	98841	9578	00	None	48.3963912	-119.5454377	Okanogan County
125614	Fee-for-Service	1932122579	1932122579	1	1	LIN, JAMES	2/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82428	None	None	0	In state provider	None	801 E MOUNTAIN VIEW ST	STE C	BARSTOW	CA	92311	3052	36	06071	34.89324445	-117.0177579	San Bernardino County
125617	Fee-for-Service	1205843778	1205843778	2	1	LAM, CHI Y MD	6/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	39312	41	Internal Medicine	0	In state provider	None	223 N GARFIELD AVENUE	SUITE 206	MONTEREY PARK	CA	91754	1700	19	06037	34.0646166	-118.1228948	Los Angeles County
125637	Fee-for-Service	1538181482	1538181482	1	6	LA CLINICA DE LA RAZA INC	12/23/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1187 MEADOW LANE	None	CONCORD	CA	94520	3745	07	06013	37.96001427	-122.0422115	Contra Costa County
125654	Fee-for-Service	1528630522	1528630522	1	1	LAM HOME HEALTH CARE INC	6/10/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1200 E ROUTE 66	STE 210	GLENDORA	CA	91740	6360	19	06037	34.12873149	-117.8422695	Los Angeles County
125665	Fee-for-Service	1356492896	1356492896	1	1	LEMOORE UNION HSD	7/24/1999	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	101 E BUSH STREET	None	LEMOORE	CA	93245	3601	16	06031	36.29828838	-119.7793912	Kings County
125673	Fee-for-Service	1831178250	1831178250	1	1	LANE, STEVEN R MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	60899	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	# AC9	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
125689	Fee-for-Service	1760616098	1760616098	1	1	LEE, CINDY L MD	7/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106312	01	General Practice	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
125702	Fee-for-Service	1326236662	1326236662	1	1	LEE, JASON D MD	8/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88138	22	Pathology (M.D. only)	0	In state provider	None	700 LAEWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
125706	Fee-for-Service	1134495302	1134495302	1	1	LAU, EVA OD	1/22/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3900 ALAMO ST	None	SIMI VALLEY	CA	93063	2111	56	06111	34.28628637	-118.7195497	Ventura County
125828	Fee-for-Service	1275504409	1275504409	1	1	LAMOTTE, JEREMY P MD	5/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106889	01	General Practice	0	In state provider	None	26991 CROWN VALLEY PKWY	None	MISSION VIEJO	CA	92691	6528	30	06059	33.56210341	-117.6694207	Orange County
125830	Fee-for-Service	1285923623	1285923623	1	3	LEWIS, MARSHALL S MD APC	1/20/2015	193200000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1031 N DEMAREE ST	None	VISALIA	CA	93291	4117	54	06107	36.338409	-119.3322735	Tulare County
125846	Fee-for-Service	1396742904	1396742904	1	1	LOPATEGUI, JEAN R MD	12/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	50833	68	Hematology	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
125848	Fee-for-Service	1558518258	1558518258	1	1	LIU, JACK J MD	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129495	04	Otology, Laryngology, Rhinology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
125855	Fee-for-Service	1790960128	1790960128	1	1	LUE, JAMES MD	10/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91550	10	Gastroenterology (M.D. only)	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
125870	Fee-for-Service	1518222538	1518222538	1	1	LIU, TIFFANY Q OD	12/10/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	15068 GOLDENWEST ST	None	WESTMINSTER	CA	92683	6152	30	06059	33.743178	-118.0069006	Orange County
125893	Fee-for-Service	1679790398	1679790398	1	1	LOHRENTZ, CINDY L NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
125901	Fee-for-Service	1528562006	1528562006	1	1	LIN, JEFFREY MD	8/1/2023	207L00000X	NA	Other	026	PHYSICIANS	165438	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
125910	Fee-for-Service	1518135953	1518135953	1	1	LIN, LEE DO	9/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10192	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
125911	Fee-for-Service	1568960151	1568960151	1	1	LAI, JANIE Y PSYD	4/7/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	140 E COMMONWEALTH AVE	SUITE 101	FULLERTON	CA	92832	1905	30	06059	33.87034048	-117.922437	Orange County
125925	Fee-for-Service	1538181482	1538181482	1	6	LA CLINICA DE LA RAZA INC	12/23/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1187 MEADOW LANE	None	CONCORD	CA	94520	3745	07	06013	37.96001427	-122.0422115	Contra Costa County
125977	Fee-for-Service	1457457756	1457457756	1	1	LUNA, NATHAN MD	7/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82622	40	Pediatrics	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
125986	Fee-for-Service	1306307707	1306307707	1	1	LIVE WELL PHARMACY INC	11/27/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15871 POMONA RINCON RD	STE 110	CHINO HILLS	CA	91709	5563	36	06071	33.96441085	-117.6909113	San Bernardino County
126004	Fee-for-Service	1720185291	1720185291	1	1	LE, ANTHONY W	8/16/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
126005	Fee-for-Service	1063525871	1063525871	1	1	LA CO MARTIN LUTHER KING	4/28/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	MLKING/DREW FAM PLANNING	12021 WILMINGTON AVE	None	LOS ANGELES	CA	90059	3019	19	06037	33.922863	-118.2431655	Los Angeles County
126013	Fee-for-Service	1588016679	1588016679	1	1	LIN, AMY E MD	9/21/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	181768	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
126037	Fee-for-Service	1558704668	1558704668	1	1	LO, JESSIE MD	8/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148179	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	SUITE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
126067	Fee-for-Service	1548315906	1548315906	1	1	LOS ANGELES COUNTY CCS	2/24/1994	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	LOS ANGELES MTU	1925 S BUDLONG AVE	None	LOS ANGELES	CA	90007	1109	19	06037	34.03903111	-118.2962577	Los Angeles County
126102	Fee-for-Service	1770658817	1770658817	1	1	LINDQUIST, CRAIG MD	7/31/1986	207R00000X	NA	Other	026	PHYSICIANS	42717	77	Infectious Disease	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
126105	Fee-for-Service	1477851350	1477851350	1	1	LTC ORTHOPAEDICS, INC	10/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	95953	20	Orthopedic Surgery	0	In state provider	None	2816 ROWENA AVE	SUITE 4	LOS ANGELES	CA	90039	2550	19	06037	34.1076083	-118.2651591	Los Angeles County
126106	Fee-for-Service	1821178823	1821178823	1	1	LIU, JENNIFER N OD	1/24/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	110 N LA BREA AVE	None	INGLEWOOD	CA	90301	1708	19	06037	33.96345848	-118.3533454	Los Angeles County
126114	Fee-for-Service	1043323058	1043323058	1	1	LANGILLE,DAVID K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	736 N BATTLEFIELD BLVD	None	CHESAPEAKE	VA	23320	4941	00	None	36.74619744	-76.24489616	Chesapeake city
126120	Fee-for-Service	1285923623	1285923623	1	3	LEWIS, MARSHALL S MD APC	1/20/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	1031 N DEMAREE ST	None	VISALIA	CA	93291	4117	54	06107	36.338409	-119.3322735	Tulare County
126121	Fee-for-Service	1497478077	1497478077	1	1	LI, PEIBEI PT	5/10/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1280 CORONA POINTE CT	STE 118	CORONA	CA	92879	1770	33	06065	33.87039079	-117.5408442	Riverside County
126126	Fee-for-Service	1881169373	1881169373	1	1	LAM, KENNETH MD	11/25/2019	208M00000X	NA	Other	026	PHYSICIANS	158863	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
126195	Fee-for-Service	1346404340	1346404340	1	1	LIN, JOSEPH L MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114615	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
126200	Fee-for-Service	1164499851	1164499851	1	1	LE, CHAU M MD	9/16/1989	207L00000X	NA	Other	026	PHYSICIANS	35779	05	Anesthesiology	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
126229	Fee-for-Service	1043623515	1043623515	1	1	LEE, RICHARD E MD	10/8/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	172549	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
126244	Fee-for-Service	1386080356	1386080356	1	1	LIAO, VIVIAN P MD	12/1/2017	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	131922	25	Physical Medicine and Rehabilitation	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
126265	Fee-for-Service	1033491444	1033491444	1	1	LORMED LLC	7/16/2013	332BP3500X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	3307 BROADWAY ST	STE 150	MOUNT VERNON	IL	62864	2387	00	None	38.3143109	-88.93274633	Jefferson County
126268	Fee-for-Service	1316025216	1316025216	1	1	LUO, XING-XING	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73788	None	None	0	In state provider	None	4785 N 1ST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
126272	Fee-for-Service	1508944141	1508944141	1	1	LEE, KENNETH D MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	84505	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
126279	Fee-for-Service	1184068496	1184068496	1	1	LEE, WEN-SHIN MD	4/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131696	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	SUITE 1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
126315	Fee-for-Service	1235234071	1235234071	1	1	LIGHTHALL, GEOFFREY K MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61154	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
126317	Fee-for-Service	1205884442	1205884442	1	1	LAM, SYLVIA Y MD	7/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	42338	40	Pediatrics	0	In state provider	None	210 N GARFIELD AVE	STE 316	MONTEREY PARK	CA	91754	1746	19	06037	34.064181	-118.122834	Los Angeles County
126321	Fee-for-Service	1831128263	1831128263	1	1	LEWIS, LISA M LCSW	5/30/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9268 MADISON AVE	None	ORANGEVALE	CA	95662	5858	34	06067	38.668779	-121.208481	Sacramento County
126388	Fee-for-Service	1184022089	1184022089	1	1	LAM, LESLIE A PT	3/8/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
126389	Fee-for-Service	1770658817	1770658817	1	1	LINDQUIST, CRAIG MD	7/31/1986	207R00000X	NA	Other	026	PHYSICIANS	42717	01	General Practice	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
126459	Fee-for-Service	1023437829	1023437829	1	1	LIN, VICKI CHIA HUI	3/19/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
126537	Fee-for-Service	1679553101	1679553101	1	1	LIN, JENNIFER I MD	7/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91543	02	General Surgery	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
126555	Fee-for-Service	1831224500	1831224500	1	1	LANG, JULIE LMFT	5/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	405 W MAIN ST	None	GRASS VALLEY	CA	95945	6403	29	06057	39.21922156	-121.0650095	Nevada County
126559	Fee-for-Service	1699944132	1699944132	1	1	LEARY, SCOTT MD INC	9/26/2012	207T00000X	NA	General Surgery	026	PHYSICIANS	79086	14	Neurological Surgery	0	In state provider	None	7625 MESA COLLEGE	SUITE 305A	SAN DIEGO	CA	92111	5343	37	06073	32.80089797	-117.1572727	San Diego County
126563	Fee-for-Service	1790987105	1790987105	1	1	LEE, STEPHEN P MD	7/21/2009	208600000X	NA	General Surgery	026	PHYSICIANS	108115	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
126585	Fee-for-Service	1902030711	1902030711	1	1	LEE, PAUL MD	7/29/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	187540	30	Radiology	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
126587	Fee-for-Service	1003345737	1003345737	1	1	LE, STEPHANIE T V MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	158529	07	Dermatology	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
126604	Fee-for-Service	1548340763	1548340763	1	1	LIU, VIVIAN MD	11/5/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	55075	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA #530	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
126607	Fee-for-Service	1063591865	1063591865	2	1	LINCARE INC	5/2/2017	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	314 WEST SEQUOIA CIR	None	PORTERVILLE	CA	93257	1691	54	06107	36.08168896	-119.0233914	Tulare County
126614	Fee-for-Service	1366079956	1366079956	1	1	LEE, JINWOO MD	8/2/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	187745	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
126622	Fee-for-Service	1508397936	1508397936	1	1	LAU, KARRIE K DO	7/2/2020	207R00000X	NA	Other	026	PHYSICIANS	17865	41	Internal Medicine	0	In state provider	None	465 W PUTNAM AVENUE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
126638	Fee-for-Service	1982135315	1982135315	1	1	LEE, SHIMWOO MD	6/2/2022	2085R0204X	NA	Other	026	PHYSICIANS	158159	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
126731	Fee-for-Service	1063574838	1063574838	1	1	LEBOVIC, JOSEPH MD INC	3/1/1983	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1450 10TH ST	STE 206	SANTA MONICA	CA	90401	2831	19	06037	34.01992119	-118.4882747	Los Angeles County
126770	Fee-for-Service	1063062628	1063062628	1	1	LOK, KEVIN CRNA	10/14/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
126780	Fee-for-Service	1831244250	1831244250	1	1	LOS ANGELES COUNTY CCS	3/23/1994	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	SOUTH BAY MTU	1820 HAVEMEYER LN	None	REDONDO BEACH	CA	90278	4828	19	06037	33.8604717	-118.3791071	Los Angeles County
126808	Fee-for-Service	1699272781	1699272781	1	1	LEE, JAE-YEON MD	7/6/2022	207P00000X	NA	Other	026	PHYSICIANS	178280	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
126849	Fee-for-Service	1154692804	1154692804	1	1	LAM, MELISSA Y MD	11/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120774	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
126894	Fee-for-Service	1184748592	1184748592	1	1	LOMELI, EVA A LCSW	8/8/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
126905	Fee-for-Service	1194187203	1194187203	1	1	LOGAN, ALEXANDER A MD	10/29/2020	207R00000X	NA	Other	026	PHYSICIANS	168914	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
126921	Fee-for-Service	1821160649	1821160649	1	1	LEVY, ALEXANDER O MD	7/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85771	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
126939	Fee-for-Service	1023468253	1023468253	1	1	LEMERAND, KERRIE L MD	6/30/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	140959	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
126999	Fee-for-Service	1609965532	1609965532	1	1	LEE, KYUNG R MD	5/30/1994	207R00000X	NA	Other	026	PHYSICIANS	49227	41	Internal Medicine	0	In state provider	None	2645 OCEAN AVE	STE 305	SAN FRANCISCO	CA	94132	1647	38	06075	37.73199657	-122.4739936	San Francisco County
127006	Fee-for-Service	1720243454	1720243454	1	1	LA CLINICA DE LA RAZA	8/1/2011	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	220 HOSPITAL DRIVE	None	VALLEJO	CA	94589	2517	48	06095	38.13109785	-122.238998	Solano County
127026	Fee-for-Service	1205330495	1205330495	1	1	LI, DANIEL Y MD	4/18/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	163783	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
127028	Fee-for-Service	1538103742	1538103742	1	1	LE RENARD, CHRISTOPHE C	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63590	None	None	0	In state provider	MD	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
127034	Fee-for-Service	1386796886	1386796886	1	1	LARA, CARRIE A	2/29/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3558 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
127039	Fee-for-Service	1457415879	1457415879	1	1	LANDICHO, OLIVA E MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75889	36	Psychiatry	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
127043	Fee-for-Service	1811366529	1811366529	1	1	LOHR, MELISSA D	11/7/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
127061	Fee-for-Service	1881070407	1881070407	1	1	LYAPIN, ALEXEY NP	10/11/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
127063	Fee-for-Service	1538181482	1538181482	1	3	LA CLINICA DE LA RAZA INC	2/10/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2217 CHARLOMAR ROAD	None	CONCORD	CA	94518	2504	07	06013	37.94928392	-122.0298181	Contra Costa County
127105	Fee-for-Service	1306890389	1306890389	1	5	LOS ROBLES HOSPITAL	8/4/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	227 W JANSS ROAD	STE 340	THOUSAND OAKS	CA	91360	1879	56	06111	34.20611691	-118.883861	Ventura County
127107	Fee-for-Service	1083679856	1083679856	1	1	LIBERMAN, RICARDO MD	11/1/1981	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	29497	40	Pediatrics	0	In state provider	None	100 CONGRESS STREET	None	PASADENA	CA	91105	0000	19	06037	34.13395172	-118.1534955	Los Angeles County
127126	Fee-for-Service	1689621393	1689621393	1	1	LIFE CARE DIABETIC SUPPLIES,	3/12/2012	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	INC	840 JUPITER PARK	SUITES 101 & 106	JUPITER	FL	33458	8947	00	None	26.92639254	-80.14509052	Palm Beach County
127147	Fee-for-Service	1114969946	1114969946	2	1	LONGS DRUG STORES CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2630 W EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	1117	43	06085	37.40212151	-122.1149462	Santa Clara County
127161	Fee-for-Service	1942363494	1942363494	1	1	LEE, MIMI LCSW	6/11/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
127178	Fee-for-Service	1336409739	1336409739	1	1	LEAO, JESSICA K LCSW	8/14/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 JUNIPERO SERRA BLVD	SUITE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
127179	Fee-for-Service	1700463452	1700463452	1	1	LEW, KELLY J MD	8/1/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
127190	Fee-for-Service	1003968249	1003968249	1	1	LEONG, MARY OD	11/26/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
127203	Fee-for-Service	1982700035	1982700035	1	1	LOMIS, THOMAS J MD INC	4/7/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	VALLEY COMP SURGICAL CTR	15211 VANOWEN ST	STE 208	VAN NUYS	CA	91405	3606	19	06037	34.19395411	-118.4642527	Los Angeles County
127207	Fee-for-Service	1285862870	1285862870	1	1	LISING, MELANIE A MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113768	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
127216	Fee-for-Service	1114983244	1114983244	1	1	LEINEN, JEFFREY J MD	8/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51510	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5176 HILL RD E	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
127230	Fee-for-Service	1669582557	1669582557	1	1	LEATHERBARROW, KATHLEEN NP	10/12/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	141337	-	NOT APPLICABLE	0	In state provider	None	800 SCENIC DRIVE	BLDG 4	MODESTO	CA	95350	6131	50	06099	37.64722447	-120.9836925	Stanislaus County
127248	Fee-for-Service	1740744622	1740744622	1	1	LLAVE, JESSIECA V RCP	3/1/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
127293	Fee-for-Service	1720243454	1720243454	1	1	LA CLINICA DE LA RAZA	2/10/2009	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	220 HOSPITAL DRIVE	None	VALLEJO	CA	94589	2517	48	06095	38.13109785	-122.238998	Solano County
127294	Fee-for-Service	1659388155	1659388155	1	1	LE, HAI M MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63535	41	Internal Medicine	0	In state provider	None	130 CEDAR RD	None	VISTA	CA	92083	5102	37	06073	33.18682732	-117.2839184	San Diego County
127297	Fee-for-Service	1053334748	1053334748	1	1	LEE, WAI SHAT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55211	28	Proctology (colon and rectal)	0	In state provider	None	540 E HERNDON AVENUE	#106	FRESNO	CA	93720	2993	10	06019	36.83755403	-119.7784187	Fresno County
127330	Fee-for-Service	1407003874	1407003874	1	1	LA CHIUSA, IDA CHI LCSW	5/27/2010	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	502 W EL NORTE PKWY	None	ESCONDIDO	CA	92026	3983	37	06073	33.14438924	-117.098135	San Diego County
127335	Fee-for-Service	1629797204	1629797204	1	1	LEE, HANNAH A NP	10/14/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
127347	Fee-for-Service	1538181482	1538181482	1	3	LA CLINICA DE LA RAZA INC	2/10/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2217 CHARLOMAR ROAD	None	CONCORD	CA	94518	2504	07	06013	37.94928392	-122.0298181	Contra Costa County
127405	Fee-for-Service	1205857836	1205857836	1	1	LEE, ANTHONY W MD	1/1/1989	208G00000X	NA	General Surgery	026	PHYSICIANS	49338	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1111 SONOMA AVE	STE 114	SANTA ROSA	CA	95405	4813	49	06097	38.442042	-122.700033	Sonoma County
127415	Fee-for-Service	1497729446	1497729446	1	1	LOW, RUSSELL N MD	4/30/1990	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	58511	30	Radiology	0	In state provider	None	8008 FROST ST	STE 106	SAN DIEGO	CA	92123	4229	37	06073	32.80027859	-117.1524832	San Diego County
127439	Fee-for-Service	1033263033	1033263033	1	1	LIM, BENEDICT A PHD	8/4/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
127453	Fee-for-Service	1700880267	1700880267	1	1	LEE, SEUNG K MD	1/13/2021	208600000X	NA	General Surgery	026	PHYSICIANS	54971	None	None	0	In state provider	None	7807 LAGUNA BLVD	480	ELK GROVE	CA	95758	7953	34	06067	38.423736	-121.410846	Sacramento County
127473	Fee-for-Service	1134365406	1134365406	1	1	LEE, KRIS S MD	10/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105009	08	Family Practice	0	In state provider	None	2279 E PALMDALE BLVD	STE A	PALMDALE	CA	93550	4909	19	06037	34.58020552	-118.087164	Los Angeles County
127486	Fee-for-Service	1699138107	1699138107	1	1	LEISHMAN, BRIGHAM P DO	1/30/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15902	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
127493	Fee-for-Service	1609102433	1609102433	1	1	LEMUS-RANGEL, RAFAEL MD	2/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107205	14	Neurological Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
127499	Fee-for-Service	1982930939	1982930939	1	1	LEUNG, LYDIA C MD	8/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110120	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
127531	Fee-for-Service	1467498428	1467498428	1	1	LEE, CURTIS W Q MD	11/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42801	41	Internal Medicine	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
127580	Fee-for-Service	1356674626	1356674626	1	1	LANE, BRIAN R	3/1/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	250 TRAVELODGE DRIVE	None	EL CAJON	CA	92020	4126	37	06073	32.79312432	-116.980275	San Diego County
127582	Fee-for-Service	1720243454	1720243454	1	1	LA CLINICA DE LA RAZA	2/10/2009	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	220 HOSPITAL DRIVE	None	VALLEJO	CA	94589	2517	48	06095	38.13109785	-122.238998	Solano County
127584	Fee-for-Service	1053334748	1053334748	1	1	LEE, WAI SHAT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55211	02	General Surgery	0	In state provider	None	540 E HERNDON AVENUE	#106	FRESNO	CA	93720	2993	10	06019	36.83755403	-119.7784187	Fresno County
127593	Fee-for-Service	1063574473	1063574473	1	1	LIU, MARIA R CRNA	9/21/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
127600	Fee-for-Service	1124230784	1124230784	1	1	LATRONICA, MARK L MD	7/21/2009	207L00000X	NA	Other	026	PHYSICIANS	99390	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	0648	38	06075	37.7634502	-122.4579779	San Francisco County
127615	Fee-for-Service	1053093294	1053093294	1	1	LEWIS, CHANEL L	3/24/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
127633	Fee-for-Service	1841234598	1841234598	1	1	LINCOLN COUNTY HOSPITAL	3/22/2010	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	DISTRICT 3	10 NICHOLS ST	None	DAVENPORT	WA	99122	9729	00	None	47.65822094	-118.1458997	Lincoln County
127668	Fee-for-Service	1306279427	1306279427	1	1	LEE, JAY W DO	8/9/2023	207L00000X	NA	Other	026	PHYSICIANS	20907	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
127698	Fee-for-Service	1225078330	1225078330	1	1	LAURSEN, HANS GD DO	9/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	8932	01	General Practice	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
127722	Fee-for-Service	1487605127	1487605127	1	1	LOBOSKY, JEFFREY M MD	3/27/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	38633	14	Neurological Surgery	0	In state provider	None	251 COHASSET RD	STE 370	CHICO	CA	95926	2207	04	06007	39.75090044	-121.8522609	Butte County
127728	Fee-for-Service	1053440016	1053440016	1	1	LEWIS, ELISE A MD	9/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80179	08	Family Practice	0	In state provider	None	1450 TREAT BLVD	STE 160	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
127735	Fee-for-Service	1497868871	1497868871	1	1	LOO, KEK-KHEE	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68039	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
127736	Fee-for-Service	1184875056	1184875056	1	1	LEIGHTON, LYNETTE E MD	8/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104902	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
127762	Fee-for-Service	1386624435	1386624435	1	1	LE, VAN A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	THE RADIOLOGY GROUP INC	941 KAMEBAMEHA HIGHWAY	SUITE 208	PEARL CITY	HI	96782	0000	00	None	21.39429472	-157.97183	Honolulu County
127763	Fee-for-Service	1386718799	1386718799	1	1	LEDESMA, STEVE G MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78553	41	Internal Medicine	0	In state provider	None	1200 W GONZALES RD	STE 300	OXNARD	CA	93036	3075	56	06111	34.21910561	-119.1919869	Ventura County
127765	Fee-for-Service	1013250463	1013250463	1	1	LEE, ANDY Y MD	6/3/2020	390200000X	NA	Other	026	PHYSICIANS	135643	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
127817	Fee-for-Service	1952400574	1952400574	1	1	LANCE, BONNIE JO DPM	1/31/1990	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1000 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4639	19	06037	34.01070086	-118.1110129	Los Angeles County
127818	Fee-for-Service	1538780218	1538780218	1	1	LEE, LAIN L NP	6/2/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3114 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	19	06037	34.02383346	-118.137193	Los Angeles County
127822	Fee-for-Service	1861787228	1861787228	1	1	LIM, MICHAEL J MD	8/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117024	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
127826	Fee-for-Service	1043345861	1043345861	1	1	LANDESMAN, BARBARA A MD	3/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93333	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
127836	Fee-for-Service	1740373356	1740373356	1	1	LEE, GERRY M MD	9/24/1982	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	40717	01	General Practice	0	In state provider	None	1166 HIGH ST	None	AUBURN	CA	95603	5110	31	06061	38.89666783	-121.0720201	Placer County
127871	Fee-for-Service	1720243454	1720243454	1	1	LA CLINICA DE LA RAZA	2/10/2009	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	220 HOSPITAL DRIVE	None	VALLEJO	CA	94589	2517	48	06095	38.13109785	-122.238998	Solano County
127918	Fee-for-Service	1316215155	1316215155	1	1	LAHTI, DEBORA A	1/28/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92193	2410	37	06073	32.7537975	-117.1658298	San Diego County
127922	Fee-for-Service	1841234598	1841234598	1	1	LINCOLN COUNTY HOSPITAL	3/22/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	DISTRICT 3	10 NICHOLS ST	None	DAVENPORT	WA	99122	9729	00	None	47.65822094	-118.1458997	Lincoln County
127939	Fee-for-Service	1033747860	1033747860	1	1	LOPEZ, EDGAR R MD	9/14/2023	207R00000X	NA	Other	026	PHYSICIANS	188069	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
127987	Fee-for-Service	1225078330	1225078330	1	1	LAURSEN, HANS GD DO	9/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	8932	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
128009	Fee-for-Service	1053440016	1053440016	1	1	LEWIS, ELISE A MD	9/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80179	01	General Practice	0	In state provider	None	1450 TREAT BLVD	STE 160	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
128011	Fee-for-Service	1831264837	1831264837	1	1	LINCARE INC	10/21/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	None	1964 MESQUITE AVE	SUITE B	LAKE HAVASU CITY	AZ	86403	5890	00	None	34.478109	-114.3331605	Mohave County
128016	Fee-for-Service	1215955141	1215955141	1	1	LAO, KELLY APC	9/1/2002	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	KELLY LAO OD	240 MERIDIAN AVE	STE 1	SAN JOSE	CA	95126	2927	43	06085	37.32468731	-121.9137566	Santa Clara County
128029	Fee-for-Service	1184640641	1184640641	1	1	LAUBLY, JUSTINE N MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75077	None	None	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
128040	Fee-for-Service	1356535371	1356535371	1	1	LONG, RACHEL B MD	1/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126008	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	12610 GLENOAKS BLVD	None	SYLMAR	CA	91342	4783	19	06037	34.299351	-118.4390254	Los Angeles County
128054	Fee-for-Service	1386718799	1386718799	1	1	LEDESMA, STEVE G MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78553	45	Nephrology (Renal-Kidney)	0	In state provider	None	1200 W GONZALES RD	STE 300	OXNARD	CA	93036	3075	56	06111	34.21910561	-119.1919869	Ventura County
128097	Fee-for-Service	1831551910	1831551910	1	1	LE, THUY M MD	9/23/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	150394	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
128100	Fee-for-Service	1467039511	1467039511	1	1	LI, LETITIA MD	7/30/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
128115	Fee-for-Service	1942384011	1942384011	1	1	LAM, VIET M MD	9/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82021	41	Internal Medicine	0	In state provider	None	2070 CLINTON AVE	STE 2113	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
128137	Fee-for-Service	1114043965	1114043965	1	1	LEUNG, STEPHANIE A LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
128158	Fee-for-Service	1720243454	1720243454	1	1	LA CLINICA DE LA RAZA	2/10/2009	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	220 HOSPITAL DRIVE	None	VALLEJO	CA	94589	2517	48	06095	38.13109785	-122.238998	Solano County
128162	Fee-for-Service	1568477446	1568477446	1	2	LANCASTER CARD MED GRP	2/28/1986	174400000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	1535 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	2667	15	06029	35.6489946	-117.6698641	Kern County
128189	Fee-for-Service	1114124682	1114124682	1	1	LOPEZ, RODRIGO F CRNA	5/19/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	555 HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
128195	Fee-for-Service	1528839818	1528839818	1	1	LOUIS, STRIANIE CRNA	2/27/2025	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
128228	Fee-for-Service	1326630104	1326630104	1	1	LEGACY HEALTHCARE, LLC	5/31/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2610 CENTRAL AVENUE	STE 150	UNION CITY	CA	94587	4824	01	06001	37.59098824	-122.0397758	Alameda County
128231	Fee-for-Service	1972946010	1972946010	1	1	LEE, STEPHANIE Y MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136149	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
128242	Fee-for-Service	1558934232	1558934232	1	1	LASALLE, CORINNE LMFT	9/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
128247	Fee-for-Service	1811459456	1811459456	1	1	LISH, JONATHAN M MD	3/7/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177373	None	None	0	In state provider	None	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	37	06073	32.90618683	-117.1814064	San Diego County
128250	Fee-for-Service	1285800839	1285800839	1	1	LI, JENNIFER N MD	5/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114555	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
128252	Fee-for-Service	1487846051	1487846051	1	1	LOLOYAN, SHIRLEEN D MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107467	40	Pediatrics	0	In state provider	None	5333 HOLLISTER AVENUE	STE 250	GOLETA	CA	93111	2466	42	06083	34.43491982	-119.8105484	Santa Barbara County
128261	Fee-for-Service	1114925542	1114925542	1	1	LABBAN, GEORGE MD	2/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53848	78	Neoplastic Diseases/Oncology	0	In state provider	None	15400 NATIONAL AVE	STE 201	LOS GATOS	CA	95032	2433	43	06085	37.24429169	-121.9493834	Santa Clara County
128264	Fee-for-Service	1528264587	1528264587	1	1	LEVY, JEAN M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
128278	Fee-for-Service	1366539314	1366539314	2	1	LIANG, XIAYUAN MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	22	Pathology (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
128295	Fee-for-Service	1851814503	1851814503	1	1	LIN, YENJUI PHD	8/29/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
128304	Fee-for-Service	1093874695	1093874695	1	1	LOWE, TIMOTHY MD	7/3/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	51342	05	Anesthesiology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
128307	Fee-for-Service	1457401051	1457401051	1	1	LANDON, EDWARD C OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	16656 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91387	3217	19	06037	34.42662199	-118.4262946	Los Angeles County
128316	Fee-for-Service	1881742781	1881742781	1	1	LIMTAO, D. CECILIA C.MD	4/30/1989	2084P0800X	NA	Psychiatry	026	PHYSICIANS	45209	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
128320	Fee-for-Service	1194768945	1194768945	2	1	LONGS DRUG STORE CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4400 COFFEE RD	None	BAKERSFIELD	CA	93308	5032	15	06029	35.399421	-119.092103	Kern County
128325	Fee-for-Service	1730160425	1730160425	1	1	LOZADA-PASTORIO, ELIZ MD	8/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90108	41	Internal Medicine	0	In state provider	None	5353 MISSION CENTER RD	STE 318	SAN DIEGO	CA	92108	1305	37	06073	32.77207362	-117.154699	San Diego County
128370	Fee-for-Service	1700974557	1700974557	1	1	LEE, MARTIN N MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97018	40	Pediatrics	0	In state provider	None	2020 SUTTER PLACE	None	DAVIS	CA	95616	6213	57	06113	38.56287659	-121.7715536	Yolo County
128402	Fee-for-Service	1841233699	1841233699	2	1	LONGS DRUG STORES CALIFORNIA	12/16/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	LLC	800 1ST ST	None	GILROY	CA	95020	4976	43	06085	37.01350432	-121.5873025	Santa Clara County
128406	Fee-for-Service	1770962201	1770962201	1	1	LIFE POINT MEDICAL AND URGEN	5/3/2021	163WG0000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	T CARE INC	9057 CENTRAL AVE	None	MONTCLAIR	CA	91763	1622	19	06037	34.0896003	-117.6894613	San Bernardino County
128455	Fee-for-Service	1467417352	1467417352	1	1	LEXINGTON REGIONAL HEALTH	9/18/2017	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	1201 N ERIE STREET	None	LEXINGTON	NE	68850	0980	00	None	40.7858253	-99.75752467	Dawson County
128465	Fee-for-Service	1417099953	1417099953	1	1	LAVIN-MOND, SANDRA LCSW	1/25/2012	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	8665 WILSHIRE BLVD	SUITE 407	BEVERLY HILLS	CA	90211	2933	19	06037	34.06625528	-118.380319	Los Angeles County
128468	Fee-for-Service	1770531394	1770531394	1	1	LIPKOWITZ, ALLAN MD	5/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	54476	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
128515	Fee-for-Service	1326630104	1326630104	1	1	LEGACY HEALTHCARE, LLC	5/31/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2610 CENTRAL AVENUE	STE 150	UNION CITY	CA	94587	4824	01	06001	37.59098824	-122.0397758	Alameda County
128519	Fee-for-Service	1194775551	1194775551	1	1	LYNCH, THOMAS G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
128540	Fee-for-Service	1487846051	1487846051	1	1	LOLOYAN, SHIRLEEN D MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107467	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	5333 HOLLISTER AVENUE	STE 250	GOLETA	CA	93111	2466	42	06083	34.43491982	-119.8105484	Santa Barbara County
128549	Fee-for-Service	1114925542	1114925542	1	1	LABBAN, GEORGE MD	2/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53848	68	Hematology	0	In state provider	None	15400 NATIONAL AVE	STE 201	LOS GATOS	CA	95032	2433	43	06085	37.24429169	-121.9493834	Santa Clara County
128613	Fee-for-Service	1962472308	1962472308	1	1	LE PHARMACY CORPORATION	9/3/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	19582 BEACH BLVD	STE 118	HUNTINGTON BEACH	CA	92648	2996	30	06059	33.67831649	-117.9885198	Orange County
128615	Fee-for-Service	1730160425	1730160425	1	1	LOZADA-PASTORIO, ELIZ MD	8/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90108	45	Nephrology (Renal-Kidney)	0	In state provider	None	5353 MISSION CENTER RD	STE 318	SAN DIEGO	CA	92108	1305	37	06073	32.77207362	-117.154699	San Diego County
128659	Fee-for-Service	1477729861	1477729861	1	1	LOU, DAVID Y MD	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111343	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
128662	Fee-for-Service	1215962592	1215962592	1	1	LAGUE, MARY J PHD	5/28/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
128695	Fee-for-Service	1770962201	1770962201	1	1	LIFE POINT MEDICAL AND URGEN	5/3/2021	163WG0000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	T CARE INC	9057 CENTRAL AVE	None	MONTCLAIR	CA	91763	1622	19	06037	34.0896003	-117.6894613	San Bernardino County
128744	Fee-for-Service	1467417352	1467417352	1	1	LEXINGTON REGIONAL HEALTH	9/18/2017	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	1201 N ERIE STREET	None	LEXINGTON	NE	68850	0980	00	None	40.7858253	-99.75752467	Dawson County
128745	Fee-for-Service	1730289588	1730289588	1	1	LOH, MIGNON L MD	1/1/2000	2080P0207X	NA	Hematology	026	PHYSICIANS	85466	78	Neoplastic Diseases/Oncology	0	In state provider	None	505 PARNASSUS AVE	# M696	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
128758	Fee-for-Service	1295813889	1295813889	1	1	LUDINGTON, LANCE L MD	2/8/2015	208600000X	NA	General Surgery	026	PHYSICIANS	63915	None	None	0	In state provider	None	6460 PENTZ RD	SUITE A	PARADISE	CA	95969	3673	04	06007	39.77082001	-121.5795537	Butte County
128764	Fee-for-Service	1992853477	1992853477	1	1	LOUIE, LANA D MD	4/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100603	02	General Surgery	0	In state provider	None	3300 WEBSTER ST	None	OAKLAND	CA	94609	3120	01	06001	37.82132826	-122.2621843	Alameda County
128784	Fee-for-Service	1417998816	1417998816	1	1	LAWRY, MONICA A MD	11/1/1996	207N00000X	NA	Dermatology	026	PHYSICIANS	83452	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
128787	Fee-for-Service	1861577520	1861577520	1	1	LANDAW, IRENE S MD	8/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	64665	40	Pediatrics	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
128807	Fee-for-Service	1477618890	1477618890	3	1	LUXURY PHARMACEUTICALS, INC.	5/11/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17643 SHERMAN WAY	104	VAN NUYS	CA	91406	3510	19	06037	34.20123351	-118.5179895	Los Angeles County
128845	Fee-for-Service	1972193217	1972193217	1	1	LOCKWOOD, SARAH NP	4/19/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1211 W LA PALMA AVE	STE 207	ANAHEIM	CA	92801	2139	30	06059	33.84718298	-117.933758	Orange County
128857	Fee-for-Service	1982773990	1982773990	1	1	LA HUNTINGTON HEALTHCARE LLC	2/19/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4515 HUNTINGTON DR S	None	LOS ANGELES	CA	90032	1940	19	06037	34.08405479	-118.1882702	Los Angeles County
128858	Fee-for-Service	1467462507	1467462507	1	1	LEDVIN, VERONICA MD	3/4/2021	207R00000X	NA	Other	026	PHYSICIANS	167547	None	None	0	In state provider	None	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
128887	Fee-for-Service	1841741857	1841741857	1	1	LANDOR DIALYSIS LLC	12/10/2018	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2980 ADVANTAGE WAY	None	SACRAMENTO	CA	95834	9666	34	06067	38.653956	-121.5289485	Sacramento County
128896	Fee-for-Service	1144521329	1144521329	1	1	LONDONO, DIANA C MD	1/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108119	34	Urology and Urological Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
128901	Fee-for-Service	1457567810	1457567810	1	1	LOPEZ-MOLINA, DANIEL NP	11/5/2018	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
128903	Fee-for-Service	1497960678	1497960678	1	1	LEVY, LOUIS J JR MD APC	8/20/1984	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	37491	20	Orthopedic Surgery	0	In state provider	None	300 SOUTH PIERCE STREET	SUITE 202	EL CAJON	CA	92020	4124	37	06073	32.79286035	-116.9780352	San Diego County
128912	Fee-for-Service	1700835584	1700835584	1	1	LEE, BYRON K MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	54582	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
128921	Fee-for-Service	1053958660	1053958660	1	1	LLUCH, CHRISTINE	7/11/2024	106S00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1020 TIERRA DEL REY	A1	CHULA VISTA	CA	91910	7886	37	06073	32.6377383	-117.0196092	San Diego County
128940	Fee-for-Service	1023195880	1023195880	1	1	LIANG, SONGLIN MD	12/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95440	22	Pathology (M.D. only)	0	In state provider	None	1401 GARCES HWY	None	DELANO	CA	93215	3690	15	06029	35.76144847	-119.238912	Kern County
128967	Fee-for-Service	1356014328	1356014328	1	1	LUI, JONATHAN S OT	7/29/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8545 SIERRA AVE	None	FONTANA	CA	92335	3868	36	06071	34.09849683	-117.4356608	San Bernardino County
128987	Fee-for-Service	1407829773	1407829773	1	1	LA JOLLA ENDOSCOPY CTR	12/1/1999	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER LP	9850 GENESEE AVE	STE 980	LA JOLLA	CA	92037	1234	37	06073	32.882913	-117.226341	San Diego County
129000	Fee-for-Service	1619178944	1619178944	1	1	LIN, AMY MD	6/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92766	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
129004	Fee-for-Service	1043529720	1043529720	1	1	LYON, MATTHEW E LCSW	10/24/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
129025	Fee-for-Service	1982141578	1982141578	1	1	LAZO, YANINA	5/31/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	16624 SUGAR LANE	None	FONTANA	CA	92337	7626	36	06071	34.06083594	-117.4416245	San Bernardino County
129026	Fee-for-Service	1285641449	1285641449	1	1	LONG, ROGER K MD	7/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	74233	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
129033	Fee-for-Service	1730289588	1730289588	1	1	LOH, MIGNON L MD	1/1/2000	2080P0207X	NA	Hematology	026	PHYSICIANS	85466	68	Hematology	0	In state provider	None	505 PARNASSUS AVE	# M696	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
129041	Fee-for-Service	1033133046	1033133046	1	1	LEONARD, MARY B MD	10/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132734	45	Nephrology (Renal-Kidney)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
129046	Fee-for-Service	1710046370	1710046370	1	1	LEE, ANNIE MD	2/1/1999	2085B0100X	NA	MRI Provider	026	PHYSICIANS	79799	30	Radiology	0	In state provider	None	450 E HUNTINGTON DR	None	ARCADIA	CA	91006	3748	19	06037	34.14015053	-118.0208745	Los Angeles County
129048	Fee-for-Service	1609098136	1609098136	1	1	LIOU, JAMES S MD	11/16/2010	207N00000X	NA	Dermatology	026	PHYSICIANS	113539	07	Dermatology	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
129051	Fee-for-Service	1790195089	1790195089	1	1	LEONARD, KRISTIN B DO	12/16/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14827	08	Family Practice	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
129079	Fee-for-Service	1174548952	1174548952	1	1	LONG BEACH ANESTHESIA	8/21/2006	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	MEDICAL GROUP, INC	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
129102	Fee-for-Service	1700230307	1700230307	1	1	LIU, LINUS Y MD	10/23/2019	207R00000X	NA	Other	026	PHYSICIANS	150600	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
129176	Fee-for-Service	1093553661	1093553661	1	1	LOVE, SHAYANNA	9/6/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	01	06001	0	0	None
129178	Fee-for-Service	1093094161	1093094161	1	1	LE, GRACE T NP	3/29/2019	363LC0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
129197	Fee-for-Service	1770849804	1770849804	1	1	LIU, YUNXIANG MD	8/15/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	129713	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
129245	Fee-for-Service	1144434895	1144434895	1	1	LUEDTKE, PIA L MD	8/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90407	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
129260	Fee-for-Service	1194365775	1194365775	1	1	LY, HAI T CRNA	4/8/2020	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
129289	Fee-for-Service	1891897765	1891897765	1	1	LEMON, KYLE W MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68175	41	Internal Medicine	0	In state provider	None	200 MED PLAZA STE 365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
129312	Fee-for-Service	1982141578	1982141578	1	1	LAZO, YANINA	5/31/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	16624 SUGAR LANE	None	FONTANA	CA	92337	7626	36	06071	34.06083594	-117.4416245	San Bernardino County
129328	Fee-for-Service	1033133046	1033133046	1	1	LEONARD, MARY B MD	10/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132734	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
129365	Fee-for-Service	1720167711	1720167711	1	1	LOO, BILLY W MD	7/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76374	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
129404	Fee-for-Service	1316665789	1316665789	1	1	LO, LOK YI NP	12/12/2024	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
129428	Fee-for-Service	1336206358	1336206358	1	1	LEE, STEVE S DO	8/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8551	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
129456	Fee-for-Service	1962864819	1962864819	1	1	LI, MENGLU MD	8/30/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	154438	40	Pediatrics	0	In state provider	None	7225 RAINBOW DR	None	SAN JOSE	CA	95129	4552	43	06085	37.30146258	-122.0315034	Santa Clara County
129515	Fee-for-Service	1144807413	1144807413	1	1	LESTER, LYNETTE MD	10/8/2024	2086S0120X	NA	General Surgery	026	PHYSICIANS	191698	85	Surgery-Pediatric	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
129519	Fee-for-Service	1801236625	1801236625	1	1	LANG, DONALD J CNP	8/23/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
129533	Fee-for-Service	1588723175	1588723175	1	1	LEDERMAN, LYN C MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24536	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
129547	Fee-for-Service	1457959397	1457959397	1	1	LOYAL WAY HOSPICE AND	12/17/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	301 E GLENOAKS BLVD	#4	GLENDALE	CA	91207	2115	19	06037	34.1584102	-118.2525964	Los Angeles County
129583	Fee-for-Service	1851610638	1851610638	1	1	LYNN, MARC D LMFT	10/3/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
129597	Fee-for-Service	1750449062	1750449062	1	1	LAVI, DARIUSH S MD INC	8/7/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70042	41	Internal Medicine	0	In state provider	None	1503 S COAST DR	STE 109	COSTA MESA	CA	92626	1526	30	06059	33.69159551	-117.9203625	Orange County
129598	Fee-for-Service	1396911509	1396911509	1	1	LMS HEALTH PARTNERS INC	7/7/2008	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	9201-9203 S VERMONT AVE	None	LOS ANGELES	CA	90044	3321	19	06037	33.95310932	-118.2919208	Los Angeles County
129626	Fee-for-Service	1922042753	1922042753	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1113 E CHAMPLAIN DR	None	FRESNO	CA	93720	4223	10	06019	36.87115763	-119.7630811	Fresno County
129637	Fee-for-Service	1730459025	1730459025	1	1	LABORATORY CORPORATION OF	1/9/2012	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	AMERICA	605 E HUNTINGTON DR	STE 209	MONROVIA	CA	91016	6353	19	06037	34.14064622	-117.9920237	Los Angeles County
129646	Fee-for-Service	1770527111	1770527111	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1675 HOLLENBECK AVE	None	SUNNYVALE	CA	94087	5402	43	06085	37.33836306	-122.0414534	Santa Clara County
129739	Fee-for-Service	1982864559	1982864559	1	1	LAI, ALBERT MD	11/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119775	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
129746	Fee-for-Service	1235129420	1235129420	1	1	LIPPER, BENNET L MD	3/31/1996	207R00000X	NA	Other	026	PHYSICIANS	68798	None	None	0	In state provider	None	533 E MICHELTORENA ST	STE 102	SANTA BARBARA	CA	93103	2260	42	06083	34.43233822	-119.701775	Santa Barbara County
129751	Fee-for-Service	1487610432	1487610432	1	1	LE, JACQUELIN M OD	3/19/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3807 FAIRMOUNT AVE	STE 200	SAN DIEGO	CA	92105	2659	37	06073	32.74810088	-117.1008928	San Diego County
129792	Fee-for-Service	1588829154	1588829154	1	1	LUC, QUYEN N MD	6/8/2010	2084N0402X	NA	Neurology	026	PHYSICIANS	96950	13	Neurology (M.D. only)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
129794	Fee-for-Service	1790906816	1790906816	1	1	LEE, DAN MD	5/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85766	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
129804	Fee-for-Service	1699711846	1699711846	1	1	LENIHAN, MICHAEL MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	61864	20	Orthopedic Surgery	0	In state provider	None	955 LANE AVENUE	SUITE 200	CHULA VISTA	CA	91914	4525	37	06073	32.65121611	-116.9615942	San Diego County
129807	Fee-for-Service	1982068656	1982068656	1	1	LEW, SIMONE T MD	11/24/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	151647	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
129821	Fee-for-Service	1588723175	1588723175	1	1	LEDERMAN, LYN C MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24536	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
129837	Fee-for-Service	1457959397	1457959397	1	1	LOYAL WAY HOSPICE AND	12/17/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	301 E GLENOAKS BLVD	#4	GLENDALE	CA	91207	2115	19	06037	34.1584102	-118.2525964	Los Angeles County
129852	Fee-for-Service	1770945131	1770945131	1	1	LIU, CATERINA Y MD	10/10/2019	207R00000X	NA	Other	026	PHYSICIANS	150712	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
129865	Fee-for-Service	1497997217	1497997217	1	1	LOZA, MARIA A MD	11/2/2010	207P00000X	NA	Other	026	PHYSICIANS	106859	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
129882	Fee-for-Service	1750449062	1750449062	1	1	LAVI, DARIUSH S MD INC	8/7/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70042	01	General Practice	0	In state provider	None	1503 S COAST DR	STE 109	COSTA MESA	CA	92626	1526	30	06059	33.69159551	-117.9203625	Orange County
129917	Fee-for-Service	1235227109	1235227109	1	1	LIN, MORGAN Z MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	52480	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5565 W LAS POSITAS BLVD	STE 300	PLEASANTON	CA	94588	5808	01	06001	37.69215143	-121.8800337	Alameda County
129934	Fee-for-Service	1053610659	1053610659	1	1	LATA, THOMAS A CRNA	5/3/2011	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
129953	Fee-for-Service	1023207511	1023207511	1	1	LONG, ZSOFIA B MD	6/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97292	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
129958	Fee-for-Service	1568774321	1568774321	1	3	LANGUAGE ESSENTIALS SPEECH P	7/17/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ATHOLOGY, INC.	210 PORTER DR	STE 120	SAN RAMON	CA	94583	1525	07	06013	37.77413352	-121.991328	Contra Costa County
129963	Fee-for-Service	1962883306	1962883306	1	1	LANE, SARAH K LCSW	9/16/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
129968	Fee-for-Service	1023166089	1023166089	1	1	LIM, SAMUEL L MD	6/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	56374	01	General Practice	0	In state provider	None	430 W BASELINE RD	None	CLAREMONT	CA	91711	1607	19	06037	34.12157453	-117.7214355	Los Angeles County
129970	Fee-for-Service	1679079503	1679079503	1	1	LIANG, TOM Z	8/1/2024	207ZP0102X	NA	Other	026	PHYSICIANS	165984	22	Pathology (M.D. only)	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
129975	Fee-for-Service	1275858292	1275858292	1	1	LIU, STEPHEN H MD	9/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111234	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
129992	Fee-for-Service	1124212303	1124212303	1	1	LAZATIN, SERGIO C DC	2/8/2015	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	11633 SAN VICENTE BLVD	STE 214	LOS ANGELES	CA	90049	6511	19	06037	34.05402447	-118.4632335	Los Angeles County
129993	Fee-for-Service	1285052928	1285052928	1	1	LEVINE, ALISON S MD	11/10/2020	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
129996	Fee-for-Service	1003174897	1003174897	1	1	LEDESMA, MARK NEIL B MD	11/16/2017	207L00000X	NA	Other	026	PHYSICIANS	132913	05	Anesthesiology	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
130001	Fee-for-Service	1306880190	1306880190	1	1	LAMBROS, JOHN A MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68320	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1701 SANTA ANITA AVE	None	EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
130003	Fee-for-Service	1255368874	1255368874	1	1	LO, SIMON K MD	1/17/1984	174400000X	NA	Other	026	PHYSICIANS	51850	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
130052	Fee-for-Service	1922427020	1922427020	1	1	LIN, ALICE DO	2/12/2019	207R00000X	NA	Other	026	PHYSICIANS	14854	01	General Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
130060	Fee-for-Service	1124334453	1124334453	1	1	LOPEZ, MARIO O MD INC	7/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33916	08	Family Practice	0	In state provider	None	720 ALAMITOS AVE	None	LONG BEACH	CA	90813	4726	19	06037	33.77576654	-118.1800352	Los Angeles County
130079	Fee-for-Service	1003514480	1003514480	1	1	LAM, CHRISTINA K	4/2/2023	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
130090	Fee-for-Service	1952459752	1952459752	1	1	LANG, DANIEL MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	67182	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
130093	Fee-for-Service	1699711846	1699711846	1	1	LENIHAN, MICHAEL MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	61864	66	Emergency Medicine (Urgent Care)	0	In state provider	None	955 LANE AVENUE	SUITE 200	CHULA VISTA	CA	91914	4525	37	06073	32.65121611	-116.9615942	San Diego County
130133	Fee-for-Service	1720075641	1720075641	1	1	LEE, ERIC W MD	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	65673	20	Orthopedic Surgery	0	In state provider	None	1310 W STEWART DR	STE 510	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
130186	Fee-for-Service	1508810532	1508810532	1	1	LEMON, DWIGHT A MD	4/24/1990	207P00000X	NA	Other	026	PHYSICIANS	62906	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3475 KENYON ST	None	SAN DIEGO	CA	92110	5002	37	06073	32.74962645	-117.2151566	San Diego County
130205	Fee-for-Service	1235227109	1235227109	1	1	LIN, MORGAN Z MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	52480	41	Internal Medicine	0	In state provider	None	5565 W LAS POSITAS BLVD	STE 300	PLEASANTON	CA	94588	5808	01	06001	37.69215143	-121.8800337	Alameda County
130207	Fee-for-Service	1679678916	1679678916	1	1	LIN, RUBIN C DO	6/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9047	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
130217	Fee-for-Service	1639551013	1639551013	1	1	LEE, JANINE B MD	5/30/2022	208VP0000X	NA	Other	026	PHYSICIANS	168975	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
130243	Fee-for-Service	1831158880	1831158880	1	1	LIMJOCO, TERESA I MD	5/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134342	22	Pathology (M.D. only)	0	In state provider	None	2615 EYE STREET	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
130255	Fee-for-Service	1023166089	1023166089	1	1	LIM, SAMUEL L MD	6/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	56374	08	Family Practice	0	In state provider	None	430 W BASELINE RD	None	CLAREMONT	CA	91711	1607	19	06037	34.12157453	-117.7214355	Los Angeles County
130262	Fee-for-Service	1679079503	1679079503	1	1	LIANG, TOM Z	8/1/2024	207ZP0102X	NA	Other	026	PHYSICIANS	165984	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
130284	Fee-for-Service	1144301516	1144301516	1	1	LUTNESS, CAROLE L LCSW	9/19/2011	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	23560 LYONS AVE	#204	NEWHALL	CA	91321	5726	19	06037	34.37936213	-118.5462451	Los Angeles County
130295	Fee-for-Service	1811947609	1811947609	1	1	LAMBERTS, ERIC W MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	1240 E 9TH ST	None	RENO	NV	89512	2964	00	None	39.53846574	-119.7974202	Washoe County
130337	Fee-for-Service	1750503017	1750503017	1	1	LONG BEACH MEMORIAL MED	8/1/2000	193400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2865 ATLANTIC AVE	STE 110	LONG BEACH	CA	90806	7408	19	06037	33.809418	-118.185058	Los Angeles County
130338	Fee-for-Service	1922427020	1922427020	1	1	LIN, ALICE DO	2/12/2019	207R00000X	NA	Other	026	PHYSICIANS	14854	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
130348	Fee-for-Service	1639664782	1639664782	1	1	LIMAR ADULT DAY HEALTH CARE	4/20/2021	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CENTER	2809 TWEEDY BLVD	UNIT B	SOUTH GATE	CA	90280	7426	19	06037	33.94599284	-118.2211199	Los Angeles County
130350	Fee-for-Service	1174822639	1174822639	1	1	LEE, ELLEN E MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134311	36	Psychiatry	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
130377	Fee-for-Service	1952459752	1952459752	1	1	LANG, DANIEL MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	67182	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
130386	Fee-for-Service	1104956127	1104956127	1	1	LEAFE, MORGAN E MD	2/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139056	40	Pediatrics	0	In state provider	None	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
130416	Fee-for-Service	1891948527	1891948527	1	1	LE, DUY M MD	10/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110391	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
130459	Fee-for-Service	1982784625	1982784625	1	1	LIN, PETER H MD	6/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135687	02	General Surgery	0	In state provider	None	1082 GLENDON AVENUE	None	LOS ANGELES	CA	90024	2908	19	06037	34.06109265	-118.4443071	Los Angeles County
130467	Fee-for-Service	1265017172	1265017172	1	1	LOYAL HANDS HOME HEALTH CARE	2/28/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	825 COLORADO BLVD	SUITE 112	LOS ANGELES	CA	90041	1741	19	06037	34.14010093	-118.1843351	Los Angeles County
130501	Fee-for-Service	1013928225	1013928225	1	1	LEE, GERALD K	9/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67966	30	Radiology	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
130542	Fee-for-Service	1700050515	1700050515	1	1	LALAS, SERAFIN T JR MD	1/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113532	36	Psychiatry	0	In state provider	None	1686 BARTON ROAD	None	REDLANDS	CA	92373	7761	36	06071	34.04833901	-117.2120103	San Bernardino County
130552	Fee-for-Service	1134239338	1134239338	1	1	LUBARSKY FRIEDMAN, SUZANNE L	3/30/2022	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	170638	None	None	0	In state provider	MD	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
130574	Fee-for-Service	1437284239	1437284239	1	1	LEVINE, JACK S PHD	1/21/2004	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 TERRADO PLZ	STE 246	COVINA	CA	91723	3412	19	06037	34.07598226	-117.8892839	Los Angeles County
130576	Fee-for-Service	1124160015	1124160015	1	1	LEE, AMY OD	2/11/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4171 PIEDMONT AVE	STE 109	OAKLAND	CA	94611	5188	01	06001	37.82726494	-122.251408	Alameda County
130597	Fee-for-Service	1063441392	1063441392	1	1	LIN, YI-HSIANG DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	CHIROPRACTIC PC	10405 LOWER AZUSA RD	None	TEMPLE CITY	CA	91780	3470	19	06037	34.0918891	-118.0409293	Los Angeles County
130637	Fee-for-Service	1174822639	1174822639	1	1	LEE, ELLEN E MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134311	38	Geriatrics	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
130657	Fee-for-Service	1104196484	1104196484	1	1	LABORATORY CORPORATION OF	1/9/2012	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	AMERICA	3550 Q STREET	STE 102	BAKERSFIELD	CA	93301	1645	15	06029	35.391978	-119.0105025	Kern County
130665	Fee-for-Service	1033131511	1033131511	1	1	LANDSBERG JOHN M MD	4/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	56442	08	Family Practice	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
130670	Fee-for-Service	1568774321	1568774321	1	2	LANGUAGE ESSENTIALS SPEECH P	7/8/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ATHOLOGY, INC.	60 FENTON ST	STE 2	LIVERMORE	CA	94550	4196	01	06001	37.67760213	-121.7834094	Alameda County
130674	Fee-for-Service	1801274535	1801274535	1	1	LUXHOJ, ANDREW C DO	7/6/2022	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	18942	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
130692	Fee-for-Service	1073017471	1073017471	1	1	LIANG, LIDIA T DO	5/14/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17910	08	Family Practice	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
130696	Fee-for-Service	1659545069	1659545069	1	1	LIBERTY HOMES	11/20/2007	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	19834 HATHAWAY AVE	None	HAYWARD	CA	94541	2313	01	06001	37.67513909	-122.1131713	Alameda County
130732	Fee-for-Service	1467504969	1467504969	1	1	LICHTY, DENISE M PHD	1/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
130735	Fee-for-Service	1548200686	1548200686	1	1	LAM, JIM W MD	3/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	51171	01	General Practice	0	In state provider	None	27231 LA PAZ RD	STE A	LAGUNA NIGUEL	CA	92677	3627	30	06059	33.56889655	-117.7077443	Orange County
130766	Fee-for-Service	1033651096	1033651096	1	1	LIGHT ANGEL HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13609 VICTORY BLVD	STE 236	VAN NUYS	CA	91401	1736	19	06037	34.18671049	-118.429353	Los Angeles County
130771	Fee-for-Service	1093336414	1093336414	1	1	LOVING HANDS HOSPICE	6/22/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	401 N BRAND BLVD	STE 230	GLENDALE	CA	91203	4443	19	06037	34.151958	-118.255149	Los Angeles County
130869	Fee-for-Service	1891708079	1891708079	1	1	LOS ANGELES CO	12/1/1977	261Q00000X	NA	Other	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	GLENDALE HEALTH CTR	501 N GLENDALE AVE	None	GLENDALE	CA	91206	3312	19	06037	34.15307402	-118.243996	Los Angeles County
130875	Fee-for-Service	1619022852	1619022852	1	1	LYONS HUBER ANESTHESIA A	2/15/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL CORPORATION	10 WOODLAND RD	None	SAINT HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
130884	Fee-for-Service	1881827723	1881827723	1	1	LA BIANCO, JOYCE V LMFT	5/9/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	JOYCE LA BIANCO, LMFT	7177 BROCKTON AVE	SUITE 452	RIVERSIDE	CA	92506	2631	33	06065	33.94289496	-117.3943941	Riverside County
130888	Fee-for-Service	1336271972	1336271972	1	1	LOPEZ, SASHA Y LMFT	10/31/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	30732 ROARING RIVERS DR	None	COARSEGOLD	CA	93614	9641	20	06039	37.19496175	-119.7851608	Madera County
130889	Fee-for-Service	1992850556	1992850556	1	1	LOIZEAUX-WITTE, JOHN MD	4/1/2000	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	82321	30	Radiology	0	In state provider	None	9808 VENICE BLVD	FL 2	CULVER CITY	CA	90232	2732	19	06037	34.0236396	-118.3980847	Los Angeles County
130897	Fee-for-Service	1114519220	1114519220	1	1	LILIENTHAL, BETH DOULA	8/2/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	44	06087	0	0	None
130900	Fee-for-Service	1447003983	1447003983	1	1	LAKEWOOD HOSPITALIST MEDICAL	10/1/2024	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	3700 E SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.8601747	-118.148313	Los Angeles County
130910	Fee-for-Service	1366903809	1366903809	1	1	LICHT, BRIAN M MD	1/1/2024	207L00000X	NA	Other	026	PHYSICIANS	189924	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
130944	Fee-for-Service	1205995941	1205995941	1	1	LAM, ALBERT H MD	8/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95758	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
130954	Fee-for-Service	1033131511	1033131511	1	1	LANDSBERG JOHN M MD	4/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	56442	01	General Practice	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
130976	Fee-for-Service	1457370595	1457370595	1	1	LINDA CHAMBLISS M.D.	10/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
130987	Fee-for-Service	1891182465	1891182465	1	1	LAU, ERIC K C MD	6/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15311	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
130988	Fee-for-Service	1508954017	1508954017	1	1	LIN, FRANK MD	2/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85261	01	General Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
131025	Fee-for-Service	1548200686	1548200686	1	1	LAM, JIM W MD	3/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	51171	08	Family Practice	0	In state provider	None	27231 LA PAZ RD	STE A	LAGUNA NIGUEL	CA	92677	3627	30	06059	33.56889655	-117.7077443	Orange County
131038	Fee-for-Service	1023076874	1023076874	1	1	LADD DANIEL LAKE M.D.	10/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 W LEOTA ST	None	NORTH PLATTE	NE	69101	6525	00	None	41.12078954	-100.7706728	Lincoln County
131054	Fee-for-Service	1033651096	1033651096	1	1	LIGHT ANGEL HOSPICE INC	7/30/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13609 VICTORY BLVD	STE 236	VAN NUYS	CA	91401	1736	19	06037	34.18671049	-118.429353	Los Angeles County
131060	Fee-for-Service	1093336414	1093336414	1	1	LOVING HANDS HOSPICE	6/22/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	401 N BRAND BLVD	STE 230	GLENDALE	CA	91203	4443	19	06037	34.151958	-118.255149	Los Angeles County
131066	Fee-for-Service	1093893596	1093893596	1	1	LENNON, MICHAEL B MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	44033	41	Internal Medicine	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
131082	Fee-for-Service	1558354720	1558354720	1	1	LINVILLE, JAMES S OD	1/31/1989	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	579 4TH AVE	None	GUSTINE	CA	95322	1143	24	06047	37.25579853	-121.0006477	Merced County
131084	Fee-for-Service	1245694710	1245694710	1	1	LEE, SEUNG W MD	8/20/2021	207L00000X	NA	Other	026	PHYSICIANS	172517	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
131131	Fee-for-Service	1588908388	1588908388	1	2	LOMA LINDA UNIVERSITY MEDICA	8/3/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	28078 BAXTER RD	SUITE 220	MURRIETA	CA	92563	1401	33	06065	33.615	-117.1670265	Riverside County
131141	Fee-for-Service	1275558785	1275558785	1	1	LEVINE, MORTON S MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	33471	40	Pediatrics	0	In state provider	None	15230 LAKESHORE DR	None	CLEARLAKE	CA	95422	8107	17	06033	38.95005226	-122.6264492	Lake County
131159	Fee-for-Service	1144280348	1144280348	1	1	LOCKE, DANNY MD	5/31/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36304	08	Family Practice	0	In state provider	None	420 W ROWLAND ST	None	COVINA	CA	91723	2943	19	06037	34.078949	-117.8963031	Los Angeles County
131167	Fee-for-Service	1861551590	1861551590	1	1	LEE, THOMAS J OD	2/11/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
131188	Fee-for-Service	1760552152	1760552152	1	1	LEBO, DEBRA K DO	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	6858	None	None	0	In state provider	None	36243 INLAND VALLEY DR	STE 100	WILDOMAR	CA	92595	9547	33	06065	33.591528	-117.2393325	Riverside County
131218	Fee-for-Service	1972546745	1972546745	2	1	LONGS DRUG STORE CA LLC	4/23/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1000 W KETTLEMAN LN	None	LODI	CA	95240	6054	39	06077	38.11540947	-121.2846975	San Joaquin County
131223	Fee-for-Service	1235298845	1235298845	1	1	LEE, LENA S MD	9/30/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	79322	40	Pediatrics	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
131240	Fee-for-Service	1962845834	1962845834	1	1	LIU, YUAN F MD	8/3/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	132208	04	Otology, Laryngology, Rhinology	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
131254	Fee-for-Service	1134418114	1134418114	1	1	LIBERTY HOSPICE INC	5/17/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1111 N BRAND BLVD	SUITE 314	LOS ANGELES	CA	91202	3071	19	06037	34.1622	-118.2550855	Los Angeles
131265	Fee-for-Service	1518457308	1518457308	1	1	LARA, DANIEL DO	3/7/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17783	None	None	0	In state provider	None	8120 TIMBERLAKE WAY	SUITE 107	SACRAMENTO	CA	95823	5413	34	06067	38.461023	-121.41414	Sacramento County
131279	Fee-for-Service	1508285990	1508285990	1	1	LEDBETTER, SARAH E MD	11/16/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153790	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
131281	Fee-for-Service	1063150324	1063150324	1	1	LOPEZ, JORGE CRNA	10/6/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
131282	Fee-for-Service	1235456526	1235456526	1	1	LOPEZ-ORTEGA, TESLA NP	2/14/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
131316	Fee-for-Service	1205370467	1205370467	1	1	LUZ HOME HEALTH CARE INC	2/21/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2701 E GAGE AVE	STE 203	HUNTINGTON PARK	CA	90255	5491	19	06037	33.98166646	-118.222227	Los Angeles County
131334	Fee-for-Service	1255835740	1255835740	1	1	LANE, MEGHAN C MD	5/13/2022	207R00000X	NA	Other	026	PHYSICIANS	174132	None	None	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
131338	Fee-for-Service	1730341595	1730341595	1	1	LAWANDE, NEIL R MD	7/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106020	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
131343	Fee-for-Service	1104866078	1104866078	1	1	LINDQUIST, RICHARD, J	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1460 G ST	None	SPRINGFIELD	OR	97477	4112	00	None	44.0524395	-123.0035985	Lane County
131355	Fee-for-Service	1922370071	1922370071	1	1	LIU, YAN MD	8/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135953	25	Physical Medicine and Rehabilitation	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
131394	Fee-for-Service	1558540583	1558540583	1	1	LEXANN PHARMACY INC	11/13/2007	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	LEXANN PHARMACY INC	1569 LEXANN DR	STE 104	SAN JOSE	CA	95121	1793	43	06085	37.30790568	-121.8141983	Santa Clara County
131397	Fee-for-Service	1477533610	1477533610	1	1	LATEEF, MARYAM H NP	1/31/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
131425	Fee-for-Service	1053774919	1053774919	1	1	LYFOUNG, HNOUKAJ A MD	10/28/2021	208600000X	NA	General Surgery	026	PHYSICIANS	172228	None	None	0	In state provider	None	3010 COLBY	STE 118	BERKELEY	CA	94705	2091	01	06001	37.85492078	-122.2576101	Alameda County
131443	Fee-for-Service	1952797193	1952797193	1	1	LIM, JANE E MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147236	41	Internal Medicine	0	In state provider	None	4312 WOODMAN AVE	STE 102	SHERMAN OAKS	CA	91423	4823	19	06037	34.148637	-118.4312035	Los Angeles County
131477	Fee-for-Service	1619919446	1619919446	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8320 EL CAMINO REAL	None	ATASCADERO	CA	93422	5354	40	06079	35.4738325	-120.6568869	San Luis Obispo County
131482	Fee-for-Service	1548977184	1548977184	1	1	LEGACY SENIOR LIVING LLC	11/17/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	19892 POTOMAC LN	None	HUNTINGTON BEACH	CA	92646	3520	30	06059	33.67351557	-117.9652961	Orange County
131511	Fee-for-Service	1023220894	1023220894	1	1	LE, MARTIN MD	9/19/2023	207L00000X	NA	Other	026	PHYSICIANS	93732	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
131515	Fee-for-Service	1104024173	1104024173	1	1	LEE, JEFFREY B MD	3/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109138	40	Pediatrics	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
131524	Fee-for-Service	1548828197	1548828197	1	1	LOPEZ, JESUS CRNA	11/9/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
131546	Fee-for-Service	1134418114	1134418114	1	1	LIBERTY HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1111 N BRAND BLVD	SUITE 314	LOS ANGELES	CA	91202	3071	19	06037	34.1622	-118.2550855	Los Angeles
131582	Fee-for-Service	1447295357	1447295357	1	1	LABROT, GEORGE E MD	11/27/1985	207R00000X	NA	Other	026	PHYSICIANS	26732	41	Internal Medicine	0	In state provider	None	2200 SANTA MONICA BLVD	STE 209	SANTA MONICA	CA	90404	2312	19	06037	34.02998528	-118.478349	Los Angeles County
131625	Fee-for-Service	1821025479	1821025479	1	1	LEVINE, JON D MD	4/1/1984	207R00000X	NA	Other	026	PHYSICIANS	40116	83	Rheumatology	0	In state provider	None	505 PARNASSUS AVE	# 997M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
131644	Fee-for-Service	1649652009	1649652009	1	1	LEIS, LAURA S OD	1/30/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
131658	Fee-for-Service	1982811600	1982811600	1	1	LARCABAL, JOHN OD	8/15/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12138 FIRESTONE BLVD	None	NORWALK	CA	90650	2908	19	06037	33.90876295	-118.0747274	Los Angeles County
131665	Fee-for-Service	1689773483	1689773483	1	1	LITTLE, HEATHER AU	5/11/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1260 HEALDSBURG AVE	SUITE 202	HEALDSBURG	CA	95448	3407	49	06097	38.62584553	-122.8726666	Sonoma County
131674	Fee-for-Service	1073661906	1073661906	1	1	LEE, STEVEN W MD	4/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90954	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
131683	Fee-for-Service	1952711533	1952711533	1	1	LA CASA PRIMAVERA, LLC	6/27/2014	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1740 GRAND AVE	None	LONG BEACH	CA	90804	2011	19	06037	33.7887	-118.148033	Los Angeles County
131705	Fee-for-Service	1043276140	1043276140	1	1	LO, GARLAN G MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	57913	None	None	0	In state provider	None	1850 S AZUSA AVE	STE 107	HACIENDA HEIGHTS	CA	91745	6827	19	06037	33.98895597	-117.9322797	Los Angeles County
131711	Fee-for-Service	1952956245	1952956245	1	1	LAND OF PEACE 6	9/20/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	22626 KITTRIDGE ST	None	WEST HILLS	CA	91307	3608	19	06037	34.1914765	-118.6199955	Los Angeles County
131736	Fee-for-Service	1164857538	1164857538	1	2	LANDE, CLAIRE MD	12/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127214	40	Pediatrics	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
131757	Fee-for-Service	1720282031	1720282031	1	1	LEE, RAYMOND MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 NE 92ND AVE	None	VANCOUVER	WA	98664	3225	00	None	45.624546	-122.579703	Clark County
131776	Fee-for-Service	1518491281	1518491281	1	1	LE, CHRISTINE A DO	6/23/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	17181	None	None	0	In state provider	None	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	15	06029	35.3540847	-119.0536548	Kern County
131790	Fee-for-Service	1457371320	1457371320	1	1	LEVY, SCOTT A	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83077	None	None	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
131799	Fee-for-Service	1295152106	1295152106	1	1	LEE, DANIEL K MD	11/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1600 MEDICAL PKWY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
131859	Fee-for-Service	1154370138	1154370138	1	1	LAVEE, ALLEN E MD	1/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	41578	05	Anesthesiology	0	In state provider	None	3325 CHANATE ROAD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
131863	Fee-for-Service	1093752404	1093752404	2	1	LINCARE INC	2/18/2021	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4300 STINE RD	STE 603	BAKERSFIELD	CA	93313	2364	15	06029	35.315757	-119.0565615	Kern County
131865	Fee-for-Service	1699931204	1699931204	1	1	LIU, KENNETH MD	2/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113867	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
131878	Fee-for-Service	1013216951	1013216951	1	1	LABUGUEN, MELINDA D MD INC	12/12/2011	193400000X	NA	Other	026	PHYSICIANS	52770	22	Pathology (M.D. only)	0	In state provider	None	18300 HWY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
131888	Fee-for-Service	1144266081	1144266081	1	1	LALONDE, FRANCOIS D MD	7/1/1998	174400000X	NA	Other	026	PHYSICIANS	62102	20	Orthopedic Surgery	0	In state provider	None	3030 CHILDRENS WAY	STE 410	SAN DIEGO	CA	92123	4228	37	06073	32.798889	-117.150826	San Diego County
131890	Fee-for-Service	1104235688	1104235688	1	1	LUGO, ALEJANDRA NP	6/4/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1317 OAKDALE RD	SUITE 440	MODESTO	CA	95355	3364	50	06099	37.662489	-120.957588	Stanislaus County
131894	Fee-for-Service	1730764416	1730764416	1	1	LODEEN, HOMAYOON MD	8/21/2024	390200000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
131911	Fee-for-Service	1205847431	1205847431	1	1	LEE, ALAN C MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71069	08	Family Practice	0	In state provider	None	1304 15TH ST	STE 400	SANTA MONICA	CA	90404	1813	19	06037	34.02600773	-118.486172	Los Angeles County
131926	Fee-for-Service	1922467786	1922467786	1	1	LEE, ANDREW K DO	12/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14436	01	General Practice	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
131936	Fee-for-Service	1346283108	1346283108	2	1	LONGS DRUG STORES CA LLC	5/29/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1835 CLIFF DR	None	SANTA BARBARA	CA	93109	1652	42	06083	34.40143379	-119.7216679	Santa Barbara County
131962	Fee-for-Service	1730521196	1730521196	1	1	LAST, BENEDICTE A M PSYD	7/2/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	206 N JACKSON ST	SUITE 202	GLENDALE	CA	91206	4330	19	06037	34.14852285	-118.2501237	Los Angeles County
131994	Fee-for-Service	1043367717	1043367717	1	1	LIGHTMAN, JANIS M OD	1/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
132028	Fee-for-Service	1073708079	1073708079	1	2	LONDON, RUTHANN LMFT	8/14/2020	106H00000X	NA	Mental Health Outpatient Services	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	155 HOSPITALITY LN	245	SAN BERNARDINO	CA	92408	3305	36	06071	34.06580948	-117.2856915	San Bernardino County
132029	Fee-for-Service	1518951383	1518951383	1	1	LERMAN, ROBERT D MD	1/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	62204	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1355 SAN PABLO ST	None	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
132032	Fee-for-Service	1750334702	1750334702	1	1	LUIS URIBE MD	8/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 W ESPLANADE AVE	STE 103	KENNER	LA	70065	2473	00	None	30.02314699	-90.27161194	Jefferson Parish
132063	Fee-for-Service	1518458165	1518458165	1	1	LEONARD, SEAN NP	9/19/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	301 VICTORIA STREET	None	COSTA MESA	CA	92627	1995	30	06059	33.65258952	-117.9121545	Orange County
132069	Fee-for-Service	1235173683	1235173683	2	1	LONGS DRUG STORES CA LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1405 HERNDON AVE	None	CLOVIS	CA	93611	0504	10	06019	36.83756091	-119.6903698	Fresno County
132071	Fee-for-Service	1265455695	1265455695	1	1	LIN-NGUYEN, JENNIFER W	3/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91544	40	Pediatrics	0	In state provider	MD	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
132099	Fee-for-Service	1023358611	1023358611	1	1	LIU, AMY X MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121184	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
132127	Fee-for-Service	1851400451	1851400451	1	1	LEE, SUN H MD	3/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	52937	14	Neurological Surgery	0	In state provider	None	501 S BUENA VISTA STREET	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
132150	Fee-for-Service	1316175607	1316175607	1	1	LARSON, BRETT R OD	6/2/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3953 W STETSON AVE	None	HEMET	CA	92545	9687	33	06065	33.72930152	-117.012681	Riverside County
132165	Fee-for-Service	1124283072	1124283072	1	1	LAURA M STUEMKY, M.D.	11/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6161 S YALE AVE	None	TULSA	OK	74136	1902	00	None	36.07272	-95.9191515	Tulsa County
132176	Fee-for-Service	1144266081	1144266081	1	1	LALONDE, FRANCOIS D MD	7/1/1998	174400000X	NA	Other	026	PHYSICIANS	62102	40	Pediatrics	0	In state provider	None	3030 CHILDRENS WAY	STE 410	SAN DIEGO	CA	92123	4228	37	06073	32.798889	-117.150826	San Diego County
132188	Fee-for-Service	1154616373	1154616373	1	1	LENIHAN, COLIN R MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127012	45	Nephrology (Renal-Kidney)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
132196	Fee-for-Service	1780795716	1780795716	1	1	LIN, NORTON C MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71561	05	Anesthesiology	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
132251	Fee-for-Service	1396764247	1396764247	1	1	LYNCH, JOSEPH P III MD	9/16/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86970	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA # 365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
132279	Fee-for-Service	1144242637	1144242637	1	1	LINDA C LEVEE NP	9/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1720 UNIVERSITY DR S	None	FARGO	ND	58103	4940	00	None	46.853136	-96.797421	Cass County
132289	Fee-for-Service	1669785739	1669785739	1	1	LOREDO, SHARMAN T LCSW	7/25/2016	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	40 ELDRIDGE AVE	STE 9C	VACAVILLE	CA	95688	6823	48	06095	38.35699577	-122.0011996	Solano County
132295	Fee-for-Service	1972998326	1972998326	1	1	LIEN, CHRISTINA J DO	2/29/2024	208600000X	NA	General Surgery	026	PHYSICIANS	15099	None	None	0	In state provider	None	25550 HAWTHORNE BLVD	STE 209	TORRANCE	CA	90505	6832	19	06037	33.79398714	-118.3491878	Los Angeles County
132339	Fee-for-Service	1770898397	1770898397	1	1	LACAYO, CLAUDIA M NP	1/6/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
132354	Fee-for-Service	1225078363	1225078363	1	1	LEWIS, GREGORY R MD	7/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142894	01	General Practice	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06269295	-118.2030006	Los Angeles County
132376	Fee-for-Service	1942361712	1942361712	1	1	LINK, SUSAN H OD	2/7/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3300 WEBSTER ST	STE 608	OAKLAND	CA	94609	3117	01	06001	37.82132826	-122.2621843	Alameda County
132386	Fee-for-Service	1376860957	1376860957	1	1	LIU, YUNGUANG MD	3/10/2022	207ZP0102X	NA	Other	026	PHYSICIANS	171050	None	None	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
132388	Fee-for-Service	1902834054	1902834054	2	1	LOGIUDICE, PHILIP MD	7/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	18670	02	General Surgery	0	In state provider	None	2274 RUE LA CHARLENE	None	RANCHO PALOS VERD	CA	90275	6357	19	06037	33.73528948	-118.321047	Los Angeles County
132466	Fee-for-Service	1467217588	1467217588	1	1	LOMIBAO PSYCHOLOGICAL SERVIC	5/2/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ES	8788 ELK GROVE BLVD	BLDG 3, STE 12E	ELK GROVE	CA	95624	1766	34	06067	38.408382	-121.3770645	Sacramento County
132470	Fee-for-Service	1255447108	1255447108	2	1	LONGS DRUG STORES CA LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1299 E ONTARIO AVE	None	CORONA	CA	92881	3617	33	06065	33.84703836	-117.5402426	Riverside County
132491	Fee-for-Service	1801815048	1801815048	1	1	LIU, STEVEN T	4/8/2021	207R00000X	NA	Other	026	PHYSICIANS	53222	None	None	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
132505	Fee-for-Service	1235323775	1235323775	1	1	LE, PHUC V MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108719	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06482757	-118.4443441	Los Angeles County
132555	Fee-for-Service	1659628519	1659628519	1	1	LIN, GRACE MD	8/9/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	155114	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
132559	Fee-for-Service	1891135448	1891135448	1	1	LI, JOSEPH C MD	7/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146238	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
132569	Fee-for-Service	1679679500	1679679500	1	1	LECH, AGNIESZKA MD	3/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93023	41	Internal Medicine	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
132589	Fee-for-Service	1548283526	1548283526	2	1	LAVIAN, CYRUS RAFAEL MD	11/25/2019	207R00000X	NA	Other	026	PHYSICIANS	44927	41	Internal Medicine	0	In state provider	None	822 EAST AVENUE K	None	LANCASTER	CA	93535	9416	19	06037	34.67493856	-118.1138795	Los Angeles County
132645	Fee-for-Service	1316365786	1316365786	1	1	LAGUNA, MEREDITH L C MD	6/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141438	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
132647	Fee-for-Service	1689616856	1689616856	1	1	LEWIS, MEGAN B	1/30/2003	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2910 JEFFERSON ST	STE 201	CARLSBAD	CA	92008	2358	37	06073	33.16226261	-117.3463592	San Diego County
132663	Fee-for-Service	1588808703	1588808703	1	1	LEONIAK, JENNIFER L DO	10/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13410	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95381	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
132675	Fee-for-Service	1699252734	1699252734	1	1	LARSON, ANASTASHIA S LCSW	5/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
132716	Fee-for-Service	1720195035	1720195035	1	1	LEE, ROBERT K MD	6/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81586	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
132761	Fee-for-Service	1356847875	1356847875	1	1	LEON, DAVID A MD	7/8/2024	390200000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
132771	Fee-for-Service	1689740169	1689740169	1	1	LIU, YU-CHUAN MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64763	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
132788	Fee-for-Service	1134552953	1134552953	1	1	LEWIS, MARINA S	11/20/2019	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
132850	Fee-for-Service	1255795258	1255795258	1	1	LOS ANGELES COMMUNITY	10/14/2016	261QS1000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	COLLEGE DISTRICT	6201 WINNETKA AVENUE	None	WOODLAND HILLS	CA	91371	0001	19	06037	34.1823453	-118.5710283	Los Angeles County
132859	Fee-for-Service	1679679500	1679679500	1	1	LECH, AGNIESZKA MD	3/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93023	40	Pediatrics	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
132876	Fee-for-Service	1588608756	1588608756	1	1	LANDAU, CLAUDIA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67736	41	Internal Medicine	0	In state provider	None	110 41ST ST	None	OAKLAND	CA	94611	5250	01	06001	37.82617734	-122.2513788	Alameda County
132912	Fee-for-Service	1861684250	1861684250	1	1	LUDLOW, SARA M MD	10/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106048	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
132914	Fee-for-Service	1316014228	1316014228	1	1	LEHRMAN, EDWARD A MD	4/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	37209	18	Ophthalmology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
132921	Fee-for-Service	1902286206	1902286206	1	1	LAUS, KATHARINA MD	10/3/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	160748	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
132928	Fee-for-Service	1356575922	1356575922	1	1	LANE, MEREDITH L MD	10/12/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	167427	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	18300 HWY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
132930	Fee-for-Service	1073869392	1073869392	1	1	LATINA, MARCELINO D DO	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14151	40	Pediatrics	0	In state provider	None	9089 BASELINE ROAD	SUITE 100	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
132945	Fee-for-Service	1720199334	1720199334	1	1	LIN, MICHAEL Y. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	660 S EUCLID AVE	None	SAINT LOUIS	MO	63110	1010	00	None	38.63518793	-90.26307576	St. Louis city
132951	Fee-for-Service	1558569178	1558569178	1	1	L&N, INC	3/27/2007	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1211 RADCLIFF LN	None	HAYWARD	CA	94545	2643	01	06001	37.64241455	-122.0962094	Alameda County
132957	Fee-for-Service	1649392028	1649392028	1	1	LEE, BEN MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	95760	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
132963	Fee-for-Service	1114115565	1114115565	1	1	LANGE, SARAH E NP	2/20/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
132986	Fee-for-Service	1366931503	1366931503	1	1	LIVAK HALE, ANNA K LCSW	6/6/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
132988	Fee-for-Service	1982654745	1982654745	1	1	LEE, MARGARET H MD	6/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80838	30	Radiology	0	In state provider	None	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	19	06037	34.32450186	-118.4456317	Los Angeles County
133013	Fee-for-Service	1831691534	1831691534	1	1	LAM, PATRICK H MD	12/15/2020	207L00000X	NA	Other	026	PHYSICIANS	153910	None	None	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
133033	Fee-for-Service	1740881085	1740881085	1	1	LA MAESTRA FAMILY CLINIC	2/9/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	181 REA AVENUE	None	EL CAJON	CA	92020	3985	37	06073	32.79568447	-116.960454	San Diego County
133035	Fee-for-Service	1962695379	1962695379	1	1	LEWIS, MIRIAM CNP	11/26/2017	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	19353 VICTORY BLVD	None	RESEDA	CA	91335	6302	19	06037	34.18659936	-118.5552114	Los Angeles County
133051	Fee-for-Service	1356847875	1356847875	1	1	LEON, DAVID A MD	7/8/2024	390200000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
133064	Fee-for-Service	1457746026	1457746026	1	1	LE, OLIVER P MD	4/13/2020	246ZN0300X	NA	Other	026	PHYSICIANS	155246	None	None	0	In state provider	None	7223 CHURCH STREET	A20	HIGHLAND	CA	92346	5869	36	06071	34.122888	-117.1737945	San Bernardino County
133075	Fee-for-Service	1891894713	1891894713	1	1	LANZAT, MISHA DPM	1/18/2008	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3743 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1703	19	06037	34.02418646	-118.1927217	Los Angeles County
133146	Fee-for-Service	1134654148	1134654148	1	1	LAVEMAN, EVAN MD	9/10/2020	207P00000X	NA	Other	026	PHYSICIANS	158280	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13100 STUDEBAKER ROAD	None	NORWALK	CA	90650	2531	19	06037	33.912594	-118.099152	Los Angeles County
133152	Fee-for-Service	1669605747	1669605747	1	2	LIU, BO	9/12/2016	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	109174	02	General Surgery	0	In state provider	None	8608 UTICA AVENUE	SUITE 218	RANCHO CUCAMONGA	CA	91730	4879	36	06071	34.097247	-117.573008	San Bernardino County
133164	Fee-for-Service	1588608756	1588608756	1	1	LANDAU, CLAUDIA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67736	38	Geriatrics	0	In state provider	None	110 41ST ST	None	OAKLAND	CA	94611	5250	01	06001	37.82617734	-122.2513788	Alameda County
133201	Fee-for-Service	1487716601	1487716601	1	1	LOVINA ABDUL-MALIK, CARRIE A	9/22/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
133221	Fee-for-Service	1811243793	1811243793	1	1	LEWIS, MELVIN R LMFT	10/18/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9000 MING AVE	STE L-1B	BAKERSFIELD	CA	93311	1318	15	06029	35.33989328	-119.1034715	Kern County
133222	Fee-for-Service	1669433561	1669433561	1	1	LEE, SHIN MD	9/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86131	05	Anesthesiology	0	In state provider	None	3828 DELMAS TERRACE	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
133309	Fee-for-Service	1902112444	1902112444	1	1	LONG, LAWRENCE S	6/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114068	05	Anesthesiology	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
133321	Fee-for-Service	1740881085	1740881085	1	1	LA MAESTRA FAMILY CLINIC	2/9/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	181 REA AVENUE	None	EL CAJON	CA	92020	3985	37	06073	32.79568447	-116.960454	San Diego County
133330	Fee-for-Service	1235468208	1235468208	1	1	LIU, LIZA OSANO PT	8/3/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8800 STOCKDALE HWY	150	BAKERSFIELD	CA	93311	1012	15	06029	35.35448783	-119.0995578	Kern County
133367	Fee-for-Service	1265495477	1265495477	1	1	LAI, JEOUHSING MD	7/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74805	36	Psychiatry	0	In state provider	None	1830 FLOWER ST	RM 3138	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
133368	Fee-for-Service	1922093269	1922093269	1	1	LOUIE LUU, LYNNE D	8/20/2013	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9351 BOLSA AVENUE	None	WESTMINSTER	CA	92683	5928	30	06059	33.7449993	-117.9657689	Orange County
133376	Fee-for-Service	1972358620	1972358620	1	1	LEVAS, DEAHNNE MD	7/30/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
133441	Fee-for-Service	1144674300	1144674300	1	1	LIU, ZEFU DO	10/7/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	20116	None	None	0	In state provider	None	2911 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98821335	-121.978125	Santa Cruz County
133449	Fee-for-Service	1235665662	1235665662	1	1	LUHAR, RIYA DO	10/7/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	19975	None	None	0	In state provider	None	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	37	06073	33.12288368	-117.3058276	San Diego County
133519	Fee-for-Service	1982759304	1982759304	1	1	LOS ANGELES COUNTY CCS	6/14/1994	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	SAN PEDRO MTU	308 S WEYMOUTH AVE	None	SAN PEDRO	CA	90732	3426	19	06037	33.739515	-118.309653	Los Angeles County
133521	Fee-for-Service	1891832242	1891832242	1	1	LAKE, BYRON F MD	3/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	58831	01	General Practice	0	In state provider	None	300 SIERRA COLLEGE DRIVE	SUITE 170	GRASS VALLEY	CA	95945	5070	29	06057	39.23625806	-121.054471	Nevada County
133535	Fee-for-Service	1396818605	1396818605	1	1	LEE, SCOTT X MD	8/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80136	41	Internal Medicine	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
133538	Fee-for-Service	1689758856	1689758856	1	1	LOW, LARAINE R OD	1/31/1990	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7309 STOCKTON BLVD	None	SACRAMENTO	CA	95823	2782	34	06067	38.492028	-121.4267355	Sacramento County
133586	Fee-for-Service	1922087717	1922087717	1	1	LEE, DAVID A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	640 JACKSON ST	None	SAINT PAUL	MN	55101	2502	00	None	44.95496967	-93.09587426	Ramsey County
133615	Fee-for-Service	1073797882	1073797882	1	1	LEE, TOMMY MD	12/9/2009	207R00000X	NA	Other	026	PHYSICIANS	102899	41	Internal Medicine	0	In state provider	None	510 SUPERIOR AVENUE	SUITE 290	NEWPORT BEACH	CA	92663	3664	30	06059	33.63019271	-117.9294795	Orange County
133649	Fee-for-Service	1043724719	1043724719	1	1	LIANG, ANNA X NP	6/25/2019	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
133688	Fee-for-Service	1427070168	1427070168	1	1	LOS ANGELES COUNTY	7/1/2000	282N00000X	NA	Hospitals	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HARBOR-UCLA MEDICAL CTR	1000 W CARSON ST	# L4	TORRANCE	CA	90502	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
133748	Fee-for-Service	1003872805	1003872805	1	1	LARSON, MERLIN D MD	10/31/1991	207L00000X	NA	Other	026	PHYSICIANS	30707	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
133750	Fee-for-Service	1083056097	1083056097	1	1	LOEWEN, JULIE S MD	11/8/2018	207R00000X	NA	Other	026	PHYSICIANS	127038	41	Internal Medicine	0	In state provider	None	2110 PROFESSIONAL DR	STE 120	ROSEVILLE	CA	95661	3779	31	06061	38.74234873	-121.2521259	Placer County
133835	Fee-for-Service	1649242207	1649242207	1	1	LE, JAMES D MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68171	None	None	0	In state provider	None	250 S GRAND AVE	None	GLENDORA	CA	91741	4218	19	06037	34.132842	-117.872523	Los Angeles County
133850	Fee-for-Service	1881902161	1881902161	1	1	LARGAESPADA, ALEXANDER A LMF	4/25/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
133875	Fee-for-Service	1720143803	1720143803	1	1	LINQUIST, JEANNE A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	34478	41	Internal Medicine	0	In state provider	None	8 FAIROAKS CT	None	SAN MATEO	CA	94403	3173	41	06081	37.53346244	-122.3226836	San Mateo County
133879	Fee-for-Service	1851745947	1851745947	1	1	LUAN, ANNA MD	6/4/2024	208200000X	NA	General Surgery	026	PHYSICIANS	151169	24	Plastic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
133883	Fee-for-Service	1760743132	1760743132	1	1	LINDGREN, AMY K MD	4/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126206	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
133903	Fee-for-Service	1619000189	1619000189	1	2	LARBIE, REGINA K BOCP	10/14/2021	1744P3200X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	5331 PIRRONE RD	STE. / APT. #B	SALIDA	CA	95368	9089	50	06099	37.7166377	-121.0921217	Stanislaus County
133912	Fee-for-Service	1538242763	1538242763	1	1	LE, GIA D MD, INC	10/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	32938	05	Anesthesiology	0	In state provider	None	4060 WHITTIER BOULEVARD	None	LOS ANGELES	CA	90023	2526	19	06037	34.02390148	-118.184319	Los Angeles County
133942	Fee-for-Service	1376706325	1376706325	1	1	LALANI, GAUTAM G MD	9/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104693	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
133944	Fee-for-Service	1679894166	1679894166	1	1	LEE, WAYNE S MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120779	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
133978	Fee-for-Service	1427070168	1427070168	1	1	LOS ANGELES COUNTY	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HARBOR-UCLA MEDICAL CTR	1000 W CARSON ST	# L4	TORRANCE	CA	90502	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
133997	Fee-for-Service	1336637511	1336637511	1	1	LUKE, ADAM LMFT	3/12/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	118505	-	NOT APPLICABLE	0	In state provider	None	11501 DOLAN AVE	8332 IOWA ST	DOWNEY	CA	90241	4921	19	06037	33.93694144	-118.1331643	Los Angeles County
134041	Fee-for-Service	1679688683	1679688683	1	1	LEE, ERIC J MD	7/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100560	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
134066	Fee-for-Service	1982790812	1982790812	1	1	LEE, ERIC T MD	7/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	50428	41	Internal Medicine	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
134068	Fee-for-Service	1104886241	1104886241	1	1	LE, HOANG T MD	5/11/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	67079	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
134073	Fee-for-Service	1093264376	1093264376	1	1	LEE, ANNA G OT	7/9/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
134080	Fee-for-Service	1184894925	1184894925	1	1	LOPEZ, RAYMOND F	8/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102710	08	Family Practice	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
134114	Fee-for-Service	1093081705	1093081705	1	1	LOPEZ, BALBINO E MD	6/14/2021	207L00000X	NA	Other	026	PHYSICIANS	172286	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
134115	Fee-for-Service	1780601567	1780601567	1	1	LEGRIS, MICHAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	810 E 27TH ST	None	MINNEAPOLIS	MN	55407	0000	00	None	44.95374448	-93.26145339	Hennepin County
134125	Fee-for-Service	1275914087	1275914087	1	1	LEE, ALLAN MD INC	1/11/2016	207R00000X	NA	Other	026	PHYSICIANS	54273	41	Internal Medicine	0	In state provider	None	400 EVELYN AVENUE	SUITE 107	ALBANY	CA	94706	1350	01	06001	37.89873243	-122.2971602	Alameda County
134132	Fee-for-Service	1841224268	1841224268	1	1	LEE, WAYNE M MD	1/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84742	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300230	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
134151	Fee-for-Service	1497833032	1497833032	1	1	LASH, ALAN MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	35820	83	Rheumatology	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
134165	Fee-for-Service	1316189475	1316189475	1	1	LIQUIN YIN	10/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13103 E MANSFIELD AVE	None	SPOKANE VLY	WA	99216	1642	00	None	47.67755045	-117.228357	Spokane County
134172	Fee-for-Service	1154071652	1154071652	1	1	LAING, OLIVIA E LCSW	8/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
134184	Fee-for-Service	1336906791	1336906791	1	1	LARA, JORGE R RCP	5/30/2024	2279P3900X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
134218	Fee-for-Service	1730281049	1730281049	2	1	LEAMER, MELISSA E DC	11/3/2006	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	900 G ST	STE 200	MODESTO	CA	95354	3446	50	06099	37.63708931	-120.9974943	Stanislaus County
134232	Fee-for-Service	1689834475	1689834475	1	1	LAL, DEVYANI MD	5/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106768	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
134259	Fee-for-Service	1518963719	1518963719	1	1	LIN, ANDREW YUH-FONG MD	4/30/1985	207R00000X	NA	Other	026	PHYSICIANS	37779	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	23600 TELO AVE	STE 280	TORRANCE	CA	90505	4037	19	06037	33.81215054	-118.3384029	Los Angeles County
134277	Fee-for-Service	1164572186	1164572186	1	1	LOGAN, IAN J MD	8/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97807	41	Internal Medicine	0	In state provider	None	2068 JOHN JONES RD	None	DAVIS	CA	95616	9711	57	06113	38.56390812	-121.7690112	Yolo County
134327	Fee-for-Service	1033323290	1033323290	1	1	LIANG, LEONARD W MD	7/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	66024	34	Urology and Urological Surgery	0	In state provider	A PROFESSIONAL CORP	1513 S GRAND AVE	STE 300	LOS ANGELES	CA	90015	3021	19	06037	34.03596303	-118.266212	Los Angeles County
134338	Fee-for-Service	1730176207	1730176207	1	1	LIKOSKY, WILLIAM H MD	1/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	23813	36	Psychiatry	0	In state provider	None	290 N WAYTE LANE	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
134348	Fee-for-Service	1639118748	1639118748	1	1	LEE, TONNY M MD	3/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	68665	41	Internal Medicine	0	In state provider	None	23560 MADISON ST	STE 211	TORRANCE	CA	90505	4710	19	06037	33.81145007	-118.3479265	Los Angeles County
134354	Fee-for-Service	1104886241	1104886241	1	1	LE, HOANG T MD	5/11/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	67079	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
134388	Fee-for-Service	1003348376	1003348376	1	1	LIN, YEA PING MD	8/2/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178817	None	None	0	In state provider	None	47647 CALEO BAY DR	STE 210	LA QUINTA	CA	92253	8858	33	06065	33.70305235	-116.2936509	Riverside County
134399	Fee-for-Service	1417085978	1417085978	1	1	LEARY, SCOTT P MD	7/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79086	14	Neurological Surgery	0	In state provider	None	6645 ALVARADO RD	STE 4000	SAN DIEGO	CA	92120	5208	37	06073	32.7772577	-117.0575222	San Diego County
134423	Fee-for-Service	1861436800	1861436800	1	1	LEVIN, PHILIP RICHARD	8/31/1995	207L00000X	NA	Other	026	PHYSICIANS	78388	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
134438	Fee-for-Service	1497833032	1497833032	1	1	LASH, ALAN MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	35820	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
134444	Fee-for-Service	1982638649	1982638649	1	1	LI, VUY Y MD	10/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93883	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2690 PACIFIC AVE	STE 290	LONG BEACH	CA	90806	2631	19	06037	33.805854	-118.1936805	Los Angeles County
134448	Fee-for-Service	1134797145	1134797145	1	1	LISA NJENGA	1/18/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	6801 CASA DEL ESTE WAY	None	SACRAMENTO	CA	95828	1305	34	06067	38.508444	-121.424427	Sacramento County
134457	Fee-for-Service	1063413110	1063413110	1	1	LEVINE, BRETT A MD PC	2/8/2015	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	74806	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	21320 HAWTHORNE BLVD	STE 119	TORRANCE	CA	90720	3370	19	06037	33.83462628	-118.3529587	Los Angeles County
134481	Fee-for-Service	1093009854	1093009854	1	1	LIN, JODY L MD	7/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130601	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
134513	Fee-for-Service	1003928318	1003928318	1	1	LUNCHICK, ERIC J OD	1/31/1986	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8956 CORBIN AVE	None	NORTHRIDGE	CA	91324	3311	19	06037	34.23337673	-118.5622875	Los Angeles County
134520	Fee-for-Service	1952904831	1952904831	1	1	LOYD, JOSEPH J CNP	12/1/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
134534	Fee-for-Service	1245318872	1245318872	1	1	LEUNG, GORDON K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	75787	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
134540	Fee-for-Service	1578821336	1578821336	1	1	LUI, JEANNIE S MD	2/17/2020	207L00000X	NA	Other	026	PHYSICIANS	165619	05	Anesthesiology	0	In state provider	None	975 SOUTH FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
134549	Fee-for-Service	1518963719	1518963719	1	1	LIN, ANDREW YUH-FONG MD	4/30/1985	207R00000X	NA	Other	026	PHYSICIANS	37779	41	Internal Medicine	0	In state provider	None	23600 TELO AVE	STE 280	TORRANCE	CA	90505	4037	19	06037	33.81215054	-118.3384029	Los Angeles County
134553	Fee-for-Service	1902984818	1902984818	1	1	LAWLOR, CURTIS K DPM	5/17/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
134588	Fee-for-Service	1831193556	1831193556	1	1	LAURA KAY SCHROEDER M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	16620 N 40TH ST	STE H-4	PHOENIX	AZ	85032	0000	00	None	33.637653	-111.9969405	Maricopa County
134627	Fee-for-Service	1730176207	1730176207	1	1	LIKOSKY, WILLIAM H MD	1/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	23813	13	Neurology (M.D. only)	0	In state provider	None	290 N WAYTE LANE	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
134632	Fee-for-Service	1639118748	1639118748	1	1	LEE, TONNY M MD	3/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	68665	10	Gastroenterology (M.D. only)	0	In state provider	None	23560 MADISON ST	STE 211	TORRANCE	CA	90505	4710	19	06037	33.81145007	-118.3479265	Los Angeles County
134639	Fee-for-Service	1790192573	1790192573	1	1	LOUIS, ROBERT G MD INC	8/6/2014	207T00000X	NA	General Surgery	026	PHYSICIANS	122626	14	Neurological Surgery	0	In state provider	None	361 HOSPITAL ROAD	SUITE 224	NEWPORT BEACH	CA	92663	3522	30	06059	33.62579141	-117.9299554	Orange County
134672	Fee-for-Service	1841679610	1841679610	1	1	LIFECARE SOLUTIONS	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE AND HOSPICE	39675 CEDAR BLVD	SUITE 240B	NEWARK	CA	94560	5489	01	06001	37.52050519	-121.9962032	Alameda County
134675	Fee-for-Service	1326801176	1326801176	1	1	LEVIN, LELAH	9/9/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
134684	Fee-for-Service	1174715569	1174715569	1	1	LEVIS, JENNIFER A PHD	6/2/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
134693	Fee-for-Service	1548370562	1548370562	1	1	LERNER, ROGER L MD	1/1/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	28501	41	Internal Medicine	0	In state provider	None	8920 WILSHIRE BLVD	STE 518	BEVERLY HILLS	CA	90211	1949	19	06037	34.06703599	-118.3863456	Los Angeles County
134698	Fee-for-Service	1558484857	1558484857	1	1	LIN, ANDREW MD	5/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99209	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
134706	Fee-for-Service	1710003728	1710003728	1	1	LIPAROTO, BLAYNE R PT	7/24/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4572 TELEPHONE RD	STE 903	VENTURA	CA	93003	5663	56	06111	34.25635267	-119.2348313	Ventura County
134721	Fee-for-Service	1275652877	1275652877	1	1	LOWDER, GARY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3421 MEDICAL PARK DR	None	MONROE	LA	71203	2355	00	None	32.57793846	-92.07056949	Ouachita Parish
134736	Fee-for-Service	1134797145	1134797145	1	1	LISA NJENGA	1/18/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	6801 CASA DEL ESTE WAY	None	SACRAMENTO	CA	95828	1305	34	06067	38.508444	-121.424427	Sacramento County
134754	Fee-for-Service	1629108717	1629108717	1	1	LEE, AMY C MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98828	13	Neurology (M.D. only)	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
134797	Fee-for-Service	1619593126	1619593126	1	1	LEON, LAURA MD	10/25/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183552	None	None	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
134798	Fee-for-Service	1669443701	1669443701	1	1	LEON, ARTURO MD	4/11/2008	207P00000X	NA	Other	026	PHYSICIANS	41600	66	Emergency Medicine (Urgent Care)	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
134824	Fee-for-Service	1124116371	1124116371	1	1	LIN, CHERI C MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104869	03	Allergy	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
134832	Fee-for-Service	1740690478	1740690478	1	1	LUSKIN, KATHLEEN MD	2/14/2025	207K00000X	NA	Other	086	MEDICAL DIRECTORS	235407146	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	214	TRUCKEE	CA	96161	0232	29	06057	39.33573744	-120.180872	Nevada County
134839	Fee-for-Service	1689787962	1689787962	1	1	LAMB, CAROL L MD	6/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	58079	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
134842	Fee-for-Service	1770110504	1770110504	1	1	LEE, STACEY MD	7/9/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
134848	Fee-for-Service	1902339096	1902339096	1	1	LAWAL, RISIKAI NP	11/6/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
134897	Fee-for-Service	1891561213	1891561213	1	1	LERMA, REBEKKA Y NP	10/1/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1665 S IMPERIAL AVE	SUITE C	EL CENTRO	CA	92243	4247	13	06025	32.77860065	-115.5695241	Imperial County
134898	Fee-for-Service	1225041262	1225041262	1	1	LAU, ALEX K LAC	8/8/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1098 FOSTER CITY BLVD.	STE 301	FOSTER CITY	CA	94404	0000	41	06081	37.5537827	-122.2558392	San Mateo County
134900	Fee-for-Service	1851442057	1851442057	1	1	LIAO, JENG-JONG MD	2/1/1996	207RC0200X	NA	Other	026	PHYSICIANS	50014	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 N GARFIELD AVE	STE 209	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
134905	Fee-for-Service	1669992848	1669992848	1	1	LAI, LUCINDA MD	8/11/2021	207P00000X	NA	Other	026	PHYSICIANS	171862	None	None	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
134953	Fee-for-Service	1902069511	1902069511	1	1	LADINE, NATALIE M MD	4/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111230	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
134961	Fee-for-Service	1841679610	1841679610	1	1	LIFECARE SOLUTIONS	8/16/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE AND HOSPICE	39675 CEDAR BLVD	SUITE 240B	NEWARK	CA	94560	5489	01	06001	37.52050519	-121.9962032	Alameda County
134971	Fee-for-Service	1568405389	1568405389	1	1	LINETSKY, MICHAEL MD	6/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94782	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
134979	Fee-for-Service	1548370562	1548370562	1	1	LERNER, ROGER L MD	1/1/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	28501	67	Endocrinology	0	In state provider	None	8920 WILSHIRE BLVD	STE 518	BEVERLY HILLS	CA	90211	1949	19	06037	34.06703599	-118.3863456	Los Angeles County
135000	Fee-for-Service	1376057513	1376057513	1	1	LOOKOFSKY, TAYLOR S LMFT	7/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
135019	Fee-for-Service	1609865377	1609865377	1	1	LIU, ERIC TSE-CHUN MD	9/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89407	41	Internal Medicine	0	In state provider	None	3811 VALLEY CENTRE DR	None	SAN DIEGO	CA	92130	3082	37	06073	32.93760492	-117.2320932	San Diego County
135028	Fee-for-Service	1285633867	1285633867	1	1	LALLY, JAMES M DO	6/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	6259	08	Family Practice	0	In state provider	None	13193 CENTRAL AVE	STE 100	CHINO	CA	91710	3522	36	06071	34.01406506	-117.6891684	San Bernardino County
135031	Fee-for-Service	1437357951	1437357951	1	1	LEVINE, MARK D MD DO	5/4/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	34333	None	None	0	In state provider	None	4190 DOUGLAS BLVD	SUITE 300	ROSEVILLE	CA	95746	5918	31	06061	38.740617	-121.2229935	Placer County
135040	Fee-for-Service	1588018774	1588018774	1	1	LEE, CALVIN MD	5/7/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	153864	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
135059	Fee-for-Service	1063158038	1063158038	1	1	LAKE COUNTY TRIBAL HEALTH	12/16/2022	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	14440 OLYMPIC BLVD	None	CLEARLAKE	CA	95422	8809	17	06033	38.96189799	-122.6409389	Lake County
135065	Fee-for-Service	1699120147	1699120147	1	1	LUDIN, JILL M MD	12/11/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	169004	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
135077	Fee-for-Service	1225583164	1225583164	1	1	LARA, NOELLE T PHD	11/18/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
135079	Fee-for-Service	1629003421	1629003421	1	1	LENZ, WAYNE P LMFT	2/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
135082	Fee-for-Service	1043342124	1043342124	1	1	LACE, CHRISTOPHER J MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
135121	Fee-for-Service	1396706644	1396706644	1	1	LEE, JUDY SK OD	6/30/1993	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	874C BLOSSOM HILL RD	None	SAN JOSE	CA	95123	2725	43	06085	37.2502227	-121.858389	Santa Clara County
135133	Fee-for-Service	1740717453	1740717453	1	1	LOADER, TASHA N DO	10/21/2021	204D00000X	NA	Other	026	PHYSICIANS	18932	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
135187	Fee-for-Service	1851442057	1851442057	1	1	LIAO, JENG-JONG MD	2/1/1996	207RC0200X	NA	Other	026	PHYSICIANS	50014	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	500 N GARFIELD AVE	STE 209	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
135297	Fee-for-Service	1699302851	1699302851	1	1	LIU, YANG MD	9/13/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
135363	Fee-for-Service	1518300078	1518300078	1	1	LAI, LAURA J MD	10/29/2018	2084P0804X	NA	Psychiatry	026	PHYSICIANS	136143	26	Psychiatry (child)	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
135414	Fee-for-Service	1710662002	1710662002	1	1	LEE, JOSHUA D MD	10/6/2023	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	189740	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
135416	Fee-for-Service	1023252897	1023252897	1	1	LUGATIMAN, THERESA M S	5/27/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
135441	Fee-for-Service	1225003320	1225003320	1	1	LALAJI, TEJAL M MD	10/20/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	110845	None	None	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
135462	Fee-for-Service	1417267162	1417267162	1	1	LAY, VANESA F LCSW	5/23/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVENUE	None	W00DLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
135501	Fee-for-Service	1093704249	1093704249	1	1	LINCOLN GLEN MANOR FOR	7/26/1979	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SENIOR CITIZENS	2671 PLUMMER AVE	None	SAN JOSE	CA	95125	4867	43	06085	37.27600097	-121.8960051	Santa Clara County
135503	Fee-for-Service	1346442985	1346442985	1	1	LE, TRAM BAO MD	12/9/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	105829	08	Family Practice	0	In state provider	None	5507 EL CAJON BLVD	SUITE L	SAN DIEGO	CA	92115	3624	37	06073	32.75824665	-117.0763619	San Diego County
135519	Fee-for-Service	1245272061	1245272061	2	1	LONGS DRUG STORE CA LLC	11/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	575 S CITRUS AVE	None	COVINA	CA	91723	2930	19	06037	34.079724	-117.8901495	Los Angeles County
135523	Fee-for-Service	1992945570	1992945570	1	1	LIN, LAVINIA H MD	9/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114655	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
135552	Fee-for-Service	1063583326	1063583326	1	1	LIPMAN, ZACHARY J MD	10/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90178	05	Anesthesiology	0	In state provider	None	6760 N WEST AVE	STE 101	FRESNO	CA	93711	1396	10	06019	36.83680611	-119.8262508	Fresno County
135622	Fee-for-Service	1932345162	1932345162	1	1	LEDFORD, JAMIE R MD	10/12/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	136341	30	Radiology	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
135633	Fee-for-Service	1730401514	1730401514	1	1	LAPINSKI, ALEXANDER J PSYD	6/15/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	220 SANSOME	400	SAN FRANCISCO	CA	94104	2321	38	06075	37.79250132	-122.4009823	San Francisco County
135652	Fee-for-Service	1518300078	1518300078	1	1	LAI, LAURA J MD	10/29/2018	2084P0804X	NA	Psychiatry	026	PHYSICIANS	136143	36	Psychiatry	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
135672	Fee-for-Service	1336448083	1336448083	1	1	LAUB, NATALIE C MD	7/27/2020	2080C0008X	NA	Psychiatry	026	PHYSICIANS	168555	47	Miscellaneous	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
135682	Fee-for-Service	1841652864	1841652864	1	1	LI, ALEXANDRIA MD	7/23/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	168107	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
135683	Fee-for-Service	1942780424	1942780424	1	1	LE, YVONNE T PT	10/30/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
135724	Fee-for-Service	1871671974	1871671974	1	1	LEWIS, BRAD A MD	10/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80864	40	Pediatrics	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
135737	Fee-for-Service	1710481866	1710481866	1	1	LIU, ANDREW C MD	4/24/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	165817	None	None	0	In state provider	None	3300 VISTA WAY	SUITE B	OCEANSIDE	CA	92056	3632	37	06073	33.18081595	-117.3156434	San Diego County
135745	Fee-for-Service	1538219449	1538219449	1	1	LIN, JENNIFER M MD	1/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78736	18	Ophthalmology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
135747	Fee-for-Service	1831207588	1831207588	1	1	LUMKIN, BARRY MD	8/31/1991	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	67349	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
135781	Fee-for-Service	1902131386	1902131386	1	1	LEYVA BUCCIO, CHRISTINE LMF	8/23/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	1010 NORTH CENTRAL AVE S	SUITE 310	GLENDALE	CA	91202	2937	19	06037	34.13415031	-118.2577919	Los Angeles County
135804	Fee-for-Service	1396403606	1396403606	1	1	LUBANS DEHAVEN, TESA	11/8/2024	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	4056 ALTA MESA DR	None	REDDING	CA	96002	3732	45	06089	40.54821409	-122.3303114	Shasta County
135832	Fee-for-Service	1174865521	1174865521	1	1	LIEBESKIND, EMILY S NP	12/11/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
135846	Fee-for-Service	1083293047	1083293047	1	1	LEE, JACQUELINE MD	5/14/2024	207R00000X	NA	Other	026	PHYSICIANS	181866	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
135886	Fee-for-Service	1720575913	1720575913	1	1	LA, TIFFANY N OD	4/5/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
135887	Fee-for-Service	1083875207	1083875207	1	1	LEE, CHI H MD	3/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112380	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
135914	Fee-for-Service	1215381215	1215381215	1	1	LEONG, SHELLEY MD	8/26/2019	207R00000X	NA	Other	026	PHYSICIANS	152494	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
135934	Fee-for-Service	1215590518	1215590518	1	1	LINTON, BRIAUNA NP	7/1/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
135938	Fee-for-Service	1306131503	1306131503	1	1	LY, JENNIFER PHD	6/16/2022	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	675 18TH STREET	None	SAN FRANCISCO	CA	94143	0984	38	06075	37.76085391	-122.4356007	San Francisco County
135950	Fee-for-Service	1295883122	1295883122	1	1	LIN, SANDRA M OD	5/1/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
135959	Fee-for-Service	1336448083	1336448083	1	1	LAUB, NATALIE C MD	7/27/2020	2080C0008X	NA	Psychiatry	026	PHYSICIANS	168555	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
135966	Fee-for-Service	1841461332	1841461332	1	1	LEFOWITZ, EMILY S PHD	5/28/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
135981	Fee-for-Service	1114243136	1114243136	1	1	LEE, JOYCE X MD	9/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120350	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 364, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
135988	Fee-for-Service	1538187810	1538187810	1	1	LIAO, SHANG C MD	3/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	38344	08	Family Practice	0	In state provider	None	1532 SAVIERS RD	None	OXNARD	CA	93033	1737	56	06111	34.183836	-119.1773915	Ventura County
136013	Fee-for-Service	1275398372	1275398372	1	1	LICON, DANIEL NP	7/18/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95926	2281	04	06007	39.750084	-121.7934327	Butte County
136018	Fee-for-Service	1841891165	1841891165	1	1	LEE, YIP HAN CRNA	11/14/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
136034	Fee-for-Service	1609924554	1609924554	1	1	LIU, BRANT C MD	6/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84743	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
136036	Fee-for-Service	1225140288	1225140288	1	2	LAROCQUE, TODD M MD	2/21/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55172	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4077 5TH AVENUE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
136042	Fee-for-Service	1578049292	1578049292	1	1	LURYE, BIANA MD INC	9/25/2018	207L00000X	NA	Other	026	PHYSICIANS	102511	05	Anesthesiology	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
136085	Fee-for-Service	1801974480	1801974480	1	1	LIU, CHUNHUA MD	11/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93918	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
136088	Fee-for-Service	1588087142	1588087142	1	1	LEE, SEOLHYUN MD	1/26/2021	207RN0300X	NA	Nephrology	026	PHYSICIANS	159407	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
136098	Fee-for-Service	1700900743	1700900743	1	1	LAM, ANTHONY W MD	9/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110904	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2382 CRENSHAW BLVD	STE 5	TORRANCE	CA	90501	3333	19	06037	33.82267285	-118.3284556	Los Angeles County
136104	Fee-for-Service	1558816538	1558816538	1	1	LYNN, BRITTANY LMFT	10/31/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29748 RANCHO CALIFORNIA	RD	TEMECULA	CA	92591	5286	33	06065	33.50662849	-117.1428887	Riverside County
136105	Fee-for-Service	1215590682	1215590682	1	1	LEE, ANDRE MD	8/1/2022	207P00000X	NA	Other	026	PHYSICIANS	177856	None	None	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
136124	Fee-for-Service	1336124254	1336124254	1	1	LEVIN, GARY A MD	11/15/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	36940	05	Anesthesiology	0	In state provider	None	23201 LAKE CENTER DR	STE 320	EL TORO	CA	92630	6808	30	06059	33.6255281	-117.7160257	Orange County
136157	Fee-for-Service	1831454735	1831454735	1	1	LI, MINRONG R CRNA	1/12/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
136159	Fee-for-Service	1003221847	1003221847	1	1	LILITWAT, WEERAPONG MD	7/25/2024	2080P0203X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
136163	Fee-for-Service	1992119903	1992119903	1	1	LOPEZ, ROBERT MD	7/28/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	167913	41	Internal Medicine	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
136178	Fee-for-Service	1942772454	1942772454	1	1	LAI, ELISA RRT	2/19/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
136182	Fee-for-Service	1487707212	1487707212	1	1	LO, BETH MD	1/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86564	12	Manipulative Therapy (D.O. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
136197	Fee-for-Service	1942762554	1942762554	1	1	LIN, JEFFREY C LCSW	10/16/2023	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
136228	Fee-for-Service	1326217357	1326217357	1	1	LAFRANCE, TONY	3/24/2008	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2190 MERIDIAN PARK BLVD	STE E	CONCORD	CA	94520	5715	07	06013	37.97722817	-122.0572904	Contra Costa County
136239	Fee-for-Service	1760877633	1760877633	1	1	LYFORD, WILLIS H	11/15/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	183093	None	None	0	In state provider	None	6605 NANCY RIDGE DR	None	SAN DIEGO	CA	92121	2253	37	06073	32.88682438	-117.1796133	San Diego County
136308	Fee-for-Service	1194025957	1194025957	1	1	LEE, EDMOND DPM INC	11/22/2010	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	500 N. GARFIELD AVE.	STE 305	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
136320	Fee-for-Service	1780108449	1780108449	1	1	LA FAMILY FOOT & ANKLE PC A	11/6/2018	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	CALIFORNIA PODIATRY CORP	266 S HARVARD BLVD	370	LOS ANGELES	CA	90004	4372	19	06037	34.069221	-118.3041245	Los Angeles County
136373	Fee-for-Service	1558304394	1558304394	2	1	LONGS DRUG STORE CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17579 VIERRA CANYON RD	None	SALINAS	CA	93907	3312	27	06053	36.79229853	-121.6638114	Monterey County
136376	Fee-for-Service	1184160673	1184160673	1	1	LATTIN, CYNTHIA	3/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
136389	Fee-for-Service	1568758043	1568758043	1	1	LIMMER, KIRSTEN E J MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132358	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
136412	Fee-for-Service	1336124254	1336124254	1	1	LEVIN, GARY A MD	11/15/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	36940	78	Neoplastic Diseases/Oncology	0	In state provider	None	23201 LAKE CENTER DR	STE 320	EL TORO	CA	92630	6808	30	06059	33.6255281	-117.7160257	Orange County
136416	Fee-for-Service	1790860526	1790860526	1	1	LINCARE INC	9/24/1998	332B00000X	NA	Other	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	10571 CALLE LEE	STE 155	LOS ALAMITOS	CA	90720	2572	30	06059	33.808932	-118.057357	Orange County
136436	Fee-for-Service	1124086590	1124086590	1	1	LEONARD, JOSEPH F MD	10/13/1981	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34516	08	Family Practice	0	In state provider	None	2701 ATLANTIC AVE	None	LONG BEACH	CA	90806	2701	19	06037	33.807735	-118.1850575	Los Angeles County
136438	Fee-for-Service	1306831649	1306831649	2	1	LUU, CHARLES C OD	5/27/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 LAGUNA ROAD	SUITE C	FULLERTON	CA	92835	3634	30	06059	33.89326085	-117.9300987	Orange County
136447	Fee-for-Service	1518260561	1518260561	1	1	LUE, KENNETH G DO	12/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11455	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
136449	Fee-for-Service	1235463381	1235463381	1	1	LONG, TIERNEY LCSW	5/13/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	560 30TH AVE	# 41	SANTA CRUZ	CA	95062	5030	44	06087	36.961632	-121.9731735	Santa Cruz County
136478	Fee-for-Service	1689802126	1689802126	1	1	LAL, MANOJ K DPM	9/12/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1100 N PALM CANYON DR	SUITE 208	PALM SPRINGS	CA	92262	4426	33	06065	33.838182	-116.546744	Riverside County
136491	Fee-for-Service	1922502541	1922502541	1	1	LU, JOCELYN MD	8/7/2024	2086S0122X	NA	General Surgery	026	PHYSICIANS	192373	24	Plastic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
136506	Fee-for-Service	1598296709	1598296709	1	1	LIN, JEFFERY MD	12/13/2024	208800000X	NA	Other	026	PHYSICIANS	160339	34	Urology and Urological Surgery	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
136523	Fee-for-Service	1669664330	1669664330	1	1	LAMB, LYNN M PHD	7/5/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
136534	Fee-for-Service	1871282244	1871282244	1	1	LDS HOMES LLC	4/3/2025	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	836 SAN SIMEON DR	None	CONCORD	CA	94518	2245	07	06013	37.94481694	-122.0197119	Contra Costa County
136613	Fee-for-Service	1629469465	1629469465	1	1	LIFECARE CHIROPRACTIC KENT	2/14/2019	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	HARDENBROOK DC INC	10594 COMBIE RD	STE 2	AUBURN	CA	95602	8988	29	06057	39.0427472	-121.083772	Nevada County
136626	Fee-for-Service	1619281532	1619281532	1	1	LOYA, MIGUEL A DO	2/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12324	41	Internal Medicine	0	In state provider	None	215 PESETAS LANE	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
136653	Fee-for-Service	1215581947	1215581947	1	1	LIU, KELLY OD	1/17/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
136681	Fee-for-Service	1821082272	1821082272	1	1	LUTTGE, SCOTT K MD	7/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89231	34	Urology and Urological Surgery	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
136683	Fee-for-Service	1669494415	1669494415	1	1	LOYA, DAVID MD	10/18/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55017	None	None	0	In state provider	None	1400 EAST CHURCH STREET	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
136684	Fee-for-Service	1366947905	1366947905	1	1	LUCE, MARIE S MD	8/1/2024	208600000X	NA	General Surgery	026	PHYSICIANS	164095	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
136698	Fee-for-Service	1255537189	1255537189	1	1	LOPEZ, JOSEPH F MD	12/31/1988	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	55217	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3400 LOMITA BLVD	STE 301	TORRANCE	CA	90505	4971	19	06037	33.81309744	-118.3448635	Los Angeles County
136701	Fee-for-Service	1336124254	1336124254	1	1	LEVIN, GARY A MD	11/15/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	36940	30	Radiology	0	In state provider	None	23201 LAKE CENTER DR	STE 320	EL TORO	CA	92630	6808	30	06059	33.6255281	-117.7160257	Orange County
136704	Fee-for-Service	1790860526	1790860526	1	1	LINCARE INC	4/8/2004	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	10571 CALLE LEE	STE 155	LOS ALAMITOS	CA	90720	2572	30	06059	33.808932	-118.057357	Orange County
136710	Fee-for-Service	1164644357	1164644357	1	1	LORANGE, ELLEN A DO	1/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14389	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
136724	Fee-for-Service	1619197373	1619197373	1	1	LIAO, ANDREW W MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	94171	08	Family Practice	0	In state provider	None	612 W DUARTE RD	STE 202	ARCADIA	CA	91007	9226	19	06037	34.12647805	-118.051994	Los Angeles County
136725	Fee-for-Service	1518996693	1518996693	1	1	LIU, KATHLEEN D MD	9/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78234	45	Nephrology (Renal-Kidney)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
136737	Fee-for-Service	1518260561	1518260561	1	1	LUE, KENNETH G DO	12/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11455	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
136757	Fee-for-Service	1033548136	1033548136	1	1	LEO, JENNIFER K PHD	4/1/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
136781	Fee-for-Service	1568552370	1568552370	1	1	LAKHANI, MOHAN MD	11/28/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	121572	None	None	0	In state provider	None	2975 N SYCAMORE DR	None	SIMI VALLEY	CA	93065	1207	56	06111	34.28924598	-118.7439214	Ventura County
136782	Fee-for-Service	1124186705	1124186705	1	1	LAM, SHERMAN SHU WAH	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
136797	Fee-for-Service	1508212663	1508212663	1	1	LARSEN, NICHOLAS W MD	8/24/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	155442	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
136801	Fee-for-Service	1982889119	1982889119	1	1	LEETCH, MONIQUE S OT	4/13/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
136805	Fee-for-Service	1285771477	1285771477	1	1	LIN, KAITY Y MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	92578	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
136816	Fee-for-Service	1154493476	1154493476	1	1	LEVINE, FRED MD	8/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	65341	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
136832	Fee-for-Service	1104876093	1104876093	1	1	LEE, DANIEL MD	1/1/1998	207R00000X	NA	Other	026	PHYSICIANS	61630	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
136845	Fee-for-Service	1770843054	1770843054	1	1	LI, MING C MD	4/15/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	127280	68	Hematology	0	In state provider	None	27800 MEDICAL CENTER RD	STE 461	MISSION VIEJO	CA	92691	6424	30	06059	33.55952733	-117.6645199	Orange County
136853	Fee-for-Service	1528341427	1528341427	1	1	LOCKWOOD, JULIE A LMFT	1/13/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
136896	Fee-for-Service	1366642795	1366642795	1	1	LEE, ERNEST E MD	12/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104481	07	Dermatology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
136913	Fee-for-Service	1508976473	1508976473	1	1	LAWSON, ELEAZAR MD	7/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73870	66	Emergency Medicine (Urgent Care)	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
136917	Fee-for-Service	1699097212	1699097212	1	1	LEE, ESTHER	6/7/2010	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11105 KNOTT AVE	STE A-B	CYPRESS	CA	90630	5137	30	06059	33.80083909	-118.0111199	Orange County
136920	Fee-for-Service	1861492860	1861492860	1	1	LIU, NORMAN H MD	5/1/2000	207W00000X	NA	Ophthalmology	026	PHYSICIANS	63593	18	Ophthalmology	0	In state provider	None	12665 GARDEN GROVE BLVD	SUITE 401	GARDEN GROVE	CA	92843	1918	30	06059	33.77450141	-117.9123364	Orange County
136930	Fee-for-Service	1134356280	1134356280	1	1	LEE, JONGMI NP	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
136939	Fee-for-Service	1801186192	1801186192	1	1	LUK, LAUREN J MD	9/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147988	04	Otology, Laryngology, Rhinology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
136963	Fee-for-Service	1689828840	1689828840	1	1	LITA & AVA INCORPORATED	11/1/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1250 S WINCHESTER BLVD	None	SAN JOSE	CA	95128	3906	43	06085	37.30254286	-121.9498662	Santa Clara County
136973	Fee-for-Service	1770655003	1770655003	1	1	LEE, SANG-MIN J MD	12/5/2007	208800000X	NA	Other	026	PHYSICIANS	89250	34	Urology and Urological Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
136977	Fee-for-Service	1821254665	1821254665	1	1	LEVIN, JEFFREY R MD INC	10/8/2008	261QH0100X	NA	Other	026	PHYSICIANS	46304	13	Neurology (M.D. only)	0	In state provider	None	1541 FLORIDA AVE	STE 300	MODESTO	CA	95350	4439	50	06099	37.666863	-120.9962775	Stanislaus County
136979	Fee-for-Service	1518925098	1518925098	1	1	LEE, DANIEL KEUNHO DPM	1/17/2007	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	MC 8201	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
136987	Fee-for-Service	1255537189	1255537189	1	1	LOPEZ, JOSEPH F MD	12/31/1988	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	55217	41	Internal Medicine	0	In state provider	None	3400 LOMITA BLVD	STE 301	TORRANCE	CA	90505	4971	19	06037	33.81309744	-118.3448635	Los Angeles County
136997	Fee-for-Service	1457029159	1457029159	1	1	LUX HOSPICE	10/28/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	322 E BROADWAY	None	GLENDALE	CA	91205	9998	19	06037	34.1462667	-118.2518458	Los Angeles County
137006	Fee-for-Service	1043667355	1043667355	1	1	LUNDY, ADAM MD	11/1/2024	207R00000X	NA	Other	026	PHYSICIANS	154778	41	Internal Medicine	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
137017	Fee-for-Service	1336451426	1336451426	1	1	LEE, DAVID S MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130967	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
137020	Fee-for-Service	1982187027	1982187027	1	1	LEE, JISUN J	6/26/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	400 CARLTON AVE	SUITE 200	LOS GATOS	CA	95032	2629	43	06085	37.24728836	-121.9514527	Santa Clara County
137067	Fee-for-Service	1689940652	1689940652	1	1	LORBER, JEREMY MD	7/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130351	78	Neoplastic Diseases/Oncology	0	In state provider	None	9090 WILSHIRE BLVD	SUITE 200	BEVERLY HILLS	CA	90211	1850	19	06037	34.06702873	-118.3894057	Los Angeles County
137105	Fee-for-Service	1598474033	1598474033	1	1	LEAVITT, NADEZDA LMFT	8/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21700 OXNARD ST	STE 400	WOODLAND HILLS	CA	91367	7559	19	06037	34.17913947	-118.6020135	Los Angeles County
137140	Fee-for-Service	1033145941	1033145941	2	2	LONKY, STEWARD A MD	7/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	25948	41	Internal Medicine	0	In state provider	None	8540 S SEPULVEDA BLVD	STE 1010	LOS ANGELES	CA	90045	3808	19	06037	33.96022076	-118.3961982	Los Angeles County
137161	Fee-for-Service	1538502455	1538502455	1	1	LEE, JAMES MD	5/9/2019	208200000X	NA	General Surgery	026	PHYSICIANS	160245	24	Plastic Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 465	LOS ANGELES	CA	90095	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
137187	Fee-for-Service	1912358664	1912358664	1	1	LIMBONG, SAMUEL H MD	3/26/2020	390200000X	NA	Other	026	PHYSICIANS	153140	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
137194	Fee-for-Service	1033186374	1033186374	1	1	LUM, JOSEPH J MD	10/5/2009	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	93920	30	Radiology	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
137197	Fee-for-Service	1053416230	1053416230	1	1	LOWERY, WILLIAM S MD	5/31/1988	207RP1001X	NA	Pulmonology	026	PHYSICIANS	53058	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
137224	Fee-for-Service	1326077173	1326077173	1	1	LABEAUD, ANGELLE D MD	1/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109428	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
137281	Fee-for-Service	1811074750	1811074750	1	1	LEVIN, ELEANOR G MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42429	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
137285	Fee-for-Service	1457029159	1457029159	1	1	LUX HOSPICE	10/28/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	322 E BROADWAY	None	GLENDALE	CA	91205	9998	19	06037	34.1462667	-118.2518458	Los Angeles County
137289	Fee-for-Service	1649476128	1649476128	1	1	LAI, FRED MD	10/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105247	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
137294	Fee-for-Service	1457449969	1457449969	1	1	LIN, TAIHON MD	8/31/1980	207R00000X	NA	Other	026	PHYSICIANS	35727	41	Internal Medicine	0	In state provider	None	3655 LOMITA BLVD	STE 101	TORRANCE	CA	90505	1901	19	06037	33.81497113	-118.3489779	Los Angeles County
137302	Fee-for-Service	1891867644	1891867644	1	1	LAI, SANDRA W MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81003	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
137309	Fee-for-Service	1851522015	1851522015	1	2	LA CLINICA DE LA RAZA, INC.	12/30/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	555 RALPH APEZZATO	MEMORIAL PKWY	ALAMEDA	CA	94501	2109	01	06001	37.781514	-122.279319	Alameda County
137341	Fee-for-Service	1376162032	1376162032	1	1	LAM, HOA KY DO	8/12/2024	207L00000X	NA	Other	026	PHYSICIANS	22644	05	Anesthesiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
137354	Fee-for-Service	1689940652	1689940652	1	1	LORBER, JEREMY MD	7/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130351	68	Hematology	0	In state provider	None	9090 WILSHIRE BLVD	SUITE 200	BEVERLY HILLS	CA	90211	1850	19	06037	34.06702873	-118.3894057	Los Angeles County
137370	Fee-for-Service	1639180086	1639180086	1	1	LAM, LINDA L MD	2/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87699	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
137384	Fee-for-Service	1417244831	1417244831	1	1	LALLY, ERIN B MD	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143148	18	Ophthalmology	0	In state provider	None	2110 FOREST AVE	STE B	SAN JOSE	CA	95128	1469	43	06085	37.32701954	-121.9374675	Santa Clara County
137388	Fee-for-Service	1972148823	1972148823	1	1	LUMEN HOSPICE INC	9/14/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	9029 RESEDA BLVD	STE 200	NORTHRIDGE	CA	91324	3932	19	06037	34.23452657	-118.536098	Los Angeles County
137425	Fee-for-Service	1033145941	1033145941	2	2	LONKY, STEWARD A MD	7/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	25948	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	8540 S SEPULVEDA BLVD	STE 1010	LOS ANGELES	CA	90045	3808	19	06037	33.96022076	-118.3961982	Los Angeles County
137453	Fee-for-Service	1760407936	1760407936	1	2	LYAPIS, VICTOR	3/15/2023	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	54424	None	None	0	In state provider	None	2186 GEARY BLVD	104	SAN FRANCISCO	CA	94115	3455	38	06075	37.78343395	-122.4392245	San Francisco County
137497	Fee-for-Service	1659885275	1659885275	1	1	LINARES, MARIA E LMFT	4/30/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52493	-	NOT APPLICABLE	0	In state provider	None	1200 N MAIN ST	STE 301	SANTA ANA	CA	92701	3630	30	06059	33.755175	-117.8676195	Orange County
137513	Fee-for-Service	1245395987	1245395987	1	1	LEUNG, KWOK Y LMFT	1/22/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
137514	Fee-for-Service	1326077173	1326077173	1	1	LABEAUD, ANGELLE D MD	1/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109428	77	Infectious Disease	0	In state provider	None	725 WELCH RD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
137556	Fee-for-Service	1558410514	1558410514	1	1	LEITHISER, RICHARD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	SLOT 653	LITTLE ROCK	AR	72225	1418	00	None	34.742745	-92.2927905	Pulaski County
137571	Fee-for-Service	1225253651	1225253651	1	1	LAJOIE, ADRIANNE M MD	2/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	84301	10	Gastroenterology (M.D. only)	0	In state provider	None	700 GARDEN VIEW CT	STE 102	ENCINITAS	CA	92024	2478	37	06073	33.05922419	-117.260629	San Diego County
137582	Fee-for-Service	1457449969	1457449969	1	1	LIN, TAIHON MD	8/31/1980	207R00000X	NA	Other	026	PHYSICIANS	35727	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3655 LOMITA BLVD	STE 101	TORRANCE	CA	90505	1901	19	06037	33.81497113	-118.3489779	Los Angeles County
137585	Fee-for-Service	1760708333	1760708333	1	1	LEE, ELAINE S MD	6/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118859	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23845 MCBEAN PARKWAY	None	VALENCIA	CA	91355	2083	19	06037	34.39696803	-118.5525278	Los Angeles County
137609	Fee-for-Service	1730107343	1730107343	1	1	LERMAN, STEVEN E MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	78361	34	Urology and Urological Surgery	0	In state provider	None	7930 FROST ST	STE 407	SAN DIEGO	CA	92123	4286	37	06073	32.80027001	-117.1532893	San Diego County
137626	Fee-for-Service	1346306032	1346306032	1	1	LAM, FONG W MD	7/1/2021	2080P0203X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
137642	Fee-for-Service	1689940652	1689940652	1	1	LORBER, JEREMY MD	7/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130351	41	Internal Medicine	0	In state provider	None	9090 WILSHIRE BLVD	SUITE 200	BEVERLY HILLS	CA	90211	1850	19	06037	34.06702873	-118.3894057	Los Angeles County
137644	Fee-for-Service	1134390651	1134390651	1	1	LUU, MINNELLY MD	10/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120646	07	Dermatology	0	In state provider	None	4650 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
137646	Fee-for-Service	1942064233	1942064233	1	1	LY, KELVIN RCP	2/22/2024	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
137661	Fee-for-Service	1972544948	1972544948	1	1	LONGCHAMP, CARLA P MD	7/31/1995	261QR1300X	NA	Rural Health Center	026	PHYSICIANS	76332	08	Family Practice	0	In state provider	None	1245 S MAIN ST	None	WILLITS	CA	95490	4305	23	06045	39.39914622	-123.3495915	Mendocino County
137675	Fee-for-Service	1609278175	1609278175	1	1	LUU, AMBER M NP	6/5/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
137676	Fee-for-Service	1972148823	1972148823	1	1	LUMEN HOSPICE INC	9/14/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	9029 RESEDA BLVD	STE 200	NORTHRIDGE	CA	91324	3932	19	06037	34.23452657	-118.536098	Los Angeles County
137695	Fee-for-Service	1972585743	1972585743	1	1	LARA, PRIMO N JR	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55072	41	Internal Medicine	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
137713	Fee-for-Service	1649651076	1649651076	1	1	LEITZKE, ARTHUR S MD	1/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143982	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
137718	Fee-for-Service	1356499388	1356499388	1	1	LEUNG, JACQUELYN D MD	12/26/2007	207R00000X	NA	Other	026	PHYSICIANS	90451	41	Internal Medicine	0	In state provider	None	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.8531521	-117.8160824	Orange County
137748	Fee-for-Service	1598839052	1598839052	1	1	LIN,STEPHANIE C MD	10/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	68739	02	General Surgery	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
137751	Fee-for-Service	1720270952	1720270952	1	1	LI, TOM T	10/19/2007	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	301 W VALLEY	STE 202	SAN GABRIEL	CA	91776	3756	19	06037	34.07955517	-118.1040708	Los Angeles County
137785	Fee-for-Service	1912057043	1912057043	1	1	LUDMER, CAREN D PHD	8/14/1988	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2126 SUTTER ST	None	SAN FRANCISCO	CA	94115	3120	38	06075	37.78584684	-122.4354571	San Francisco County
137790	Fee-for-Service	1174694830	1174694830	1	1	LEUNG, RICHARD J MD APC	6/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	48263	18	Ophthalmology	0	In state provider	None	3075 HEALTH CENTER DR	STE 403	SAN DIEGO	CA	92123	2773	37	06073	32.79963065	-117.1556197	San Diego County
137798	Fee-for-Service	1912925074	1912925074	1	1	LANGLOIS, LEO P MD	3/8/2023	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	86015	None	None	0	In state provider	None	230 S MONTCLAIR ST	SUITE 101	BAKERSFIELD	CA	93309	3117	15	06029	35.35252191	-119.0555354	Kern County
137808	Fee-for-Service	1568917524	1568917524	1	1	LAL, NILZA W NP	10/18/2023	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
137845	Fee-for-Service	1861764326	1861764326	1	1	LEAHY, SONJA NP	12/15/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
137859	Fee-for-Service	1225253651	1225253651	1	1	LAJOIE, ADRIANNE M MD	2/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	84301	41	Internal Medicine	0	In state provider	None	700 GARDEN VIEW CT	STE 102	ENCINITAS	CA	92024	2478	37	06073	33.05922419	-117.260629	San Diego County
137893	Fee-for-Service	1730107343	1730107343	1	1	LERMAN, STEVEN E MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	78361	40	Pediatrics	0	In state provider	None	7930 FROST ST	STE 407	SAN DIEGO	CA	92123	4286	37	06073	32.80027001	-117.1532893	San Diego County
137906	Fee-for-Service	1225047418	1225047418	1	1	LIFECARE HOME HEALTH SVS INC	7/11/2007	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	540 E FOOTHILL BLVD	SUTIE 200	SAN DIMAS	CA	91773	1251	19	06037	34.12294006	-117.7973426	Los Angeles County
137916	Fee-for-Service	1679884233	1679884233	1	1	LUM, STANTON WS APMC	8/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	76820	05	Anesthesiology	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
137934	Fee-for-Service	1164701165	1164701165	1	1	LOPEZ-BOPP, DANIELLE M LMFT	2/6/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	24977 WASHINGTON AVENUE	SUITES K & L	MURRIETA	CA	92562	6149	33	06065	33.55150034	-117.2118708	Riverside County
137967	Fee-for-Service	1265846695	1265846695	1	1	LEHIGH VALLEY TOXICOLOGY LLC	12/17/2019	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	2550 BRODHEAD RD	None	BETHLEHEM	PA	18020	8922	00	None	40.67936534	-75.35762479	Northampton County
137984	Fee-for-Service	1972585743	1972585743	1	1	LARA, PRIMO N JR	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55072	68	Hematology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
137995	Fee-for-Service	1588196943	1588196943	1	1	LIN, PEIYIN MD	6/17/2022	390200000X	NA	Other	026	PHYSICIANS	157507	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
138002	Fee-for-Service	1962840876	1962840876	1	1	LOY, BO N MD	3/14/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	156456	None	None	0	In state provider	None	152 PIONEER LN	STE D	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
138065	Fee-for-Service	1619085586	1619085586	1	1	LI, QUINN MD	12/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87986	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
138069	Fee-for-Service	1043865595	1043865595	1	1	LEE, LYDIA PT	6/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
138071	Fee-for-Service	1578851655	1578851655	1	1	LAWS, SHELENA D MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122768	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2175 ROSALINE AVENUE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
138109	Fee-for-Service	1033278601	1033278601	1	1	LEE, MI-KYUNG MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80550	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
138111	Fee-for-Service	1891936456	1891936456	1	1	LIN, MARIA H MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106642	67	Endocrinology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
138134	Fee-for-Service	1821030644	1821030644	2	1	LONGS DRUG STORES CA LLC	12/26/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	515 S STATE HWY 49	None	JACKSON	CA	95642	2534	03	06005	38.34437516	-120.7695587	Amador County
138137	Fee-for-Service	1770789364	1770789364	1	1	LOBO, KRISTIN M MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	43243	01	General Practice	0	In state provider	None	6955 FOOTHILL BLVD	SUITE 200	OAKLAND	CA	94605	2426	01	06001	37.76924146	-122.1732586	Alameda County
138166	Fee-for-Service	1992723662	1992723662	1	1	LEE, CAROLYN Y G NP	1/16/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
138167	Fee-for-Service	1942596341	1942596341	1	1	LESLEIN, NICHOLAS S MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141731	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
138183	Fee-for-Service	1356669899	1356669899	1	1	LANSDOWN, DREW A MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	121573	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
138197	Fee-for-Service	1053698514	1053698514	1	1	LAM, LILY F	12/15/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
138218	Fee-for-Service	1104830371	1104830371	1	1	LEE, JASON C MD	12/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82022	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
138236	Fee-for-Service	1457507709	1457507709	1	1	LAUZON, VANESSA L MD	7/15/2013	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	112525	01	General Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
138238	Fee-for-Service	1497780985	1497780985	1	1	LIBKE, ROBERT D MD	2/8/2015	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	13591	41	Internal Medicine	0	In state provider	None	5070 E CLINTON WAY	None	FRESNO	CA	93727	1506	10	06019	36.77192171	-119.7244325	Fresno County
138241	Fee-for-Service	1427252303	1427252303	1	1	LEE, SZE-CHING MD	10/17/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	22827	34	Urology and Urological Surgery	0	In state provider	None	3544 W OLYMPIC BLVD	None	LOS ANGELES	CA	90019	3500	19	06037	34.05246985	-118.3163186	Los Angeles County
138296	Fee-for-Service	1689625980	1689625980	1	1	LEBANON COMMUNITY HOSP	7/23/2000	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	525 N SANTIAM HWY	None	LEBANON	OR	97355	4363	00	None	44.55079187	-122.9084587	Linn County
138337	Fee-for-Service	1265413736	1265413736	1	1	LAI, NEUZIL MD	7/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89533	13	Neurology (M.D. only)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
138361	Fee-for-Service	1467494278	1467494278	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	175 E 17TH ST	None	COSTA MESA	CA	92627	3708	30	06059	33.63585309	-117.9195052	Orange County
138399	Fee-for-Service	1891936456	1891936456	1	1	LIN, MARIA H MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106642	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
138444	Fee-for-Service	1376931295	1376931295	1	1	LIFELONG MEDICAL CARE	11/30/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	386 14TH ST	None	OAKLAND	CA	94612	3211	01	06001	37.80371572	-122.2696209	Alameda County
138476	Fee-for-Service	1679689921	1679689921	1	1	LANDERS, RICHARD D MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	53483	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	11177 TAMPA AVE	None	NORTHRIDGE	CA	91326	2254	19	06037	34.27373836	-118.5564202	Los Angeles County
138477	Fee-for-Service	1386209260	1386209260	1	1	LAKESIDE UNION SCHOOL	7/1/2019	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	14535 OLD RIVER RD	None	BAKERSFIELD	CA	93311	9756	15	06029	35.22194472	-119.1099519	Kern County
138500	Fee-for-Service	1457332512	1457332512	1	1	LITTELL, GLENN H MD	4/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	70346	22	Pathology (M.D. only)	0	In state provider	None	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
138518	Fee-for-Service	1841910775	1841910775	1	1	LOPEZ, YENIA M LMFT	9/12/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA	802	SAN DIEGO	CA	92108	3102	37	06073	32.76632791	-117.1616245	San Diego County
138521	Fee-for-Service	1457507709	1457507709	1	1	LAUZON, VANESSA L MD	7/15/2013	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	112525	36	Psychiatry	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
138527	Fee-for-Service	1093066441	1093066441	1	1	LEE M. WEISSMAN, AU.D, AUDIO	12/24/2013	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	RING AIDS	505 SAN MARIN DRIVE	A130	NOVATO	CA	94945	1309	21	06041	38.12144894	-122.5842153	Marin County
138537	Fee-for-Service	1972521201	1972521201	1	1	LAWRENCE A CAIN	11/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	577 S RIVER RD	None	ST GEORGE	UT	84790	2097	00	None	37.09860456	-113.5565227	Washington County
138586	Fee-for-Service	1689625980	1689625980	1	1	LEBANON COMMUNITY HOSP	7/24/2001	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	525 N SANTIAM HWY	None	LEBANON	OR	97355	4363	00	None	44.55079187	-122.9084587	Linn County
138598	Fee-for-Service	1497358873	1497358873	1	1	LUPAS, GARIMA J PSYD	4/8/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 DEERWOOD RD	STE 200	SAN RAMON	CA	94583	4445	07	06013	37.77475997	-121.9892508	Contra Costa County
138610	Fee-for-Service	1437326386	1437326386	1	1	LEONARD, SUSAN D MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105969	38	Geriatrics	0	In state provider	None	200 MEDICAL PLAZA	#420	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
138639	Fee-for-Service	1790132637	1790132637	1	1	LIU, WENDY W MD	7/14/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	173663	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
138653	Fee-for-Service	1396986253	1396986253	1	1	LAND, TONI	2/8/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	1	Border provider	None	252 DEL NORTE LN	None	BROOKINGS	OR	97415	9025	00	None	42.04981628	-124.2726995	Curry County
138668	Fee-for-Service	1821452103	1821452103	1	1	LU, ANDREW J MD	8/16/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172520	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
138682	Fee-for-Service	1023037199	1023037199	1	1	LOMIS, THOMAS J MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	83600	02	General Surgery	0	In state provider	None	15211 VANOWEN STREET	SUITE 208	VAN NUYS	CA	91405	3606	19	06037	34.19395411	-118.4642527	Los Angeles County
138687	Fee-for-Service	1376530006	1376530006	1	1	LIBERMAN, MARTIN S MD	3/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	26857	10	Gastroenterology (M.D. only)	0	In state provider	None	3637 SACRAMENTO ST	SUITE B	SAN FRANCISCO	CA	94118	1726	38	06075	37.78743747	-122.4526382	San Francisco County
138689	Fee-for-Service	1013273713	1013273713	1	1	LIN, KENNY A MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126874	26	Psychiatry (child)	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
138694	Fee-for-Service	1205940723	1205940723	2	1	LOPEZ, JAIME MD	5/5/2011	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	50641	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8135 S PAINTER AVE	STE 205	WHITTIER	CA	90602	3170	19	06037	33.965829	-118.032738	Los Angeles County
138701	Fee-for-Service	1063242162	1063242162	1	1	LEINAH NGUYEN OD INC	10/25/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	16481 MAGNOLIA ST	None	WESTMINSTER	CA	92683	7827	30	06059	33.72334854	-117.9719942	Orange County
138704	Fee-for-Service	1659403665	1659403665	1	1	LOWE, DEBORAH A LMFT	11/6/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9800 S LA CIENEGA BLVD	SUITE 200	INGLEWOOD	CA	90301	4408	19	06037	33.947001	-118.370043	Los Angeles County
138735	Fee-for-Service	1376931295	1376931295	1	1	LIFELONG MEDICAL CARE	11/30/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	386 14TH ST	None	OAKLAND	CA	94612	3211	01	06001	37.80371572	-122.2696209	Alameda County
138736	Fee-for-Service	1629238324	1629238324	1	1	LINDSEY GRABNER	11/23/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	888 SWIFT BLVD	None	RICHLAND	WA	99352	3514	00	None	46.28046647	-119.28231	Benton County
138759	Fee-for-Service	1225316482	1225316482	1	1	LAB GENOMICS, LLC	8/9/2017	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	11160 WARNER AVE	SUITE 415	FOUNTAIN VALLEY	CA	92708	4056	30	06059	33.71630854	-117.934317	Orange County
138765	Fee-for-Service	1679689921	1679689921	1	1	LANDERS, RICHARD D MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	53483	41	Internal Medicine	0	In state provider	None	11177 TAMPA AVE	None	NORTHRIDGE	CA	91326	2254	19	06037	34.27373836	-118.5564202	Los Angeles County
138769	Fee-for-Service	1992749337	1992749337	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4550 MERIDIAN AVE	None	SAN JOSE	CA	95124	4828	43	06085	37.25692988	-121.8994742	Santa Clara County
138785	Fee-for-Service	1285847665	1285847665	1	1	LEE, SERENA K MD	6/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97380	66	Emergency Medicine (Urgent Care)	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
138791	Fee-for-Service	1942243779	1942243779	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	809 BAY AVE	None	CAPITOLA	CA	95010	2136	44	06087	36.98080235	-121.9552352	Santa Cruz County
138794	Fee-for-Service	1922401819	1922401819	1	1	LYON, JOSEPH Q NP	12/21/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
138795	Fee-for-Service	1952564262	1952564262	1	1	LEE, OLIVIA MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104695	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
138806	Fee-for-Service	1457507709	1457507709	1	1	LAUZON, VANESSA L MD	7/15/2013	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	112525	08	Family Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
138823	Fee-for-Service	1790178432	1790178432	1	1	LIU, DENNIS H MD	3/25/2021	207P00000X	NA	Other	026	PHYSICIANS	157498	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
138850	Fee-for-Service	1154384527	1154384527	1	1	LAMBERT, DAVID P. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 THOMPSON ST	None	SAINT PAUL	MN	55102	2370	00	None	44.94428014	-93.10733608	Ramsey County
138883	Fee-for-Service	1790168870	1790168870	1	1	LOPER, NICHOLAS E NP	5/14/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
138890	Fee-for-Service	1437326386	1437326386	1	1	LEONARD, SUSAN D MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105969	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	#420	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
138893	Fee-for-Service	1942485099	1942485099	1	1	LUPA, MICHAEL D MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126267	04	Otology, Laryngology, Rhinology	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
138897	Fee-for-Service	1972558138	1972558138	1	1	LIN, JOHN MD	11/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82618	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
138922	Fee-for-Service	1528402633	1528402633	1	1	LIU, ERICA T MD	6/30/2017	207W00000X	NA	Ophthalmology	026	PHYSICIANS	149632	18	Ophthalmology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
138942	Fee-for-Service	1023049590	1023049590	1	1	LEE, EUGENE Y MD	1/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87261	10	Gastroenterology (M.D. only)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
138945	Fee-for-Service	1891157251	1891157251	1	1	LEVIN, ASHLEY S LMFT	4/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
138949	Fee-for-Service	1982197505	1982197505	1	1	LANE, VICTORIA E LCSW	10/16/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
138952	Fee-for-Service	1417164492	1417164492	1	1	LEE, BONNIE A MD	8/13/2019	207ND0900X	NA	Dermatology	026	PHYSICIANS	111736	07	Dermatology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
138977	Fee-for-Service	1437348919	1437348919	1	1	LEE, RYAN Y DPM	9/18/2008	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	770 WASHINGTON	STE 202	SAN DIEGO	CA	92103	2209	37	06073	32.75014189	-117.1579654	San Diego County
138978	Fee-for-Service	1013273713	1013273713	1	1	LIN, KENNY A MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126874	36	Psychiatry	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
138981	Fee-for-Service	1689824245	1689824245	1	1	LOVE, ROBIN L LCSW	5/23/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
139000	Fee-for-Service	1992725527	1992725527	1	1	LEVIN, ROBERT MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	21065	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1301 20TH ST	STE 590	SANTA MONICA	CA	90404	2054	19	06037	34.02976782	-118.4812493	Los Angeles County
139004	Fee-for-Service	1063504298	1063504298	1	1	LEE, CAROL KA LOK MD	7/31/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	62717	40	Pediatrics	0	In state provider	None	1518 NORIEGA ST	# 200	SAN FRANCISCO	CA	94122	4434	38	06075	37.75410453	-122.4800952	San Francisco County
139006	Fee-for-Service	1689719155	1689719155	1	1	LEE, MARJORIE Y	10/16/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
139017	Fee-for-Service	1801830245	1801830245	2	1	LONGS DRUG STORES CA LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10455 S DE ANZA BLVD	None	CUPERTINO	CA	95014	3011	43	06085	37.316601	-122.032407	Santa Clara County
139047	Fee-for-Service	1477933224	1477933224	1	1	LYONS, JORDAN	7/21/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183177	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
139080	Fee-for-Service	1164846275	1164846275	1	1	LALL, KRISHNEEL A CRNA	4/27/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
139094	Fee-for-Service	1841374824	1841374824	1	1	LUM, RYAN S MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74527	41	Internal Medicine	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
139115	Fee-for-Service	1073599478	1073599478	1	1	LABORATORY CORPORATION OF AM	11/23/2021	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	ERICA	550 17TH AVE	SUITE 300	SEATTLE	WA	98122	5789	00	None	47.60689769	-122.3102467	King County
139132	Fee-for-Service	1467432237	1467432237	1	1	LLOYD RODERICK ANDERSON, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6567 E CARONDELET DR	STE 305	TUCSON	AZ	85710	0000	00	None	32.226876	-110.8535445	Pima County
139135	Fee-for-Service	1982812939	1982812939	1	1	LOYDS LIBERTY HOMES INC	3/11/1997	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7604 KROLL WAY	None	BAKERSFIELD	CA	93309	2324	15	06029	35.35004018	-119.0877514	Kern County
139136	Fee-for-Service	1225325772	1225325772	1	1	LEE, DEREK T MD	7/9/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	145718	30	Radiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
139151	Fee-for-Service	1134283559	1134283559	1	1	LABA, MICHELLE MD	12/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60439	40	Pediatrics	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
139186	Fee-for-Service	1851402143	1851402143	1	1	LOOK, MICHELLE L MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62798	08	Family Practice	0	In state provider	None	6699 ALVARADO RD	STE 2100	SAN DIEGO	CA	92120	5238	37	06073	32.77665383	-117.0540279	San Diego County
139187	Fee-for-Service	1154552081	1154552081	1	1	LIM, ANNIE K DO	4/23/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	18707	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
139201	Fee-for-Service	1215290622	1215290622	1	1	LE, BAO GIA LMFT	1/11/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	594 NORTH GLASSELL STREE	None	ORANGE	CA	92867	6748	30	06059	33.796782	-117.853129	Orange County
139204	Fee-for-Service	1396859179	1396859179	1	1	LAKE ELSINORE FAMILY	9/1/1997	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	2499 E LAKESHORE DR	None	LAKE ELSINORE	CA	92530	4446	33	06065	33.66050702	-117.3018956	Riverside County
139213	Fee-for-Service	1386801330	1386801330	1	1	LEE, BRYAN K	8/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105716	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
139221	Fee-for-Service	1316976913	1316976913	1	1	LUDMER, PAUL L MD	3/31/1985	207R00000X	NA	Other	026	PHYSICIANS	46760	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	375 34TH ST	FL 2	OAKLAND	CA	94609	2814	01	06001	37.8221386	-122.2625188	Alameda County
139225	Fee-for-Service	1891871018	1891871018	1	1	LIM, JOHN C MD	11/30/1983	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	52785	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
139227	Fee-for-Service	1043327364	1043327364	1	1	LEE, HSINGYEE MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81679	30	Radiology	0	In state provider	None	6855 NOBLE AVE	None	VAN NUYS	CA	91405	3729	19	06037	34.19496251	-118.4618831	Los Angeles County
139267	Fee-for-Service	1558441915	1558441915	1	1	LOSADA, MIGUEL A MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	23249	01	General Practice	0	In state provider	None	3250 EL CAJON BLVD	None	SAN DIEGO	CA	92104	1409	37	06073	32.75537549	-117.123903	San Diego County
139301	Fee-for-Service	1164604377	1164604377	1	1	LUTHRA, SHEETAL DO	4/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9625	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
139334	Fee-for-Service	1649341694	1649341694	1	1	LINDEBORG, DENNIS M MD	12/11/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67683	05	Anesthesiology	0	In state provider	ATTN MGA OFFICE	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
139347	Fee-for-Service	1134213572	1134213572	1	1	LOWE, SPENCER T MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	44007	41	Internal Medicine	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
139362	Fee-for-Service	1477545176	1477545176	1	1	LICHT, NURIT MD	11/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90977	08	Family Practice	0	In state provider	None	1301 SOUTHPOINT BLVD	STE A	PETALUMA	CA	94954	6858	49	06097	38.26109022	-122.6476782	Sonoma County
139379	Fee-for-Service	1346700994	1346700994	1	1	LIEVANOS, EDWARD MD	9/12/2023	390200000X	NA	Other	026	PHYSICIANS	182160	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
139385	Fee-for-Service	1083814636	1083814636	1	1	LERNER, ELENA MD	8/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101810	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
139394	Fee-for-Service	1346282175	1346282175	2	1	LONGS DRUG STORE CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1435 E GRAND AVE	None	ARROYO GRANDE	CA	93420	2423	40	06079	35.12079311	-120.6063123	San Luis Obispo County
139399	Fee-for-Service	1114201282	1114201282	1	1	LIEBLING, PETER D MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118555	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
139402	Fee-for-Service	1285025486	1285025486	1	1	LESCHER, NICOLE LCSW	12/21/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	55 SCHOOL STREET	SUITE S	COLFAX	CA	95713	1598	31	06061	39.10263019	-120.9536588	Placer County
139411	Fee-for-Service	1568934818	1568934818	1	1	LIM, ANDREW S CRNA	4/1/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
139416	Fee-for-Service	1205015062	1205015062	1	1	LOZA, JULIO A DO INC	2/8/2008	193400000X	NA	Other	026	PHYSICIANS	7721	41	Internal Medicine	0	In state provider	None	1700 CESAR CHAVEZ AVE	STE 3600	LOS ANGELES	CA	90033	2478	19	06037	34.05101259	-118.217259	Los Angeles County
139420	Fee-for-Service	1952344749	1952344749	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1175 2ND ST	None	BRENTWOOD	CA	94513	2211	07	06013	37.9374467	-121.6986415	Contra Costa County
139435	Fee-for-Service	1134283559	1134283559	1	1	LABA, MICHELLE MD	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
139441	Fee-for-Service	1619972700	1619972700	1	1	LOO, JOHN-CHARLES A MD	7/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67200	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVE	FL 3	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
139459	Fee-for-Service	1750667275	1750667275	1	1	LEPE, PATRICIA M	12/30/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
139485	Fee-for-Service	1033477427	1033477427	1	2	LINDBORG, RYAN S MD	7/20/2022	2086S0127X	NA	General Surgery	026	PHYSICIANS	177446	None	None	0	In state provider	None	6555 COYLE	SUITE 220	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
139492	Fee-for-Service	1396859179	1396859179	1	1	LAKE ELSINORE FAMILY	9/1/1997	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	2499 E LAKESHORE DR	None	LAKE ELSINORE	CA	92530	4446	33	06065	33.66050702	-117.3018956	Riverside County
139507	Fee-for-Service	1316338072	1316338072	1	1	LEVINE, JONATHAN M MD	5/26/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176639	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
139510	Fee-for-Service	1467820589	1467820589	1	1	LEE AND WU OPTOMETRISTS	10/7/2015	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	1033 HIGHLAND AVENUE	None	NATIONAL CITY	CA	91950	3515	37	06073	32.67616613	-117.0977972	San Diego County
139525	Fee-for-Service	1114005733	1114005733	1	1	LIAO, TIMOTHY E MD	7/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86483	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
139546	Fee-for-Service	1629397088	1629397088	1	1	LOS NIETOS UESD	4/10/1999	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	8324 WESTMAN AVE	None	WHITTIER	CA	90606	3314	19	06037	33.96655278	-118.0667766	Los Angeles County
139558	Fee-for-Service	1902976848	1902976848	1	1	LIAO, ANDREW B MD	6/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109634	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
139614	Fee-for-Service	1952939274	1952939274	1	1	LEVINE, NICOLE L MD	4/22/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	1225 15TH ST	2100	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
139621	Fee-for-Service	1649341694	1649341694	1	1	LINDEBORG, DENNIS M MD	12/11/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67683	01	General Practice	0	In state provider	ATTN MGA OFFICE	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
139629	Fee-for-Service	1114005287	1114005287	1	1	LOZANO, MICHAEL R MD	11/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	50592	41	Internal Medicine	0	In state provider	None	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
139635	Fee-for-Service	1134213572	1134213572	1	1	LOWE, SPENCER T MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	44007	83	Rheumatology	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
139660	Fee-for-Service	1912093865	1912093865	1	1	LEITNER, PAUL MD	10/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	42193	41	Internal Medicine	0	In state provider	None	8540 S SEPULVEDA BLVD	STE 910	LOS ANGELES	CA	90045	3808	19	06037	33.96022076	-118.3961982	Los Angeles County
139671	Fee-for-Service	1033361019	1033361019	1	1	LABASTIDA, ELENA A LMFT	7/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1255 W COLTON AVE	#504	REDLANDS	CA	92374	2861	36	06071	34.06285254	-117.20178	San Bernardino County
139682	Fee-for-Service	1609849074	1609849074	1	9	LA MAESTRA FAMILY CLINIC INC	5/2/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4187 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	0000	37	06073	32.752908	-117.1008345	San Diego County
139731	Fee-for-Service	1619972700	1619972700	1	1	LOO, JOHN-CHARLES A MD	7/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67200	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	2801 ATLANTIC AVE	FL 3	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
139747	Fee-for-Service	1336249531	1336249531	1	1	LOMITA FAMILY MEDICAL GROUP	9/9/2008	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC	903 CARDIFF ST	None	SAN DIEGO	CA	92114	5019	37	06073	32.71551283	-117.0252276	San Diego County
139778	Fee-for-Service	1396859179	1396859179	1	1	LAKE ELSINORE FAMILY	9/1/1997	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	2499 E LAKESHORE DR	None	LAKE ELSINORE	CA	92530	4446	33	06065	33.66050702	-117.3018956	Riverside County
139786	Fee-for-Service	1457691503	1457691503	1	1	LAWRENSON, LESLEY E MD	12/31/2018	2085R0001X	NA	Other	026	PHYSICIANS	133577	32	Radiation Therapy (D.O. only)	0	In state provider	None	14608 HAWTHORNE BLVD	None	LAWNDALE	CA	90260	1521	19	06037	33.898932	-118.352374	Los Angeles County
139792	Fee-for-Service	1174681050	1174681050	1	1	LINDBERG, JOHN WALTER MD	11/30/1991	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	69560	25	Physical Medicine and Rehabilitation	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
139800	Fee-for-Service	1689116204	1689116204	1	1	LAU, SAMANTHA M S	5/10/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
139823	Fee-for-Service	1871001024	1871001024	1	1	LASTRA, AMALIA M LCSW	12/12/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
139827	Fee-for-Service	1366978843	1366978843	1	1	LUMEN HEALTH AND PSYCHOLOGIC	10/8/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	AL SERVICES INC.	8421 AUBURN BLVD	SUITE 110	CITRUS HEIGHTS	CA	95610	0359	34	06067	38.719026	-121.291335	Sacramento County
139854	Fee-for-Service	1346420098	1346420098	1	1	LIN, ROBERT T MD	7/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97748	08	Family Practice	0	In state provider	None	23512 MADERO RD	None	MISSION VIEJO	CA	92691	2743	30	06059	33.62192373	-117.6765103	Orange County
139886	Fee-for-Service	1154533487	1154533487	1	1	LEUNG, CHERRY NP	11/20/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
139889	Fee-for-Service	1609371384	1609371384	1	1	LIN, CHRISTINA Q MD	5/10/2023	207R00000X	NA	Other	026	PHYSICIANS	166133	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
139892	Fee-for-Service	1780030478	1780030478	1	1	LI, ERIC Y MD	9/25/2019	2086S0122X	NA	General Surgery	026	PHYSICIANS	149860	24	Plastic Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
139917	Fee-for-Service	1114005287	1114005287	1	1	LOZANO, MICHAEL R MD	11/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	50592	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
139946	Fee-for-Service	1033662218	1033662218	1	1	LESMONI INC	9/30/2018	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2215 FIELD ST	None	ANTIOCH	CA	94531	8097	07	06013	38.00434828	-121.8492369	Contra Costa County
139969	Fee-for-Service	1609849074	1609849074	1	9	LA MAESTRA FAMILY CLINIC INC	5/2/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4187 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	0000	37	06073	32.752908	-117.1008345	San Diego County
139994	Fee-for-Service	1881742062	1881742062	1	1	LINNA, DAG PETER A MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	73037	41	Internal Medicine	0	In state provider	None	65 N 1ST AVE	STE 103	ARCADIA	CA	91006	3244	19	06037	34.14085163	-118.0283923	Los Angeles County
140020	Fee-for-Service	1629011937	1629011937	2	1	LONGS DRUG STORE CAL LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	41 N MAIN ST	None	ANGELS CAMP	CA	95222	9332	05	06009	38.08333515	-120.559997	Calaveras County
140027	Fee-for-Service	1649512310	1649512310	1	1	LEBANO, RICHARD S MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144324	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
140035	Fee-for-Service	1336249531	1336249531	1	1	LOMITA FAMILY MEDICAL GROUP	9/9/2008	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC	903 CARDIFF ST	None	SAN DIEGO	CA	92114	5019	37	06073	32.71551283	-117.0252276	San Diego County
140046	Fee-for-Service	1851522015	1851522015	1	1	LA CLINICA DE LA RAZA, INC.	11/12/2009	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1926 19TH AVE	None	OAKLAND	CA	94606	4126	01	06001	37.78963762	-122.2378966	Alameda County
140069	Fee-for-Service	1396859179	1396859179	1	1	LAKE ELSINORE FAMILY	9/1/1997	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	2499 E LAKESHORE DR	None	LAKE ELSINORE	CA	92530	4446	33	06065	33.66050702	-117.3018956	Riverside County
140077	Fee-for-Service	1457428427	1457428427	1	1	LONIKA'S HOME, INC	8/26/2005	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LONIKA HOME APHENA	24336 APHENA AVE	None	MISSION VIEJO	CA	92691	4511	30	06059	33.60873647	-117.6865889	Orange County
140094	Fee-for-Service	1760589220	1760589220	1	1	LATIFT,RIFAT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
140116	Fee-for-Service	1366978843	1366978843	1	1	LUMEN HEALTH AND PSYCHOLOGIC	10/8/2018	103TC0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	AL SERVICES INC.	8421 AUBURN BLVD	SUITE 110	CITRUS HEIGHTS	CA	95610	0359	34	06067	38.719026	-121.291335	Sacramento County
140132	Fee-for-Service	1740570662	1740570662	1	1	LUENPRAKANSIT, KATE MD	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122772	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
140138	Fee-for-Service	1376144956	1376144956	1	1	LION HOSPICE CARE INC	10/12/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13317 VENTURA BLVD	STE H2	SHERMAN OAKS	CA	91423	6271	19	06037	34.14670639	-118.4231775	Los Angeles County
140144	Fee-for-Service	1861260523	1861260523	1	1	LOLIE, JACQUELINE ALISI	4/24/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	9350 THE RESORT PKWY	UNIT 427	RANCHO CUCAMONGA	CA	91730	9214	36	06071	34.083459	-117.5631995	San Bernardino County
140151	Fee-for-Service	1952537326	1952537326	1	1	LUCAS, SARAH P MD	5/5/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	155280	None	None	0	In state provider	None	9850 GENESEE AVE	SUITE 410	LA JOLLA	CA	92037	1224	37	06073	32.882913	-117.226341	San Diego County
140177	Fee-for-Service	1548691686	1548691686	1	1	LARKIN, ALLISON J CNP	9/27/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10455 S DE ANZA BLVD	None	CUPERTINO	CA	95014	3011	43	06085	37.316601	-122.032407	Santa Clara County
140179	Fee-for-Service	1942632542	1942632542	1	1	LEE, ERIC W MD	9/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132034	05	Anesthesiology	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1365	10	06019	36.7423511	-119.7834688	Fresno County
140242	Fee-for-Service	1376732685	1376732685	1	1	LEBLANC, ALLYN E NP	7/10/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
140256	Fee-for-Service	1124040431	1124040431	1	1	LI, JUI-JUNG R MD	7/1/1986	207R00000X	NA	Other	026	PHYSICIANS	42835	41	Internal Medicine	0	In state provider	None	3655 LOMITA BLVD	STE 121	TORRANCE	CA	90505	1908	19	06037	33.81497113	-118.3489779	Los Angeles County
140275	Fee-for-Service	1336991751	1336991751	1	1	LP RELIABLE TRANSPORTATION	4/16/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	12648 BERENDA ST	None	VICTORVILLE	CA	92394	9552	36	06071	34.52715414	-117.3874202	San Bernardino County
140282	Fee-for-Service	1568536209	1568536209	1	1	LOWE, NANCY M PT	6/6/2020	2251E1200X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
140301	Fee-for-Service	1215124763	1215124763	1	1	LI, LEON T MD	2/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99428	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
140303	Fee-for-Service	1316709041	1316709041	1	1	LYONS, THOMAS M LMFT	9/2/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	123563	-	NOT APPLICABLE	0	In state provider	None	1910 S CAMINO REAL	None	PALM SPRINGS	CA	92264	9290	33	06065	33.797259	-116.539091	Riverside County
140331	Fee-for-Service	1851522015	1851522015	1	1	LA CLINICA DE LA RAZA, INC.	11/12/2009	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1926 19TH AVE	None	OAKLAND	CA	94606	4126	01	06001	37.78963762	-122.2378966	Alameda County
140356	Fee-for-Service	1225590201	1225590201	1	1	LEWIS, KRISTIN M MD	6/17/2022	207P00000X	NA	Other	026	PHYSICIANS	177729	None	None	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
140377	Fee-for-Service	1922175843	1922175843	1	1	LIU, GEORGE Y MD	12/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	85066	84	Surgery-Head and Neck	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
140393	Fee-for-Service	1467114769	1467114769	1	1	LIU, YOUNG PT	3/19/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
140403	Fee-for-Service	1366978843	1366978843	1	1	LUMEN HEALTH AND PSYCHOLOGIC	10/29/2019	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	AL SERVICES INC.	8421 AUBURN BLVD	SUITE 110	CITRUS HEIGHTS	CA	95610	0359	34	06067	38.719026	-121.291335	Sacramento County
140412	Fee-for-Service	1699986331	1699986331	1	2	LOS ANGELES COUNTY	11/12/2020	No Taxonomy Provided	NA	None	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	1100 N STATE ST	ROOM C2K100	LOS ANGELES	CA	90033	5000	19	06037	34.05981579	-118.2103192	Los Angeles County
140427	Fee-for-Service	1376144956	1376144956	1	1	LION HOSPICE CARE INC	10/12/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13317 VENTURA BLVD	STE H2	SHERMAN OAKS	CA	91423	6271	19	06037	34.14670639	-118.4231775	Los Angeles County
140433	Fee-for-Service	1861260523	1861260523	1	1	LOLIE, JACQUELINE ALISI	4/24/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	9350 THE RESORT PKWY	UNIT 427	RANCHO CUCAMONGA	CA	91730	9214	36	06071	34.083459	-117.5631995	San Bernardino County
140464	Fee-for-Service	1578610317	1578610317	1	1	LITVAK, MONA S MD	10/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83421	41	Internal Medicine	0	In state provider	None	2900 WHIPPLE AVE	STE 130	REDWOOD CITY	CA	94062	2844	41	06081	37.4783072	-122.2551089	San Mateo County
140465	Fee-for-Service	1093722258	1093722258	1	1	LUJAN, BRANDON J MD	9/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87781	18	Ophthalmology	0	In state provider	None	185 BERRY STREET	STE 130	SAN FRANCISCO	CA	94107	1756	38	06075	37.77667282	-122.3921584	San Francisco County
140494	Fee-for-Service	1912966680	1912966680	1	1	LIEU, DAVID K W MD	7/31/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42121	22	Pathology (M.D. only)	0	In state provider	FINE NEEDLE ASPIRATION	320 S GARFIELD AVE	STE 278	ALHAMBRA	CA	91801	6815	19	06037	34.09184212	-118.1245127	Los Angeles County
140570	Fee-for-Service	1295228518	1295228518	1	1	LIMA OVERBY, REBECCA C OT	9/10/2020	225XP0019X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
140580	Fee-for-Service	1770528002	1770528002	1	1	LEVIN, ROY J MD	7/1/2000	207P00000X	NA	Other	026	PHYSICIANS	24866	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2200 CLOVIS AVE	None	CLOVIS	CA	93612	3915	10	06019	36.80635198	-119.7004625	Fresno County
140616	Fee-for-Service	1588961239	1588961239	1	1	LOCKWOOD, MICHAEL I	4/12/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
140650	Fee-for-Service	1104997162	1104997162	1	1	LEONE, ANTHONY J MD	4/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79936	20	Orthopedic Surgery	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
140682	Fee-for-Service	1497088637	1497088637	1	1	LEE, BRIAN MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	108932	14	Neurological Surgery	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
140688	Fee-for-Service	1831261155	1831261155	1	1	LEUNG, GEOFFREY W MD	4/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	89812	08	Family Practice	0	In state provider	None	505 S BUENA VISTA AVE	None	CORONA	CA	92882	1901	33	06065	33.87798339	-117.5774303	Riverside County
140694	Fee-for-Service	1366978843	1366978843	1	1	LUMEN HEALTH AND PSYCHOLOGIC	1/15/2022	103TC0700X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	AL SERVICES INC.	8421 AUBURN BLVD	SUITE 110	CITRUS HEIGHTS	CA	95610	0359	34	06067	38.719026	-121.291335	Sacramento County
140710	Fee-for-Service	1710109657	1710109657	1	1	LEHMAN, RICHARD E	7/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108523	None	None	0	In state provider	None	320 W PUEBLO STREET	None	SANTA BARBARA	CA	93105	4311	42	06083	34.42954414	-119.7230551	Santa Barbara County
140722	Fee-for-Service	1649385527	1649385527	1	1	LEE, LEVONNE R MD	2/15/2001	207W00000X	NA	Ophthalmology	026	PHYSICIANS	73941	18	Ophthalmology	0	In state provider	None	2390 E FLORIDA AVE	STE 207	HEMET	CA	92544	4755	33	06065	33.7477405	-116.94681	Riverside County
140735	Fee-for-Service	1154714111	1154714111	1	1	LEE, CATHERINE MD	8/1/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	162782	None	None	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
140756	Fee-for-Service	1891769022	1891769022	1	1	LENG, WENDY W MD	10/16/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84896	34	Urology and Urological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
140760	Fee-for-Service	1023196771	1023196771	1	1	LOCKE, ALEXANDER MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	61608	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
140795	Fee-for-Service	1972023547	1972023547	1	1	LACOCQUE, PATRICIA A LCSW	2/14/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1025 MANDANA BLVD	None	OAKLAND	CA	94610	1801	01	06001	37.81271747	-122.228021	Alameda County
140796	Fee-for-Service	1912963638	1912963638	1	1	LAU, JOHN C MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76497	30	Radiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
140809	Fee-for-Service	1528180361	1528180361	1	1	LAI, WILLIAM MD	11/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93123	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
140906	Fee-for-Service	1851522015	1851522015	1	6	LA CLINICA DE LA RAZA, INC.	10/30/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	15980 MARCELLA STREET	None	SAN LEANDRO	CA	94578	2122	01	06001	37.70161587	-122.1167973	Alameda County
140907	Fee-for-Service	1043335540	1043335540	1	1	LEE, JUDY C MD	2/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93175	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
140940	Fee-for-Service	1033219084	1033219084	2	1	LADINES, ROBERT E MD	8/16/2010	207R00000X	NA	Other	026	PHYSICIANS	51126	41	Internal Medicine	0	In state provider	None	1515 N FAIR OAKS AVE	None	PASADENA	CA	91103	1808	19	06037	34.17206003	-118.1507387	Los Angeles County
140972	Fee-for-Service	1285773366	1285773366	1	1	LEWIS, ANN J MD	8/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72730	79	Neurology-Child	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
140974	Fee-for-Service	1447677521	1447677521	1	1	LECHNER, MELISSA G MD	4/22/2020	207RE0101X	NA	Endocrinology	026	PHYSICIANS	155836	41	Internal Medicine	0	In state provider	None	100 MEDICAL PLAZA STE 70	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
140976	Fee-for-Service	1578874681	1578874681	1	1	LYON, REGAN F MD	5/15/2020	207P00000X	NA	Other	026	PHYSICIANS	165707	66	Emergency Medicine (Urgent Care)	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
140982	Fee-for-Service	1336324904	1336324904	1	1	LA MAESTRA FAMILY CLINIC INC	5/22/2007	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CLINIC-NATIONAL CITY	217 HIGHLAND AVE	None	NATIONAL CITY	CA	91950	1518	37	06073	32.68298968	-117.1005464	San Diego County
140997	Fee-for-Service	1487932372	1487932372	1	1	LEUNG, HOBART MD	4/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138293	None	None	0	In state provider	None	742 W HIGHLAND AVE	None	SAN BERNARDINO	CA	92405	3839	36	06071	34.13604853	-117.29952	San Bernardino County
141002	Fee-for-Service	1851334387	1851334387	1	1	LAWSON, FRANCES K MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	77897	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1515 E OCEAN AVE	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
141012	Fee-for-Service	1154703940	1154703940	1	1	LI, WILLIAM MD	6/7/2022	207RC0200X	NA	Other	026	PHYSICIANS	150608	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
141030	Fee-for-Service	1033293337	1033293337	1	1	LAM,TROY T MD	2/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	70538	41	Internal Medicine	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
141034	Fee-for-Service	1780169680	1780169680	1	1	LEYRITANA, ISABEL F	11/27/2019	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	400 30TH ST	STE 101	OAKLAND	CA	94609	3306	01	06001	37.81907725	-122.2648838	Alameda County
141073	Fee-for-Service	1710372701	1710372701	1	1	LOYA, JOSHUA J MD	7/17/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	169079	None	None	0	In state provider	None	2675 HARRIS ST	None	EUREKA	CA	95503	4806	12	06023	40.78053022	-124.1369379	Humboldt County
141093	Fee-for-Service	1932418977	1932418977	1	1	LUUS CHIROPRACTIC INC	2/20/2015	193400000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4427 EUCLID AVE	None	SAN DIEGO	CA	92115	4523	37	06073	32.7570336	-117.0921463	San Diego County
141096	Fee-for-Service	1093840670	1093840670	1	1	LEUNG, MARIA C LCSW	12/9/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
141136	Fee-for-Service	1720163264	1720163264	1	1	LORCH, GERALD S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4011 TALBOT RD S	FL 5	RENTON	WA	98055	5773	00	None	47.44331246	-122.2117632	King County
141172	Fee-for-Service	1710309695	1710309695	1	1	LEE, PATRICIA Y	4/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8881 FLETCHER PKWY	STE 200	LA MESA	CA	91942	3135	37	06073	32.78442148	-117.0073814	San Diego County
141174	Fee-for-Service	1508217084	1508217084	1	1	LUY, TONY C OD	6/8/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4403 S VERMONT AVE	None	LOS ANGELES	CA	90037	2413	19	06037	34.00342736	-118.2915892	Los Angeles County
141192	Fee-for-Service	1851522015	1851522015	1	6	LA CLINICA DE LA RAZA, INC.	10/30/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	15980 MARCELLA STREET	None	SAN LEANDRO	CA	94578	2122	01	06001	37.70161587	-122.1167973	Alameda County
141201	Fee-for-Service	1184902900	1184902900	1	1	LE, DUY-PHUONG L NP	12/12/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
141202	Fee-for-Service	1952537532	1952537532	1	1	LUCAS, DOUGLAS E DO	8/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13066	20	Orthopedic Surgery	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	3202	43	06085	37.43920432	-122.162109	Santa Clara County
141203	Fee-for-Service	1396887287	1396887287	1	1	LAPID, TERRY MD	2/28/1983	207P00000X	NA	Other	026	PHYSICIANS	34113	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15891 LOS GATOS ALMADEN	None	LOS GATOS	CA	95032	3742	43	06085	37.24361275	-121.9477516	Santa Clara County
141240	Fee-for-Service	1467506691	1467506691	1	1	LITTLEFIELD PHYSICAL THERAPY	10/20/2009	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	27525 ENTERPRISE CIR W	STE 101-C	TEMECULA	CA	92590	4884	33	06065	33.5139765	-117.1641993	Riverside County
141249	Fee-for-Service	1720582836	1720582836	1	1	LEE, SAMUEL MD	10/30/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	190182	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
141260	Fee-for-Service	1447677521	1447677521	1	1	LECHNER, MELISSA G MD	4/22/2020	207RE0101X	NA	Endocrinology	026	PHYSICIANS	155836	67	Endocrinology	0	In state provider	None	100 MEDICAL PLAZA STE 70	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
141261	Fee-for-Service	1952394025	1952394025	1	1	LEE, GLORIA L MD	4/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51138	41	Internal Medicine	0	In state provider	None	612 E JANSS RD	None	THOUSAND OAKS	CA	91360	5113	56	06111	34.19957051	-118.8666284	Ventura County
141273	Fee-for-Service	1255863338	1255863338	1	1	LE, GREY MD	8/24/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158282	08	Family Practice	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
141277	Fee-for-Service	1255774220	1255774220	1	1	LIBBON, RANDI H MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	36	Psychiatry	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
141308	Fee-for-Service	1366428021	1366428021	1	1	LIN, HUEY C	10/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84585	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
141320	Fee-for-Service	1578726212	1578726212	1	1	LUU, VU H MD	9/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
141328	Fee-for-Service	1861159709	1861159709	1	1	LH HOME CARE SERVICE INC	5/20/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	520 E WILSON AVE	STE 240	GLENDALE	CA	91206	4350	19	06037	34.14812361	-118.2491324	Los Angeles County
141336	Fee-for-Service	1427118868	1427118868	1	1	LANDON, CHRIS MD	12/1/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	38056	40	Pediatrics	0	In state provider	None	77 BIRCH ST	STE C	REDWOOD CITY	CA	94062	1400	41	06081	37.4880698	-122.2402057	San Mateo County
141355	Fee-for-Service	1265522320	1265522320	1	1	LOUIE, KINGMAN J OD	2/24/1999	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9098 LAGUNA MAIN ST	STE 3	ELK GROVE	CA	95758	7449	34	06067	38.427129	-121.47138	Sacramento County
141371	Fee-for-Service	1215129309	1215129309	1	1	LEE, MONICA E MD	1/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	101114	68	Hematology	0	In state provider	None	1245 WHILSHIRE BLVD	SUITE 303	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
141372	Fee-for-Service	1417573676	1417573676	1	1	LICON, CHLOE LMFT	3/17/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9260 ALCOSTA BLVD	BUILDING A, SUITE A5	SAN RAMON	CA	94583	4134	07	06013	37.73166348	-121.9267174	Contra Costa County
141374	Fee-for-Service	1972667962	1972667962	1	1	LOUIE, EMIL S OD	10/22/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	611 SOUTH MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
141379	Fee-for-Service	1538178272	1538178272	1	1	LEE, JOHN B MD	10/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89667	None	None	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
141386	Fee-for-Service	1083767164	1083767164	1	1	LIANG, JANE H O D INC	6/21/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	FOCUS VISION OPTOMET CTR	2115 S HACIENDA BLVD	None	HACIENDA HEIGHTS	CA	91745	4243	19	06037	33.9953837	-117.9684974	Los Angeles County
141401	Fee-for-Service	1114976362	1114976362	1	1	LE, SON T MD INC	1/1/2000	193400000X	NA	Other	026	PHYSICIANS	63381	41	Internal Medicine	0	In state provider	None	8887 WESTMINSTER AVE	None	GARDEN GROVE	CA	92844	2608	30	06059	33.75942652	-117.974097	Orange County
141418	Fee-for-Service	1407833031	1407833031	1	1	LEVINE-KOGAN, MAURICIO	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	45582	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	765 MEDICAL CENTER CT	STE 201	CHULA VISTA	CA	91911	6600	37	06073	32.619069	-117.020835	San Diego County
141433	Fee-for-Service	1376078238	1376078238	1	1	LONDON, DENNIS MD	3/10/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
141495	Fee-for-Service	1649228073	1649228073	1	1	LEE, JANICE MD	8/14/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80178	47	Miscellaneous	0	In state provider	None	513 PARNASSUS AVE	RM 5738	SAN FRANCISCO	CA	94143	2205	38	06075	37.76344756	-122.4581992	San Francisco County
141499	Fee-for-Service	1952488512	1952488512	1	1	LIMB, ANDREW J MD	11/2/2008	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	71527	None	None	0	In state provider	None	999 S FAIRMONT AVE	STE 215	LODI	CA	95240	5142	39	06077	38.1206163	-121.2858323	San Joaquin County
141531	Fee-for-Service	1508422403	1508422403	1	1	LATTHIVONGSKORN, JIRAYUT MD	11/9/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177304	None	None	0	In state provider	MPH	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
141537	Fee-for-Service	1639453822	1639453822	1	1	LE, HONG T DO	9/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1775 THOMPSON ROAD	None	COOS BAY	OR	97420	2125	00	None	43.383456	-124.2330435	Coos County
141543	Fee-for-Service	1376692608	1376692608	1	1	LEE, JOHN S MD	12/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87504	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
141564	Fee-for-Service	1760531693	1760531693	1	1	LEE, PAUL S MD	11/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79889	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
141576	Fee-for-Service	1295248235	1295248235	1	1	LEWIS, KRISTIN L NP	11/27/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
141606	Fee-for-Service	1528002979	1528002979	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1005 E BIDWELL ST	None	FOLSOM	CA	95630	5548	34	06067	38.6685	-121.156218	Sacramento County
141620	Fee-for-Service	1144654856	1144654856	1	1	LOESCH, JAMES LMFT	12/28/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1010 W CHAPMAN AVE	None	ORANGE	CA	92868	2847	30	06059	33.78785047	-117.8631495	Orange County
141624	Fee-for-Service	1427118868	1427118868	1	1	LANDON, CHRIS MD	12/1/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	38056	03	Allergy	0	In state provider	None	77 BIRCH ST	STE C	REDWOOD CITY	CA	94062	1400	41	06081	37.4880698	-122.2402057	San Mateo County
141640	Fee-for-Service	1851522015	1851522015	1	4	LA CLINICA DE LA RAZA, INC.	12/30/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1700 SANTA CLARA AVE	None	ALAMEDA	CA	94501	2515	01	06001	37.77136257	-122.2558246	Alameda County
141644	Fee-for-Service	1629120001	1629120001	1	1	LANDSBERGER, RUTH MD	4/10/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54044	41	Internal Medicine	0	In state provider	None	1355 SAN PABLO ST	None	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
141645	Fee-for-Service	1497872915	1497872915	1	1	LIGHT-ALLENDE, KIMBERLY	5/4/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
141663	Fee-for-Service	1215129309	1215129309	1	1	LEE, MONICA E MD	1/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	101114	78	Neoplastic Diseases/Oncology	0	In state provider	None	1245 WHILSHIRE BLVD	SUITE 303	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
141695	Fee-for-Service	1326208638	1326208638	1	1	LUTCHMAN, GLEN A MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87513	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
141713	Fee-for-Service	1245630342	1245630342	1	1	LEBOFF, BONNIE J MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	61137	40	Pediatrics	0	In state provider	None	595 BUCKINGHAM WAY	STE 355	SAN FRANCISCO	CA	94132	1955	38	06075	37.73012679	-122.4767395	San Francisco County
141721	Fee-for-Service	1841234689	1841234689	1	1	LCPS ACQUISITION LLC	7/18/2011	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	1	Border provider	None	930 12TH PLACE	None	PRESCOTT	AZ	86305	1436	00	None	34.564941	-112.483602	Yavapai County
141723	Fee-for-Service	1528646411	1528646411	1	1	LEEDS, DAVID MD	1/10/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
141731	Fee-for-Service	1497867477	1497867477	1	1	LEE HO, JAIME S MD	12/1/1987	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	24547	02	General Surgery	0	In state provider	None	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
141742	Fee-for-Service	1477573319	1477573319	1	1	LUTTRULL, JEFFREY K MD	1/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	50280	18	Ophthalmology	0	In state provider	DBA:VENT CO RETINA&VITRE	3160 TELEGRAPH RD	STE 230	VENTURA	CA	93003	3252	56	06111	34.27228149	-119.2529119	Ventura County
141743	Fee-for-Service	1962727552	1962727552	1	1	LEE, YAUK K MD	6/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117603	30	Radiology	0	In state provider	None	3301 C STREET	SUITE 500	SACRAMENTO	CA	95816	3386	34	06067	38.579877	-121.456143	Sacramento County
141754	Fee-for-Service	1508643867	1508643867	1	1	LAMBRECHT, DONNA AU	3/5/2024	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	802 MAGNOLIA AVE	STE 208	CORONA	CA	92879	3157	33	06065	33.8596449	-117.5529774	Riverside County
141780	Fee-for-Service	1851163323	1851163323	1	1	LE, PHI LOAN PSYD	6/11/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
141783	Fee-for-Service	1821009580	1821009580	1	1	LIN, JAMES T MD	4/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86869	05	Anesthesiology	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
141805	Fee-for-Service	1487689733	1487689733	1	1	LOO, SANDRA	8/19/2005	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
141833	Fee-for-Service	1386025062	1386025062	1	1	LIN, JONATHAN H MD	11/14/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	149019	None	None	0	In state provider	None	THREE MEDICAL PLAZA	STE 120	ROSEVILLE	CA	95661	3088	31	06061	38.76566391	-121.2457432	Placer County
141851	Fee-for-Service	1801859715	1801859715	1	1	LIM, FRED T MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75403	None	None	0	In state provider	None	2410 SAMARITAN DR	STE 101	SAN JOSE	CA	95124	3909	43	06085	37.25107654	-121.9451342	Santa Clara County
141859	Fee-for-Service	1821243759	1821243759	2	1	LE, CHARLES N MD	2/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124891	41	Internal Medicine	0	In state provider	None	4440 EUCLID AVE	SUITE A	SAN DIEGO	CA	92115	4522	37	06073	32.7574568	-117.0921943	San Diego County
141865	Fee-for-Service	1629405253	1629405253	1	1	LIU, COLLIN MD	3/21/2025	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
141869	Fee-for-Service	1215428784	1215428784	1	1	LAKSHMI K AVALA MD INC	6/22/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	79103	40	Pediatrics	0	In state provider	None	6341 AUBURN BLVD	None	CITRUS HEIGHTS	CA	95621	5203	34	06067	38.682126	-121.3165035	Sacramento County
141872	Fee-for-Service	1992883250	1992883250	1	1	LA ROSA, FRANCISCO G MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	22	Pathology (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
141895	Fee-for-Service	1285689935	1285689935	1	1	LYNCH, TERRY MD	5/31/1989	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	54838	30	Radiology	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
141907	Fee-for-Service	1588632194	1588632194	1	1	LEE, JOUNG H MD	3/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	88061	14	Neurological Surgery	0	In state provider	None	501 S BUENA VISTA STREET	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
141910	Fee-for-Service	1699752923	1699752923	1	1	LANDMARK MEDICAL CENTER	6/8/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	115 CASS AVE	None	WOONSOCKET	RI	02895	4705	00	None	42.00534041	-71.49594512	Providence County
141912	Fee-for-Service	1427118868	1427118868	1	1	LANDON, CHRIS MD	12/1/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	38056	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	77 BIRCH ST	STE C	REDWOOD CITY	CA	94062	1400	41	06081	37.4880698	-122.2402057	San Mateo County
141956	Fee-for-Service	1194085936	1194085936	1	1	LEE, ANGELA H	6/1/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
141958	Fee-for-Service	1861781551	1861781551	1	1	LEUNG, ALBERT C MD	6/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130071	None	None	0	In state provider	None	1520 STOCKTON STREET	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
141961	Fee-for-Service	1235587122	1235587122	1	1	LIBERAL HOME HEALTH INC	3/2/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	13363 SATICOY ST	STE 106A	NORTH HOLLYWOOD	CA	91605	3400	19	06037	34.2086537	-118.424562	Los Angeles County
141982	Fee-for-Service	1326208638	1326208638	1	1	LUTCHMAN, GLEN A MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87513	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
141996	Fee-for-Service	1487865184	1487865184	1	1	LOS ANGELES COUNTY	5/23/2007	No Taxonomy Provided	NA	None	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	DEPARTMENT OF HEALTH SVS	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
142027	Fee-for-Service	1275571010	1275571010	1	1	LAO, JESUS H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72724	05	Anesthesiology	0	In state provider	None	23861 MCBEAN PKWY	STE A1	VALENCIA	CA	91355	2003	19	06037	34.39567343	-118.5542698	Los Angeles County
142061	Fee-for-Service	1568179331	1568179331	2	1	LATHROP, ORIAN	12/31/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5290 OVERPASS RD	UNIT 209	SANTA BARBARA	CA	93111	2042	42	06083	34.43960012	-119.8079098	Santa Barbara County
142067	Fee-for-Service	1942444617	1942444617	1	1	LE, DOAN T MD	11/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132606	40	Pediatrics	0	In state provider	None	1820 41ST AVE	SUITE D	CAPITOLA	CA	95010	2516	44	06087	36.975573	-121.964832	Santa Cruz County
142093	Fee-for-Service	1679731889	1679731889	1	1	LACAZE, COURTNEY A MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105930	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
142100	Fee-for-Service	1689753394	1689753394	1	1	LEE, HON S MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	84585	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
142118	Fee-for-Service	1932214384	1932214384	2	1	LIM, LEI Y MD	7/8/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	140120	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
142152	Fee-for-Service	1922662576	1922662576	1	1	LOVING HANDS HOSPICE LLC	5/10/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	363 WEST 6TH STREET	SUITE 6	SAN BERNARDINO	CA	92401	1128	36	06071	34.1101665	-117.291177	San Bernardino County
142177	Fee-for-Service	1104856012	1104856012	1	1	LICHWA, EDWIN A DO	12/24/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	6985	08	Family Practice	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
142179	Fee-for-Service	1184631954	1184631954	1	1	LE, PHA C MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9993	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
142194	Fee-for-Service	1154561900	1154561900	1	1	LEE, KOK-FON	9/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106497	41	Internal Medicine	0	In state provider	None	123 N GARFIELD AVENUE	SUITE A	ALHAMBRA	CA	91801	3564	19	06037	34.09636542	-118.127778	Los Angeles County
142195	Fee-for-Service	1578790135	1578790135	1	1	LYONS, MORGAN E DO	2/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12371	41	Internal Medicine	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3009	56	06111	34.27623479	-119.2520218	Ventura County
142198	Fee-for-Service	1699752923	1699752923	1	1	LANDMARK MEDICAL CENTER	6/8/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	115 CASS AVE	None	WOONSOCKET	RI	02895	4705	00	None	42.00534041	-71.49594512	Providence County
142224	Fee-for-Service	1134457708	1134457708	1	1	LEE, HAN S MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99392	13	Neurology (M.D. only)	0	In state provider	None	3301 C STREET	STE 200-E	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
142297	Fee-for-Service	1649316498	1649316498	1	1	LARGENT, MICHELLE L LMFT	11/17/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12575 NEWPORT AVE	SUITE A	TUSTIN	CA	92780	2452	30	06059	33.75394555	-117.8064378	Orange County
142313	Fee-for-Service	1205003159	1205003159	1	1	LEUNG, DANIEL C MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104697	05	Anesthesiology	0	In state provider	None	2420 CAMINO RAMON	SUITE 270	SAN RAMON	CA	94583	4385	07	06013	37.77229042	-121.9634581	Contra Costa County
142331	Fee-for-Service	1740437359	1740437359	1	1	LELKES, EFRAT MD	6/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108260	66	Emergency Medicine (Urgent Care)	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
142349	Fee-for-Service	1194014951	1194014951	1	1	LINDBERG, CARL B DPM	7/9/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2907 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98793933	-121.9782322	Santa Cruz County
142361	Fee-for-Service	1841617990	1841617990	1	1	LADWIG, NICHOLAS MD	6/20/2019	207ZP0102X	NA	Other	026	PHYSICIANS	140561	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
142397	Fee-for-Service	1649212457	1649212457	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2700 YULUPA AVE	None	SANTA ROSA	CA	95405	8563	49	06097	38.4273	-122.6668545	Sonoma County
142402	Fee-for-Service	1346853553	1346853553	1	1	LEE, VALERIE M RCP	9/11/2020	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
142410	Fee-for-Service	1548791734	1548791734	1	1	LI, YAN MD	6/13/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159530	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
142439	Fee-for-Service	1922662576	1922662576	1	1	LOVING HANDS HOSPICE LLC	5/10/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	363 WEST 6TH STREET	SUITE 6	SAN BERNARDINO	CA	92401	1128	36	06071	34.1101665	-117.291177	San Bernardino County
142448	Fee-for-Service	1073504213	1073504213	1	1	LANUM, DAVID M	5/5/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
142463	Fee-for-Service	1710187398	1710187398	1	1	LUTZ, FREDA	2/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
142466	Fee-for-Service	1104856012	1104856012	1	1	LICHWA, EDWIN A DO	12/24/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	6985	01	General Practice	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
142504	Fee-for-Service	1538307780	1538307780	1	1	LICHTMAN, AARON M MD	9/21/2009	207UN0902X	NA	Other	026	PHYSICIANS	60561	42	Nuclear Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
142511	Fee-for-Service	1134457708	1134457708	1	1	LEE, HAN S MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99392	22	Pathology (M.D. only)	0	In state provider	None	3301 C STREET	STE 200-E	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
142571	Fee-for-Service	1689777138	1689777138	1	1	LI, MICHAEL OD	1/13/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6250 VALLEY SPRINGS PKWY	None	RIVERSIDE	CA	92507	0970	33	06065	33.93822925	-117.2877761	Riverside County
142583	Fee-for-Service	1376907683	1376907683	1	1	LOFTUS, CHRISTOPHER MD	8/27/2023	208800000X	NA	Other	026	PHYSICIANS	187709	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
142596	Fee-for-Service	1902067390	1902067390	1	1	LOGAN, JOSHUA E MD	1/28/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	115432	34	Urology and Urological Surgery	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
142603	Fee-for-Service	1336450055	1336450055	1	1	LIU, RUIHAI LAC	11/28/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	E	299 W HILLCREST DR	STE 206	NEWBURY PARK	CA	91320	5906	56	06111	34.18347138	-118.8843918	Ventura County
142618	Fee-for-Service	1740437359	1740437359	1	1	LELKES, EFRAT MD	6/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108260	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
142625	Fee-for-Service	1518257146	1518257146	1	1	LI CHIROPRACTIC CENTER A PRO	12/29/2017	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	FESSIONAL CORPORATION	388 9TH ST	STE. 208	OAKLAND	CA	94607	4287	01	06001	37.80019425	-122.2715222	Alameda County
142662	Fee-for-Service	1073691572	1073691572	1	1	LE, SUSAN P MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89810	08	Family Practice	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
142665	Fee-for-Service	1104866649	1104866649	1	1	LIN, BYRON H MD	4/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	51772	41	Internal Medicine	0	In state provider	None	1153 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4714	19	06037	34.08087826	-118.1230792	Los Angeles County
142668	Fee-for-Service	1336595453	1336595453	1	1	LINX HEALTHCARE	11/16/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	21006 DEVONSHIRE ST	SUITE 210	CHATSWORTH	CA	91311	8272	19	06037	34.25722549	-118.5913485	Los Angeles County
142690	Fee-for-Service	1750944450	1750944450	1	1	LIOU, YUJIE L	7/3/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	21151	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
142708	Fee-for-Service	1376575167	1376575167	1	1	LINK, GARY W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 E DUNLAP AVE	None	PHOENIX	AZ	85020	2825	00	None	33.568947	-112.0712985	Maricopa County
142718	Fee-for-Service	1336436971	1336436971	1	1	LANDRY, VICTORIA A NP	11/7/2018	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
142771	Fee-for-Service	1265552301	1265552301	1	1	LOS ROBLES COMPREHENSIVE	10/17/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	PERINATAL SVCS MED GRP	2220 LYNN RD	STE 107B	THOUSAND OAKS	CA	91360	8014	56	06111	34.20863046	-118.8852156	Ventura County
142791	Fee-for-Service	1205465135	1205465135	1	1	LE, ANDREW	6/27/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186664	08	Family Practice	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
142800	Fee-for-Service	1396742367	1396742367	1	1	LIPOVETSKY, VLADIMIR MD	3/31/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	77605	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
142810	Fee-for-Service	1962609636	1962609636	1	1	LIMKETKAI, BERKELEY N MD	11/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132318	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
142816	Fee-for-Service	1467410514	1467410514	1	1	LEE, HANMIN MD	7/1/2000	2086S0120X	NA	General Surgery	026	PHYSICIANS	85790	02	General Surgery	0	In state provider	None	PO BOX 104	None	SAN FRANCISCO	CA	94104	0104	38	06075	0	0	None
142832	Fee-for-Service	1215343017	1215343017	1	1	LIU, ANDREA J OD	7/23/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 E HERNDON AVE	STE 201	FRESNO	CA	93720	3226	10	06019	36.83744648	-119.7646425	Fresno County
142838	Fee-for-Service	1700960895	1700960895	1	1	LRGHEALTHCARE	3/23/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	15 AIKEN AVE	None	FRANKLIN	NH	03235	1259	00	None	43.44748499	-71.64231657	Merrimack County
142873	Fee-for-Service	1205914819	1205914819	1	1	LOH, JOANIE MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	62105	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
142908	Fee-for-Service	1043403066	1043403066	1	1	LUO, JIANN-GANG F MD	2/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94497	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
142931	Fee-for-Service	1275895443	1275895443	1	1	LIERA, CARMEN G LCSW	2/1/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
142958	Fee-for-Service	1609134345	1609134345	1	1	LYNN, THERESA M MD	8/7/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144922	08	Family Practice	0	In state provider	None	8881 FLETCHER PKWY	STE 105	LA MESA	CA	91942	3132	37	06073	32.78442148	-117.0073814	San Diego County
143005	Fee-for-Service	1427090539	1427090539	1	1	LAL, MUNISH MD	8/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	85179	01	General Practice	0	In state provider	None	2767 OLIVE HIGHWAY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
143072	Fee-for-Service	1730189283	1730189283	1	1	LURIE, LOUIS MD	10/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	13181	20	Orthopedic Surgery	0	In state provider	None	450 4TH AVE	STE 311	CHULA VISTA	CA	91910	4429	37	06073	32.63513513	-117.0820663	San Diego County
143078	Fee-for-Service	1083908289	1083908289	1	1	LEE, JOHN J MD	1/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	54490	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
143084	Fee-for-Service	1053461483	1053461483	1	1	LIOU, STEVE S MD	3/24/2010	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	93177	84	Surgery-Head and Neck	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
143099	Fee-for-Service	1962609636	1962609636	1	1	LIMKETKAI, BERKELEY N MD	11/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132318	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
143101	Fee-for-Service	1467410514	1467410514	1	1	LEE, HANMIN MD	7/1/2000	2086S0120X	NA	General Surgery	026	PHYSICIANS	85790	85	Surgery-Pediatric	0	In state provider	None	PO BOX 104	None	SAN FRANCISCO	CA	94104	0104	38	06075	0	0	None
143125	Fee-for-Service	1700960895	1700960895	1	1	LRGHEALTHCARE	3/23/2009	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	15 AIKEN AVE	None	FRANKLIN	NH	03235	1259	00	None	43.44748499	-71.64231657	Merrimack County
143128	Fee-for-Service	1306502596	1306502596	1	1	LINARES MEDICAL CORPORATION	5/26/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	9310 E VALLEY BLVD	STE A	ROSEMEAD	CA	91770	1924	19	06037	34.08101299	-118.0667382	Los Angeles County
143197	Fee-for-Service	1043403066	1043403066	1	1	LUO, JIANN-GANG F MD	2/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94497	45	Nephrology (Renal-Kidney)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
143222	Fee-for-Service	1740437375	1740437375	1	1	LEE, TAE YOUNG MD	12/18/2019	2278C0205X	NA	Other	026	PHYSICIANS	165290	41	Internal Medicine	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
143349	Fee-for-Service	1801258157	1801258157	1	1	LARA OSPINA, TATIANA MD	11/1/2023	2080P0207X	NA	Hematology	026	PHYSICIANS	178409	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
143358	Fee-for-Service	1730189283	1730189283	1	1	LURIE, LOUIS MD	10/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	13181	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 4TH AVE	STE 311	CHULA VISTA	CA	91910	4429	37	06073	32.63513513	-117.0820663	San Diego County
143362	Fee-for-Service	1699089268	1699089268	1	1	LEE, JUNE J DO	2/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13639	01	General Practice	0	In state provider	None	21311 MADRONA AVE	SUITE 100-A	TORRANCE	CA	90503	4011	19	06037	33.835599	-118.3450965	Los Angeles County
143365	Fee-for-Service	1558045641	1558045641	1	1	LONG-SMITH, PATRICE TOLABOR	1/31/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
143393	Fee-for-Service	1154021582	1154021582	1	1	LAURELGROVE BOARD AND CARE	3/16/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	8221 LAURELGROVE AVE	None	NORTH HOLLYWOOD	CA	91605	1320	19	06037	34.22037709	-118.4009126	Los Angeles County
143405	Fee-for-Service	1306010814	1306010814	1	1	LEWIS, MEGHAN R MD	9/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	108776	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1450 SAN PABLO ST	STE 6200	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
143431	Fee-for-Service	1265165583	1265165583	1	1	LIFE BUILDERS FAMILY COUNSEL	9/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3200 E GUASTI RD	STE 100	ONTARIO	CA	91761	8661	36	06071	34.06518	-117.5822055	San Bernardino County
143432	Fee-for-Service	1881078707	1881078707	1	1	LEE, DAE-WON MD	11/12/2018	207P00000X	NA	Other	026	PHYSICIANS	152262	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
143438	Fee-for-Service	1740554773	1740554773	1	1	LIBERTY DIALYSIS	8/28/2013	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	PASADENA LLC	757 S RAYMOND AVE	None	PASADENA	CA	91105	3250	19	06037	34.132635	-118.1488095	Los Angeles County
143440	Fee-for-Service	1750301305	1750301305	1	1	LEE, WEI-NCHIH	4/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	53138	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
143465	Fee-for-Service	1609215482	1609215482	2	1	LEE DERMATOLOGY PC	1/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	None	None	0	In state provider	None	929 CLAY ST	SUITE 105	SAN FRANCISCO	CA	94108	1558	38	06075	37.79398652	-122.4083496	San Francisco County
143491	Fee-for-Service	1780707075	1780707075	1	1	LEWIS, ANDREA NP	4/27/2022	363LN0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
143505	Fee-for-Service	1811259328	1811259328	1	1	LEUNG, KELLY K M DO	3/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12421	01	General Practice	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
143562	Fee-for-Service	1275607020	1275607020	1	1	LE, YUNG TIEN MD	12/1/1997	174400000X	NA	Other	026	PHYSICIANS	61766	41	Internal Medicine	0	In state provider	None	130 CEDAR RD	None	VISTA	CA	92083	5102	37	06073	33.18682732	-117.2839184	San Diego County
143575	Fee-for-Service	1669963484	1669963484	1	1	LEE, JUSTIN M PT	7/26/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
143600	Fee-for-Service	1083173363	1083173363	1	1	LEE, VIVIAN MD	11/8/2022	207R00000X	NA	Other	026	PHYSICIANS	177300	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
143609	Fee-for-Service	1104861657	1104861657	1	1	LIEU, DAVID K W	6/1/2004	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	837 COUNTRY RD	None	MONTEREY PARK	CA	91755	4276	19	06037	34.05381237	-118.1111409	Los Angeles County
143632	Fee-for-Service	1780674622	1780674622	1	3	LEB, MICHAEL R MD	3/1/2002	174400000X	NA	Other	026	PHYSICIANS	41857	None	None	0	In state provider	PACIFICA WOMENS HEALTH	12954 HAWTHORNE BLVD	STE 100	HAWTHORNE	CA	90250	4418	19	06037	33.91447388	-118.3523875	Los Angeles County
143650	Fee-for-Service	1619975356	1619975356	1	1	LEE, JULIA L MD	4/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97017	30	Radiology	0	In state provider	None	2800 L STREET	STE 610	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
143694	Fee-for-Service	1306010814	1306010814	1	1	LEWIS, MEGHAN R MD	9/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	108776	02	General Surgery	0	In state provider	None	1450 SAN PABLO ST	STE 6200	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
143757	Fee-for-Service	1295765857	1295765857	1	1	LINDSAY, KAREN L MD	1/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	30432	10	Gastroenterology (M.D. only)	0	In state provider	UCLA CTR F/T HLTH SCIENC	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
143770	Fee-for-Service	1891843694	1891843694	1	1	LEACH, MAMATA MD	2/23/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	35287	05	Anesthesiology	0	In state provider	ATTN MGA OFFICE	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
143771	Fee-for-Service	1255457495	1255457495	1	1	LEE, SUZETTE	6/14/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	12001 W WASHINGTON BLVD	None	LOS ANGELES	CA	90066	5801	19	06037	33.99760695	-118.4228296	Los Angeles County
143783	Fee-for-Service	1154192409	1154192409	1	1	LOVE RESILENCE COUNSELING IN	2/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	C.	1406 GIBSON AVE	None	CLOVIS	CA	93611	1416	10	06019	36.8258015	-119.690766	Fresno County
143822	Fee-for-Service	1073841201	1073841201	1	1	LUU, BUULOC T DO	8/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10093	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
143845	Fee-for-Service	1952489007	1952489007	1	1	LEE, GILLIAN C MD	9/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81568	41	Internal Medicine	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
143867	Fee-for-Service	1427262682	1427262682	1	1	LEE, ANDY Y MD	10/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109430	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
143886	Fee-for-Service	1184709859	1184709859	1	1	LIM, DANIEL R MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79091	30	Radiology	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
143891	Fee-for-Service	1093066441	1093066441	1	2	LEE M. WEISSMAN, AU.D, AUDIO	6/8/2020	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	RING AIDS	8911 LAKEWOOD DRIVE	SUITE 27A	WINDSOR	CA	95492	7856	49	06097	38.55034733	-122.8042316	Sonoma County
143900	Fee-for-Service	1518007418	1518007418	1	1	LABEL, NORMAN MD	2/23/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	17258	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
143901	Fee-for-Service	1679623474	1679623474	1	1	LAROCHE, CHARLES J MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81067	41	Internal Medicine	0	In state provider	None	2660 W COVELL BLVD	None	DAVIS	CA	95616	5645	57	06113	38.56101005	-121.7821776	Yolo County
143907	Fee-for-Service	1710654959	1710654959	1	1	LUU, RICHARD PT	10/8/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
143921	Fee-for-Service	1245522796	1245522796	1	1	LE, DAVID H MD	8/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114246	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
143923	Fee-for-Service	1194964932	1194964932	1	1	LUSSIER, EILEEN F PHD	8/2/2004	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
143949	Fee-for-Service	1568629293	1568629293	1	1	LUONG, CUONG	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
143961	Fee-for-Service	1881697381	1881697381	1	3	LAKE COUNTY TRIBAL HEALTH	11/21/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	14678 LAKESHORE DRIVE	None	CLEARLAKE	CA	95422	9290	17	06033	38.95000853	-122.636988	Lake County
144008	Fee-for-Service	1861875601	1861875601	1	1	LENARTOWICZ, MAGDA MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137356	38	Geriatrics	0	In state provider	None	4955 VAN NUYS BLVD	STE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
144044	Fee-for-Service	1295765857	1295765857	1	1	LINDSAY, KAREN L MD	1/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	30432	41	Internal Medicine	0	In state provider	UCLA CTR F/T HLTH SCIENC	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
144067	Fee-for-Service	1477692069	1477692069	1	1	LEIGH, ERICA MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	80607	40	Pediatrics	0	In state provider	None	2970 HILLTOP MALL RD	STE 305	RICHMOND	CA	94806	5274	07	06013	37.97819764	-122.329244	Contra Costa County
144072	Fee-for-Service	1023660867	1023660867	1	1	LITTLE MUNCHKINS PROFESSIONA	7/27/2020	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	307 2ND AVE	None	SAN MATEO	CA	94403	1326	41	06081	37.56642166	-122.3231158	San Mateo County
144152	Fee-for-Service	1740486752	1740486752	1	1	LIEBMAN, ROSS F MD	10/10/2008	2084S0012X	NA	Neurology	026	PHYSICIANS	103799	36	Psychiatry	0	In state provider	None	701 E 28TH	STE 318	LONG BEACH	CA	90806	2785	19	06037	33.80803441	-118.1847137	Los Angeles County
144162	Fee-for-Service	1619506359	1619506359	1	1	LEE, ERNEST Y MD	7/3/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	185902	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
144170	Fee-for-Service	1073557419	1073557419	1	1	LOPEZ, PEDRO M MD	12/1/2003	207L00000X	NA	Other	026	PHYSICIANS	54753	41	Internal Medicine	0	In state provider	None	2377 W FOOTHILL BLVD	STE 20	UPLAND	CA	91786	3584	36	06071	34.10690963	-117.6975663	San Bernardino County
144175	Fee-for-Service	1548351471	1548351471	1	1	LESTER, ARNOLD I MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	29800	07	Dermatology	0	In state provider	None	3831 HUGHES AVE	STE 505	CULVER CITY	CA	90232	6859	19	06037	34.02243278	-118.3981492	Los Angeles County
144188	Fee-for-Service	1952563108	1952563108	1	1	LOO, SONJA N MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123220	05	Anesthesiology	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
144193	Fee-for-Service	1730251075	1730251075	1	1	LE, PAUL T MD	9/16/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49944	05	Anesthesiology	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
144202	Fee-for-Service	1740574581	1740574581	1	1	LYSTAD, ERIK MD	8/12/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
144237	Fee-for-Service	1104806330	1104806330	1	1	LANE, FRANCESCA M OD	6/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8706	08	Family Practice	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
144247	Fee-for-Service	1952092884	1952092884	1	1	LAY, CYNTHIA PT	10/31/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
144255	Fee-for-Service	1659820124	1659820124	1	1	LARSON, MEGAN AU	4/27/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	628 CALIFORNIA BLVD	D-1	SAN LUIS OBISPO	CA	93401	2542	40	06079	35.28917428	-120.6578269	San Luis Obispo County
144308	Fee-for-Service	1639217979	1639217979	1	1	LUK, YIN F MD FACS	8/23/2021	208600000X	NA	General Surgery	026	PHYSICIANS	166006	None	None	0	In state provider	None	328 S 1ST STREET	SUITES F AND G	ALHAMBRA	CA	91801	3789	19	06037	34.09104553	-118.1252904	Los Angeles County
144312	Fee-for-Service	1548640899	1548640899	1	1	LUONG, JENNIFER DO	10/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14981	01	General Practice	0	In state provider	None	606 E MILL ST	None	SAN BERNARDINO	CA	92415	0011	36	06071	34.09217051	-117.271935	San Bernardino County
144319	Fee-for-Service	1407847908	1407847908	1	1	LAWRIE, ALISA J MD	7/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77245	40	Pediatrics	0	In state provider	None	5726 LA JOLLA BLVD	STE 107	LA JOLLA	CA	92037	7342	37	06073	32.81639594	-117.2711804	San Diego County
144336	Fee-for-Service	1053486514	1053486514	1	1	LEONARD, JEFFREY A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	28927	13	Neurology (M.D. only)	0	In state provider	A MEDICAL CORPORATION	2833 LOMA VISTA RD	None	VENTURA	CA	93003	1545	56	06111	34.27534273	-119.2580429	Ventura County
144344	Fee-for-Service	1760403455	1760403455	1	1	LARSEN, KAMI A MD	11/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3006 S MARYLAND PKWY	#315	LAS VEGAS	NV	89109	6205	00	None	36.135288	-115.1368705	Clark County
144348	Fee-for-Service	1841483336	1841483336	1	1	LEW, WESLEY K MD	12/26/2007	208600000X	NA	General Surgery	026	PHYSICIANS	94393	02	General Surgery	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
144371	Fee-for-Service	1780758102	1780758102	1	1	LONGENECKER, RICHARD W	6/3/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
144382	Fee-for-Service	1962545863	1962545863	1	1	LEVENSON, JEREMY E MD INC	8/8/2006	193400000X	NA	Other	026	PHYSICIANS	22502	18	Ophthalmology	0	In state provider	None	11645 WILSHIRE BLVD	STE 600	LOS ANGELES	CA	90025	6807	19	06037	34.05005135	-118.4602303	Los Angeles County
144441	Fee-for-Service	1225576259	1225576259	1	1	LIMON, JORGE	4/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	406 9TH AVE STE 208	None	SAN DIEGO	CA	92101	7277	37	06073	32.70964777	-117.1564988	San Diego County
144442	Fee-for-Service	1740486752	1740486752	1	1	LIEBMAN, ROSS F MD	10/10/2008	2084S0012X	NA	Neurology	026	PHYSICIANS	103799	13	Neurology (M.D. only)	0	In state provider	None	701 E 28TH	STE 318	LONG BEACH	CA	90806	2785	19	06037	33.80803441	-118.1847137	Los Angeles County
144459	Fee-for-Service	1073557419	1073557419	1	1	LOPEZ, PEDRO M MD	12/1/2003	207L00000X	NA	Other	026	PHYSICIANS	54753	05	Anesthesiology	0	In state provider	None	2377 W FOOTHILL BLVD	STE 20	UPLAND	CA	91786	3584	36	06071	34.10690963	-117.6975663	San Bernardino County
144482	Fee-for-Service	1588870380	1588870380	1	1	LEV, RAISA MD	12/13/2024	2085N0700X	NA	MRI Provider	026	PHYSICIANS	82723	30	Radiology	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
144566	Fee-for-Service	1174745640	1174745640	1	1	LATT, LEONARD D MD	6/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99828	20	Orthopedic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
144626	Fee-for-Service	1609145036	1609145036	1	1	LAN, FANG MD	10/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131100	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
144647	Fee-for-Service	1679676035	1679676035	1	1	LIN, GEORGE I MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67423	08	Family Practice	0	In state provider	None	1850 S AZUSA AVE	STE 205	HACIENDA HEIGHTS	CA	91745	6853	19	06037	33.98895597	-117.9322797	Los Angeles County
144649	Fee-for-Service	1609845767	1609845767	1	1	LUI, YEE-BUN B MD	2/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87512	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
144661	Fee-for-Service	1013907047	1013907047	1	1	LEE, BYUNG H MD	8/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129773	05	Anesthesiology	0	In state provider	None	450 GREENFIELD AVENUE	None	HANFORD	CA	93230	3722	16	06031	36.328968	-119.6582195	Kings County
144662	Fee-for-Service	1841274750	1841274750	1	1	LORCH, RACHEL H OT	10/11/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
144666	Fee-for-Service	1225092125	1225092125	1	1	LAUGHLINN, MICHAEL W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
144669	Fee-for-Service	1033445135	1033445135	1	1	LOSADA, ELIZABETH M MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111342	40	Pediatrics	0	In state provider	None	3925 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
144706	Fee-for-Service	1558496679	1558496679	1	1	LANIP, MARY S R MFT	12/2/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	46280	-	NOT APPLICABLE	0	In state provider	None	2425 ENBORG LANE	None	SAN JOSE	CA	95128	2648	43	06085	37.31105733	-121.937923	Santa Clara County
144726	Fee-for-Service	1588158893	1588158893	1	1	LIFE HOSPICE INC	11/20/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5101 E LA PALMA AVE	100-P	ANAHEIM	CA	92807	2056	30	06059	33.861852	-117.8056575	Orange County
144791	Fee-for-Service	1396274254	1396274254	1	1	LANGE, STEVEN MD	2/17/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	175894	None	None	0	In state provider	None	150 W. WASHINGTON STREET	None	SAN DIEGO	CA	92103	2005	37	06073	32.74999225	-117.1647027	San Diego County
144796	Fee-for-Service	1033665526	1033665526	1	3	LAGS RECOVERY CENTERS, INC.	6/10/2021	101YA0400X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	135 CARMEN LN	None	SANTA MARIA	CA	93458	7729	42	06083	34.92484952	-120.4374645	Santa Barbara County
144809	Fee-for-Service	1255395398	1255395398	1	1	LIN, HORNG J MD	12/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88657	None	None	0	In state provider	None	1174 CASTRO ST	STE 201	MOUNTAIN VIEW	CA	94040	2569	43	06085	37.3822628	-122.0861276	Santa Clara County
144818	Fee-for-Service	1326241696	1326241696	1	1	LEE, YANG W MD	6/27/2009	193400000X	NA	Other	026	PHYSICIANS	30367	01	General Practice	0	In state provider	None	5981 ATLANTIC AVE	None	LONG BEACH	CA	90805	3510	19	06037	33.86335743	-118.1850869	Los Angeles County
144822	Fee-for-Service	1770994659	1770994659	1	1	LEE, DAVID J DO	5/25/2017	207R00000X	NA	Other	026	PHYSICIANS	15464	41	Internal Medicine	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
144851	Fee-for-Service	1407930407	1407930407	1	1	LIN, ERIC YUH-REN MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85099	24	Plastic Surgery	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
144865	Fee-for-Service	1124230909	1124230909	1	1	LEUIN, SHELBY C MD	12/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112930	04	Otology, Laryngology, Rhinology	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
144874	Fee-for-Service	1295121713	1295121713	1	1	LUBOMIRSKY, BRYAN A MD	4/15/2020	390200000X	NA	Other	026	PHYSICIANS	144871	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
144906	Fee-for-Service	1023561172	1023561172	1	1	LEE, PAUL MD	6/26/2023	207R00000X	NA	Other	026	PHYSICIANS	151228	None	None	0	In state provider	None	10 CONGRESS STREET	200	PASADENA	CA	91105	3023	19	06037	34.13396893	-118.1528162	Los Angeles County
144912	Fee-for-Service	1093886970	1093886970	1	1	LEMAL, PAUL E MD	4/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	41309	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
144940	Fee-for-Service	1649424276	1649424276	1	1	LEE-HENDERSON, MARY H	6/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97639	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
144952	Fee-for-Service	1801206479	1801206479	1	1	LUTFEALI, SHAZIA MD	5/1/2020	207KA0200X	NA	Other	026	PHYSICIANS	164370	03	Allergy	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
144967	Fee-for-Service	1639310154	1639310154	1	1	LEAPS AND BOUNDS FAMILY	6/5/2018	193400000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	COUNSELING CENTER INC	15235 BURBANK BLVD	A3	SHERMAN OAKS	CA	91411	3500	19	06037	34.17211848	-118.465128	Los Angeles County
145004	Fee-for-Service	1760403547	1760403547	1	1	LARSEN, JAMES P MD	8/31/1990	207K00000X	NA	Other	026	PHYSICIANS	50426	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	# 3600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
145013	Fee-for-Service	1588158893	1588158893	1	1	LIFE HOSPICE INC	11/20/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5101 E LA PALMA AVE	100-P	ANAHEIM	CA	92807	2056	30	06059	33.861852	-117.8056575	Orange County
145023	Fee-for-Service	1336279991	1336279991	1	1	LA FRENIERE, MARIE GALE	10/1/2006	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	9535 RESEDA BLVD	SUITE 112	NORTHRIDGE	CA	91324	6022	19	06037	34.243128	-118.5361055	Los Angeles County
145036	Fee-for-Service	1770808719	1770808719	1	1	LIMBO, MARY M MD	1/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119090	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
145051	Fee-for-Service	1932200524	1932200524	1	1	LINZMEYER, KRISTIN M MD	10/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	520 MEDICAL CENTER DR	STE 100	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
145083	Fee-for-Service	1033665526	1033665526	1	3	LAGS RECOVERY CENTERS, INC.	6/10/2021	101YA0400X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	135 CARMEN LN	None	SANTA MARIA	CA	93458	7729	42	06083	34.92484952	-120.4374645	Santa Barbara County
145125	Fee-for-Service	1366451593	1366451593	1	1	LEIBHAM, STEPHEN P MD	5/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	70104	41	Internal Medicine	0	In state provider	None	7590 MIRAMAR RD	STE C	SAN DIEGO	CA	92126	4232	37	06073	32.88443824	-117.1520684	San Diego County
145129	Fee-for-Service	1891713145	1891713145	1	1	LAWSON, ROBERT F MD	4/30/1985	207P00000X	NA	Other	026	PHYSICIANS	50720	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
145192	Fee-for-Service	1538102363	1538102363	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4850 SAN FELIPE RD	None	SAN JOSE	CA	95135	1266	43	06085	37.30018811	-121.7720554	Santa Clara County
145236	Fee-for-Service	1588908388	1588908388	1	1	LOMA LINDA UNIVERSITY MEDICA	1/1/2013	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER-MURRIETA	28062 BAXTER ROAD	None	MURRIETA	CA	92563	1401	33	06065	33.61350847	-117.1691225	Riverside County
145243	Fee-for-Service	1134374275	1134374275	1	1	LEE, PETER K DO	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10635	41	Internal Medicine	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
145245	Fee-for-Service	1417169269	1417169269	1	1	LONG, KEVAN E MD	5/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82620	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
145277	Fee-for-Service	1992770770	1992770770	1	1	LEE, LESTER H MD	5/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90177	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
145294	Fee-for-Service	1073556247	1073556247	2	2	LONGS DRUG STORES CALIFORNIA	2/5/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1960 TICE VALLEY BLVD	None	WALNUT CREEK	CA	94595	2203	07	06013	37.87765203	-122.0733166	Contra Costa County
145318	Fee-for-Service	1063462364	1063462364	1	1	LOVINGER, AARON V MD	7/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	4880 S WYNN RD	None	LAS VEGAS	NV	89103	5406	00	None	36.10169134	-115.1953733	Clark County
145336	Fee-for-Service	1932200524	1932200524	1	1	LINZMEYER, KRISTIN M MD	10/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	520 MEDICAL CENTER DR	STE 100	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
145337	Fee-for-Service	1487062691	1487062691	1	1	LOAIZA, JESUS C LCSW	12/28/2023	390200000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	45926 OASIS ST	None	INDIO	CA	92201	4559	33	06065	33.715512	-116.2207015	Riverside County
145341	Fee-for-Service	1518713072	1518713072	1	1	LABCORP GENETICS INC	8/5/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	1400 16TH ST	None	SAN FRANCISCO	CA	94103	5110	38	06075	37.76620435	-122.4012608	San Francisco County
145348	Fee-for-Service	1821130865	1821130865	1	1	LYELL, DEIRDRE J MD	8/3/2000	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	72758	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
145356	Fee-for-Service	1669797346	1669797346	1	1	LARRY NICKELL JR MD	4/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1390 KELLY JOHNSON BLVD	None	COLORADO SPGS	CO	80920	3908	00	None	38.94541301	-104.8041837	El Paso County
145357	Fee-for-Service	1891167672	1891167672	1	1	LARSON, LESLEY A NP	4/18/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
145359	Fee-for-Service	1821173584	1821173584	1	1	LOVELL, GLENDA N MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73362	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
145372	Fee-for-Service	1033665526	1033665526	1	3	LAGS RECOVERY CENTERS, INC.	7/27/2022	101YA0400X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	135 CARMEN LN	None	SANTA MARIA	CA	93458	7729	42	06083	34.92484952	-120.4374645	Santa Barbara County
145404	Fee-for-Service	1932210523	1932210523	1	1	LEVEY, DOUGLAS I MD	10/31/1993	207R00000X	NA	Other	026	PHYSICIANS	73345	41	Internal Medicine	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
145434	Fee-for-Service	1891798971	1891798971	1	1	LIU, YAO MD	12/9/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	60724	None	None	0	In state provider	None	2300 W SUNNYSIDE AVE	None	VISALIA	CA	93277	7287	54	06107	36.303597	-119.316294	Tulare County
145436	Fee-for-Service	1780674622	1780674622	1	2	LEB, MICHAEL R MD	4/1/1996	174400000X	NA	Other	026	PHYSICIANS	41857	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	PACIFICA WOMEN'S HEALTCR	11101 VENICE BLVD	None	LOS ANGELES	CA	90034	6914	19	06037	34.0137099	-118.4160082	Los Angeles County
145440	Fee-for-Service	1407571938	1407571938	1	1	LABASTIDA TORRES, JACOBO MD	12/20/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	None	1101 CHERRY ST	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
145492	Fee-for-Service	1932260148	1932260148	1	1	LARKIN, LUCY E	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
145516	Fee-for-Service	1821104845	1821104845	1	1	LLOYD, GEOFFREY K DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	7967	08	Family Practice	0	In state provider	None	2121 W MAGNOLIA BLVD	None	BURBANK	CA	91506	1706	19	06037	34.17309265	-118.3314784	Los Angeles County
145519	Fee-for-Service	1881949048	1881949048	1	1	LOWE, IAN J PSYD	2/7/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
145526	Fee-for-Service	1588908388	1588908388	1	1	LOMA LINDA UNIVERSITY MEDICA	1/1/2013	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER-MURRIETA	28062 BAXTER ROAD	None	MURRIETA	CA	92563	1401	33	06065	33.61350847	-117.1691225	Riverside County
145527	Fee-for-Service	1154409043	1154409043	1	1	LEU, YI-SHIAU MD	11/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70540	40	Pediatrics	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
145561	Fee-for-Service	1730240276	1730240276	1	1	LATHAM, KIMBERLY R CRNA	11/23/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
145578	Fee-for-Service	1164431383	1164431383	1	1	LODI MEMORIAL HOSP	11/7/1996	261QR1300X	NA	Rural Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	GALT MEDICAL SERVICES	387 CIVIC DR	None	GALT	CA	95632	2059	34	06067	38.252268	-121.2966855	Sacramento County
145606	Fee-for-Service	1477513349	1477513349	1	1	LEE, SEI J MD	7/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	73480	41	Internal Medicine	0	In state provider	None	1001 POTERO AVENUE	RH22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
145609	Fee-for-Service	1790070522	1790070522	1	1	LOUGEE, MARIEL A MD	10/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144844	01	General Practice	0	In state provider	None	2500 ALHAMBRA AVE	None	MARTINEZ	CA	94553	3156	07	06013	38.00658519	-122.1309063	Contra Costa County
145621	Fee-for-Service	1952453300	1952453300	1	1	LAU, JANICE L OD	1/30/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12650 SABRE SPRINGS PKWY	SUITES 203	SAN DIEGO	CA	92128	4114	37	06073	32.94887812	-117.0963903	San Diego County
145629	Fee-for-Service	1851522015	1851522015	1	3	LA CLINICA DE LA RAZA, INC.	12/30/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	670 W MIDWAY AVE	None	ALAMEDA	CA	94501	7257	01	06001	37.78560733	-122.2991573	Alameda County
145648	Fee-for-Service	1316297799	1316297799	1	1	LIU, XIAOLI MD	9/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122496	38	Geriatrics	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
145652	Fee-for-Service	1578636270	1578636270	1	1	LEMECHA, DOROTHY E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
145659	Fee-for-Service	1033665526	1033665526	1	3	LAGS RECOVERY CENTERS, INC.	6/16/2022	101YA0400X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	135 CARMEN LN	None	SANTA MARIA	CA	93458	7729	42	06083	34.92484952	-120.4374645	Santa Barbara County
145661	Fee-for-Service	1710065537	1710065537	1	1	LEVENTHAL, JANET B MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51502	05	Anesthesiology	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
145702	Fee-for-Service	1285030015	1285030015	1	1	LE, DANA OD	6/17/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14501 MAGNOLIA STREET	SUITE 103	WESTMINSTER	CA	92683	1307	30	06059	33.75188963	-117.9723601	Orange County
145713	Fee-for-Service	1265507073	1265507073	1	1	LEE, DAVID A MD	5/31/1992	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	58084	40	Pediatrics	0	In state provider	None	3850 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1502	38	06075	37.78587201	-122.4578677	San Francisco County
145724	Fee-for-Service	1952345886	1952345886	1	1	LABERGE, JEANNE M MD	1/1/1997	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	46193	01	General Practice	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
145759	Fee-for-Service	1013396274	1013396274	1	1	LEE, ANDY B DO	6/3/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15233	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
145788	Fee-for-Service	1346350493	1346350493	1	1	LEE, TIMOTHY Y MD	4/30/1989	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	60986	41	Internal Medicine	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
145835	Fee-for-Service	1033462064	1033462064	1	1	LOZANO, GUSTAVO LCSW	5/31/2024	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
145855	Fee-for-Service	1558458364	1558458364	1	1	LEE, JOSEPH Y	1/1/1999	207W00000X	NA	Ophthalmology	026	PHYSICIANS	60445	None	None	0	In state provider	None	3920 WILSHIRE BLVD	None	LOS ANGELES	CA	90010	3303	19	06037	34.06166351	-118.312092	Los Angeles County
145858	Fee-for-Service	1477058675	1477058675	1	1	LIM, ANTHONY MD	10/22/2021	207P00000X	NA	Other	026	PHYSICIANS	164965	None	None	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
145865	Fee-for-Service	1164431383	1164431383	1	1	LODI MEMORIAL HOSP	11/7/1996	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	GALT MEDICAL SERVICES	387 CIVIC DR	None	GALT	CA	95632	2059	34	06067	38.252268	-121.2966855	Sacramento County
145866	Fee-for-Service	1861594954	1861594954	1	1	LAI, ROSANNA J MD	8/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75888	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
145874	Fee-for-Service	1184063943	1184063943	1	1	LEE, EUN KYUNG MD	11/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141769	01	General Practice	0	In state provider	None	2601 VIA CAMPO	None	MONTEBELLO	CA	90640	1807	19	06037	34.03278164	-118.1237597	Los Angeles County
145892	Fee-for-Service	1477513349	1477513349	1	1	LEE, SEI J MD	7/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	73480	01	General Practice	0	In state provider	None	1001 POTERO AVENUE	RH22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
145897	Fee-for-Service	1619650314	1619650314	1	1	LINDSAY HEALTHCARE INC	8/15/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	831A N SEQUOIA AVE	None	LINDSAY	CA	93247	1424	54	06107	36.21358715	-119.0961637	Tulare County
145919	Fee-for-Service	1568425148	1568425148	1	1	LI, TSUNG T MD	11/1/1995	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	74650	None	None	0	In state provider	None	2961 SUMMIT ST	STE 1	OAKLAND	CA	94609	3482	01	06001	37.81865235	-122.2647856	Alameda County
145932	Fee-for-Service	1518379007	1518379007	1	1	LOGAN, ANDREW J MD	9/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141755	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
145938	Fee-for-Service	1043287253	1043287253	1	1	LOCK, ROBERT L DO	11/14/1997	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	2000 HIGHWAY 95	STE 200	BULLHEAD CITY	AZ	86442	6057	00	None	35.11494	-114.5975085	Mohave County
145977	Fee-for-Service	1699708271	1699708271	1	1	LIPSCHER, RANDOLPH B MD	5/31/2023	207P00000X	NA	Other	026	PHYSICIANS	172458	None	None	0	In state provider	None	27200 CALAROGA	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
145982	Fee-for-Service	1386706182	1386706182	1	1	LIM, JENNIFER I MD	2/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81961	18	Ophthalmology	0	In state provider	None	960 E GREEN ST	STE 254	PASADENA	CA	91106	2418	19	06037	34.14451994	-118.1301695	Los Angeles County
146001	Fee-for-Service	1023180254	1023180254	1	1	LEE, JIA MING CA	2/8/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1523 IRVING ST	None	SAN FRANCISCO	CA	94122	1908	38	06075	37.76365732	-122.4743604	San Francisco County
146021	Fee-for-Service	1649632308	1649632308	1	1	LEE, CHLOE H DO	3/26/2024	208M00000X	NA	Other	026	PHYSICIANS	21274	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
146028	Fee-for-Service	1245201599	1245201599	1	1	LENSER, DENA A MD	10/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83542	None	None	0	In state provider	None	1400 FLORIDA AVE	STE 202	MODESTO	CA	95350	4445	50	06099	37.66410995	-120.996159	Stanislaus County
146041	Fee-for-Service	1780799403	1780799403	1	1	LEE, CURTIS G MD	11/30/1995	207R00000X	NA	Other	026	PHYSICIANS	50548	41	Internal Medicine	0	In state provider	None	3400 LOMITA BLVD	STE 310	TORRANCE	CA	90505	4921	19	06037	33.81309744	-118.3448635	Los Angeles County
146069	Fee-for-Service	1366723181	1366723181	2	1	LOS FELIZ HOSPICE HEALTH	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE	732 N DIAMOND BAR BLVD	SUITE 228	DIAMOND BAR	CA	91765	1046	19	06037	34.03302363	-117.80804	Los Angeles County
146095	Fee-for-Service	1770527095	1770527095	1	1	LOOMBA, NAVDEEP MD	9/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93212	None	None	0	In state provider	None	15248 11TH STREET	None	VICTORVILLE	CA	92395	3704	36	06071	34.52825401	-117.2925587	San Bernardino County
146142	Fee-for-Service	1194763045	1194763045	1	1	LUTHERAN HOSP	6/11/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1730 W 25TH ST	None	CLEVELAND	OH	44113	3170	00	None	41.487147	-81.7074495	Cuyahoga County
146175	Fee-for-Service	1275584112	1275584112	1	1	LEWIS, ALAN J MD	7/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90976	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
146207	Fee-for-Service	1902827116	1902827116	1	1	LICHTER, JULIAN MD A	2/2/2011	207RP1001X	NA	Pulmonology	026	PHYSICIANS	33711	29	Pulmonary Diseases (M.D. only)	0	In state provider	PROFESSIONAL CORPORATION	501 WASHINGTON ST	STE 508	SAN DIEGO	CA	92103	2231	37	06073	32.74986289	-117.1599343	San Diego County
146215	Fee-for-Service	1750458873	1750458873	1	1	LOFQUIST, FREDERICA S MD	1/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	65301	None	None	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
146219	Fee-for-Service	1518990027	1518990027	1	1	LEVIADIN, PEJMAN D MD	7/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	60515	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
146220	Fee-for-Service	1134380173	1134380173	1	1	LY, ALEX H MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120555	41	Internal Medicine	0	In state provider	None	555 TACHEVAH DRIVE	3W 105	PALM SPRINGS	CA	92262	5747	33	06065	33.83753681	-116.5424435	Riverside County
146227	Fee-for-Service	1548358559	1548358559	1	1	LASSMANN, BRITTA MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110579	77	Infectious Disease	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
146256	Fee-for-Service	1427110329	1427110329	1	1	LIVINGSTON COMMUNITY HEALTH	1/9/1995	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	600 B ST	BUILDING B	LIVINGSTON	CA	95334	9593	24	06047	37.38589253	-120.734559	Merced County
146265	Fee-for-Service	1114029188	1114029188	1	1	LAI, LILY L MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	80261	02	General Surgery	0	In state provider	None	50 BELLEFONTAINE ST	STE 104	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
146333	Fee-for-Service	1073555801	1073555801	2	1	LONGS DRUG STORES CALIFOR	9/15/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	30261 GOLDEN LANTERN	None	LAGUNA NIGUEL	CA	92677	5979	30	06059	33.522948	-117.6858995	Orange County
146334	Fee-for-Service	1922539139	1922539139	1	1	LAVIN, PAUL MD	3/4/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	None	None	None	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
146336	Fee-for-Service	1922172535	1922172535	1	1	LAU, GARRICK C MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81445	05	Anesthesiology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
146358	Fee-for-Service	1366723181	1366723181	2	1	LOS FELIZ HOSPICE HEALTH	1/20/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE	732 N DIAMOND BAR BLVD	SUITE 228	DIAMOND BAR	CA	91765	1046	19	06037	34.03302363	-117.80804	Los Angeles County
146394	Fee-for-Service	1124086988	1124086988	1	1	LU, RONNIE M MD	6/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78049	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
146397	Fee-for-Service	1457857609	1457857609	1	1	LUXENBERG, EVAN J MD	7/17/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	187130	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
146426	Fee-for-Service	1659513414	1659513414	1	1	LU, NANCY T MD	3/31/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61933	None	None	0	In state provider	None	2705 LOMA VISTA RD	None	VENTURA	CA	93003	1581	56	06111	34.27504051	-119.2600018	Ventura County
146428	Fee-for-Service	1194763045	1194763045	1	1	LUTHERAN HOSP	6/11/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1730 W 25TH ST	None	CLEVELAND	OH	44113	3170	00	None	41.487147	-81.7074495	Cuyahoga County
146454	Fee-for-Service	1427110329	1427110329	1	4	LIVINGSTON COMMUNITY HEALTH	3/26/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2141 COLORADO AVE	None	TURLOCK	CA	95382	2011	50	06099	37.51231802	-120.8353115	Stanislaus County
146489	Fee-for-Service	1902827116	1902827116	1	1	LICHTER, JULIAN MD A	2/2/2011	207RP1001X	NA	Pulmonology	026	PHYSICIANS	33711	66	Emergency Medicine (Urgent Care)	0	In state provider	PROFESSIONAL CORPORATION	501 WASHINGTON ST	STE 508	SAN DIEGO	CA	92103	2231	37	06073	32.74986289	-117.1599343	San Diego County
146498	Fee-for-Service	1144438987	1144438987	1	1	LENG, THEODORE MD	6/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106892	18	Ophthalmology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
146509	Fee-for-Service	1548358559	1548358559	1	1	LASSMANN, BRITTA MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110579	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
146527	Fee-for-Service	1548452337	1548452337	1	1	LEE, NAHEE MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101542	05	Anesthesiology	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06287152	-118.2029433	Los Angeles County
146538	Fee-for-Service	1265532014	1265532014	1	1	LIVERMORE MEDICAL CLINIC	10/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	PC	87 FENTON ST	STE 210	LIVERMORE	CA	94550	4159	01	06001	37.676565	-121.7834555	Alameda County
146544	Fee-for-Service	1285228056	1285228056	1	2	LOS ANGELES CARDIOVASCULAR C	4/27/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	None	None	0	In state provider	ARE	1300 N VERMONT AVE	STE 401	LOS ANGELES	CA	90027	6086	19	06037	34.0956033	-118.2916918	Los Angeles County
146549	Fee-for-Service	1538826565	1538826565	1	1	LEA HOME HEALTH	6/12/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6356 VAN NUYS BLVD	STE 232	VAN NUYS	CA	91401	2743	19	06037	34.185861	-118.4487045	Los Angeles County
146551	Fee-for-Service	1427110329	1427110329	1	1	LIVINGSTON COMMUNITY HEALTH	1/9/1995	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	600 B ST	BUILDING B	LIVINGSTON	CA	95334	9593	24	06047	37.38589253	-120.734559	Merced County
146555	Fee-for-Service	1114029188	1114029188	1	1	LAI, LILY L MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	80261	78	Neoplastic Diseases/Oncology	0	In state provider	None	50 BELLEFONTAINE ST	STE 104	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
146618	Fee-for-Service	1720616360	1720616360	1	1	LEWIS BAILEY RESIDENTIAL CAR	9/23/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	FACILITY FOR THE ELDERLY	26364 MALLORY COURT	None	MENIFEE	CA	92584	3818	33	06065	33.65830651	-117.2000357	Riverside County
146622	Fee-for-Service	1043575491	1043575491	1	1	LAU, MARIA M DO	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13675	01	General Practice	0	In state provider	None	1400 NORIEGA ST	None	SAN FRANCISCO	CA	94122	4432	38	06075	37.75415191	-122.4788414	San Francisco County
146656	Fee-for-Service	1750473203	1750473203	1	1	LAI, ROSE K MD	10/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54902	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 3000	LOS ANGELES	CA	90033	5315	19	06037	34.06269295	-118.2030006	Los Angeles County
146666	Fee-for-Service	1407318587	1407318587	1	1	LEE, YOUNG S MD	3/28/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181586	None	None	0	In state provider	None	23815 STUART RANCH ROAD	300	MALIBU	CA	90265	4861	19	06037	34.03957842	-118.6927134	Los Angeles County
146673	Fee-for-Service	1093987364	1093987364	1	1	LINEBERRY, OLENA K MD	1/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129184	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
146692	Fee-for-Service	1871892133	1871892133	1	1	LEE, SAMUEL J MD	8/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123222	25	Physical Medicine and Rehabilitation	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	7303	56	06111	34.27623479	-119.2520218	Ventura County
146701	Fee-for-Service	1043746092	1043746092	1	1	LIMAYE, NIKHIL S MD	7/1/2020	207R00000X	NA	Other	026	PHYSICIANS	163227	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
146740	Fee-for-Service	1427110329	1427110329	1	4	LIVINGSTON COMMUNITY HEALTH	3/26/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2141 COLORADO AVE	None	TURLOCK	CA	95382	2011	50	06099	37.51231802	-120.8353115	Stanislaus County
146764	Fee-for-Service	1043418668	1043418668	1	1	LEE, ONEIL MD	9/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148275	30	Radiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
146765	Fee-for-Service	1487866588	1487866588	1	1	LEE, EDWARD W MD	3/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106255	18	Ophthalmology	0	In state provider	None	4220 W 3RD ST	SUITE 206	LOS ANGELES	CA	90020	3450	19	06037	34.0689595	-118.306251	Los Angeles County
146787	Fee-for-Service	1386286789	1386286789	1	1	LEWIS, JENNIFER LMFT	7/16/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	180 17TH STREET	None	PACIFIC GROVE	CA	93950	0545	27	06053	36.62199223	-121.9186759	Monterey County
146793	Fee-for-Service	1588984611	1588984611	1	1	LEE-KLASS, IRENE H MD	1/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118610	08	Family Practice	0	In state provider	None	2020 SUTTER PLACE	SUITE 101	DAVIS	CA	95616	6213	57	06113	38.56287659	-121.7715536	Yolo County
146814	Fee-for-Service	1396877361	1396877361	1	1	LARRATT-SMITH, JENNIFER H	5/24/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
146822	Fee-for-Service	1265532014	1265532014	1	1	LIVERMORE MEDICAL CLINIC	10/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	PC	87 FENTON ST	STE 210	LIVERMORE	CA	94550	4159	01	06001	37.676565	-121.7834555	Alameda County
146831	Fee-for-Service	1427110329	1427110329	1	1	LIVINGSTON COMMUNITY HEALTH	7/1/1994	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	600 B ST	BUILDING B	LIVINGSTON	CA	95334	9593	24	06047	37.38589253	-120.734559	Merced County
146846	Fee-for-Service	1124035159	1124035159	1	1	LA CLINICA DE LA RAZA	6/1/2005	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	FAMIY OPTICAL I	3060 E 9TH ST	STE B	OAKLAND	CA	94601	2925	01	06001	37.774259	-122.2304173	Alameda County
146863	Fee-for-Service	1639517444	1639517444	1	1	LEVINE, MICHAEL N MD	4/5/2021	2086S0129X	NA	General Surgery	026	PHYSICIANS	137048	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
146876	Fee-for-Service	1508145863	1508145863	1	1	LAM, LINDA H MD	6/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117820	41	Internal Medicine	0	In state provider	None	10 WOODLAND RD	None	ST HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
146877	Fee-for-Service	1194466417	1194466417	1	1	LEE, REBECCA	10/18/2023	390200000X	NA	Other	026	PHYSICIANS	21597	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
146882	Fee-for-Service	1548788235	1548788235	1	1	LANSON TT CORP	10/30/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14211 EUCLID ST	STE A	GARDEN GROVE	CA	92843	4992	30	06059	33.757191	-117.937638	Orange County
146912	Fee-for-Service	1487693909	1487693909	1	1	LEVY, JEFFREY H MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49361	05	Anesthesiology	0	In state provider	None	2000 VALE RD	None	SAN PABLO	CA	94806	3808	07	06013	37.95393251	-122.3375029	Contra Costa County
146913	Fee-for-Service	1467913848	1467913848	1	1	LIEDERBAUER, ERIK MD	7/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	320 SANTA FE DRIVE	107-B	ENCINITAS	CA	92024	1334	37	06073	33.038847	-117.285579	San Diego County
146925	Fee-for-Service	1346316403	1346316403	1	1	LAZARK, HEATHER M	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
146935	Fee-for-Service	1720266042	1720266042	1	1	LANGDON, DAVID B MD	8/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94462	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
146940	Fee-for-Service	1437172970	1437172970	1	1	LUU, VICTOR N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	48045	01	General Practice	0	In state provider	None	624 W DUARTE RD	STE 205	ARCADIA	CA	91007	9260	19	06037	34.12637452	-118.0527313	Los Angeles County
146946	Fee-for-Service	1275797409	1275797409	1	2	LTP GENERATIONS LLC	2/7/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	309 MACARTHUR BLVD	None	OAKLAND	CA	94610	3233	01	06001	37.81428418	-122.2515188	Alameda County
146955	Fee-for-Service	1962896860	1962896860	1	1	LI, TING MD	8/24/2020	208M00000X	NA	Other	026	PHYSICIANS	167755	41	Internal Medicine	0	In state provider	None	5250 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91601	3186	19	06037	34.1665161	-118.3755868	Los Angeles County
146962	Fee-for-Service	1093987364	1093987364	1	1	LINEBERRY, OLENA K MD	1/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129184	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
146972	Fee-for-Service	1811004625	1811004625	1	1	LALEZARZADEH, FARIBORZ	7/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8309	02	General Surgery	0	In state provider	MD	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
146973	Fee-for-Service	1144534876	1144534876	1	1	LIAO, KEVIN DO	7/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14967	01	General Practice	0	In state provider	None	8110 MANGO AVE	None	FONTANA	CA	92335	3603	36	06071	34.10549796	-117.4314604	San Bernardino County
147037	Fee-for-Service	1801087309	1801087309	1	1	LESSER, LENARD I MD	10/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106722	08	Family Practice	0	In state provider	None	1920 COLORADO BLVD	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
147062	Fee-for-Service	1588735807	1588735807	1	1	LIN, DAVID B PHD	9/27/2006	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
147063	Fee-for-Service	1881015170	1881015170	1	1	LOPEZ, CECILIA M LMFT	10/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	104025	-	NOT APPLICABLE	0	In state provider	None	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	43	06085	37.34293689	-121.9270392	Santa Clara County
147101	Fee-for-Service	1689780090	1689780090	1	1	LAWRENCE J WIELAND MD	3/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2350 BUHNE ST	STE A	EUREKA	CA	95501	3205	12	06023	40.78592523	-124.1422103	Humboldt County
147111	Fee-for-Service	1265532014	1265532014	1	1	LIVERMORE MEDICAL CLINIC	10/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	PC	87 FENTON ST	STE 210	LIVERMORE	CA	94550	4159	01	06001	37.676565	-121.7834555	Alameda County
147119	Fee-for-Service	1427110329	1427110329	1	1	LIVINGSTON COMMUNITY HEALTH	3/1/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	600 B ST	BUILDING B	LIVINGSTON	CA	95334	9593	24	06047	37.38589253	-120.734559	Merced County
147138	Fee-for-Service	1508845181	1508845181	1	1	LUNDQUIST, ERIK J MD	5/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104950	08	Family Practice	0	In state provider	None	28780 SINGLE OAK DRIVE	STE 160	TEMECULA	CA	92590	5528	33	06065	33.49890392	-117.1612965	Riverside County
147140	Fee-for-Service	1124035159	1124035159	1	1	LA CLINICA DE LA RAZA	6/1/2005	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	FAMIY OPTICAL I	3060 E 9TH ST	STE B	OAKLAND	CA	94601	2925	01	06001	37.774259	-122.2304173	Alameda County
147156	Fee-for-Service	1891132254	1891132254	1	1	LANDIS, BRANDI R MD	7/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	5400 SOUTH RAINBOW BLVD	None	LAS VEGAS	NV	89118	1859	00	None	36.090072	-115.2405585	Clark County
147170	Fee-for-Service	1487738464	1487738464	1	1	LAURBERG, BJOERN MD	9/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	62239	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
147186	Fee-for-Service	1629559299	1629559299	2	1	LARKIN, WILLIAM LCSW	10/4/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NICAL SOCIAL WORKER	4045 BAYBERRY DR	None	CHINO HILLS	CA	91709	3311	36	06071	33.96645551	-117.7161658	San Bernardino County
147216	Fee-for-Service	1619372265	1619372265	1	1	LEIGH, VICTORIA L DO	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13640	41	Internal Medicine	0	In state provider	None	1095 IRVINE BLVD	None	TUSTIN	CA	92780	3526	30	06059	33.74821163	-117.8097851	Orange County
147228	Fee-for-Service	1437172970	1437172970	1	1	LUU, VICTOR N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	48045	40	Pediatrics	0	In state provider	None	624 W DUARTE RD	STE 205	ARCADIA	CA	91007	9260	19	06037	34.12637452	-118.0527313	Los Angeles County
147245	Fee-for-Service	1700349842	1700349842	1	1	LOWRY, CASSANDRA DO	10/18/2023	390200000X	NA	Other	026	PHYSICIANS	21261	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
147282	Fee-for-Service	1881797140	1881797140	1	1	LADDARAN, BENITO MD	4/11/1995	2085U0001X	NA	Other	026	PHYSICIANS	36591	30	Radiology	0	In state provider	None	2105 BEVERLY BLVD	STE 117	LOS ANGELES	CA	90057	2216	19	06037	34.06682861	-118.2706286	Los Angeles County
147302	Fee-for-Service	1376640664	1376640664	1	1	LEWIS, SCOTT A OD	6/9/1993	152WC0802X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	24400 JACKSON AVE	STE A	MURRIETA	CA	92562	1987	33	06065	33.57240222	-117.2050098	Riverside County
147305	Fee-for-Service	1396277364	1396277364	1	1	LIU, FRED X MD	10/15/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	158767	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
147306	Fee-for-Service	1609882851	1609882851	1	1	LIN, SIMON J MD	10/31/1984	207L00000X	NA	Other	026	PHYSICIANS	40358	05	Anesthesiology	0	In state provider	None	9080 COLIMA ROAD	None	WHITTIER	CA	90605	1898	19	06037	33.95062799	-118.0051627	Los Angeles County
147326	Fee-for-Service	1801087309	1801087309	1	1	LESSER, LENARD I MD	10/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106722	41	Internal Medicine	0	In state provider	None	1920 COLORADO BLVD	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
147336	Fee-for-Service	1881797744	1881797744	1	1	LEE, SANG KI MD	11/30/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	38087	41	Internal Medicine	0	In state provider	None	5150 GRAVES AVE	STE 4	SAN JOSE	CA	95129	5004	43	06085	37.29450218	-121.9927703	Santa Clara County
147349	Fee-for-Service	1285822932	1285822932	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1496 EAST AVE	None	CHICO	CA	95926	1610	04	06007	39.7611985	-121.8156885	Butte County
147357	Fee-for-Service	1700100732	1700100732	1	1	LAU, TSANG MD	2/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149776	41	Internal Medicine	0	In state provider	None	1420 S CENTRAL AVENUE	None	GLENDALE	CA	91204	1000	19	06037	34.12811155	-118.2577764	Los Angeles County
147389	Fee-for-Service	1689780090	1689780090	1	1	LAWRENCE J WIELAND MD	3/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2350 BUHNE ST	STE A	EUREKA	CA	95501	3205	12	06023	40.78592523	-124.1422103	Humboldt County
147408	Fee-for-Service	1114964228	1114964228	1	1	LERNER, CARLOS F MD	3/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98508	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
147412	Fee-for-Service	1033665526	1033665526	1	4	LAGS RECOVERY CENTERS, INC.	1/26/2023	101YA0400X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	801 E CHAPEL ST	1-6	SANTA MARIA	CA	93454	4607	42	06083	34.9542915	-120.424455	Santa Barbara County
147447	Fee-for-Service	1013271568	1013271568	1	1	LIU, FAN MD	5/21/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	170199	None	None	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
147449	Fee-for-Service	1972741379	1972741379	1	1	LUNA, BRENDA R LCSW	1/23/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
147453	Fee-for-Service	1487738464	1487738464	1	1	LAURBERG, BJOERN MD	9/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	62239	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
147460	Fee-for-Service	1316421746	1316421746	1	1	LEE, MYUNG JAE OT	9/7/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3413 W PACIFIC AVE	100, 200	BURBANK	CA	91505	1555	19	06037	34.18839272	-118.3485967	Los Angeles County
147468	Fee-for-Service	1063649242	1063649242	1	1	LLANO DIALYSIS, LLC	1/1/2010	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	10690 SAN PABLO AVE	None	EL CERRITO	CA	94530	2620	07	06013	37.91248718	-122.3093002	Contra Costa County
147483	Fee-for-Service	1568664399	1568664399	1	1	LEE, ROLAND L MD	10/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92443	45	Nephrology (Renal-Kidney)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
147487	Fee-for-Service	1881088433	1881088433	1	1	LEE, JOHN H MD	10/30/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	148758	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
147523	Fee-for-Service	1386838233	1386838233	1	1	LONDON, TAMIKA R PHD	7/16/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
147542	Fee-for-Service	1316390735	1316390735	1	1	LLANES, ARTHUR S CRNA	7/14/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
147610	Fee-for-Service	1861056616	1861056616	1	1	LORIAN HEALTH HOSPICE, INC	6/16/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	9325 SKY PARK COURT	SUITE 350	SAN DIEGO	CA	92123	4383	37	06073	32.81656138	-117.1244388	San Diego County
147630	Fee-for-Service	1063499200	1063499200	1	1	LACERA, JACQUELYN V MD	6/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	76173	08	Family Practice	0	In state provider	None	830 MAGNOLIA AVE	None	CORONA	CA	92879	3128	33	06065	33.86017131	-117.5520534	Riverside County
147632	Fee-for-Service	1538366844	1538366844	1	1	LIANG, PAULYNNE P MD INC	5/1/1998	193400000X	NA	Other	026	PHYSICIANS	66406	41	Internal Medicine	0	In state provider	INC	1211 W LA PALMA AVE	STE 303	ANAHEIM	CA	92801	2811	30	06059	33.84718298	-117.933758	Orange County
147659	Fee-for-Service	1396215299	1396215299	1	1	LOPEZ, JENNIFER LCSW	9/9/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
147674	Fee-for-Service	1306220157	1306220157	1	1	LACY, KIMBERLY A LMFT	5/30/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
147678	Fee-for-Service	1235102252	1235102252	2	1	LOGAN, AVIS E MD	11/30/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	73867	08	Family Practice	0	In state provider	None	2790 S ELM AVE	None	FRESNO	CA	93706	5435	10	06019	36.700533	-119.7908665	Fresno County
147691	Fee-for-Service	1316496375	1316496375	1	1	LOW, BRYAN T PT	4/14/2020	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	81 CERNON STREET	None	VACAVILLE	CA	95688	2803	48	06095	38.36102104	-121.9906107	Solano County
147696	Fee-for-Service	1033665526	1033665526	1	4	LAGS RECOVERY CENTERS, INC.	1/26/2023	101YA0400X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	801 E CHAPEL ST	1-6	SANTA MARIA	CA	93454	4607	42	06083	34.9542915	-120.424455	Santa Barbara County
147727	Fee-for-Service	1457428427	1457428427	1	2	LONIKA'S HOME, INC	1/9/2004	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LONIKA HOME SPARTAN	24371 SPARTAN ST	None	MISSION VIEJO	CA	92691	3920	30	06059	33.60828891	-117.6843804	Orange County
147736	Fee-for-Service	1548905391	1548905391	1	1	LEGACY ADVANCED NURSING PRAC	12/29/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	TICE INCORPORATED	710 EUCLID ST	SUITE 208	ANAHEIM	CA	92801	4122	30	06059	33.8420837	-117.9415765	Orange County
147749	Fee-for-Service	1144425364	1144425364	1	1	LANGSTON, SABAH M DO	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11377	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9041 MAGNOLIA AVE	STE 305	RIVERSIDE	CA	92503	3957	33	06065	33.92541585	-117.4378266	Riverside County
147751	Fee-for-Service	1932283918	1932283918	1	1	LAKSHMANAN, HARI MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67295	25	Physical Medicine and Rehabilitation	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
147771	Fee-for-Service	1568664399	1568664399	1	1	LEE, ROLAND L MD	10/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92443	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
147781	Fee-for-Service	1336132919	1336132919	1	1	LIT, EUGENE S MD	5/22/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79201	18	Ophthalmology	0	In state provider	None	3300 TELEGRAPH AVE	None	OAKLAND	CA	94609	3028	01	06001	37.82176506	-122.266417	Alameda County
147787	Fee-for-Service	1841421328	1841421328	1	1	LUCKS, BONNIE D PHD	9/30/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7200 PARKWAY DR	STE 113	LA MESA	CA	91942	1534	37	06073	32.77297454	-117.0419524	San Diego County
147793	Fee-for-Service	1376572743	1376572743	1	1	LEUNG, DENNIS W OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	310 BARBER CT	None	MILPITAS	CA	95035	7922	43	06085	37.42206986	-121.9181098	Santa Clara County
147795	Fee-for-Service	1225327349	1225327349	1	1	LAW, NANCY DO	6/14/2017	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	15618	77	Infectious Disease	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
147811	Fee-for-Service	1205913969	1205913969	1	1	LEE, RAYMOND W MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66832	None	None	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
147828	Fee-for-Service	1235289059	1235289059	1	1	LOREY, THOMAS S. MD	2/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	73424	22	Pathology (M.D. only)	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
147850	Fee-for-Service	1780641324	1780641324	1	1	LJUNG, BRITT-MARIE E MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	37614	90	Pathology-Forensic	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
147867	Fee-for-Service	1104860543	1104860543	2	1	LONGS DRUG STORE CA, INC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1750 41ST AVE	None	CAPITOLA	CA	95010	2503	44	06087	36.974772	-121.9648335	Santa Cruz County
147871	Fee-for-Service	1417975392	1417975392	1	1	LIN, ROSE H MD	9/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90043	41	Internal Medicine	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
147899	Fee-for-Service	1861056616	1861056616	1	1	LORIAN HEALTH HOSPICE, INC	6/16/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	9325 SKY PARK COURT	SUITE 350	SAN DIEGO	CA	92123	4383	37	06073	32.81656138	-117.1244388	San Diego County
147919	Fee-for-Service	1457632333	1457632333	1	1	LEE, JENNIFER H LCSW	6/23/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
147921	Fee-for-Service	1629438064	1629438064	1	1	LASERMD PAIN RELIEF, INC.	4/4/2018	261QP3300X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	2809 N SEPULVEDA BLVD	SUITE C	MANHATTAN BEACH	CA	90266	2727	19	06037	33.89654236	-118.3961215	Los Angeles County
147937	Fee-for-Service	1255903266	1255903266	1	1	LEIBOVITCH, SARAH MD	3/5/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183165	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
147983	Fee-for-Service	1033665526	1033665526	1	4	LAGS RECOVERY CENTERS, INC.	1/26/2023	101YA0400X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	801 E CHAPEL ST	1-6	SANTA MARIA	CA	93454	4607	42	06083	34.9542915	-120.424455	Santa Barbara County
148050	Fee-for-Service	1912438664	1912438664	1	1	LEE, JOSHUA A MD	2/8/2021	207P00000X	NA	Other	026	PHYSICIANS	157703	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
148051	Fee-for-Service	1518041029	1518041029	1	1	LOPEZ, FABIAN A MD	4/20/2020	174400000X	NA	Other	026	PHYSICIANS	55182	41	Internal Medicine	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
148058	Fee-for-Service	1336116854	1336116854	1	1	LEZINE-HANNA, JACQUELINE T M	7/28/2009	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	80690	None	None	0	In state provider	T MD	4644 LINCOLN BLVD	STE 101	MARINA DEL REY	CA	90292	6374	19	06037	33.98210351	-118.4405172	Los Angeles County
148064	Fee-for-Service	1518175637	1518175637	1	1	LOTAN, ROI M MD	12/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144854	30	Radiology	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
148072	Fee-for-Service	1013200278	1013200278	1	1	LOPES DE MENEZES, DAVINA E	9/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130581	40	Pediatrics	0	In state provider	MD	222 W 39TH AVE	None	SAN MATEO	CA	94403	4304	41	06081	37.53039072	-122.2987772	San Mateo County
148075	Fee-for-Service	1396844379	1396844379	1	1	LIM, KHENG, J MD	12/6/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53548	40	Pediatrics	0	In state provider	None	9209 COLIMA RD	STE 4200	WHITTIER	CA	90605	1827	19	06037	33.9505367	-118.0054552	Los Angeles County
148078	Fee-for-Service	1962899823	1962899823	1	1	LERNER, JONATHAN I	8/14/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	146035	None	None	0	In state provider	None	765 MEDICAL CENTER CT	STE 211	CHULA VISTA	CA	91911	6656	37	06073	32.619069	-117.020835	San Diego County
148099	Fee-for-Service	1578615910	1578615910	1	1	LAM, AMY W OD	5/7/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	23206 LYONS AVE	STE 102	NEWHALL	CA	91321	2671	19	06037	34.37981956	-118.5384385	Los Angeles County
148141	Fee-for-Service	1780641324	1780641324	1	1	LJUNG, BRITT-MARIE E MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	37614	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
148153	Fee-for-Service	1891180188	1891180188	1	1	LEE, GRACE J MD	9/9/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	143773	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
148160	Fee-for-Service	1114998622	1114998622	1	1	LI, DAWSON T OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1002 WIBLE RD	None	BAKERSFIELD	CA	93304	4137	15	06029	35.344476	-119.038922	Kern County
148181	Fee-for-Service	1770581381	1770581381	1	1	LE, LISA K MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	70998	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 RESERVOIR DR	STE 210	SAN DIEGO	CA	92120	5185	37	06073	32.77628471	-117.0563688	San Diego County
148216	Fee-for-Service	1437497831	1437497831	1	1	LA MOBILE ULTRASOUND	5/31/2013	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2211 W MAGNOLIA	#205 B	BURBANK	CA	91506	1753	19	06037	34.1728873	-118.3320905	Los Angeles County
148219	Fee-for-Service	1396045985	1396045985	1	1	LATIGUE, KIMBERLY	2/8/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
148227	Fee-for-Service	1285212837	1285212837	1	1	LEE, CLARENCE D MD	5/24/2024	207R00000X	NA	Other	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	3500 LOMITA BLVD	300, 302, M100	TORRANCE	CA	90505	5038	19	06037	33.81384593	-118.3465974	Los Angeles County
148233	Fee-for-Service	1396045613	1396045613	1	1	LAM, CUONG H MD	5/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110731	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
148265	Fee-for-Service	1336228469	1336228469	1	1	LIVELY, ALICE J DO	1/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8708	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
148291	Fee-for-Service	1053999003	1053999003	1	1	LONGEVITY BOARD AND CARE	2/3/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	10348 LARAMIE STREET	None	CHATSWORTH	CA	91311	2530	19	06037	34.25886632	-118.5728353	Los Angeles County
148309	Fee-for-Service	1225190721	1225190721	1	1	LIANG, ADA XIYANG	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	114 WESTDALE AVE	None	DALY CITY	CA	94015	1024	41	06081	37.70647864	-122.4804456	San Mateo County
148345	Fee-for-Service	1972512127	1972512127	1	1	LEE, KRISTEN A OD	9/24/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10614 LOWER AZUSA RD	None	EL MONTE	CA	91731	1210	19	06037	34.09235767	-118.0371362	Los Angeles County
148371	Fee-for-Service	1649346164	1649346164	1	1	LUCERO, JENNIFER M MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82431	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
148382	Fee-for-Service	1891721171	1891721171	1	1	LIAU, CHIANG-YUAN C MD	2/8/2015	207N00000X	NA	Dermatology	026	PHYSICIANS	31031	08	Family Practice	0	In state provider	None	550 N MONTEREY AVE	None	ONTARIO	CA	91764	3318	36	06071	34.069239	-117.642987	San Bernardino County
148408	Fee-for-Service	1952969065	1952969065	1	1	LEE, MARIANA V OT	9/27/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	403 W ADAMS BLVD	None	LOS ANGELES	CA	90007	2664	19	06037	34.02741539	-118.2743622	Los Angeles County
148413	Fee-for-Service	1205238193	1205238193	1	1	LIN, WESLEY H MD	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130817	40	Pediatrics	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
148428	Fee-for-Service	1326231010	1326231010	1	1	LACEY, TARA D NP	4/7/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
148452	Fee-for-Service	1578976593	1578976593	1	1	LIM, SIMON CHRISTOPHER L MD	9/14/2017	207R00000X	NA	Other	026	PHYSICIANS	143236	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
148468	Fee-for-Service	1770581381	1770581381	1	1	LE, LISA K MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	70998	40	Pediatrics	0	In state provider	None	5555 RESERVOIR DR	STE 210	SAN DIEGO	CA	92120	5185	37	06073	32.77628471	-117.0563688	San Diego County
148514	Fee-for-Service	1548722796	1548722796	1	1	LABARBERA, MICHAEL MD	8/28/2024	208M00000X	NA	Other	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
148525	Fee-for-Service	1932129780	1932129780	1	1	LOOMBA, DAVE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	94674	05	Anesthesiology	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
148544	Fee-for-Service	1922019348	1922019348	1	1	LEE, SEUNG M	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	68956	40	Pediatrics	0	In state provider	None	2030-1 W PICO BLVD	None	LOS ANGELES	CA	90006	5011	19	06037	34.04706445	-118.2822723	Los Angeles County
148573	Fee-for-Service	1528270998	1528270998	1	1	LATONA, ZITA R MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	94914	01	General Practice	0	In state provider	None	2400 BALFOUR ROAD	SUITE 120	BRENTWOOD	CA	94513	4956	07	06013	37.92519383	-121.734461	Contra Costa County
148602	Fee-for-Service	1366408460	1366408460	1	1	LE, HIEN S MD	9/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86945	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
148647	Fee-for-Service	1942369517	1942369517	1	1	LAFOND, STEVEN A MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75258	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
148649	Fee-for-Service	1578117776	1578117776	1	1	LIFE TO LIFE HOSPICE CARE	8/21/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	905 S LAKE ST	UNIT 203	BURBANK	CA	91502	2436	19	06037	34.1695314	-118.3061352	Los Angeles County
148657	Fee-for-Service	1932726791	1932726791	1	1	LI, SHUNING MD	6/28/2023	208M00000X	NA	Other	026	PHYSICIANS	186898	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
148669	Fee-for-Service	1891721171	1891721171	1	1	LIAU, CHIANG-YUAN C MD	2/8/2015	207N00000X	NA	Dermatology	026	PHYSICIANS	31031	07	Dermatology	0	In state provider	None	550 N MONTEREY AVE	None	ONTARIO	CA	91764	3318	36	06071	34.069239	-117.642987	San Bernardino County
148680	Fee-for-Service	1609922996	1609922996	1	1	LANZI, BETH K	2/8/2015	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	665 F STREET	STE B	ARCATA	CA	95521	6364	12	06023	40.86666737	-124.0854964	Humboldt County
148685	Fee-for-Service	1265792949	1265792949	1	1	LENNOX, JASON J LMFT	6/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
148687	Fee-for-Service	1861569683	1861569683	1	1	LEE, JENNET C MD	11/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91214	45	Nephrology (Renal-Kidney)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
148699	Fee-for-Service	1639674450	1639674450	1	1	LA BARBA, DEAN MD	12/23/2019	390200000X	NA	Other	026	PHYSICIANS	164661	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
148710	Fee-for-Service	1043257769	1043257769	1	1	LAM, EUGENE C MD	4/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	83230	10	Gastroenterology (M.D. only)	0	In state provider	None	2001 SANTA MONICA BLVD	STE 360W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
148723	Fee-for-Service	1285178491	1285178491	1	1	LIGHT OF HOPE COUNSELING SER	8/20/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	108 ORANGE STREET	STE B	REDLANDS	CA	92373	4719	36	06071	34.056972	-117.182554	San Bernardino County
148735	Fee-for-Service	1063617900	1063617900	1	1	LAWSON, ERIN F	9/17/2008	207L00000X	NA	Other	026	PHYSICIANS	104867	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
148743	Fee-for-Service	1720393242	1720393242	1	1	LIANG, ADELEINE C PSYD	4/29/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8775 AERO DRIVE	STE 238	SAN DIEGO	CA	92123	1756	37	06073	32.80965551	-117.1391563	San Diego County
148764	Fee-for-Service	1790052728	1790052728	1	1	LOWENTHAL, JULIA K NP	7/10/2020	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
148770	Fee-for-Service	1275631434	1275631434	1	1	LOS ANGELES INSTITUTE	8/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	FOR OPHTHALMIC SURGERY	5363 BALBOA BLVD	STE 545	ENCINO	CA	91316	2854	19	06037	34.169058	-118.5011265	Los Angeles County
148771	Fee-for-Service	1316783012	1316783012	1	1	L&H MEDICAL GROUP INC	2/14/2025	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	725 S GLENDALE AVE STE G	None	GLENDALE	CA	91205	4147	19	06037	34.13774391	-118.2513154	Los Angeles County
148803	Fee-for-Service	1932121209	1932121209	1	1	LEVINE, ARTHUR MD	5/1/1998	207L00000X	NA	Other	026	PHYSICIANS	81113	05	Anesthesiology	0	In state provider	None	3857 BIRCH ST	STE 709	NEWPORT BEACH	CA	92660	2616	30	06059	33.66332364	-117.8712141	Orange County
148813	Fee-for-Service	1427387869	1427387869	1	1	LIU, JONATHAN C MD INC	3/9/2010	193400000X	NA	Other	026	PHYSICIANS	97174	02	General Surgery	0	In state provider	None	518 N COURT	STE B	VISALIA	CA	93291	4913	54	06107	36.334548	-119.292057	Tulare County
148814	Fee-for-Service	1750368700	1750368700	1	1	LABORATORY CORPORATION OF AM	1/18/2019	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	ERICA HOLDINGS	1912 TW ALEXANDER DR	None	RTP	NC	27709	0150	00	None	35.91900174	-78.82559066	Durham County
148823	Fee-for-Service	1689989733	1689989733	1	1	LEE, ROBERTA MD	6/1/2021	208600000X	NA	General Surgery	026	PHYSICIANS	62669	None	None	0	In state provider	None	3536 MENDOCINO AVE	STE 200	SANTA ROSA	CA	95403	3634	49	06097	38.473326	-122.725935	Sonoma County
148826	Fee-for-Service	1174928097	1174928097	1	1	LE, TAM MD PC	11/10/2014	193400000X	NA	Other	026	PHYSICIANS	117637	41	Internal Medicine	0	In state provider	None	199 E WEBSTER ST	None	COLUSA	CA	95932	2954	06	06011	39.20737704	-122.0004043	Colusa County
148858	Fee-for-Service	1407301989	1407301989	1	1	LAMA, TENZIN D NP	10/9/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
148896	Fee-for-Service	1972663896	1972663896	1	1	LAM, LINDA A MD	4/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90448	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	STE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
148928	Fee-for-Service	1932164720	1932164720	1	1	LOPOPOLO, CHRISTINE M MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81973	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	35 CASA STREET	STE 130	SAN LUIS OBISPO	CA	93405	1887	40	06079	35.29359615	-120.6654304	San Luis Obispo County
148936	Fee-for-Service	1578117776	1578117776	1	1	LIFE TO LIFE HOSPICE CARE	8/21/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	905 S LAKE ST	UNIT 203	BURBANK	CA	91502	2436	19	06037	34.1695314	-118.3061352	Los Angeles County
148945	Fee-for-Service	1881082329	1881082329	1	1	LIFELONG MEDICAL CARE	4/28/2015	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	10700 MACARTHUR BLVD	SUITE 14B	OAKLAND	CA	95605	5260	01	06001	37.74201242	-122.151048	Alameda County
148957	Fee-for-Service	1891721171	1891721171	1	1	LIAU, CHIANG-YUAN C MD	2/8/2015	207N00000X	NA	Dermatology	026	PHYSICIANS	31031	01	General Practice	0	In state provider	None	550 N MONTEREY AVE	None	ONTARIO	CA	91764	3318	36	06071	34.069239	-117.642987	San Bernardino County
148974	Fee-for-Service	1861569683	1861569683	1	1	LEE, JENNET C MD	11/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91214	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
149002	Fee-for-Service	1114176674	1114176674	1	1	LEVINSOHN, DANIEL E MD	1/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121183	18	Ophthalmology	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
149011	Fee-for-Service	1326092800	1326092800	1	1	LOPEZ, JAIME MD INC	3/31/1987	193400000X	NA	Other	026	PHYSICIANS	50641	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8135 S PAINTER AVE	STE 205	WHITTIER	CA	90602	3170	19	06037	33.965829	-118.032738	Los Angeles County
149091	Fee-for-Service	1770977027	1770977027	1	1	LADD, SCOTT E DO	8/13/2015	207R00000X	NA	Other	026	PHYSICIANS	13780	None	None	0	In state provider	None	301 VICTORIA ST	None	COSTA MESA	CA	92627	1992	30	06059	33.65258952	-117.9121545	Orange County
149092	Fee-for-Service	1154933034	1154933034	1	1	LIM, ANDREW S MD	10/9/2020	2085R0001X	NA	Other	026	PHYSICIANS	169906	30	Radiology	0	In state provider	None	200 MEDICAL PLAZA	STE B265	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
149100	Fee-for-Service	1184875684	1184875684	1	1	LOS ANGELES SLEEP DISORDERS	1/30/2018	291U00000X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	GROUP	331 HUGHES AVENUE	STE 510	CULVER CITY	CA	90232	6856	19	06037	34.023267	-118.39878	Los Angeles County
149101	Fee-for-Service	1497049753	1497049753	1	1	LEE, LARRY V MD	7/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143094	20	Orthopedic Surgery	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
149145	Fee-for-Service	1174006985	1174006985	1	1	LAKESIDE FAMILY COUNSELING &	5/30/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INTERVENTION SERVICES	1500 PALMA DR	SUITE #230	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
149224	Fee-for-Service	1669684072	1669684072	1	1	LUO, CAESAR K MD	9/5/2017	207W00000X	NA	Ophthalmology	026	PHYSICIANS	148441	18	Ophthalmology	0	In state provider	None	122 LA CASA VIA	STE 223	WALNUT CREEK	CA	94598	3014	07	06013	37.91198028	-122.041845	Contra Costa County
149237	Fee-for-Service	1063188670	1063188670	1	1	LAHUYNH, JONATHAN NP	3/6/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8851 CENTER DR	STE 505	LA MESA	CA	91942	3032	37	06073	32.78189749	-117.0075062	San Diego County
149322	Fee-for-Service	1245942440	1245942440	1	1	LATERNEAU, VANESSA J LPCC	7/31/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3186 VISTA WAY	304	OCEANSIDE	CA	92056	3631	37	06073	33.18250958	-117.3219375	San Diego County
149363	Fee-for-Service	1962419549	1962419549	1	1	LUKAS, BRIAN PSYD	5/25/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1035 SAN PABLO AVE	SUITE 8	ALBANY	CA	94706	2277	01	06001	37.88531142	-122.2973343	Alameda County
149371	Fee-for-Service	1760656417	1760656417	1	1	LEE, GARY A OD APC	9/24/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10614 LOWER AZUSA RD	None	EL MONTE	CA	91731	1210	19	06037	34.09235767	-118.0371362	Los Angeles County
149382	Fee-for-Service	1831266790	1831266790	1	1	LOPEZ-GIBSON, EDUARDO MD	7/1/1998	2084P0800X	NA	Psychiatry	026	PHYSICIANS	51298	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
149391	Fee-for-Service	1942468947	1942468947	1	1	LIANG, JONATHAN MD	10/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	105971	84	Surgery-Head and Neck	0	In state provider	None	3779 PIEDMONT AVENUE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
149400	Fee-for-Service	1790360634	1790360634	1	1	LOPEZ, AMY M CNP	11/18/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	511 N HOLLYWOOD WAY	None	BURBANK	CA	91505	3406	19	06037	34.15985598	-118.3431272	Los Angeles County
149412	Fee-for-Service	1508121013	1508121013	1	1	LE, DUY MD	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120775	13	Neurology (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
149421	Fee-for-Service	1467523340	1467523340	1	1	LEE, STEVEN L MD	3/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	62693	02	General Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
149433	Fee-for-Service	1255486544	1255486544	1	1	LAI, YIHSIEN LAC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1000 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4709	19	06037	34.084557	-118.123042	Los Angeles County
149451	Fee-for-Service	1740227040	1740227040	1	1	LAI, SEN BIN MD	4/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	32145	None	None	0	In state provider	None	2690 PACIFIC AVE	STE 290	LONG BEACH	CA	90806	2631	19	06037	33.805854	-118.1936805	Los Angeles County
149460	Fee-for-Service	1942498001	1942498001	1	1	LIANG, ERICA T MD	2/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105115	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
149471	Fee-for-Service	1659329639	1659329639	1	1	LOH, CATHERINE PHD	9/30/2005	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
149474	Fee-for-Service	1952304073	1952304073	1	1	LEONARD JOFFE, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4753 EAST CAMP LOWELL DR	None	TUCSON	AZ	85712	0000	00	None	32.267079	-110.890881	Pima County
149490	Fee-for-Service	1316728959	1316728959	1	1	LU FAMILY CORPORATION	1/30/2024	193400000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2123 S HACIENDA BLVD	None	HACIENDA HEIGHTS	CA	91745	4243	19	06037	33.99521958	-117.9685486	Los Angeles County
149491	Fee-for-Service	1922350537	1922350537	1	1	LIN, JEN-GU NP	8/3/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
149527	Fee-for-Service	1568545374	1568545374	1	1	LEE, LAURA A MD	6/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87497	02	General Surgery	0	In state provider	None	1180 N INDIAN CANYON DR	#E218	PALM SPRINGS	CA	92262	5309	33	06065	33.839505	-116.5455735	Riverside County
149538	Fee-for-Service	1245611599	1245611599	1	1	LIU, JASMINE Y MD	5/26/2021	207L00000X	NA	Other	026	PHYSICIANS	172591	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
149555	Fee-for-Service	1821150673	1821150673	1	1	LANSENDERFER, CANDACEAN	3/16/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
149577	Fee-for-Service	1588077564	1588077564	1	1	LEUNG, SHANNON	9/4/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	162026	40	Pediatrics	0	In state provider	None	8910 VILLA LA JOLLA DR	STE 110	LA JOLLA	CA	92037	1701	37	06073	32.87058261	-117.2338797	San Diego County
149593	Fee-for-Service	1245222330	1245222330	1	1	LEUNG, ALAN W MD	3/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	61442	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
149597	Fee-for-Service	1174759955	1174759955	1	1	LAM, JOHN K S MD	2/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122862	89	Surgery-Traumatic	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
149613	Fee-for-Service	1982654844	1982654844	1	1	LACHTCHOUK, SOUSANNA NP	1/1/2001	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6200 WILSHIRE BLVD	STE 1212	LOS ANGELES	CA	90048	5813	19	06037	34.06319291	-118.3636025	Los Angeles County
149625	Fee-for-Service	1730694084	1730694084	1	1	LOS ANGELES CARE CENTER, INC	11/13/2019	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6854 TYRONE AVE	None	VAN NUYS	CA	91405	4045	19	06037	34.195473	-118.4443325	Los Angeles County
149659	Fee-for-Service	1134583982	1134583982	1	1	LEE, MICHAEL J MD	5/3/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171126	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
149669	Fee-for-Service	1568481471	1568481471	1	1	LEE, MI-JEONG	9/28/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	73179	40	Pediatrics	0	In state provider	None	2675 W OLYMPIC BLVD	103	LOS ANGELES	CA	90006	2880	19	06037	34.05243942	-118.2907458	Los Angeles County
149694	Fee-for-Service	1821044314	1821044314	1	1	LIU, ANNE Y MD	11/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	123427	77	Infectious Disease	0	In state provider	None	725 WELCH ROAD	MC5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
149701	Fee-for-Service	1467523340	1467523340	1	1	LEE, STEVEN L MD	3/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	62693	85	Surgery-Pediatric	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
149702	Fee-for-Service	1164092656	1164092656	1	1	LAWAL, HALIMA A NP	10/23/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
149704	Fee-for-Service	1891006920	1891006920	1	1	LUO, RAN MD	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135777	02	General Surgery	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
149736	Fee-for-Service	1588700264	1588700264	1	1	LATINO COMMISSION ON ALCOHOL	3/14/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	AND DRUG ABUSE SERVICES	1724 BRYANT STREET	None	SAN FRANCISCO	CA	94110	1406	38	06075	37.7650495	-122.410487	San Francisco County
149777	Fee-for-Service	1801965868	1801965868	1	1	LIVINGSTON, JULIE B MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71883	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
149791	Fee-for-Service	1831247444	1831247444	1	1	LITTELL, CARY PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
149794	Fee-for-Service	1578806295	1578806295	1	1	LIN, JAMES R MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132388	41	Internal Medicine	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
149816	Fee-for-Service	1104942366	1104942366	1	1	LARGENT, THERESA L CRNA	6/20/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
149821	Fee-for-Service	1194021683	1194021683	1	1	LEUNG, ERIC MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112863	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
149824	Fee-for-Service	1063814978	1063814978	1	1	LEAVITT, JAMIE MD	8/31/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145137	None	None	0	In state provider	None	26800 CROWN VALLEY PKWY	SUITE 330	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
149826	Fee-for-Service	1275661084	1275661084	1	1	LASALLE MEDICAL ASSOC	7/1/1996	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	17577 ARROW BLVD	None	FONTANA	CA	92335	4011	36	06071	34.09938951	-117.421272	San Bernardino County
149830	Fee-for-Service	1932423225	1932423225	1	1	LI, DOUGLAS A MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108116	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
149841	Fee-for-Service	1932102332	1932102332	1	1	LIU, JUSTIN C MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	76636	25	Physical Medicine and Rehabilitation	0	In state provider	None	450 STANYAN ST	STE 658	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
149887	Fee-for-Service	1174759955	1174759955	1	1	LAM, JOHN K S MD	2/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122862	02	General Surgery	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
149894	Fee-for-Service	1073637203	1073637203	1	1	LEY, RYAN M MD	5/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	36	Psychiatry	1	Border provider	None	1240 EAST 9TH STREET	None	RENO	NV	89512	2964	00	None	39.53846574	-119.7974202	Washoe County
149905	Fee-for-Service	1285877209	1285877209	1	1	LI, DANENG MD	2/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137025	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
149937	Fee-for-Service	1073505707	1073505707	1	1	LEMOINE, JOHN R MD	1/1/1982	207RP1001X	NA	Pulmonology	026	PHYSICIANS	38164	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
149946	Fee-for-Service	1114375672	1114375672	1	1	LEE, HYUN K PHD	7/21/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
149949	Fee-for-Service	1619036993	1619036993	1	1	LEE, CONSTANCE W MD	10/4/2018	208600000X	NA	General Surgery	026	PHYSICIANS	155403	02	General Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
149953	Fee-for-Service	1114973328	1114973328	1	1	LANDERS, DANIEL V MD	12/16/1988	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	47190	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	# 1490M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
149980	Fee-for-Service	1821044314	1821044314	1	1	LIU, ANNE Y MD	11/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	123427	41	Internal Medicine	0	In state provider	None	725 WELCH ROAD	MC5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
149993	Fee-for-Service	1285701284	1285701284	1	1	LEE, MIJIN MD	1/25/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77754	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
150026	Fee-for-Service	1003145715	1003145715	1	1	LACANLALE, JOSHUA N	11/23/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
150067	Fee-for-Service	1831206804	1831206804	1	1	LEVINE, DEBORAH J MD	9/30/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	181690	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
150130	Fee-for-Service	1780954537	1780954537	1	1	LINDSAY, LISA J CCC-SLP	4/10/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
150147	Fee-for-Service	1891853107	1891853107	1	1	LEE, JAMES MD	11/4/2024	207R00000X	NA	Other	026	PHYSICIANS	54592	41	Internal Medicine	0	In state provider	None	23512 MADERO ROAD	None	MISSION VIEJO	CA	92691	2743	30	06059	33.62192373	-117.6765103	Orange County
150177	Fee-for-Service	1053842666	1053842666	1	1	LOCKHART, PAUL MD	11/24/2023	207P00000X	NA	Other	026	PHYSICIANS	185537	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
150184	Fee-for-Service	1093123788	1093123788	1	1	LOPEZ, MAYRA A LCSW	3/9/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
150190	Fee-for-Service	1528553963	1528553963	1	1	LANDAS, TREVOR MD	9/26/2022	207P00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
150228	Fee-for-Service	1285734921	1285734921	1	1	LIN, CHUAN-HAO MD	2/20/2004	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	40357	10	Gastroenterology (M.D. only)	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
150231	Fee-for-Service	1144759085	1144759085	1	1	LICORISH, KENRICK B MD	6/21/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	159723	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
150239	Fee-for-Service	1659502037	1659502037	1	1	LIGGETTE, ANNE MD	10/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107547	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
150248	Fee-for-Service	1356398770	1356398770	1	1	LIM, PAULINE MD	11/12/2010	207W00000X	NA	Ophthalmology	026	PHYSICIANS	94201	18	Ophthalmology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
150262	Fee-for-Service	1417161886	1417161886	1	1	LEE, MICHAEL MD	6/5/2018	207P00000X	NA	Other	026	PHYSICIANS	154241	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
150270	Fee-for-Service	1821044314	1821044314	1	1	LIU, ANNE Y MD	11/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	123427	03	Allergy	0	In state provider	None	725 WELCH ROAD	MC5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
150275	Fee-for-Service	1871763813	1871763813	1	1	LITTLEFIELD, MELISSA D PT	6/10/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	41421 DATE STREET	101	MURRIETA	CA	92562	7079	33	06065	33.53012372	-117.174507	Riverside County
150319	Fee-for-Service	1518942218	1518942218	1	1	LOCKMILLER, RICHARD G MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38591	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
150344	Fee-for-Service	1134162498	1134162498	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	150 S MAIN ST	None	FORT BRAGG	CA	95437	4205	23	06045	39.44093903	-123.8059562	Mendocino County
150356	Fee-for-Service	1164406021	1164406021	1	1	LAKEWOOD EYE PHYSICIANS	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	& SURGEONS INC A MED GRP	3300 E SOUTH ST	STE 105	LAKEWOOD	CA	90805	4579	19	06037	33.86018093	-118.1537163	Los Angeles County
150361	Fee-for-Service	1003874819	1003874819	1	1	LOWER UMPQUA HOSPITAL	3/11/2008	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	600 RANCH RD	None	REEDSPORT	OR	97467	1720	00	None	43.69501605	-124.1353967	Douglas County
150394	Fee-for-Service	1336305028	1336305028	1	1	LIN, ALICE C MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137254	04	Otology, Laryngology, Rhinology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
150427	Fee-for-Service	1285806091	1285806091	1	1	LIAUW, JASON A MD	2/6/2025	207T00000X	NA	General Surgery	026	PHYSICIANS	137960	14	Neurological Surgery	0	In state provider	None	280 SOUTH MAIN STREET	SUITE 200	ORANGE	CA	92868	3852	30	06059	33.784695	-117.867327	Orange County
150458	Fee-for-Service	1336768415	1336768415	1	1	LAM, STEVEN MD	7/18/2023	207R00000X	NA	Other	026	PHYSICIANS	185437	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
150466	Fee-for-Service	1215113832	1215113832	1	1	LOO, TRICIA C MD	7/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104949	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
150483	Fee-for-Service	1538584982	1538584982	1	1	LAVIN, SHANE T MD	9/2/2022	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	178185	None	None	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
150517	Fee-for-Service	1285734921	1285734921	1	1	LIN, CHUAN-HAO MD	2/20/2004	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	40357	40	Pediatrics	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
150559	Fee-for-Service	1912967233	1912967233	1	1	LAWSON, YVONNE R MD	1/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	47537	01	General Practice	0	In state provider	None	420 W ROWLAND ST	None	COVINA	CA	91723	2943	19	06037	34.078949	-117.8963031	Los Angeles County
150562	Fee-for-Service	1245276575	1245276575	1	1	LOUIE, GERALD C	4/29/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5080 FOOTHILLS BLVD	STE 2	ROSEVILLE	CA	95747	6525	31	06061	38.76121771	-121.3102456	Placer County
150575	Fee-for-Service	1881697381	1881697381	1	2	LAKE COUNTY TRIBAL HEALTH	6/9/2022	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	14440 OLYMPIC DR	None	CLEARLAKE	CA	95422	8809	17	06033	38.96189799	-122.6409389	Lake County
150610	Fee-for-Service	1578576823	1578576823	1	1	LAURA L PEDELTY MD	3/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1740 W TAYLOR ST	None	CHICAGO	IL	60612	7232	00	None	41.8692353	-87.67061005	Cook County
150627	Fee-for-Service	1225239023	1225239023	1	1	LOHR, MARIA B MD	3/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56107	08	Family Practice	0	In state provider	None	25455 BARTON RD	None	LOMA LINDA	CA	92354	3130	36	06071	34.04805253	-117.249534	San Bernardino County
150632	Fee-for-Service	1588973523	1588973523	1	1	LEWIS, MICHELLE Y MD	7/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112253	08	Family Practice	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
150641	Fee-for-Service	1457391435	1457391435	1	1	LAMB,ROBERT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 HARRISON BLVD	None	OGDEN	UT	84403	0000	00	None	41.18328	-111.9536955	Weber County
150645	Fee-for-Service	1164406021	1164406021	1	1	LAKEWOOD EYE PHYSICIANS	7/13/2018	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	& SURGEONS INC A MED GRP	3300 E SOUTH ST	STE 105	LAKEWOOD	CA	90805	4579	19	06037	33.86018093	-118.1537163	Los Angeles County
150649	Fee-for-Service	1003874819	1003874819	1	1	LOWER UMPQUA HOSPITAL	5/1/2002	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	600 RANCH RD	None	REEDSPORT	OR	97467	1720	00	None	43.69501605	-124.1353967	Douglas County
150707	Fee-for-Service	1154069284	1154069284	1	1	LA BRUCHERIE, ANDREW W CRNA	8/1/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
150780	Fee-for-Service	1710054689	1710054689	1	1	LAIMINS, PETER D MD	9/1/1997	204D00000X	NA	Other	026	PHYSICIANS	80989	20	Orthopedic Surgery	0	In state provider	None	6719 ALVARADO RD	STE 200	SAN DIEGO	CA	92120	5256	37	06073	32.77684978	-117.055137	San Diego County
150786	Fee-for-Service	1659717767	1659717767	1	2	LUCAS, JENNIFER D LMFT	8/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6777 N WILLOW AVE	None	FRESNO	CA	93710	5900	10	06019	36.83465436	-119.7311422	Fresno County
150797	Fee-for-Service	1942738554	1942738554	1	1	LUK, MATTHEW MD	10/13/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166128	08	Family Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
150805	Fee-for-Service	1164263497	1164263497	1	1	LANE, MICHAELA J CCC-SLP	10/7/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
150811	Fee-for-Service	1225480650	1225480650	1	1	LEFLORES, DANIELLE C MD	8/3/2020	207L00000X	NA	Other	026	PHYSICIANS	154898	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
150817	Fee-for-Service	1053726729	1053726729	1	1	LIN, KATHIE S MD	6/10/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	153876	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
150863	Fee-for-Service	1881697381	1881697381	1	2	LAKE COUNTY TRIBAL HEALTH	6/9/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	14440 OLYMPIC DR	None	CLEARLAKE	CA	95422	8809	17	06033	38.96189799	-122.6409389	Lake County
150890	Fee-for-Service	1699263087	1699263087	1	1	LARRABURE, LAUREN N MD	10/11/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	165912	None	None	0	In state provider	None	2950 RESEARCH PARK DR	None	SOQUEL	CA	95073	2000	44	06087	36.98692657	-121.9685264	Santa Cruz County
150904	Fee-for-Service	1275037624	1275037624	1	1	LIN, ANDREW C DO	7/8/2022	207P00000X	NA	Other	026	PHYSICIANS	19393	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
150920	Fee-for-Service	1083707251	1083707251	1	1	LE, LOC T MD	6/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80706	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
150945	Fee-for-Service	1801851035	1801851035	1	1	LAN, YUEH TZE MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74559	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
150948	Fee-for-Service	1457512592	1457512592	1	1	LANG, CHEN MD	10/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112074	34	Urology and Urological Surgery	0	In state provider	None	3800 DALE RD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
150959	Fee-for-Service	1528057213	1528057213	1	1	LARSON, PENNY L MD	3/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93985	None	None	0	In state provider	None	7601 HOSPITAL DR	STE 220	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
150977	Fee-for-Service	1366485757	1366485757	1	1	LAI, JIM MD	6/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89768	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
150987	Fee-for-Service	1124495056	1124495056	1	1	LE, NANCY LMFT	6/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 W OLYMPIC BLVD	STE 815E	LOS ANGELES	CA	90404	3650	19	06037	34.03273663	-118.4516927	Los Angeles County
150988	Fee-for-Service	1760610976	1760610976	1	1	LOPEZ, SANDRA MD	8/11/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	177573	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
150993	Fee-for-Service	1740458629	1740458629	1	1	LAM, MARK H MD	6/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98782	08	Family Practice	0	In state provider	None	1045 W REDONDO BEACH BLV	None	GARDENA	CA	90247	4182	19	06037	33.89247044	-118.2931941	Los Angeles County
151008	Fee-for-Service	1427342112	1427342112	1	1	LUO, BECKY Y MD	11/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123252	41	Internal Medicine	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
151018	Fee-for-Service	1538494463	1538494463	1	1	LEE, CINDY S DO	10/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11450	15	Obstetrics (D.O. only)	0	In state provider	None	969 PLUMAS BLVD	None	YUBA CITY	CA	95991	4011	51	06101	39.14263634	-121.6176593	Sutter County
151019	Fee-for-Service	1376931295	1376931295	1	2	LIFELONG MEDICAL CARE	7/1/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3075 ADELINE STREET	STE 280	BERKELEY	CA	94703	2580	01	06001	37.85258905	-122.2697614	Alameda County
151025	Fee-for-Service	1346409059	1346409059	1	1	LAUREN J AKERS, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
151042	Fee-for-Service	1629124839	1629124839	1	1	LAKKANNA, SUDHAMANI H	2/4/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2518 TROON DRIVE	None	BRENTWOOD	CA	94513	5615	07	06013	37.91972886	-121.7454176	Contra Costa County
151062	Fee-for-Service	1588616528	1588616528	1	1	LEMPERT, TODD E MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55023	None	None	0	In state provider	None	7301 GIRARD AVE	STE B	LA JOLLA	CA	92037	5150	37	06073	32.83764565	-117.2715586	San Diego County
151077	Fee-for-Service	1124437868	1124437868	1	1	LANG, CATHERINE CNP	11/3/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
151095	Fee-for-Service	1992872410	1992872410	1	1	LYON MARSHALL & SCOTT MD	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	2999 REGENT ST	STE 612	BERKELEY	CA	94705	2121	01	06001	37.85592021	-122.2566436	Alameda County
151097	Fee-for-Service	1235481565	1235481565	1	1	LAM, DAISY K MSW LCSW	3/3/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	13585 SAN PABLO AVENUE	None	SAN PABLO	CA	94804	3804	07	06013	37.95651393	-122.3371491	Contra Costa County
151124	Fee-for-Service	1235361965	1235361965	1	1	LOPEZ, MARISA MSW LCSW	3/14/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19 WILLIAMSBURG LN	None	CHICO	CA	95926	2225	04	06007	39.7525191	-121.8551479	Butte County
151135	Fee-for-Service	1821520032	1821520032	1	1	LEE, ERIC H MD	6/26/2020	208M00000X	NA	Other	026	PHYSICIANS	161308	41	Internal Medicine	0	In state provider	None	1000 TRANCAS ST	SUITE 1	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
151168	Fee-for-Service	1215933874	1215933874	1	1	LEE, JOON H MD	4/17/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84459	30	Radiology	0	In state provider	None	6600 MADISON AVE	STE 11	CARMICHAEL	CA	95608	0645	34	06067	38.663028	-121.310271	Sacramento County
151235	Fee-for-Service	1801851035	1801851035	1	1	LAN, YUEH TZE MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74559	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
151281	Fee-for-Service	1699396663	1699396663	1	1	LIM, DANDRICH MD	12/5/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	189653	None	None	0	In state provider	None	925 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4442	19	06037	34.08499473	-118.1230937	Los Angeles County
151294	Fee-for-Service	1477875375	1477875375	1	1	LEE, HENRY K DO	1/9/2025	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	13442	25	Physical Medicine and Rehabilitation	0	In state provider	None	2650 ELM AVE	SUITE 210	LONG BEACH	CA	90806	1651	19	06037	33.805521	-118.1882945	Los Angeles County
151306	Fee-for-Service	1538494463	1538494463	1	1	LEE, CINDY S DO	10/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11450	09	Gynecology (D.O. only)	0	In state provider	None	969 PLUMAS BLVD	None	YUBA CITY	CA	95991	4011	51	06101	39.14263634	-121.6176593	Sutter County
151308	Fee-for-Service	1376931295	1376931295	1	2	LIFELONG MEDICAL CARE	7/1/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3075 ADELINE STREET	STE 280	BERKELEY	CA	94703	2580	01	06001	37.85258905	-122.2697614	Alameda County
151341	Fee-for-Service	1225665250	1225665250	1	1	LEE, KATHERINE MD	11/19/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	189266	15	Obstetrics (D.O. only)	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
151344	Fee-for-Service	1376931295	1376931295	1	6	LIFELONG MEDICAL CARE	12/1/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2023 VALE ROAD	SUITE 103	SAN PABLO	CA	94806	3891	07	06013	37.95369824	-122.3378493	Contra Costa County
151370	Fee-for-Service	1699013276	1699013276	1	1	LEE, RUTH G MD	12/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130968	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
151401	Fee-for-Service	1083812135	1083812135	1	1	LARRABEE, PAIGE M NP	7/28/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
151406	Fee-for-Service	1053706309	1053706309	1	1	LIN, AARON W DO	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16396	08	Family Practice	0	In state provider	None	1514 VALLEY VISTA DR	None	DIAMOND BAR	CA	91765	3929	19	06037	33.99491668	-117.8399137	Los Angeles County
151408	Fee-for-Service	1457357170	1457357170	1	1	LINCOLN, ROBERT M MD	4/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	45810	30	Radiology	0	In state provider	None	6600 MADISON AVE	STE 11	CARMICHAEL	CA	95608	0645	34	06067	38.663028	-121.310271	Sacramento County
151436	Fee-for-Service	1336777887	1336777887	1	1	LEE, JENNY J MD	2/16/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	178606	None	None	0	In state provider	None	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
151512	Fee-for-Service	1104385103	1104385103	1	1	LEE, JONATHAN B MD	7/15/2022	207P00000X	NA	Other	026	PHYSICIANS	176180	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
151513	Fee-for-Service	1851522015	1851522015	1	5	LA CLINICA DE LA RAZA, INC.	12/30/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1901 THIRD STREET	None	ALAMEDA	CA	94501	1850	01	06001	37.77880646	-122.2879491	Alameda County
151524	Fee-for-Service	1174732358	1174732358	1	1	LO, LOWELL, J MD	5/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100300	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
151546	Fee-for-Service	1992752661	1992752661	1	1	LORENZANA, VONA W MD	10/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	71680	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
151558	Fee-for-Service	1740262880	1740262880	1	1	LABORATORY CORP OF AMERICA	8/31/2010	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	5005 S 40TH STREET	STE 1200	PHOENIX	AZ	85040	2969	00	None	33.40071	-111.9945735	Maricopa County
151566	Fee-for-Service	1467434845	1467434845	2	1	LIEN THI KHONG	12/8/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MANNA PHARMACY	10402 WESTMINSTER AVE	STE C	GARDEN GROVE	CA	92843	4862	30	06059	33.75951204	-117.9478527	Orange County
151573	Fee-for-Service	1851031280	1851031280	1	1	LABOD HOME CARE INC	5/26/2022	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	21106 OAKLEAF CANYON DR	None	SANTA CLARITA	CA	91321	4674	19	06037	34.3721131	-118.5048496	Los Angeles County
151575	Fee-for-Service	1023069606	1023069606	1	1	LURIE, ALAN L MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	42034	30	Radiology	0	In state provider	None	25405 HANCOCK AVE	STE 107	MURRIETA	CA	92562	5978	33	06065	33.5580833	-117.1850127	Riverside County
151586	Fee-for-Service	1437355633	1437355633	1	1	LE BLANC, ERIN E PT	5/8/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1060 CAMERADO DRIVE	None	CAMERON PARK	CA	95682	7600	09	06017	38.6856171	-120.9860614	El Dorado County
151606	Fee-for-Service	1689818718	1689818718	1	1	LEEMAN, JOSHUA J MD	5/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123984	None	None	0	In state provider	None	1001 POTRERO AVE	ROOM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
151619	Fee-for-Service	1013357706	1013357706	1	1	LIEBERMAN, MA'AYAN E MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146719	36	Psychiatry	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
151622	Fee-for-Service	1407831381	1407831381	1	1	LEE, TENNYSON G MD	4/29/1990	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	62492	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	12183 LOCKSLEY LN	STE 108	AUBURN	CA	95602	2050	31	06061	38.9503293	-121.0966898	Placer County
151623	Fee-for-Service	1972814978	1972814978	1	1	LAKHANI, RUPA MD	11/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125834	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
151630	Fee-for-Service	1225665250	1225665250	1	1	LEE, KATHERINE MD	11/19/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	189266	09	Gynecology (D.O. only)	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
151633	Fee-for-Service	1376931295	1376931295	1	6	LIFELONG MEDICAL CARE	12/1/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2023 VALE ROAD	SUITE 103	SAN PABLO	CA	94806	3891	07	06013	37.95369824	-122.3378493	Contra Costa County
151651	Fee-for-Service	1669050183	1669050183	1	1	LUI, ALBERT Y MD	4/16/2024	208M00000X	NA	Other	026	PHYSICIANS	183761	41	Internal Medicine	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
151655	Fee-for-Service	1255539284	1255539284	1	1	LIWANAG, ERICKSON U MD	6/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	6490 S MCCARRAN BLVD	#B13	RENO	NV	89509	6165	00	None	39.47672552	-119.796471	Washoe County
151696	Fee-for-Service	1629244918	1629244918	1	1	LEE, EDWIN A MD	3/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110733	41	Internal Medicine	0	In state provider	None	1510 S CENTRAL AVE	SITE 150	GLENDALE	CA	91204	2541	19	06037	34.12709764	-118.2577911	Los Angeles County
151701	Fee-for-Service	1952516627	1952516627	1	1	LOS ANGELES HEMATOLOGY/	2/1/1998	332900000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ONCOLOGY MEDICAL GROUP	1505 WILSON TERRACE	STE 200	GLENDALE	CA	91206	4073	19	06037	34.14960934	-118.2313491	Los Angeles County
151724	Fee-for-Service	1386721215	1386721215	1	1	LEUNG, HAYDN H MD	9/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79890	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
151731	Fee-for-Service	1164860615	1164860615	1	1	LEI, LI MD	6/10/2019	207ZP0101X	NA	Other	026	PHYSICIANS	138542	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
151739	Fee-for-Service	1407912561	1407912561	1	1	LAU, LANI CNM	5/18/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
151767	Fee-for-Service	1285743153	1285743153	1	1	LLOYD, MARY A MD	5/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	65455	18	Ophthalmology	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
151807	Fee-for-Service	1962790576	1962790576	1	1	LOPES, MELANIE MFT	5/18/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1330 LINCOLN AVENUE	SUITE 310B	SAN RAFAEL	CA	94901	2143	21	06041	37.97629089	-122.5226851	Marin County
151814	Fee-for-Service	1174732358	1174732358	1	1	LO, LOWELL, J MD	5/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100300	45	Nephrology (Renal-Kidney)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
151888	Fee-for-Service	1871518209	1871518209	1	1	LEE, CHARISSA K OD	4/18/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2706 HARBOR BLVD	STE B	COSTA MESA	CA	92626	5162	30	06059	33.671484	-117.919112	Orange County
151903	Fee-for-Service	1255598579	1255598579	1	1	LEDEZMA, CARLOS J MD	9/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140296	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
151910	Fee-for-Service	1770965220	1770965220	1	1	LY, TINA NGOC TRAN MD	10/16/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186952	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
151966	Fee-for-Service	1134180946	1134180946	2	1	LEE, JEONG O	12/7/2009	302R00000X	NA	Other	026	PHYSICIANS	39186	40	Pediatrics	0	In state provider	None	760 WASHBURN	STE 21	CORONA	CA	92882	3303	33	06065	33.87374678	-117.5678721	Riverside County
151985	Fee-for-Service	1629244918	1629244918	1	1	LEE, EDWIN A MD	3/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110733	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1510 S CENTRAL AVE	SITE 150	GLENDALE	CA	91204	2541	19	06037	34.12709764	-118.2577911	Los Angeles County
151995	Fee-for-Service	1447586920	1447586920	1	1	LEE, CHING G MD INC	12/8/2009	207R00000X	NA	Other	026	PHYSICIANS	61762	41	Internal Medicine	0	In state provider	None	408 S BEACH BLVD	STE 203	ANAHEIM	CA	92804	1877	30	06059	33.82709101	-117.9932293	Orange County
151999	Fee-for-Service	1588031157	1588031157	1	1	LINCOLN MEDICAL PRACTICE INC	2/28/2024	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	901 STERLING PARKWAY	STE 101	LINCOLN	CA	95648	6315	31	06061	38.87062518	-121.2964962	Placer County
152017	Fee-for-Service	1225078579	1225078579	1	1	LEE, JUSTIN C MD	2/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146229	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
152068	Fee-for-Service	1760459358	1760459358	1	1	LUEKENGA, ARRON OD	3/24/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 E SANTA BARBARA ST	STE C	SANTA PAULA	CA	93060	2675	56	06111	34.35269772	-119.069955	Ventura County
152081	Fee-for-Service	1437165503	1437165503	1	1	LEE, NATALIE J MD	9/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	71623	05	Anesthesiology	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
152090	Fee-for-Service	1528415429	1528415429	1	1	LIU, JIAJING MD	6/14/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172719	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
152097	Fee-for-Service	1578505384	1578505384	2	1	LONGS DRUG STORE CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1060 E CYPRESS AVE	None	REDDING	CA	96002	1114	45	06089	40.57106614	-122.3520294	Shasta County
152115	Fee-for-Service	1013305242	1013305242	1	1	LOUIE, CHRISTINE Y MD	4/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122324	22	Pathology (M.D. only)	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
152128	Fee-for-Service	1114081981	1114081981	2	1	LEE, YIU FUN D MD	4/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	81110	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	16388 COLIMA RD	STE 203	HACIENDA HEIGHTS	CA	91745	5525	19	06037	33.98564913	-117.9544476	Los Angeles County
152159	Fee-for-Service	1376075895	1376075895	1	1	LI, MATTHEW H DO	10/19/2023	207L00000X	NA	Other	026	PHYSICIANS	21036	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
152164	Fee-for-Service	1235172081	1235172081	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9030 BROOKS RD S	None	WINDSOR	CA	95492	7811	49	06097	38.550672	-122.8054455	Sonoma County
152171	Fee-for-Service	1346604394	1346604394	1	1	LEE, JENNIFER	6/7/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22283	08	Family Practice	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
152199	Fee-for-Service	1053405712	1053405712	1	1	LIDESTRI, PAULA A MD	2/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	110395	25	Physical Medicine and Rehabilitation	0	In state provider	None	141 LYNCH CREEK WAY	SUITE C	PETALUMA	CA	94594	2390	49	06097	38.25192092	-122.6341929	Sonoma County
152207	Fee-for-Service	1619233483	1619233483	1	1	LAROSA, MARJORIE V	7/23/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
152209	Fee-for-Service	1619471695	1619471695	1	1	LA PRO HOME HEALTH CARE INC	2/12/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1600 VENTURA BLVD	SUITE 307	ENCINO	CA	91436	4669	19	06037	34.15678081	-118.4866764	Los Angeles County
152210	Fee-for-Service	1003376070	1003376070	1	1	LOUGHRIDGE, BRANDON MD	3/11/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
152240	Fee-for-Service	1679936363	1679936363	1	1	LAMPE, ALYSSA M MD	8/12/2021	207RE0101X	NA	Endocrinology	026	PHYSICIANS	150636	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
152241	Fee-for-Service	1144808353	1144808353	1	1	LE ROUX, MICHELLE	7/17/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
152248	Fee-for-Service	1437543345	1437543345	1	1	LIAW, NICHOLAS MD	3/7/2024	2084V0102X	NA	Neurology	026	PHYSICIANS	161691	None	None	0	In state provider	None	2190 LYNN RD	SUITE 380	THOUSAND OAKS	CA	91360	1856	56	06111	34.20728091	-118.8855456	Ventura County
152255	Fee-for-Service	1134180946	1134180946	2	1	LEE, JEONG O	10/18/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	760 WASHBURN	STE 21	CORONA	CA	92882	3303	33	06065	33.87374678	-117.5678721	Riverside County
152256	Fee-for-Service	1467719476	1467719476	1	1	LI, XIAN MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147552	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
152262	Fee-for-Service	1750461893	1750461893	1	1	LE-BUCKLIN, KHANH-VAN MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69311	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
152268	Fee-for-Service	1184647620	1184647620	1	1	LEGACY MERIDIAN PARK	5/1/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL	19300 SW 65TH AVE	None	TUALATIN	OR	97062	7706	00	None	45.378774	-122.740551	Clackamas County
152271	Fee-for-Service	1780039479	1780039479	1	1	LIU, LISA MD	9/15/2023	207R00000X	NA	Other	026	PHYSICIANS	153549	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
152336	Fee-for-Service	1205964160	1205964160	1	1	LIN, ERIC Y MD	9/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89947	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
152337	Fee-for-Service	1407114010	1407114010	1	1	LO, JENNIFER Y MD	9/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120780	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
152338	Fee-for-Service	1235421504	1235421504	1	1	LEE, MONIKA DO	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12619	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
152346	Fee-for-Service	1548233018	1548233018	2	1	LIU, PAUL H MD	8/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
152349	Fee-for-Service	1649351719	1649351719	1	1	LEWIS, CHRISTOPHER T MD	11/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	97571	02	General Surgery	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
152375	Fee-for-Service	1356379556	1356379556	1	1	LEE, YISHENG MD	12/31/1993	2080P0207X	NA	Hematology	026	PHYSICIANS	51863	78	Neoplastic Diseases/Oncology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
152378	Fee-for-Service	1619269974	1619269974	1	1	LELENTA, FATOUMATA MD	4/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119224	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
152410	Fee-for-Service	1790786002	1790786002	1	1	LUBA, DANIEL G MD	11/25/1992	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	64626	10	Gastroenterology (M.D. only)	0	In state provider	None	833 CASS ST	None	MONTEREY	CA	93940	2904	27	06053	36.59409362	-121.8954238	Monterey County
152445	Fee-for-Service	1578889416	1578889416	1	1	LIANG, MARK Y MD	6/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119336	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
152451	Fee-for-Service	1699300723	1699300723	1	1	LIFETIME HOSPICE CARE INC	5/21/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11350 VENTURA BLVD	SUITE 205	STUDIO CITY	CA	91604	3140	19	06037	34.14014506	-118.3774984	Los Angeles County
152470	Fee-for-Service	1154099646	1154099646	1	1	LIN, JACQUELINE PT	7/22/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
152502	Fee-for-Service	1891827770	1891827770	1	2	LEON, ALEJANDRO LCSW	8/19/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
152521	Fee-for-Service	1366116899	1366116899	1	1	LARGE, JENNA L	3/1/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11930 HERITAGE OAKS PL	STE 8 & 9	AUBURN	CA	95603	0000	31	06061	38.94059662	-121.0995593	Placer County
152531	Fee-for-Service	1376629030	1376629030	1	1	LAMAR, TROY M MD	12/31/1995	208600000X	NA	General Surgery	026	PHYSICIANS	77568	02	General Surgery	0	In state provider	None	10720 PARAMOUNT BLVD	None	DOWNEY	CA	90241	3346	19	06037	33.94732999	-118.1345312	Los Angeles County
152543	Fee-for-Service	1093254435	1093254435	1	1	LOS FELIZ RESIDENTIAL CARE	12/1/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	205 E. LOS FELIZ RD	None	GLENDALE	CA	91205	3118	19	06037	34.12870638	-118.2535828	Los Angeles County
152550	Fee-for-Service	1639399355	1639399355	1	1	LUPO, DANIEL J	6/16/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
152559	Fee-for-Service	1184647620	1184647620	1	1	LEGACY MERIDIAN PARK	12/7/2007	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL	19300 SW 65TH AVE	None	TUALATIN	OR	97062	7706	00	None	45.378774	-122.740551	Clackamas County
152597	Fee-for-Service	1326758897	1326758897	1	1	LAVERY, ERIN M	3/10/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2021 SPERRY AVE	STE 20	VENTURA	CA	93003	7446	56	06111	34.25452652	-119.2178238	Ventura County
152599	Fee-for-Service	1336787803	1336787803	1	1	LOVE AND LIGHT HOSPICE CARE	8/19/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	14545 FRIAR ST	SUITE 248	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
152618	Fee-for-Service	1568099976	1568099976	1	1	LEE, VICTORIA MD	12/7/2022	390200000X	NA	Other	026	PHYSICIANS	19462	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
152623	Fee-for-Service	1508432451	1508432451	1	1	LEMIRE, BRIANNA M OT	1/13/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
152635	Fee-for-Service	1548233018	1548233018	2	1	LIU, PAUL H MD	8/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
152661	Fee-for-Service	1356379556	1356379556	1	1	LEE, YISHENG MD	12/31/1993	2080P0207X	NA	Hematology	026	PHYSICIANS	51863	40	Pediatrics	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
152669	Fee-for-Service	1154479004	1154479004	1	1	LIM, CATALINA C MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32380	13	Neurology (M.D. only)	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
152673	Fee-for-Service	1194068635	1194068635	1	1	LAKE COUNTY ANESTHESIA PC	5/31/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	5176 HILL ROAD E	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
152676	Fee-for-Service	1427134568	1427134568	1	1	LENNES, INGA T MD	5/1/2024	207RX0202X	NA	Oncology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
152695	Fee-for-Service	1245417526	1245417526	1	1	LAI, PHONG Q DO	2/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10146	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
152698	Fee-for-Service	1790786002	1790786002	1	1	LUBA, DANIEL G MD	11/25/1992	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	64626	66	Emergency Medicine (Urgent Care)	0	In state provider	None	833 CASS ST	None	MONTEREY	CA	93940	2904	27	06053	36.59409362	-121.8954238	Monterey County
152713	Fee-for-Service	1447858741	1447858741	1	1	LINETT, LAUREN J MD	11/5/2020	208M00000X	NA	Other	026	PHYSICIANS	161607	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
152740	Fee-for-Service	1699300723	1699300723	1	1	LIFETIME HOSPICE CARE INC	5/21/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11350 VENTURA BLVD	SUITE 205	STUDIO CITY	CA	91604	3140	19	06037	34.14014506	-118.3774984	Los Angeles County
152761	Fee-for-Service	1447355078	1447355078	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6247 GRAHAM HILL RD	None	FELTON	CA	95018	9723	44	06087	37.0514843	-122.0688791	Santa Cruz County
152823	Fee-for-Service	1275845117	1275845117	1	1	LAN, ESTHER Q M OD	10/1/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	13800 SAN ANTONIO DR	None	NORWALK	CA	90650	4033	19	06037	33.9058081	-118.0785951	Los Angeles County
152877	Fee-for-Service	1467486803	1467486803	1	1	LERMAN, BRUCE I DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2101 FOREST AVE	STE 118	SAN JOSE	CA	95128	1472	43	06085	37.3270795	-121.93731	Santa Clara County
152885	Fee-for-Service	1336787803	1336787803	1	1	LOVE AND LIGHT HOSPICE CARE	8/19/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	14545 FRIAR ST	SUITE 248	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
152887	Fee-for-Service	1518123389	1518123389	1	1	LOZOVATSKY, MARGARET MD	11/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138861	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
152902	Fee-for-Service	1841584158	1841584158	1	1	LAM, JASON MD	6/5/2020	207RC0200X	NA	Other	026	PHYSICIANS	162105	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
152909	Fee-for-Service	1336387299	1336387299	1	1	LIONETTI, GERALDINA T MD	9/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103471	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
152942	Fee-for-Service	1891292736	1891292736	1	1	LEE, OLIVER MD	1/30/2025	207L00000X	NA	Other	026	PHYSICIANS	185543	05	Anesthesiology	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
152948	Fee-for-Service	1619336336	1619336336	1	1	LIU, STEVE J	6/24/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
152950	Fee-for-Service	1922502517	1922502517	1	1	LEON, DEANNA J MD	11/8/2022	207L00000X	NA	Other	026	PHYSICIANS	165048	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
152951	Fee-for-Service	1356379556	1356379556	1	1	LEE, YISHENG MD	12/31/1993	2080P0207X	NA	Hematology	026	PHYSICIANS	51863	68	Hematology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
153030	Fee-for-Service	1962109033	1962109033	1	15	LOS ANGELES COUNTY DEPARTMEN	2/8/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	T OF PUBLIC HEALTH	12750 ERICKSON AVE	None	DOWNEY	CA	90242	4024	19	06037	33.92539024	-118.160392	Los Angeles County
153035	Fee-for-Service	1942522800	1942522800	1	1	LI, KAI MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128382	None	None	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
153050	Fee-for-Service	1124228549	1124228549	2	1	LINDA RX PHARMACY INC	12/2/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1569 LEXANN AVE	#130	SAN JOSE	CA	95121	1794	43	06085	37.30790568	-121.8141983	Santa Clara County
153051	Fee-for-Service	1649467739	1649467739	1	1	LYLE, DEREK D MD	4/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93988	22	Pathology (M.D. only)	0	In state provider	None	1401 N PALM CANYON DRIVE	STE 203	PALM SPRINGS	CA	92262	4433	33	06065	33.841269	-116.546807	Riverside County
153055	Fee-for-Service	1699986331	1699986331	1	4	LOS ANGELES COUNTY	11/12/2020	No Taxonomy Provided	NA	None	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	1300 N MISSION RD	None	LOS ANGELES	CA	90033	1021	19	06037	34.06293911	-118.2109345	Los Angeles County
153070	Fee-for-Service	1487827929	1487827929	1	2	LEE, JOHN C MD INC	7/15/2010	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	638 W DUARTE RD	# 3A	ARCADIA	CA	91007	7616	19	06037	34.12629888	-118.0532077	Los Angeles County
153075	Fee-for-Service	1396362265	1396362265	1	1	LYNCH, RHEA FAITH G CCC-SLP	7/21/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 S HAVEN AVE	SUITE 190	ONTARIO	CA	91761	2969	36	06071	34.046307	-117.576387	San Bernardino County
153083	Fee-for-Service	1982775862	1982775862	1	1	LEHMAN-SCHLETEWITZ,	7/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	66692	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
153141	Fee-for-Service	1053358044	1053358044	1	1	LARKIN, SUZANNE C NP	2/19/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4910 AIRPORT PLAZA BLVD	STE 100	LONG BEACH	CA	90815	1264	19	06037	33.80854316	-118.1359209	Los Angeles County
153154	Fee-for-Service	1407160963	1407160963	1	1	LAWLER, JESSICA M	8/9/2010	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 W 6TH ST	STE 111	LOS ANGELES	CA	90017	1823	19	06037	34.05416748	-118.2622848	Los Angeles County
153199	Fee-for-Service	1336387299	1336387299	1	1	LIONETTI, GERALDINA T MD	9/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103471	83	Rheumatology	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
153204	Fee-for-Service	1437884038	1437884038	1	1	LA HABRA POST ACUTE LLC	8/16/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1233 WEST LA HABRA BLVD	None	LA HABRA	CA	90631	5226	30	06059	33.93188146	-117.959868	Orange County
153249	Fee-for-Service	1518013788	1518013788	1	1	LIEBESKIND, HOWARD F DPM	1/1/1979	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	7345 MEDICAL CENTER DR	STE 210	CANOGA PARK	CA	91307	1955	19	06037	34.20369349	-118.629837	Los Angeles County
153253	Fee-for-Service	1477578557	1477578557	1	1	LUND, JOHN F MD	1/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MCKAY CARDIOLOGY	4403 HARRISON BLVD,	#3490	OGDEN	UT	84003	0000	00	None	41.18328	-111.9536955	Weber County
153343	Fee-for-Service	1619923430	1619923430	1	1	LI, ARTHUR E MD	9/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85513	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
153345	Fee-for-Service	1639572621	1639572621	1	1	LOPEZ-MALDONADO, JULIO C MD	8/1/2023	208600000X	NA	General Surgery	026	PHYSICIANS	180555	None	None	0	In state provider	None	2335 E KASHIAN LANE	STE 220	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
153391	Fee-for-Service	1255338406	1255338406	1	1	LUSTER-ADALETE, RHONDA R MD	3/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	76910	41	Internal Medicine	0	In state provider	None	6339 MACK RD	None	SACRAMENTO	CA	95823	4655	34	06067	38.475585	-121.4285265	Sacramento County
153411	Fee-for-Service	1326677881	1326677881	1	1	LIU, CHRISTINA OD	2/6/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	541 W VALLEY BLVD	None	SAN GABRIEL	CA	91776	3730	19	06037	34.07941179	-118.1077	Los Angeles County
153462	Fee-for-Service	1831132182	1831132182	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3935 COCHRAN ST	None	SIMI VALLEY	CA	93063	2364	56	06111	34.27907948	-118.719441	Ventura County
153463	Fee-for-Service	1326048638	1326048638	1	1	LAVIN, MARC I MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54809	41	Internal Medicine	0	In state provider	None	23101 SHERMAN PL	STE 510	WEST HILLS	CA	91307	2040	19	06037	34.20099112	-118.6297991	Los Angeles County
153473	Fee-for-Service	1912375627	1912375627	1	1	LOPEZ, KAITLYN P LCSW	11/22/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
153487	Fee-for-Service	1922561901	1922561901	1	1	LEE, STEPHANIE Y MD	9/27/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178608	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
153518	Fee-for-Service	1497071336	1497071336	1	1	LOFTUS, PATRICIA A MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144198	04	Otology, Laryngology, Rhinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
153531	Fee-for-Service	1558330399	1558330399	1	1	LOCKWOOD, KAREN D MD	5/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133833	41	Internal Medicine	0	In state provider	None	2601 EAST MAIN STREET	SUITE 104	VENTURA	CA	93303	2801	56	06111	34.27443821	-119.2609368	Ventura County
153551	Fee-for-Service	1720702046	1720702046	1	1	LERCARA-RAGAN, SEDONA	12/20/2024	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	123 ALVARADO ST	None	FALLBROOK	CA	92028	2049	37	06073	33.38202549	-117.2506995	San Diego County
153566	Fee-for-Service	1609009935	1609009935	1	1	LEE, LISA K MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129265	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
153579	Fee-for-Service	1427029040	1427029040	1	1	LABAND, PAUL M MD	7/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135481	41	Internal Medicine	0	In state provider	None	1100 TRANCAS STREET	SUITE 205	NAPA	CA	94558	2909	28	06055	38.32316569	-122.2981938	Napa County
153600	Fee-for-Service	1053799130	1053799130	1	1	LUONG, HELEN	8/9/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
153622	Fee-for-Service	1225056336	1225056336	1	1	LADABAUM, DAN MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76563	41	Internal Medicine	0	In state provider	None	2450 ASHBY AVE	RM 1002	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
153644	Fee-for-Service	1932366895	1932366895	1	1	LIFEHOUSE INC	9/1/1992	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	393 NOVA ALBION WAY	None	SAN RAFAEL	CA	94903	3607	21	06041	37.9985266	-122.5486645	Marin County
153663	Fee-for-Service	1477750479	1477750479	1	1	LIN, VIVIAN W MD	7/31/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	98875	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1950 SUNNYCREST DR	STE 2800	FULLERTON	CA	92835	3618	30	06059	33.89240507	-117.9313904	Orange County
153698	Fee-for-Service	1316450174	1316450174	1	1	LOZANO, JOSIAH PT	5/18/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1906 VISTA DEL LAGO DRIV	A	VALLEY SPRINGS	CA	95252	9700	05	06009	38.16810805	-120.8383709	Calaveras County
153701	Fee-for-Service	1659527471	1659527471	1	1	LUKASEK, KATIE M MD	6/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116836	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 L ST	None	SACRAMENTO	CA	95816	5615	34	06067	38.57202	-121.4692695	Sacramento County
153788	Fee-for-Service	1508974718	1508974718	1	1	LEWIS, DANIEL J MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70094	41	Internal Medicine	0	In state provider	None	17909 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91387	3210	19	06037	34.41652621	-118.4458684	Los Angeles County
153794	Fee-for-Service	1285834861	1285834861	1	1	LAM, TACK C MD	10/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62794	01	General Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
153820	Fee-for-Service	1467865386	1467865386	1	1	LEVY, KAREN MD	1/24/2022	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	156399	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
153823	Fee-for-Service	1881626943	1881626943	1	1	LATARA ENTERPRISE	4/1/1994	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION LABORATORY	1716 W HOLT AVE	None	POMONA	CA	91768	3333	19	06037	34.06163251	-117.779517	Los Angeles County
153825	Fee-for-Service	1366851354	1366851354	1	1	LEON, ARACELI LCSW	10/16/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
153859	Fee-for-Service	1851042949	1851042949	1	1	LA COMPREHENSIVE MEDICAL	5/30/2024	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	GROUP	1410 WEST ALONDRA BLVD	STE B	COMPTON	CA	90220	3533	19	06037	33.88839148	-118.2446201	Los Angeles County
153878	Fee-for-Service	1770656910	1770656910	1	1	LI, ANNA E MD	4/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86195	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	260 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
153885	Fee-for-Service	1841333960	1841333960	1	1	LIU, RONGHUAN MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72410	05	Anesthesiology	0	In state provider	None	6969 BROCKTON AVE	STE B	RIVERSIDE	CA	92506	3813	33	06065	33.94701	-117.396786	Riverside County
153903	Fee-for-Service	1912189275	1912189275	1	1	LEVY, DAVID I MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	81883	14	Neurological Surgery	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
153914	Fee-for-Service	1720069289	1720069289	2	1	LEARY, BARBARA F NP	5/1/1999	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	None	SACRAMENTO	CA	95820	1532	34	06067	38.546091	-121.447305	Sacramento County
153933	Fee-for-Service	1649446378	1649446378	1	1	LU, BAOTRAM D DPM	1/12/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	75036 GERALD FORD DR	None	PALM DESERT	CA	92211	2080	33	06065	33.78158473	-116.353994	Riverside County
153946	Fee-for-Service	1619629698	1619629698	1	1	LEE, NOEL LMFT	2/6/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	132 S THOMPSON ST	None	HEMET	CA	92543	4351	33	06065	33.74675899	-116.9651207	Riverside County
153976	Fee-for-Service	1770599698	1770599698	1	1	LEPEDJIAN, KATRINE H MD	2/1/1987	207L00000X	NA	Other	026	PHYSICIANS	43396	05	Anesthesiology	0	In state provider	None	11999 SAN VICENTE BLVD	STE 440	LOS ANGELES	CA	90049	5042	19	06037	34.05233327	-118.4727195	Los Angeles County
154064	Fee-for-Service	1144586801	1144586801	1	1	LAMPREA MONTEALEGRE, JULIO A	4/4/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	169328	None	None	0	In state provider	MD	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
154127	Fee-for-Service	1548829674	1548829674	1	1	LUONG, SHIN M LCSW	2/3/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3990 WALNUT DR	None	EUREKA	CA	95503	6257	12	06023	40.77005113	-124.1430432	Humboldt County
154131	Fee-for-Service	1326445404	1326445404	1	1	LEON, ALEXINE J	12/8/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
154144	Fee-for-Service	1306832332	1306832332	1	1	LEFKOWITZ, DAVID M MD	10/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	88087	30	Radiology	0	In state provider	None	455 HICKEY BLVD	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
154257	Fee-for-Service	1003833773	1003833773	1	1	LIDIA KRASNIEWSKA MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 BROADWAY N	None	FARGO	ND	58102	3641	00	None	46.885068	-96.7872375	Cass County
154294	Fee-for-Service	1780212068	1780212068	1	1	LE, ANDREW MD	4/7/2023	207R00000X	NA	Other	026	PHYSICIANS	183698	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
154314	Fee-for-Service	1487787461	1487787461	1	1	LEE, REGINA K. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11212 HWY 151	STE 240	SAN ANTONIO	TX	78251	4501	00	None	29.46743939	-98.69462674	Bexar County
154318	Fee-for-Service	1104470897	1104470897	1	1	LLANERA, JAMIE ANNE P OD	1/4/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1575 B STREET	None	HAYWARD	CA	94541	3017	01	06001	37.67905755	-122.072805	Alameda County
154341	Fee-for-Service	1558087684	1558087684	1	1	LEE, DA M CNP	1/6/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	638 CAMINO DE LOS MARES	None	SAN CLEMENTE	CA	92673	2848	30	06059	33.45932277	-117.6517315	Orange County
154350	Fee-for-Service	1508060534	1508060534	1	1	LUI, STEPHEN MD INC	2/29/2008	207RN0300X	NA	Nephrology	026	PHYSICIANS	87511	45	Nephrology (Renal-Kidney)	0	In state provider	None	3625 MARTIN LUTHER KING	JR BLVD, STE 5	LYNWOOD	CA	90262	0000	19	06037	33.93044131	-118.2021564	Los Angeles County
154429	Fee-for-Service	1003179540	1003179540	1	1	LIN, YICHUN MD	8/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142003	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
154439	Fee-for-Service	1285080986	1285080986	1	1	LE, VIVIAN H DO	9/25/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	18538	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
154458	Fee-for-Service	1881607984	1881607984	1	1	LOSTETTER, ADRIENNE L MD	6/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	54914	40	Pediatrics	0	In state provider	None	3030 CHLIDRENS WAY	STE 112	SAN DIEGO	CA	92123	4226	37	06073	32.798889	-117.150826	San Diego County
154505	Fee-for-Service	1891884011	1891884011	2	1	LIN, YENCHIN G MD	12/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	61257	41	Internal Medicine	0	In state provider	None	13085 CENTRAL AVENUE	SUITE 6	CHINO	CA	91710	4088	36	06071	34.015761	-117.6891735	San Bernardino County
154526	Fee-for-Service	1588127583	1588127583	1	1	LEDESMA, KANDRIA J MD	7/31/2023	207P00000X	NA	Other	026	PHYSICIANS	176724	None	None	0	In state provider	None	525 WEST ACACIA STREET	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
154536	Fee-for-Service	1407002827	1407002827	1	1	LOUDEN, NELIDA A LMFT	12/3/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	643 3RD ST	None	ENCINITAS	CA	92024	3513	37	06073	33.04364029	-117.295476	San Diego County
154547	Fee-for-Service	1376093997	1376093997	1	1	LEE, HARRISON MD	9/16/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	None	07	Dermatology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
154562	Fee-for-Service	1003279456	1003279456	1	1	LARSEN, CODY MD	7/9/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
154583	Fee-for-Service	1184702870	1184702870	1	1	LINDGREN, LESLIE R MD	1/18/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73787	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
154616	Fee-for-Service	1336292994	1336292994	1	1	LIM, MABEL A MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	48096	08	Family Practice	0	In state provider	None	320 8TH ST	STE 1D	OAKLAND	CA	94607	4262	01	06001	37.79905167	-122.2707697	Alameda County
154630	Fee-for-Service	1609171990	1609171990	1	1	LIANG, CONNIE X OD	7/6/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	38069 MARTHA AVE	STE 200	FREMONT	CA	94536	3811	01	06001	37.55978715	-121.991892	Alameda County
154636	Fee-for-Service	1508060534	1508060534	1	1	LUI, STEPHEN MD INC	2/29/2008	207RN0300X	NA	Nephrology	026	PHYSICIANS	87511	41	Internal Medicine	0	In state provider	None	3625 MARTIN LUTHER KING	JR BLVD, STE 5	LYNWOOD	CA	90262	0000	19	06037	33.93044131	-118.2021564	Los Angeles County
154696	Fee-for-Service	1376931295	1376931295	1	7	LIFELONG MEDICAL CARE	11/1/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2023 VALE ROAD	SUITE 114	SAN PABLO	CA	94806	3891	07	06013	37.95369824	-122.3378493	Contra Costa County
154702	Fee-for-Service	1356803019	1356803019	1	1	LYONS, JONATHAN DO	3/3/2023	207P00000X	NA	Other	026	PHYSICIANS	20202	None	None	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
154725	Fee-for-Service	1548411093	1548411093	1	1	LINDSAY D NEWTON HUGGINS	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORTH WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
154736	Fee-for-Service	1972894368	1972894368	1	1	LEE, ANDREW C MD	4/22/2020	207R00000X	NA	Other	026	PHYSICIANS	125428	41	Internal Medicine	0	In state provider	None	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
154749	Fee-for-Service	1790784197	1790784197	1	1	LEMAN, STEVEN D MD	11/27/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	39844	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3860 SADDLE RD	None	SOUTH LAKE TAHOE	CA	96150	8673	09	06017	38.934261	-119.9399445	El Dorado County
154771	Fee-for-Service	1114947611	1114947611	1	1	LASCANO, MIGUEL	12/10/1991	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	50264	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1524 27TH ST	STE 405	BAKERSFIELD	CA	93301	2056	15	06029	35.38387747	-119.0197575	Kern County
154799	Fee-for-Service	1902071491	1902071491	1	1	LIN, JONATHAN S MD	3/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96111	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
154810	Fee-for-Service	1265696363	1265696363	1	1	LYDELL, CARMEN P MD	8/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104870	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
154854	Fee-for-Service	1790797652	1790797652	1	1	LEE, LINDA S MD	8/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91138	02	General Surgery	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
154885	Fee-for-Service	1255799409	1255799409	1	1	LANGLEY, FIONA M CRNA	2/22/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
154910	Fee-for-Service	1790736650	1790736650	1	1	LEE, TIMOTHY S MD	7/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	53587	13	Neurology (M.D. only)	0	In state provider	None	1045 ATLANTIC AVE	STE 719	LONG BEACH	CA	90813	3412	19	06037	33.780267	-118.1850795	Los Angeles County
154918	Fee-for-Service	1972689479	1972689479	1	1	LEVAN CHRISTINE TRAN MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70900	40	Pediatrics	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
154933	Fee-for-Service	1073841557	1073841557	1	1	LOW, HENRY J MEDICAL	3/28/2011	193400000X	NA	Other	026	PHYSICIANS	71770	41	Internal Medicine	0	In state provider	CORPORATION	1828 EL CAMINO REAL	STE 706	BURLINGAME	CA	94010	3122	41	06081	37.59552262	-122.3838771	San Mateo County
154963	Fee-for-Service	1972040939	1972040939	1	1	LADAGE, KIMBERLY A CNM	5/31/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
154984	Fee-for-Service	1376931295	1376931295	1	7	LIFELONG MEDICAL CARE	11/1/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2023 VALE ROAD	SUITE 114	SAN PABLO	CA	94806	3891	07	06013	37.95369824	-122.3378493	Contra Costa County
155017	Fee-for-Service	1053592030	1053592030	1	1	LEU, JENGSHIANG LAC	3/13/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1000 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4709	19	06037	34.084557	-118.123042	Los Angeles County
155018	Fee-for-Service	1386786374	1386786374	1	1	LEVINE, VICTOR D MD	6/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	22157	01	General Practice	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
155019	Fee-for-Service	1063560886	1063560886	1	1	LAWENDA, STEVEN A MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85139	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
155025	Fee-for-Service	1104906064	1104906064	1	1	LOPEZ ESCAMILLA, AZAHAR	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PHD	2050 W CHAPMAN AVE	STE 282	ORANGE	CA	92868	2696	30	06059	33.78787054	-117.87498	Orange County
155038	Fee-for-Service	1790784197	1790784197	1	1	LEMAN, STEVEN D MD	11/27/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	39844	01	General Practice	0	In state provider	None	3860 SADDLE RD	None	SOUTH LAKE TAHOE	CA	96150	8673	09	06017	38.934261	-119.9399445	El Dorado County
155060	Fee-for-Service	1104536457	1104536457	1	1	LANG, MONICA T CRNA	7/21/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
155064	Fee-for-Service	1891180071	1891180071	1	1	LASNER, ILANA DO	10/30/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	18537	13	Neurology (M.D. only)	0	In state provider	None	4676 ADMIRALTY WAY	4TH FLOOR	MARINA DEL REY	CA	90292	6601	19	06037	33.98035311	-118.4403749	Los Angeles County
155069	Fee-for-Service	1639533235	1639533235	1	1	LAI, SUNNY MD	9/29/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	167403	08	Family Practice	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
155091	Fee-for-Service	1881853661	1881853661	1	1	LOPEZ, AMY C LCSW	9/25/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
155105	Fee-for-Service	1134204803	1134204803	1	1	LIN, BETTY C MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69094	15	Obstetrics (D.O. only)	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
155107	Fee-for-Service	1588737928	1588737928	1	1	LAURANCE, SUSAN M LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3088 PIO PICO DR	STE 202	CARLSBAD	CA	92008	1965	37	06073	33.16280061	-117.3410928	San Diego County
155139	Fee-for-Service	1093773236	1093773236	2	1	LIRA, PETER M SR	10/8/2002	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	16122 COVELLO ST	None	VAN NUYS	CA	91406	2910	19	06037	34.20749285	-118.4845255	Los Angeles County
155158	Fee-for-Service	1265019020	1265019020	1	1	LAINE, LESLIE D NP	10/15/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
155194	Fee-for-Service	1104938679	1104938679	1	1	LOHIYA, GHANSHYAM MD	11/30/1988	193200000X	NA	Other	026	PHYSICIANS	34243	08	Family Practice	0	In state provider	None	1120 W WARNER AVE	STE A	SANTA ANA	CA	92707	3179	30	06059	33.71616652	-117.882981	Orange County
155209	Fee-for-Service	1164462271	1164462271	1	1	LAWRENCE, LORRAINE N LMFT	2/6/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4145 DEL MAR TRAILS RD	None	SAN DIEGO	CA	92130	2218	37	06073	32.94384949	-117.2233448	San Diego County
155211	Fee-for-Service	1659585164	1659585164	1	1	LIOKUMOVICH, VICTORIA MD	1/14/2008	207R00000X	NA	Other	026	PHYSICIANS	96668	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
155212	Fee-for-Service	1720190580	1720190580	1	1	LICATA, STEPHEN P MD	12/31/1995	207L00000X	NA	Other	026	PHYSICIANS	80519	05	Anesthesiology	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
155230	Fee-for-Service	1295904092	1295904092	1	1	LUU, BINH D MD	10/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94432	25	Physical Medicine and Rehabilitation	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
155238	Fee-for-Service	1114386547	1114386547	1	1	LEE, GRACE E LMFT	5/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
155240	Fee-for-Service	1871242669	1871242669	1	1	LONGSWORTH, EDUARDO D NP	7/23/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
155251	Fee-for-Service	1336328764	1336328764	1	1	LEE, JANE W MD	12/8/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	89008	30	Radiology	0	In state provider	None	3031 TISCH WAY	STE 400	SAN JOSE	CA	95128	2541	43	06085	37.3171883	-121.947648	Santa Clara County
155269	Fee-for-Service	1902166465	1902166465	1	1	LEVY, DANIELE V PHD	9/28/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
155278	Fee-for-Service	1265687719	1265687719	1	1	LYPKA, MICHAEL A MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89401	24	Plastic Surgery	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
155282	Fee-for-Service	1154655090	1154655090	1	1	LAO, ANGA	12/29/2009	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	450 SUTTER ST	SUITE 933	SAN FRANCISCO	CA	94108	9779	38	06075	37.78934929	-122.4077786	San Francisco County
155289	Fee-for-Service	1891818837	1891818837	1	1	LEVY, MALVINA C	3/5/2007	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1234 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3911	38	06075	37.781144	-122.4390035	San Francisco County
155307	Fee-for-Service	1386786374	1386786374	1	1	LEVINE, VICTOR D MD	6/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	22157	66	Emergency Medicine (Urgent Care)	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
155345	Fee-for-Service	1750830204	1750830204	1	1	LUONG, KYLE PT	3/8/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
155364	Fee-for-Service	1447401237	1447401237	1	1	LAU, CHRISTINE K MD	8/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101970	45	Nephrology (Renal-Kidney)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
155383	Fee-for-Service	1417263070	1417263070	1	1	LYDA, LESLIE A NP	3/11/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
155431	Fee-for-Service	1811199854	1811199854	1	1	LIN, JAMIE J MD	5/6/2016	207R00000X	NA	Other	026	PHYSICIANS	94496	77	Infectious Disease	0	In state provider	None	438 W LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
155432	Fee-for-Service	1154452142	1154452142	1	1	LEW, HOMER K DO	10/24/2009	207R00000X	NA	Other	026	PHYSICIANS	7156	41	Internal Medicine	0	In state provider	None	23521 PASEO DE VALENCIA	STE 108	LAGUNA HILLS	CA	92653	3137	30	06059	33.61113028	-117.7126684	Orange County
155514	Fee-for-Service	1811921604	1811921604	1	2	LAGUNDA, MIA M MD	1/15/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	51016	None	None	0	In state provider	None	815 MARTIN LUTHER KING B	J	BAKERSFIELD	CA	93307	1365	15	06029	35.3655	-118.985202	Kern County
155526	Fee-for-Service	1366463507	1366463507	1	1	LIN, HARTWELL N MD	12/1/1998	207P00000X	NA	Other	026	PHYSICIANS	65114	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
155535	Fee-for-Service	1487608022	1487608022	1	1	LM MEDICAL HOME CARE INC	11/24/1995	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	11856 VOSE ST	None	NORTH HOLLYWOOD	CA	91605	5747	19	06037	34.19841054	-118.391886	Los Angeles County
155536	Fee-for-Service	1801994231	1801994231	1	1	LEVINE, MATTHEW J MD	10/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77126	67	Endocrinology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
155581	Fee-for-Service	1073673265	1073673265	1	1	LEE, JOHN S MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	78574	30	Radiology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
155597	Fee-for-Service	1912200338	1912200338	1	1	LOWERRE, PATRICK J MD	9/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120056	08	Family Practice	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
155598	Fee-for-Service	1770663551	1770663551	1	1	LAS PALMAS MEDICAL GROUP	5/14/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CORPORATION	750 E GRAND AVE	STE B&C	ESCONDIDO	CA	92025	4460	37	06073	33.12531051	-117.0717604	San Diego County
155615	Fee-for-Service	1841601895	1841601895	1	1	LEWINTER, KATHERINE E MD	6/10/2020	390200000X	NA	Other	026	PHYSICIANS	147738	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
155617	Fee-for-Service	1972850717	1972850717	1	1	LINDSAY, REBECCA G MD	12/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129201	01	General Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
155649	Fee-for-Service	1114214707	1114214707	1	1	LEE, ANDREW J MD	5/17/2022	2086X0206X	NA	General Surgery	026	PHYSICIANS	175811	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
155651	Fee-for-Service	1447401237	1447401237	1	1	LAU, CHRISTINE K MD	8/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101970	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
155656	Fee-for-Service	1659356368	1659356368	1	1	LE, ANDY P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	78649	None	None	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
155669	Fee-for-Service	1215073853	1215073853	1	1	LECH, WALTER J MD	8/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140713	33	Thoracic Surgery	0	In state provider	None	800 S CENTRAL AVE	STE 305A	GLENDALE	CA	91204	4644	19	06037	34.13654729	-118.2578243	Los Angeles County
155676	Fee-for-Service	1083976179	1083976179	1	1	LEE, JESSICA Y MD	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115259	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
155687	Fee-for-Service	1033267943	1033267943	1	1	LIN, KATHRYN C MD	1/7/2008	207R00000X	NA	Other	026	PHYSICIANS	86283	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
155688	Fee-for-Service	1043368830	1043368830	1	1	LUONG, CHI L MD	1/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54814	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
155710	Fee-for-Service	1205318920	1205318920	1	1	LEE, RACHAEL O NP	3/10/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
155711	Fee-for-Service	1336134303	1336134303	1	1	LEE, LLOYD J MD	11/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	69557	40	Pediatrics	0	In state provider	None	1201 W LAMBERT RD	None	LA HABRA	CA	90631	6614	30	06059	33.92469151	-117.9595485	Orange County
155760	Fee-for-Service	1497075840	1497075840	1	1	LIM, CHRISTOPHER S MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149075	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
155761	Fee-for-Service	1851554802	1851554802	1	1	LUZANO, JAMES E MD	12/2/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	110734	-	NOT APPLICABLE	0	In state provider	None	1849 SAWTELLE BLVD	SUITE 100	LOS ANGELES	CA	90025	7082	19	06037	34.04266851	-118.4451527	Los Angeles County
155762	Fee-for-Service	1144287442	1144287442	1	1	LEWIS, ELDRIN F MD	7/15/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	169157	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
155785	Fee-for-Service	1568774321	1568774321	1	1	LANGUAGE ESSENTIALS SPEECH P	7/8/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ATHOLOGY, INC.	2180 W GRANT LINE RD	201	TRACY	CA	95377	7342	39	06077	37.75399789	-121.4571561	San Joaquin County
155808	Fee-for-Service	1427223015	1427223015	1	1	LEE, INNA LMFT	6/29/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
155860	Fee-for-Service	1578275616	1578275616	1	1	LE, QUINN	3/22/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
155894	Fee-for-Service	1457428369	1457428369	1	1	LEE, GRACE C MD	9/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87889	18	Ophthalmology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
155907	Fee-for-Service	1982228052	1982228052	1	1	LEAL, JAMES	9/27/2024	207P00000X	NA	Other	026	PHYSICIANS	23051	66	Emergency Medicine (Urgent Care)	0	In state provider	None	914 PINE STREET	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
155928	Fee-for-Service	1619354297	1619354297	1	1	LAURENCIN, LYNNEZY MD	9/11/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	66042	None	None	0	In state provider	None	3151 AIRWAY AVE	SUITE T-3	COSTA MESA	CA	92626	4627	30	06059	33.67783408	-117.8720921	Orange County
155956	Fee-for-Service	1679862635	1679862635	1	1	LIN, WALTER C MD	8/22/2019	208200000X	NA	General Surgery	026	PHYSICIANS	123426	24	Plastic Surgery	0	In state provider	None	45 CASTRO ST	STE 121	SAN FRANCISCO	CA	94114	1019	38	06075	37.76829732	-122.4357056	San Francisco County
155972	Fee-for-Service	1174192694	1174192694	1	1	LE, HOANG V PT	7/12/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	426 N. IMPERIAL AVE.	None	EL CENTRO	CA	92243	2329	13	06025	32.79599732	-115.5700423	Imperial County
155973	Fee-for-Service	1669958658	1669958658	1	1	LEE, HYESOOK CRNA	9/11/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
156003	Fee-for-Service	1295710978	1295710978	1	1	LEAHY, KEVIN E MD	9/1/1998	207L00000X	NA	Other	026	PHYSICIANS	84764	05	Anesthesiology	0	In state provider	None	1330 NATIVIDAD RD	None	SALINAS	CA	93906	3101	27	06053	36.696996	-121.633173	Monterey County
156009	Fee-for-Service	1558756700	1558756700	1	1	LEEPAE RX INC	7/27/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5832 BEACH BLVD	STE 108	BUENA PARK	CA	90621	2022	30	06059	33.875469	-117.9981525	Orange County
156028	Fee-for-Service	1700950938	1700950938	1	1	LEE, GEORGE I MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	53711	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 ALHAMBRA AVE	None	MARTINEZ	CA	94553	3156	07	06013	38.00658519	-122.1309063	Contra Costa County
156075	Fee-for-Service	1497094148	1497094148	1	1	LE, NHU-NGUYEN MD	8/8/2020	207P00000X	NA	Other	026	PHYSICIANS	157900	None	None	0	In state provider	None	1350 W COVINA BLVD	None	SAN DIMAS	CA	91773	3219	19	06037	34.09906108	-117.8343639	Los Angeles County
156089	Fee-for-Service	1033301940	1033301940	1	1	LUM, CRAIG	12/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10485	None	None	0	In state provider	None	6057 N FIRST ST	SUITE 105	FRESNO	CA	93710	5468	10	06019	36.824193	-119.7723865	Fresno County
156099	Fee-for-Service	1568895597	1568895597	1	1	LUSTER, WING SHAN L LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
156107	Fee-for-Service	1073969523	1073969523	1	1	LAMI, VICTOR V MD	8/31/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	171709	None	None	0	In state provider	None	2000 SUTTER PLACE	None	DAVIS	CA	95616	6201	57	06113	38.56289303	-121.7715238	Yolo County
156112	Fee-for-Service	1609322403	1609322403	1	1	LEE, TUYEN C CRNA	12/13/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
156179	Fee-for-Service	1235422841	1235422841	1	1	LAM, YEN T	11/4/2011	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11105 KNOTT AVE	STE B	CYPRESS	CA	90630	5137	30	06059	33.80083909	-118.0111199	Orange County
156180	Fee-for-Service	1023241957	1023241957	1	1	LE, MYAN	7/14/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
156207	Fee-for-Service	1437724218	1437724218	1	1	LIU, JEFFREY DO	2/20/2025	207R00000X	NA	Other	026	PHYSICIANS	22714	41	Internal Medicine	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
156215	Fee-for-Service	1376931295	1376931295	1	4	LIFELONG MEDICAL CARE	7/1/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	616 16TH STREET	None	OAKLAND	CA	94612	1205	01	06001	37.80726295	-122.2743035	Alameda County
156251	Fee-for-Service	1588706741	1588706741	1	1	LATHI, RUTH B MD	4/7/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71266	15	Obstetrics (D.O. only)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
156309	Fee-for-Service	1205153913	1205153913	1	1	LIN, GEORGE L MD	6/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118612	41	Internal Medicine	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
156315	Fee-for-Service	1700950938	1700950938	1	1	LEE, GEORGE I MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	53711	05	Anesthesiology	0	In state provider	None	2500 ALHAMBRA AVE	None	MARTINEZ	CA	94553	3156	07	06013	38.00658519	-122.1309063	Contra Costa County
156317	Fee-for-Service	1932771920	1932771920	1	1	LAM, MONIQUE PT	10/1/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
156345	Fee-for-Service	1659502383	1659502383	1	1	LEWIS LEONG, EUGENIE M LCSW	4/6/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3655 TORRANCE BLVD.	STE. 349	TORRANCE	CA	90503	4830	19	06037	33.83763146	-118.350612	Los Angeles County
156386	Fee-for-Service	1255896379	1255896379	1	1	LAMBENGCO, TIMOTHY	3/29/2019	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
156392	Fee-for-Service	1982628830	1982628830	1	1	LIU, CARSON, D MD	2/28/1993	208600000X	NA	General Surgery	026	PHYSICIANS	75372	02	General Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
156428	Fee-for-Service	1205049806	1205049806	1	1	LO, KUO CHING	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	15766 LA SUBIDA DR	None	HACIENDA HEIGHTS	CA	91745	4533	19	06037	33.99000295	-117.9710916	Los Angeles County
156439	Fee-for-Service	1265845200	1265845200	1	1	LORESCA, ESPECIANISE MD	1/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142671	01	General Practice	0	In state provider	None	1570 E HERNDON AVE	None	FRESNO	CA	93720	3303	10	06019	36.83756046	-119.759841	Fresno County
156468	Fee-for-Service	1659532679	1659532679	1	1	LEE, BONNY M C MD	1/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	111041	05	Anesthesiology	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4378	43	06085	37.36893518	-122.0779448	Santa Clara County
156482	Fee-for-Service	1780652586	1780652586	1	1	LENAERTS, MARC E MD	8/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53356	13	Neurology (M.D. only)	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
156499	Fee-for-Service	1659669562	1659669562	1	1	LIRA HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6222 WILSHIRE BLVD	SUITE 230	LOS ANGELES	CA	90048	5130	19	06037	34.06325771	-118.3641574	Los Angeles County
156504	Fee-for-Service	1376931295	1376931295	1	4	LIFELONG MEDICAL CARE	7/1/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	616 16TH STREET	None	OAKLAND	CA	94612	1205	01	06001	37.80726295	-122.2743035	Alameda County
156507	Fee-for-Service	1073714952	1073714952	1	1	LIMB, MARIAN J MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72053	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
156524	Fee-for-Service	1013504919	1013504919	1	1	LIFE LINE HOSPICE INC	6/16/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	127 S BRAND BLVD	STE 227	GLENDALE	CA	91204	1374	19	06037	34.145289	-118.255096	Los Angeles County
156543	Fee-for-Service	1184772972	1184772972	1	1	LEE, JIVIANNE K T MD	9/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72248	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 550	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
156554	Fee-for-Service	1659697514	1659697514	1	1	LOS ANGELES FAMILY MEDICAL	5/28/2010	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SERVICES INC	3410 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1708	19	06037	34.02760053	-118.2006123	Los Angeles County
156578	Fee-for-Service	1427217223	1427217223	1	1	LIN, JANICE MD	12/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	139485	83	Rheumatology	0	In state provider	None	300 PASTUER DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
156581	Fee-for-Service	1710943113	1710943113	1	1	LEE, GARY S MD	7/31/1989	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	61379	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
156608	Fee-for-Service	1104231646	1104231646	1	1	LE, ANNIE DIEM HANG OD	4/5/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	31700 GRAPE ST	None	LAKE ELSINORE	CA	92532	9785	33	06065	33.662241	-117.2944665	Riverside County
156619	Fee-for-Service	1568510543	1568510543	1	1	LAMMERS, PAMELA J MD	11/27/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	42119	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
156628	Fee-for-Service	1770874703	1770874703	1	1	LAFONTAINE, DIANA C MD	2/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124100	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
156629	Fee-for-Service	1750705182	1750705182	1	1	LU, ERIC MD	10/18/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	161315	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
156653	Fee-for-Service	1225324221	1225324221	1	1	LEE, SEUNG JIN	6/27/2014	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1704 W MANCHESTER AVE	SUITE 208	LOS ANGELES	CA	90047	3057	19	06037	33.9599425	-118.307079	Los Angeles County
156670	Fee-for-Service	1801231709	1801231709	1	1	LIU, JASEN Y W MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135227	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
156673	Fee-for-Service	1013262492	1013262492	1	1	LI, SHUANG MD	1/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146403	41	Internal Medicine	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
156688	Fee-for-Service	1942290762	1942290762	1	2	LE, SON H MD	12/14/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	42423	-	NOT APPLICABLE	0	In state provider	None	2180 WEST VALLEY BLVD	None	POMONA	CA	91768	3325	19	06037	34.06130455	-117.7900768	Los Angeles County
156723	Fee-for-Service	1881622702	1881622702	1	1	LEWIS, SUSAN J MD	2/1/1999	207P00000X	NA	Other	026	PHYSICIANS	84444	None	None	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
156740	Fee-for-Service	1992926620	1992926620	1	1	LAGER, JEANNETTE C MD	12/4/2008	390200000X	NA	Other	026	PHYSICIANS	104762	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
156741	Fee-for-Service	1225370232	1225370232	1	1	LAU, STEVEN K M MD	10/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154145	78	Neoplastic Diseases/Oncology	0	In state provider	None	2230 LYNN RD	STE 103	THOUSAND OAKS	CA	91360	1958	56	06111	34.20894685	-118.885185	Ventura County
156763	Fee-for-Service	1770564049	1770564049	1	1	LASSEN INDIAN HEALTH CTR	9/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	795 JOAQUIN ST	None	SUSANVILLE	CA	96130	3628	18	06035	40.42683779	-120.6570864	Lassen County
156771	Fee-for-Service	1609849074	1609849074	1	10	LA MAESTRA FAMILY CLINIC INC	5/2/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4177 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1609	37	06073	32.75278963	-117.1008335	San Diego County
156780	Fee-for-Service	1760082770	1760082770	1	1	LAND, HALEY LCSW	6/6/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
156787	Fee-for-Service	1659669562	1659669562	1	1	LIRA HOSPICE INC	8/1/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6222 WILSHIRE BLVD	SUITE 230	LOS ANGELES	CA	90048	5130	19	06037	34.06325771	-118.3641574	Los Angeles County
156813	Fee-for-Service	1013504919	1013504919	1	1	LIFE LINE HOSPICE INC	6/16/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	127 S BRAND BLVD	STE 227	GLENDALE	CA	91204	1374	19	06037	34.145289	-118.255096	Los Angeles County
156842	Fee-for-Service	1952366833	1952366833	1	1	LAW, EU-MENG MD	4/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53620	30	Radiology	0	In state provider	None	1520 SAN PABLO	LL-1600	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
156856	Fee-for-Service	1699320077	1699320077	1	1	LACKEY, SARAH C PT	5/16/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
156857	Fee-for-Service	1962666347	1962666347	1	1	LEJANO, RAYMOND S MD	3/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128324	40	Pediatrics	0	In state provider	None	1144 SONOMA AVE	SUITE 113	SANTA ROSA	CA	95405	4812	49	06097	38.441097	-122.6989755	Sonoma County
156864	Fee-for-Service	1578615373	1578615373	1	1	LIP,KWUN S MD	1/11/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73750	08	Family Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
156866	Fee-for-Service	1427217223	1427217223	1	1	LIN, JANICE MD	12/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	139485	41	Internal Medicine	0	In state provider	None	300 PASTUER DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
156886	Fee-for-Service	1093185811	1093185811	1	1	LIANG, SYLVIA PT	12/2/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8550 BALBOA BLVD	SUITE 242	NORTHRIDGE	CA	91325	3593	19	06037	34.225713	-118.5026045	Los Angeles County
156910	Fee-for-Service	1568510543	1568510543	1	1	LAMMERS, PAMELA J MD	11/27/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	42119	78	Neoplastic Diseases/Oncology	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
156913	Fee-for-Service	1790059244	1790059244	1	1	LOS ANGELES CONGREGATE	12/5/2012	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	LIVING INC	7819 ARVILLA AVE	None	SUN VALLEY	CA	91352	4314	19	06037	34.21253775	-118.3564528	Los Angeles County
156923	Fee-for-Service	1053508168	1053508168	1	1	LINDA L. ZEINEH, M.D., INC.	11/12/2021	208200000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	1310 W STEWART DR	SUITE 608	ORANGE	CA	92868	3857	30	06059	33.78236048	-117.8664975	Orange County
156940	Fee-for-Service	1275786675	1275786675	1	1	LAKATOS, PATRICIA P PHD	10/22/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
156952	Fee-for-Service	1619914769	1619914769	1	1	LIU, TSUNG-HAN MD	2/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
156955	Fee-for-Service	1356838494	1356838494	1	1	LY, PETER J MD	4/10/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1800 SPRING RIDGE	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
157014	Fee-for-Service	1295869865	1295869865	1	1	LANZONE, ELLEN R PSYD	11/21/2007	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2702 CLAYTON ROAD	None	CONCORD	CA	94519	2789	07	06013	37.97495822	-122.0271497	Contra Costa County
157047	Fee-for-Service	1063455210	1063455210	1	1	LIM, BRIAN S MD	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	84622	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
157049	Fee-for-Service	1770564049	1770564049	1	1	LASSEN INDIAN HEALTH CTR	9/1/2002	261QF0400X	NA	Federally Qualified Health Center	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	795 JOAQUIN ST	None	SUSANVILLE	CA	96130	3628	18	06035	40.42683779	-120.6570864	Lassen County
157053	Fee-for-Service	1265517114	1265517114	1	1	LAU, SUSIE H MD AMC	2/28/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	61050	41	Internal Medicine	0	In state provider	None	1700 E CESAR E CHAVEZ AV	STE 3600	LOS ANGELES	CA	90033	2478	19	06037	34.05101259	-118.217259	Los Angeles County
157059	Fee-for-Service	1609849074	1609849074	1	10	LA MAESTRA FAMILY CLINIC INC	5/2/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4177 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1609	37	06073	32.75278963	-117.1008335	San Diego County
157069	Fee-for-Service	1972589703	1972589703	1	1	LOUIE, JOHN MD	8/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82163	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
157103	Fee-for-Service	1467950550	1467950550	1	1	LA MAESTRA FAMILY CLINIC INC	11/15/2018	3336C0002X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	209 HIGHLAND AVE	None	NATIONAL CITY	CA	91950	1518	37	06073	32.68300665	-117.1005522	San Diego County
157135	Fee-for-Service	1275367435	1275367435	1	1	LEE, HLI NP	9/15/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
157162	Fee-for-Service	1265736060	1265736060	1	1	LIM, EUN JOO LAC	5/18/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3407 W 6TH ST	#604	LOS ANGELES	CA	90020	2537	19	06037	34.06363337	-118.295759	Los Angeles County
157168	Fee-for-Service	1811775224	1811775224	1	1	LOVE NEVER FAILS	1/9/2025	106H00000X	NA	Mental Health Outpatient Services	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	22580 GRAND ST	None	HAYWARD	CA	94541	5030	01	06001	37.67044406	-122.0895314	Alameda County
157196	Fee-for-Service	1568510543	1568510543	1	1	LAMMERS, PAMELA J MD	11/27/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	42119	68	Hematology	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
157274	Fee-for-Service	1174634950	1174634950	1	1	LONG, NICOLE E NP	11/15/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	348 RHEEM BLVD	None	MORAGA	CA	94556	1516	07	06013	37.86118691	-122.1278716	Contra Costa County
157284	Fee-for-Service	1942435474	1942435474	1	1	LOZADA, MIA K MD	4/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111814	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
157297	Fee-for-Service	1710920756	1710920756	1	1	LEMM, PATRICK J MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7716	08	Family Practice	0	In state provider	None	2382 CRENSHAW BLVD	STE 5	TORRANCE	CA	90501	3333	19	06037	33.82267285	-118.3284556	Los Angeles County
157333	Fee-for-Service	1598863326	1598863326	1	1	LIEBERSON, ROBERT E MD	12/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52334	01	General Practice	0	In state provider	None	751 S BASCOM AVE	STE 100	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
157361	Fee-for-Service	1962567131	1962567131	1	1	LEE, STEVEN EUGENE MD	12/31/1984	207L00000X	NA	Other	026	PHYSICIANS	54155	05	Anesthesiology	0	In state provider	None	75 NEILSON ST	None	WATSONVILLE	CA	95076	2468	44	06087	36.92823955	-121.792905	Santa Cruz County
157402	Fee-for-Service	1730363581	1730363581	1	1	LEE, GEORGE K MD	9/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107776	02	General Surgery	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
157411	Fee-for-Service	1790772846	1790772846	1	1	LENERT, PETAR S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV OF IOWA HOSP & CLNS	200 HAWKINS DR	None	IOWA CITY	IA	52242	0000	00	None	41.659929	-91.548099	Johnson County
157413	Fee-for-Service	1770675886	1770675886	1	1	LIVE WELL MEDICAL CLINIC	12/21/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1150 EL CAMINO REAL	STE 225	SAN BRUNO	CA	94066	2424	41	06081	37.636488	-122.4177075	San Mateo County
157451	Fee-for-Service	1316683493	1316683493	1	1	LOZANO HERNANDEZ, NORMA D CC	11/4/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	C-SLP	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
157458	Fee-for-Service	1285834713	1285834713	1	1	LAURY, ANNA R MD	8/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116959	22	Pathology (M.D. only)	0	In state provider	None	200 NORTH ROBERTSON	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
157473	Fee-for-Service	1144632266	1144632266	1	1	LAW, TIMOTHY D MD	11/2/2022	208C00000X	NA	General Surgery	026	PHYSICIANS	143289	None	None	0	In state provider	None	1020 29TH ST	STE 350	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
157483	Fee-for-Service	1417242975	1417242975	1	1	LAZAR, DAVID B MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127933	18	Ophthalmology	0	In state provider	None	16500 VENTURA BLVD	STE 250	ENCINO	CA	91436	2018	19	06037	34.15756758	-118.4926374	Los Angeles County
157543	Fee-for-Service	1760015689	1760015689	1	1	LITTLE, SIMON J MD	2/24/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
157546	Fee-for-Service	1861999104	1861999104	1	1	LAZEMIZADEH, BAHAREH S LMFT	10/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
157561	Fee-for-Service	1144222977	1144222977	1	1	LEVINE, ROBERT E MD INC	2/1/1999	207W00000X	NA	Ophthalmology	026	PHYSICIANS	14579	18	Ophthalmology	0	In state provider	None	2100 W 3RD ST	STE 250	LOS ANGELES	CA	90057	1922	19	06037	34.06308947	-118.2733326	Los Angeles County
157622	Fee-for-Service	1598863326	1598863326	1	1	LIEBERSON, ROBERT E MD	12/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52334	14	Neurological Surgery	0	In state provider	None	751 S BASCOM AVE	STE 100	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
157629	Fee-for-Service	1659538163	1659538163	1	1	LEE, OLIVIA T MD	10/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109846	34	Urology and Urological Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
157631	Fee-for-Service	1902855497	1902855497	1	1	LENG, ELLEN A MD	3/31/1991	207P00000X	NA	Other	026	PHYSICIANS	49694	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
157656	Fee-for-Service	1063778793	1063778793	1	1	LUU, MITCHELL N MD	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127536	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
157686	Fee-for-Service	1174719702	1174719702	1	1	LOURO, RACHEL L	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
157691	Fee-for-Service	1083067706	1083067706	1	1	LOYALTY HOSPICE, INC	12/1/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8619 RESEDA BLVD	SUITE 104	NORTHRIDGE	CA	91324	5937	19	06037	34.226982	-118.536098	Los Angeles County
157692	Fee-for-Service	1205281995	1205281995	1	1	LEREW, SHAWN W DO	7/19/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	18801	None	None	0	In state provider	None	6620 COYLE AVE	STE 212	CARMICHAEL	CA	95608	6337	34	06067	38.66751	-121.310028	Sacramento County
157699	Fee-for-Service	1770675886	1770675886	1	1	LIVE WELL MEDICAL CLINIC	12/21/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1150 EL CAMINO REAL	STE 225	SAN BRUNO	CA	94066	2424	41	06081	37.636488	-122.4177075	San Mateo County
157715	Fee-for-Service	1063800092	1063800092	1	1	LESCHKE, TYKESHIA DOULA	5/5/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	12	06023	0	0	None
157747	Fee-for-Service	1205914793	1205914793	1	1	LAU, JASON M MD	11/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94777	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
157763	Fee-for-Service	1174716609	1174716609	1	1	LIN, MEN-CHEH OD	9/17/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	477 E COLORADO BLVD	None	PASADENA	CA	91101	2024	19	06037	34.14587948	-118.140561	Los Angeles County
157781	Fee-for-Service	1659723419	1659723419	1	1	LAGISETTI, RISHIKA J DPM	6/29/2020	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2907 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98793933	-121.9782322	Santa Cruz County
157807	Fee-for-Service	1053499897	1053499897	1	1	LACY, DEE A MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	78873	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
157929	Fee-for-Service	1649234154	1649234154	1	1	LIN, IRENE M OD INC	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1000 E IMPERIAL HWY	None	LA HABRA	CA	90631	7452	30	06059	33.91737689	-117.9349347	Orange County
157935	Fee-for-Service	1407251291	1407251291	1	1	LIM, JOSHUA H LAC	2/27/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	15501 SAN FERNANDO MISSI	SUITE 311	MISSION HILLS	CA	91345	1359	19	06037	34.27189979	-118.4695266	Los Angeles County
157951	Fee-for-Service	1215023643	1215023643	1	1	LEE, SOLEDAD O MD	11/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35051	41	Internal Medicine	0	In state provider	None	6888 LINCOLN AVE	STE M	BUENA PARK	CA	90620	4107	30	06059	33.83179254	-118.013031	Orange County
157961	Fee-for-Service	1770763740	1770763740	1	1	LEKOVIC, GREGORY P MD	9/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105069	None	None	0	In state provider	None	2100 W THIRD ST	STE 111	LOS ANGELES	CA	90057	1944	19	06037	34.06308947	-118.2733326	Los Angeles County
157977	Fee-for-Service	1083067706	1083067706	1	1	LOYALTY HOSPICE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8619 RESEDA BLVD	SUITE 104	NORTHRIDGE	CA	91324	5937	19	06037	34.226982	-118.536098	Los Angeles County
157985	Fee-for-Service	1437194578	1437194578	1	1	LAUGHLIN, ROBERT L MD INC	7/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	36927	41	Internal Medicine	0	In state provider	INC	3838 SAN DIMAS	BLDG A STE 250	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
157990	Fee-for-Service	1770675886	1770675886	1	1	LIVE WELL MEDICAL CLINIC	12/21/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1150 EL CAMINO REAL	STE 225	SAN BRUNO	CA	94066	2424	41	06081	37.636488	-122.4177075	San Mateo County
158023	Fee-for-Service	1770532707	1770532707	1	1	LAURENT, LOUISE C MD	6/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80409	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
158057	Fee-for-Service	1972770832	1972770832	1	1	LEE, LENORA W MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105797	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
158096	Fee-for-Service	1053499897	1053499897	1	1	LACY, DEE A MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	78873	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
158126	Fee-for-Service	1740954536	1740954536	1	1	LOPEZ, TIESE CNP	2/28/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	33205 TEMECULA PKWY	None	TEMECULA	CA	92592	9142	33	06065	33.48600119	-117.0789409	Riverside County
158139	Fee-for-Service	1700098381	1700098381	1	1	LARES, BEATRIZ MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	43240	40	Pediatrics	0	In state provider	None	4755 E CESAR CHAVEZ AVE	STE A	LOS ANGELES	CA	90022	0000	19	06037	34.0406247	-118.1628543	Los Angeles County
158152	Fee-for-Service	1669688420	1669688420	1	1	LI, HAI-YAN MD	9/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112005	20	Orthopedic Surgery	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
158163	Fee-for-Service	1780856609	1780856609	1	1	LIU, ANDY H MD	8/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109367	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
158184	Fee-for-Service	1801828389	1801828389	1	1	LU & WEBER CORPORATION	12/23/1998	332BP3500X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10521 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1128	30	06059	33.77418147	-117.9490228	Orange County
158189	Fee-for-Service	1972550754	1972550754	1	1	LIN, AUSTIN S MD INC	7/16/2004	193400000X	NA	Other	026	PHYSICIANS	84020	05	Anesthesiology	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
158193	Fee-for-Service	1205039831	1205039831	1	1	LEE, EDWARD H DO	5/7/2011	207L00000X	NA	Other	026	PHYSICIANS	11037	05	Anesthesiology	0	In state provider	None	9080 COLIMA ROAD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
158200	Fee-for-Service	1801804653	1801804653	1	1	LEARN, RICHARD N MD	5/29/1987	207W00000X	NA	Ophthalmology	026	PHYSICIANS	19818	18	Ophthalmology	0	In state provider	None	225 W MADISON AVE	None	EL CAJON	CA	92020	3454	37	06073	32.80066448	-116.9642655	San Diego County
158203	Fee-for-Service	1932141744	1932141744	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1550 E COVELL BLVD	None	DAVIS	CA	95616	1352	57	06113	38.5620711	-121.7326169	Yolo County
158213	Fee-for-Service	1437336609	1437336609	1	1	LEE, BRYAN S MD	12/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136126	18	Ophthalmology	0	In state provider	None	762 ALTOS OAKS DRIVE	SUITE 1	LOS ALTOS	CA	94024	5435	43	06085	37.35925198	-122.0937034	Santa Clara County
158272	Fee-for-Service	1437194578	1437194578	1	1	LAUGHLIN, ROBERT L MD INC	7/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	36927	29	Pulmonary Diseases (M.D. only)	0	In state provider	INC	3838 SAN DIMAS	BLDG A STE 250	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
158300	Fee-for-Service	1558595561	1558595561	1	1	LIANG, YU MD	5/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137020	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
158328	Fee-for-Service	1205031820	1205031820	1	1	LUKAUSKIS, KRIS C MD	8/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110908	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
158357	Fee-for-Service	1316149636	1316149636	1	1	LIGHTDALE-MIRIC, NINA R MD	10/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100503	20	Orthopedic Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
158422	Fee-for-Service	1700098381	1700098381	1	1	LARES, BEATRIZ MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	43240	08	Family Practice	0	In state provider	None	4755 E CESAR CHAVEZ AVE	STE A	LOS ANGELES	CA	90022	0000	19	06037	34.0406247	-118.1628543	Los Angeles County
158434	Fee-for-Service	1922041763	1922041763	2	1	LONGS DRUG STORE CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2701 MIDDLEFIELD RD	None	PALO ALTO	CA	94306	2518	43	06085	37.43343124	-122.1292889	Santa Clara County
158450	Fee-for-Service	1184948283	1184948283	1	1	LI, ERIC C MD	6/10/2010	207L00000X	NA	Other	026	PHYSICIANS	101558	05	Anesthesiology	0	In state provider	None	2755 HERNDON AVE	None	CLOVIS	CA	93612	6800	10	06019	36.83745149	-119.6604315	Fresno County
158465	Fee-for-Service	1679566335	1679566335	1	1	LEE, PATRICK K MD	5/1/1995	207N00000X	NA	Dermatology	026	PHYSICIANS	74804	07	Dermatology	0	In state provider	None	200 MEDICAL PLAZA	STE 465	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
158508	Fee-for-Service	1144333824	1144333824	1	1	LEE, TIMOTHY S MD	3/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	70899	41	Internal Medicine	0	In state provider	None	2734 EL CAMINO REAL	None	SANTA CLARA	CA	95051	3041	43	06085	37.35228637	-121.9754073	Santa Clara County
158534	Fee-for-Service	1962552828	1962552828	1	1	LY, MARK L B OD	2/10/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
158546	Fee-for-Service	1194722785	1194722785	1	1	LLOYD DAVID BIBY M.D.	1/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	939 HARLOW RD	#110	SPRINGFIELD	OR	97477	0000	00	None	44.06977851	-123.0418746	Lane County
158551	Fee-for-Service	1205615119	1205615119	1	1	LUPESKO-PERSKY, OSNAT PSYD	9/20/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
158552	Fee-for-Service	1790739258	1790739258	1	1	LEARMAN, LEE A MD	9/1/1993	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	71945	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
158556	Fee-for-Service	1609929892	1609929892	1	1	LEE, JULIA R CRNA	3/29/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
158560	Fee-for-Service	1538121793	1538121793	1	1	LAS VEGAS DIALYSIS CTR	2/28/2007	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	GREATER LAS VEGAS DIALYS	3100 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	1900	00	None	36.15905845	-115.183809	Clark County
158569	Fee-for-Service	1154587368	1154587368	1	1	LIM, ROXANNE G MD	11/18/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	128032	None	None	0	In state provider	None	25150 HANCOCK AVE	STE 206	MURRIETA	CA	92562	5989	33	06065	33.56635084	-117.1823956	Riverside County
158570	Fee-for-Service	1609849074	1609849074	1	1	LA MAESTRA FAMILY CLINIC INC	2/9/1999	261QC1500X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1609	37	06073	32.750523	-117.100927	San Diego County
158586	Fee-for-Service	1265446090	1265446090	1	1	LUENG,FELIX MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MCKAY DEE HOSP	4401 HARRISON BLVD	None	OGDEN	UT	84403	0000	00	None	41.18328	-111.9536955	Weber County
158593	Fee-for-Service	1407182694	1407182694	1	1	LIU, DANDAN MD	5/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	110695	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
158603	Fee-for-Service	1750548640	1750548640	1	1	LUU, THAN A MD	11/26/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	101119	08	Family Practice	0	In state provider	None	33077 ALVARADO NILES RD	None	UNION CITY	CA	94587	3109	01	06001	37.59324793	-122.0436351	Alameda County
158617	Fee-for-Service	1801157896	1801157896	1	1	LI, KARIN C MD A PROF MED	1/22/2014	207R00000X	NA	Other	026	PHYSICIANS	96828	41	Internal Medicine	0	In state provider	CORP	12442 LIMONITE AVE	211	EASTVALE	CA	91752	2467	33	06065	33.97511454	-117.5531895	Riverside County
158668	Fee-for-Service	1548499437	1548499437	1	1	LOIS, VERONICA M MD	9/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119370	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
158714	Fee-for-Service	1518384726	1518384726	1	1	LIU, ZUOLU MD	9/5/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	140634	13	Neurology (M.D. only)	0	In state provider	None	2100 WEBSTER ST	115	SAN FRANCISCO	CA	94115	2373	38	06075	37.7904826	-122.4324477	San Francisco County
158727	Fee-for-Service	1821483785	1821483785	1	1	LEUNG, BRIANA MD	10/19/2023	208600000X	NA	General Surgery	026	PHYSICIANS	188323	None	None	0	In state provider	None	5555 GROSSMONT CENTER	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
158745	Fee-for-Service	1710677638	1710677638	1	1	LISBON, LACY	4/28/2025	176B00000X	NA	Licensed Midwife	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	10	06019	0	0	None
158766	Fee-for-Service	1285701334	1285701334	1	1	LEE, TYAN Y MD	8/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	25491	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	399 E HIGHLAND AVE	SUITE 110	SAN BERNARDINO	CA	92404	3842	36	06071	34.1358627	-117.2757898	San Bernardino County
158802	Fee-for-Service	1396740429	1396740429	1	2	LAYNE, TANYA E MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	80430	None	None	0	In state provider	None	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95928	3979	04	06007	39.750084	-121.7934327	Butte County
158845	Fee-for-Service	1235372517	1235372517	1	1	LOEB, JOSHUA D	7/2/2015	2084E0001X	NA	Neurology	026	PHYSICIANS	116029	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
158858	Fee-for-Service	1609849074	1609849074	1	1	LA MAESTRA FAMILY CLINIC INC	2/9/1999	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1609	37	06073	32.750523	-117.100927	San Diego County
158872	Fee-for-Service	1689130098	1689130098	1	1	LASALLE MEDICAL ASSOCIATES	4/6/2020	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	14544 7TH ST	None	VICTORVILLE	CA	92395	4214	36	06071	34.5148385	-117.314799	San Bernardino County
158911	Fee-for-Service	1730613126	1730613126	1	1	LIN, JIA MD	7/2/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	172590	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
158946	Fee-for-Service	1063590685	1063590685	1	1	LAWRENCE, THOBY J MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69088	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
158953	Fee-for-Service	1164017505	1164017505	1	1	LA HEALTH NET	3/11/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3527 OCEAN VIEW BLVD	SUITE 103	GLENDALE	CA	91208	1211	19	06037	34.20365495	-118.2281684	Los Angeles County
158967	Fee-for-Service	1609947134	1609947134	1	1	LEHMAN, DEBORAH MD	8/14/1989	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	66691	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
158995	Fee-for-Service	1255503850	1255503850	1	1	LEE, RICHARD T MD	12/21/2021	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	80861	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
159020	Fee-for-Service	1992804462	1992804462	1	1	LEWIS, PAMELA P MD	10/31/1986	208600000X	NA	General Surgery	026	PHYSICIANS	51040	02	General Surgery	0	In state provider	None	1 SHRADER ST	STE 400	SAN FRANCISCO	CA	94117	1035	38	06075	37.77467326	-122.4529451	San Francisco County
159029	Fee-for-Service	1487698825	1487698825	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 W. LODI AVE	None	LODI	CA	95240	3517	39	06077	38.13022455	-121.2745483	San Joaquin County
159034	Fee-for-Service	1083893689	1083893689	1	1	LANTIN, ANGELA T MD	11/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112424	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
159035	Fee-for-Service	1043779069	1043779069	1	1	LOUTHAN, MICHAEL J MD	2/25/2022	207P00000X	NA	Other	026	PHYSICIANS	176399	None	None	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
159076	Fee-for-Service	1992723381	1992723381	1	1	LOZANO, MATTHEW DAVID MD	4/29/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	70976	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 BROOKLYN AVE	None	LOS ANGELES	CA	90033	2462	19	06037	34.040502	-118.191954	Los Angeles County
159080	Fee-for-Service	1083685531	1083685531	1	1	LAZARUS, LAWRENCE W MD	9/3/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	21425	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	58457 29 PALMS HIGHWAY	STE 200	YUCCA VALLEY	CA	92284	5879	36	06071	34.13247642	-116.3885551	San Bernardino County
159109	Fee-for-Service	1629131636	1629131636	1	1	LAWRENCE, THOMAS P PT	5/25/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
159111	Fee-for-Service	1427898089	1427898089	1	1	LIU, DAVID T MD	10/10/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
159127	Fee-for-Service	1013463306	1013463306	1	1	LAKE ARROWHEAD HOME	4/24/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	28200 HIGHWAY 189	F240-6	LAKE ARROWHEAD	CA	92352	9700	36	06071	34.24991105	-117.1901486	San Bernardino County
159129	Fee-for-Service	1235372517	1235372517	1	1	LOEB, JOSHUA D	7/2/2015	2084E0001X	NA	Neurology	026	PHYSICIANS	116029	13	Neurology (M.D. only)	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
159140	Fee-for-Service	1366498453	1366498453	1	1	LINDA TRIBBLE M.D.	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2730 PROSPERITY AVE	STE B	FAIRFAX	VA	22031	4324	00	None	38.877561	-77.23836	City of Fairfax
159145	Fee-for-Service	1619345121	1619345121	1	1	LIMBEKAR, NAINA MD	2/17/2023	2084S0012X	NA	Neurology	026	PHYSICIANS	178344	None	None	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
159161	Fee-for-Service	1558455071	1558455071	1	1	LEE, JENNIFER S MD	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83255	67	Endocrinology	0	In state provider	None	1001 POTRERO AVE	RM 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
159169	Fee-for-Service	1689687345	1689687345	1	1	LOS ANGELES COUNTY	4/28/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	LA PUENTE FAM PLANNING	15930 CENTRAL AVE	None	LA PUENTE	CA	91744	5410	19	06037	34.01942824	-117.9506314	Los Angeles County
159189	Fee-for-Service	1396062386	1396062386	1	1	LEE, MICHAELA MD	5/25/2018	207T00000X	NA	General Surgery	026	PHYSICIANS	154154	14	Neurological Surgery	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
159222	Fee-for-Service	1396739470	1396739470	1	1	LAI, SEAN C F MD	10/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	40912	41	Internal Medicine	0	In state provider	None	2001 SANTA MONICA BLVD	# 1286W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
159226	Fee-for-Service	1649349846	1649349846	1	1	LEE, ANDREW K MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70317	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
159258	Fee-for-Service	1285789727	1285789727	1	1	LEE, DAVID S MD	4/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98571	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
159262	Fee-for-Service	1619076627	1619076627	1	1	LEE, SHARON E MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55256	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
159264	Fee-for-Service	1902975907	1902975907	1	1	LIU, ALLEN MD	4/1/2018	2086S0105X	NA	General Surgery	026	PHYSICIANS	-	24	Plastic Surgery	2	Out of state provider	None	370 E VIRGINIA AVE	SUITE 100	PHOENIX	AZ	85004	1214	00	None	33.476985	-112.0663215	Maricopa County
159273	Fee-for-Service	1619174067	1619174067	1	1	LANE, DANIEL W DO	8/21/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	10534	36	Psychiatry	0	In state provider	None	13193 CENTRAL AVENUE	SUITE 200	CHINO	CA	91710	4179	36	06071	34.01406506	-117.6891684	San Bernardino County
159283	Fee-for-Service	1437312899	1437312899	1	1	LYDECKER, KATHERINE P PHD	1/12/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
159298	Fee-for-Service	1962407825	1962407825	1	1	LOGAN, KENNETH D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50800	40	Pediatrics	0	In state provider	None	251 COHASSET RD	STE 320	CHICO	CA	95926	2239	04	06007	39.75090044	-121.8522609	Butte County
159299	Fee-for-Service	1790795318	1790795318	1	1	LIU, ALEXANDER C OD	4/19/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2280 E CARSON ST	None	LONG BEACH	CA	90807	3044	19	06037	33.83241248	-118.164456	Los Angeles County
159323	Fee-for-Service	1558448340	1558448340	1	1	LAL, SANDEEP B MD	8/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92764	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
159327	Fee-for-Service	1205299484	1205299484	1	1	LA BREA REHABILITATION	12/12/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER, LLC	505 N LA BREA AVE	None	LOS ANGELES	CA	90036	2015	19	06037	34.0805814	-118.3440947	Los Angeles County
159351	Fee-for-Service	1306330469	1306330469	1	1	LENUS CARE LLC	7/29/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5060 CALIFORNIA AVE	STE 415	BAKERSFIELD	CA	93309	0728	15	06029	35.36198786	-119.0595393	Kern County
159370	Fee-for-Service	1083685531	1083685531	1	1	LAZARUS, LAWRENCE W MD	9/3/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	21425	13	Neurology (M.D. only)	0	In state provider	None	58457 29 PALMS HIGHWAY	STE 200	YUCCA VALLEY	CA	92284	5879	36	06071	34.13247642	-116.3885551	San Bernardino County
159387	Fee-for-Service	1578763926	1578763926	1	1	LAW, YIIK MD	4/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	103795	02	General Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
159415	Fee-for-Service	1316004948	1316004948	1	1	LE, MYHANH T PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	260 INTERNATIONAL CR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
159421	Fee-for-Service	1023275237	1023275237	1	1	LEE, GRACE M MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120055	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
159424	Fee-for-Service	1952835092	1952835092	1	1	LANGFIELD, ANDREW J MD	7/21/2020	390200000X	NA	Other	026	PHYSICIANS	158555	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
159431	Fee-for-Service	1326578774	1326578774	1	1	LA MAESTRA FAMILY CLINIC INC	11/15/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	165 S 1ST ST	STE 1B	EL CAJON	CA	92019	4795	37	06073	32.794002	-116.944563	San Diego County
159434	Fee-for-Service	1548755747	1548755747	1	1	LEE, HYUNHYE PT	8/27/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
159449	Fee-for-Service	1558455071	1558455071	1	1	LEE, JENNIFER S MD	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83255	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
159459	Fee-for-Service	1033281860	1033281860	1	1	LEE, PAULA MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69721	36	Psychiatry	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
159485	Fee-for-Service	1366685067	1366685067	1	1	LEE, JOOHEE MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106466	41	Internal Medicine	0	In state provider	None	1180 E SHAW	#125	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
159494	Fee-for-Service	1902444136	1902444136	1	1	LAHEY, SHANNON LMFT	4/17/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29748 RANCHO CALIFORNIA	RD	TEMECULA	CA	92591	5286	33	06065	33.50662849	-117.1428887	Riverside County
159496	Fee-for-Service	1871671644	1871671644	1	1	LEE, CARY W MD	4/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77387	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
159510	Fee-for-Service	1396739470	1396739470	1	1	LAI, SEAN C F MD	10/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	40912	10	Gastroenterology (M.D. only)	0	In state provider	None	2001 SANTA MONICA BLVD	# 1286W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
159549	Fee-for-Service	1619076627	1619076627	1	1	LEE, SHARON E MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55256	01	General Practice	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
159553	Fee-for-Service	1902975907	1902975907	1	1	LIU, ALLEN MD	4/1/2018	2086S0105X	NA	General Surgery	026	PHYSICIANS	-	46	Hand Surgery	2	Out of state provider	None	370 E VIRGINIA AVE	SUITE 100	PHOENIX	AZ	85004	1214	00	None	33.476985	-112.0663215	Maricopa County
159576	Fee-for-Service	1205253150	1205253150	1	1	LAW, KAREN MD	10/29/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	138534	08	Family Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
159589	Fee-for-Service	1962407825	1962407825	1	1	LOGAN, KENNETH D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50800	08	Family Practice	0	In state provider	None	251 COHASSET RD	STE 320	CHICO	CA	95926	2239	04	06007	39.75090044	-121.8522609	Butte County
159639	Fee-for-Service	1306330469	1306330469	1	1	LENUS CARE LLC	7/29/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5060 CALIFORNIA AVE	STE 415	BAKERSFIELD	CA	93309	0728	15	06029	35.36198786	-119.0595393	Kern County
159643	Fee-for-Service	1205288636	1205288636	1	1	LIN, NAOMI MD	10/18/2020	208M00000X	NA	Other	026	PHYSICIANS	160223	41	Internal Medicine	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
159660	Fee-for-Service	1083685531	1083685531	1	1	LAZARUS, LAWRENCE W MD	9/3/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	21425	36	Psychiatry	0	In state provider	None	58457 29 PALMS HIGHWAY	STE 200	YUCCA VALLEY	CA	92284	5879	36	06071	34.13247642	-116.3885551	San Bernardino County
159662	Fee-for-Service	1235469396	1235469396	1	1	LOVERN, JENNIFER K DC	12/22/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	678 3RD AVE	None	CHULA VISTA	CA	91911	5736	37	06073	32.62870793	-117.0750108	San Diego County
159702	Fee-for-Service	1609859529	1609859529	1	1	LI, ANDREW J MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68582	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
159737	Fee-for-Service	1790150795	1790150795	1	1	LATOURELLE, TERESA LMFT	7/10/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
159771	Fee-for-Service	1740308360	1740308360	1	1	LESTINO, JOSEPH A PT	2/24/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5648 LAKE MURRAY BLVD	None	LA MESA	CA	91942	1929	37	06073	32.78184153	-117.03104	San Diego County
159784	Fee-for-Service	1366814204	1366814204	1	1	LOUIE, KRISTIN M MD	8/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138445	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
159821	Fee-for-Service	1134583347	1134583347	1	1	LEE, WILSON MD	8/19/2020	208M00000X	NA	Other	026	PHYSICIANS	168330	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
159837	Fee-for-Service	1619076627	1619076627	1	1	LEE, SHARON E MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55256	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
159859	Fee-for-Service	1346377439	1346377439	1	1	LIM, VALERIE A OD	2/3/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
159870	Fee-for-Service	1629126032	1629126032	1	1	LUNA, LELAND M DO	1/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	7091	01	General Practice	0	In state provider	None	161 S SPRUCE AVE	STE B	S SAN FRANCISCO	CA	94080	4517	41	06081	37.64915337	-122.4185534	San Mateo County
159874	Fee-for-Service	1457854242	1457854242	1	1	LIN, VANIA MD	9/13/2023	207RR0500X	NA	Other	026	PHYSICIANS	185767	None	None	0	In state provider	None	2999 REGENT STREET	301	BERKELEY	CA	94705	2118	01	06001	37.85592021	-122.2566436	Alameda County
159899	Fee-for-Service	1093950982	1093950982	1	1	LEYVA, JESUS PSYD	1/10/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
159909	Fee-for-Service	1598090029	1598090029	1	1	LOTUS CARE CENTER INC	9/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6011 WEST BLVD	None	LOS ANGELES	CA	90043	3801	19	06037	33.98488564	-118.335209	Los Angeles County
159925	Fee-for-Service	1376931295	1376931295	1	3	LIFELONG MEDICAL CARE	7/1/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3260 SACRAMENTO STREET	None	BERKELEY	CA	94702	2739	01	06001	37.8481184	-122.2779098	Alameda County
159926	Fee-for-Service	1912083585	1912083585	2	1	LINCARE INC	2/3/2021	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	5780 CHESAPEAKE CT	SUITE 2	SAN DIEGO	CA	92123	1030	37	06073	32.83849262	-117.1291488	San Diego County
159940	Fee-for-Service	1922041250	1922041250	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 E HWY 12	STE D	VALLEY SPRINGS	CA	95252	9494	05	06009	38.19240195	-120.8267863	Calaveras County
159945	Fee-for-Service	1891942397	1891942397	1	1	LYNG, CHRISTINE F LCSW	3/10/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
159967	Fee-for-Service	1568801579	1568801579	1	1	LIN, PHILIP W MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141732	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1798 NORTH GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
159991	Fee-for-Service	1881698447	1881698447	1	1	LIVINGSTON MEMORIAL VNA	1/1/1988	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE	1996 EASTMAN AVE	STE 108	VENTURA	CA	93003	5769	56	06111	34.25489954	-119.2300167	Ventura County
159996	Fee-for-Service	1609859529	1609859529	1	1	LI, ANDREW J MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68582	78	Neoplastic Diseases/Oncology	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
160008	Fee-for-Service	1285169367	1285169367	1	1	LUEVANOS, RYAN MD	7/8/2020	207P00000X	NA	Other	026	PHYSICIANS	166859	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
160027	Fee-for-Service	1588643795	1588643795	1	1	LEN, TRICIA A MD	4/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	74181	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
160037	Fee-for-Service	1427055706	1427055706	1	1	LO, FERNANDINA G MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51604	41	Internal Medicine	0	In state provider	None	5720 STONERIDGE MALL RD	STE 270	PLEASANTON	CA	94588	2854	01	06001	37.69247085	-121.9301884	Alameda County
160067	Fee-for-Service	1023477668	1023477668	1	1	LEDBETTER, HALEY O LCSW	6/26/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6 GOVERNORS LN	A	CHICO	CA	95926	5590	04	06007	39.75531581	-121.8582802	Butte County
160071	Fee-for-Service	1609220268	1609220268	1	1	LEE, BRIAN K MD	8/9/2022	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	154108	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
160080	Fee-for-Service	1700102308	1700102308	1	1	LIU, JUDY Z T MD	10/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135189	04	Otology, Laryngology, Rhinology	0	In state provider	None	547 EAST UNION STREET	None	PASADENA	CA	91101	1743	19	06037	34.1472385	-118.139094	Los Angeles County
160120	Fee-for-Service	1871955922	1871955922	1	1	LAM, GREGORY MD	6/5/2019	207R00000X	NA	Other	026	PHYSICIANS	151470	41	Internal Medicine	0	In state provider	None	1245 16TH ST	STE 204	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
160121	Fee-for-Service	1578122248	1578122248	1	1	LIS, RITA MD	2/20/2025	207RE0101X	NA	Endocrinology	026	PHYSICIANS	178614	67	Endocrinology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
160130	Fee-for-Service	1578690442	1578690442	1	1	LUBITZ, DIANA R LCSW	8/16/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3172 WALFORD AVE	STE 5	EUREKA	CA	95503	4898	12	06023	40.77960999	-124.1378813	Humboldt County
160132	Fee-for-Service	1962760074	1962760074	1	1	LA PORTE, PAUL F MD	6/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137327	41	Internal Medicine	0	In state provider	None	9090 WILSHIRE BLVD	STE 200	BEVERLY HILLS	CA	90211	1850	19	06037	34.06702873	-118.3894057	Los Angeles County
160136	Fee-for-Service	1114246568	1114246568	1	1	LEE, AARON J MD	12/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15545	02	General Surgery	0	In state provider	None	7111 INDIANA AVE	STE 100	RIVERSIDE	CA	92504	4557	33	06065	33.93924242	-117.3973049	Riverside County
160140	Fee-for-Service	1295992857	1295992857	1	1	LUKOW, EVAN T. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ANESTHESIA SPECIALISTS	600 GRESHAM DR	None	NORFOLK	VA	23507	1904	00	None	36.86320774	-76.30380004	Norfolk city
160184	Fee-for-Service	1346453164	1346453164	1	1	LEONEN, RYAN MD	5/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105412	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
160187	Fee-for-Service	1609313675	1609313675	1	2	LIFE STEP THERAPY INC.	10/1/2020	252Y00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	865 ANCHORAGE PLACE	None	CHULA VISTA	CA	91914	4535	37	06073	32.65523447	-116.9575942	San Diego County
160198	Fee-for-Service	1205156262	1205156262	1	1	LEE, JAKE I DPM	9/22/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
160211	Fee-for-Service	1376931295	1376931295	1	3	LIFELONG MEDICAL CARE	7/1/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3260 SACRAMENTO STREET	None	BERKELEY	CA	94702	2739	01	06001	37.8481184	-122.2779098	Alameda County
160224	Fee-for-Service	1386112597	1386112597	1	1	LEE, DAN BI CNP	11/13/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16773 BERNARDO CENTER DR	None	SAN DIEGO	CA	92128	2525	37	06073	33.01874412	-117.0752752	San Diego County
160231	Fee-for-Service	1336342708	1336342708	1	1	LIN, JENNIFER C MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111089	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
160241	Fee-for-Service	1962602029	1962602029	1	1	LALUZ, LUIS A MD	8/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	43238	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
160244	Fee-for-Service	1629148994	1629148994	1	1	LEE, BRUCE B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49085	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	966 CASS ST	STE 200	MONTEREY	CA	93940	4522	27	06053	36.5924291	-121.8964192	Monterey County
160279	Fee-for-Service	1881698447	1881698447	1	1	LIVINGSTON MEMORIAL VNA	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE	1996 EASTMAN AVE	STE 108	VENTURA	CA	93003	5769	56	06111	34.25489954	-119.2300167	Ventura County
160293	Fee-for-Service	1639363880	1639363880	1	1	LUNDY, SHANNON M PHD	7/18/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
160294	Fee-for-Service	1285169367	1285169367	1	1	LUEVANOS, RYAN MD	7/8/2020	207P00000X	NA	Other	026	PHYSICIANS	166859	70	Clinic (mixed specialty)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
160301	Fee-for-Service	1649397241	1649397241	1	1	LAI, JENNIFER C MD	4/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101839	10	Gastroenterology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
160319	Fee-for-Service	1821032962	1821032962	1	1	LEE, CHRISTOPHER MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31361	41	Internal Medicine	0	In state provider	None	3798 JANES RD	STE 18	ARCATA	CA	95521	4746	12	06023	40.89649119	-124.0930501	Humboldt County
160322	Fee-for-Service	1033305404	1033305404	1	1	LAU, ANDREA PHD	5/14/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
160390	Fee-for-Service	1932763042	1932763042	1	1	LOGAN M. HAAK, M.D., INC.	6/25/2019	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	None	None	None	0	In state provider	None	1855 01ST AVE	200B	SAN DIEGO	CA	92101	2685	37	06073	0	0	None
160392	Fee-for-Service	1154557734	1154557734	1	1	LA LEE OBGYN MEDICAL	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50371	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	ASSOCIATES	3130 W OLYMPIC BLVD	SUITE 360	LOS ANGELES	CA	90006	2494	19	06037	34.05258529	-118.3039795	Los Angeles County
160402	Fee-for-Service	1922288075	1922288075	1	1	LIU, PERRY H MD FACS	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	96604	None	None	0	In state provider	None	12021 WILSHIRE BLVD	STE 745	LOS ANGELES	CA	90025	1206	19	06037	34.04543773	-118.4658404	Los Angeles County
160424	Fee-for-Service	1508253303	1508253303	1	1	LI, MICHAEL MD	6/14/2022	207RI0008X	NA	Gastroenterology	026	PHYSICIANS	171722	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
160427	Fee-for-Service	1700886702	1700886702	1	1	LAWLER, WILLIAM E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	16403	41	Internal Medicine	0	In state provider	None	1211 W LA PALMA AVE	STE 404	ANAHEIM	CA	92801	2806	30	06059	33.84718298	-117.933758	Orange County
160428	Fee-for-Service	1083774616	1083774616	1	1	LAU, STANLEY	1/26/2004	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	A CARE MEDICAL SUPPLIES	1168 SAN GABRIEL BLVD	STE G	ROSEMEAD	CA	91770	4236	19	06037	34.04272643	-118.086007	Los Angeles County
160456	Fee-for-Service	1245751643	1245751643	1	1	LOOI, MEI H PHD	8/8/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
160476	Fee-for-Service	1609313675	1609313675	1	2	LIFE STEP THERAPY INC.	8/19/2021	252Y00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	865 ANCHORAGE PLACE	None	CHULA VISTA	CA	91914	4535	37	06073	32.65523447	-116.9575942	San Diego County
160487	Fee-for-Service	1578983169	1578983169	1	1	LIU, ROSA MD	10/28/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	139893	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
160519	Fee-for-Service	1760559579	1760559579	1	1	LI, BERDINE A	11/30/1990	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	71748	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
160531	Fee-for-Service	1962602029	1962602029	1	1	LALUZ, LUIS A MD	8/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	43238	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
160568	Fee-for-Service	1992961270	1992961270	1	1	LIN, JOHN C MD	7/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	99566	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
160579	Fee-for-Service	1427110329	1427110329	1	3	LIVINGSTON COMMUNITY HEALTH	4/1/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	600 B ST	BUILDING C	LIVINGSTON	CA	95334	9593	24	06047	37.38589253	-120.734559	Merced County
160598	Fee-for-Service	1104900919	1104900919	1	1	LIGHT, KENNETH I MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	35263	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
160692	Fee-for-Service	1790763480	1790763480	1	1	LANCASTER, LARYENTH D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3375 N CAMPBELL AVE	None	TUCSON	AZ	85719	2306	00	None	32.267907	-110.944512	Pima County
160716	Fee-for-Service	1760620330	1760620330	1	5	LODI MEMORIAL HOSPITAL	2/22/2010	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	300 W OAK STREET	None	LODI	CA	95242	3402	39	06077	38.13306845	-121.2766328	San Joaquin County
160761	Fee-for-Service	1144891458	1144891458	1	1	LUNA, KENNETH CHRISTIAN S NP	3/28/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
160764	Fee-for-Service	1609313675	1609313675	1	2	LIFE STEP THERAPY INC.	10/1/2020	252Y00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	865 ANCHORAGE PLACE	None	CHULA VISTA	CA	91914	4535	37	06073	32.65523447	-116.9575942	San Diego County
160798	Fee-for-Service	1629327994	1629327994	1	2	LANDMAN, MICHAEL D MD INC	4/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	22817	None	None	0	In state provider	None	5525 ETIWANDA AVE	STE 312	TARZANA	CA	91356	6126	19	06037	34.17046451	-118.5308463	Los Angeles County
160831	Fee-for-Service	1174699904	1174699904	1	2	LAGUNA HONDA HOSPITAL	9/24/2008	No Taxonomy Provided	NA	None	060	COUNTY HOSPITAL INPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
160837	Fee-for-Service	1730834904	1730834904	1	1	LOMA LINDA SURGICAL INSTITUT	1/23/2023	208600000X	NA	General Surgery	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	E, LLC	25915 BARTON ROAD	101	LOMA LINDA	CA	92354	3818	36	06071	34.0482545	-117.2388465	San Bernardino County
160850	Fee-for-Service	1780949131	1780949131	1	1	LEE, DANIEL J MD	5/3/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	132543	68	Hematology	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
160853	Fee-for-Service	1992961270	1992961270	1	1	LIN, JOHN C MD	7/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	99566	33	Thoracic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
160868	Fee-for-Service	1427110329	1427110329	1	3	LIVINGSTON COMMUNITY HEALTH	4/1/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	600 B ST	BUILDING C	LIVINGSTON	CA	95334	9593	24	06047	37.38589253	-120.734559	Merced County
160874	Fee-for-Service	1891743506	1891743506	1	1	LAPSI, ANAND A MD	1/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75171	30	Radiology	0	In state provider	None	3700 SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
160877	Fee-for-Service	1942395157	1942395157	1	1	LEE, MATTHEW K MD	12/1/1995	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	62718	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
160895	Fee-for-Service	1770666299	1770666299	1	1	LANGDORF, MARK IRA	10/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	62953	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
160898	Fee-for-Service	1043352115	1043352115	1	1	LEIGHT, ADAM M MD	6/7/2021	207P00000X	NA	Other	026	PHYSICIANS	170953	None	None	0	In state provider	None	2623 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	19	06037	33.98921547	-118.2242565	Los Angeles County
160899	Fee-for-Service	1174750590	1174750590	1	1	LIPPMANN, QUINN K MD	8/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125592	34	Urology and Urological Surgery	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
160920	Fee-for-Service	1669547006	1669547006	2	1	LE, TOM L MD	6/4/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	88137	08	Family Practice	0	In state provider	None	555 E OCEAN BLVD	110	LONG BEACH	CA	90802	5003	19	06037	33.76653325	-118.185777	Los Angeles County
160926	Fee-for-Service	1982857462	1982857462	1	1	LEE, PETER A MD	8/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97637	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
160948	Fee-for-Service	1134288749	1134288749	1	1	LAM, TAT S MD	12/1/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62418	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
160965	Fee-for-Service	1124509252	1124509252	1	1	LY, RICHARD OD	9/17/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	17801 PIONEER BLVD	STE F	ARTESIA	CA	90701	3962	19	06037	33.8693187	-118.0823685	Los Angeles County
160972	Fee-for-Service	1386925469	1386925469	1	1	LOWE, DEIDRA NP	11/19/2024	163W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
160981	Fee-for-Service	1609337617	1609337617	1	1	LI, MATTHEW MD	9/12/2024	208M00000X	NA	Other	026	PHYSICIANS	183100	41	Internal Medicine	0	In state provider	None	10 CONGRESS ST	STE 208	PASADENA	CA	91105	3027	19	06037	34.13396893	-118.1528162	Los Angeles County
160988	Fee-for-Service	1801924873	1801924873	1	1	LEVISTE, MARIA D MD	10/28/2009	174400000X	NA	Other	026	PHYSICIANS	39016	41	Internal Medicine	0	In state provider	None	1101 N PACIFIC AVE	STE 103	GLENDALE	CA	91202	3250	19	06037	34.16078708	-118.2644824	Los Angeles County
160994	Fee-for-Service	1609849074	1609849074	1	13	LA MAESTRA FAMILY CLINIC INC	4/19/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	165 SOUTH FIRST STREET	None	EL CAJON	CA	92019	4795	37	06073	32.794002	-116.944563	San Diego County
161043	Fee-for-Service	1801550850	1801550850	1	1	LIKINS, ANDREA R PT	11/11/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3989 STETSON	105	HEMET	CA	92545	9695	33	06065	33.72929866	-117.0132375	Riverside County
161057	Fee-for-Service	1396709325	1396709325	1	1	LI, NANCY C MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	70265	22	Pathology (M.D. only)	0	In state provider	None	21530 PIONEER BLVD	None	HAWAIIAN GARDENS	CA	90716	2608	19	06037	33.83358457	-118.0817796	Los Angeles County
161060	Fee-for-Service	1841395001	1841395001	1	1	LITTLE, DAVID G DPM	7/14/2010	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	8540 S SEPULVEDA BLVD	STE 106	LOS ANGELES	CA	90045	3811	19	06037	33.96022076	-118.3961982	Los Angeles County
161068	Fee-for-Service	1093748535	1093748535	1	1	LUO, JOHN MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55398	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
161131	Fee-for-Service	1114170727	1114170727	1	1	LAWYER, JEREMY O	8/22/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	206 MASON ST	SUITE E	UKIAH	CA	95482	4494	23	06045	39.15207956	-123.2053046	Mendocino County
161135	Fee-for-Service	1376866012	1376866012	1	1	LEE, CHRISTOPHER LAC	12/20/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
161156	Fee-for-Service	1427110329	1427110329	1	3	LIVINGSTON COMMUNITY HEALTH	4/1/2021	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	600 B ST	BUILDING C	LIVINGSTON	CA	95334	9593	24	06047	37.38589253	-120.734559	Merced County
161171	Fee-for-Service	1639510332	1639510332	1	1	LU, HELEN NP	12/30/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 160	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
161178	Fee-for-Service	1083689335	1083689335	1	1	LEIBOWITZ, KEITH A MD	9/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129017	10	Gastroenterology (M.D. only)	0	In state provider	None	918 E TUOLUMNE RD	STE 106	TURLOCK	CA	95382	2016	50	06099	37.5145617	-120.8372698	Stanislaus County
161180	Fee-for-Service	1629011044	1629011044	1	1	LI, LILY DANZHI	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	206 E LAS TUNAS DR	STE 1	SAN GABRIEL	CA	91776	1411	19	06037	34.10299799	-118.0977032	Los Angeles County
161186	Fee-for-Service	1174750590	1174750590	1	1	LIPPMANN, QUINN K MD	8/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125592	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
161192	Fee-for-Service	1558307496	1558307496	1	1	LORR, ERIC J MD	4/1/1999	207L00000X	NA	Other	026	PHYSICIANS	60356	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
161196	Fee-for-Service	1871625434	1871625434	1	1	LIN, BRIAN W MD	3/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96523	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
161201	Fee-for-Service	1922626167	1922626167	1	1	LOPEZ, ILEANA CRNA	1/8/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
161222	Fee-for-Service	1093908832	1093908832	1	1	LINN, ANDREW J MD	11/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109892	05	Anesthesiology	0	In state provider	None	3000 Q ST	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
161252	Fee-for-Service	1952356727	1952356727	1	1	LUPPI, LAWRENCE J MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36612	41	Internal Medicine	0	In state provider	None	24953 PAS DE VALENCIA	STE 14B	LAGUNA HILLS	CA	92653	3616	30	06059	33.60022665	-117.7012544	Orange County
161271	Fee-for-Service	1801234703	1801234703	1	1	LUCAS, MARNIE LMFT	9/24/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3135 BOEING AVE	A4	MCKINLEYVILLE	CA	95519	9371	12	06023	40.96714219	-124.1136378	Humboldt County
161275	Fee-for-Service	1801924873	1801924873	1	1	LEVISTE, MARIA D MD	10/28/2009	174400000X	NA	Other	026	PHYSICIANS	39016	07	Dermatology	0	In state provider	None	1101 N PACIFIC AVE	STE 103	GLENDALE	CA	91202	3250	19	06037	34.16078708	-118.2644824	Los Angeles County
161285	Fee-for-Service	1609849074	1609849074	1	13	LA MAESTRA FAMILY CLINIC INC	4/19/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	165 SOUTH FIRST STREET	None	EL CAJON	CA	92019	4795	37	06073	32.794002	-116.944563	San Diego County
161311	Fee-for-Service	1982683959	1982683959	1	1	LIN, JIAN C MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68176	13	Neurology (M.D. only)	0	In state provider	None	331 N ATLANTIC BLVD	STE 201	MONTEREY PARK	CA	91754	1500	19	06037	34.065774	-118.134357	Los Angeles County
161318	Fee-for-Service	1982150470	1982150470	1	1	LEUNG, LAWRENCE N LMFT	12/17/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
161326	Fee-for-Service	1831131416	1831131416	1	1	LIN, MICHELLE MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70157	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	# 1E	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
161331	Fee-for-Service	1386198109	1386198109	1	1	LEE, JONATHAN MD	2/9/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159735	None	None	0	In state provider	None	830 2ND ST	STE A	SANTA ROSA	CA	95404	4620	49	06097	38.440746	-122.7085605	Sonoma County
161353	Fee-for-Service	1457395287	1457395287	2	1	LONGS DRUG STORES CALIFORNIA	12/18/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	LLC	5644 MISSION CENTER RD	STE 201	SAN DIEGO	CA	92108	4328	37	06073	32.77449	-117.1570815	San Diego County
161378	Fee-for-Service	1053432807	1053432807	1	1	LOUIE, MARISA C MD	2/12/2020	2080P0204X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1500 EAST MEDICAL CENTER	None	ANN ARBOR	MI	48109	5000	00	None	42.28391347	-83.72716554	Washtenaw County
161451	Fee-for-Service	1225222466	1225222466	1	1	LAI, JENNIFER M OD	9/4/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3955 BONITA RD	None	BONITA	CA	91902	1230	37	06073	32.65714827	-117.042186	San Diego County
161463	Fee-for-Service	1083689335	1083689335	1	1	LEIBOWITZ, KEITH A MD	9/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129017	41	Internal Medicine	0	In state provider	None	918 E TUOLUMNE RD	STE 106	TURLOCK	CA	95382	2016	50	06099	37.5145617	-120.8372698	Stanislaus County
161466	Fee-for-Service	1861787798	1861787798	2	1	LURATO, INC.	1/28/2020	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	470 PLUMAS BLVD	STE. 104	YUBA CITY	CA	95991	5077	51	06101	39.13270038	-121.6141985	Sutter County
161477	Fee-for-Service	1922138171	1922138171	1	1	LENCHNER, JEFFREY B MD	8/1/1988	207P00000X	NA	Other	026	PHYSICIANS	63909	None	None	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
161494	Fee-for-Service	1710531926	1710531926	1	1	LUERAS, CLARE A CNP	2/20/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8850 VALLEY VIEW ST	None	BUENA PARK	CA	90620	3562	30	06059	33.833988	-118.0282915	Orange County
161496	Fee-for-Service	1982650040	1982650040	1	1	LARSON, MARY S MD	2/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	76435	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2900 WHIPPLE AVE	STE 230	REDWOOD CITY	CA	94062	2852	41	06081	37.4783072	-122.2551089	San Mateo County
161498	Fee-for-Service	1457409435	1457409435	1	1	LU, CHARLES I MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61301	41	Internal Medicine	0	In state provider	ATTN MGA OFFICE	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
161514	Fee-for-Service	1780600650	1780600650	1	1	LEMMO, DARLENE M LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
161520	Fee-for-Service	1952514978	1952514978	1	1	LIU, JENNA I MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91263	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
161547	Fee-for-Service	1679557862	1679557862	1	1	LASICH, CHRISTINA L MD	11/25/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	68111	-	NOT APPLICABLE	0	In state provider	None	180 SIERRA COLLEGE DRIVE	None	GRASS VALLEY	CA	95945	8116	29	06057	39.23235449	-121.0475561	Nevada County
161610	Fee-for-Service	1366590580	1366590580	1	1	LINCOLN UNIF SCHOOL DIST	7/1/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	2010 W SWAIN RD	None	STOCKTON	CA	95207	4055	39	06077	38.00038218	-121.3349067	San Joaquin County
161658	Fee-for-Service	1841051729	1841051729	1	1	LIM, MEGAN E PT	4/25/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
161698	Fee-for-Service	1376840074	1376840074	1	1	LAWNDALE HEALTHCARE	3/1/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	WELLNESS CENTRE LLC	15100 S PRAIRIE AVENUE	None	LAWNDALE	CA	90260	2209	19	06037	33.894369	-118.343811	Los Angeles County
161773	Fee-for-Service	1932596715	1932596715	1	1	LEDERLE, LAUREN I MD	9/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147821	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
161792	Fee-for-Service	1528612306	1528612306	1	1	LEIBSOHN, CHANEL LP	6/22/2022	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
161794	Fee-for-Service	1366537128	1366537128	1	1	LUNN, TIMOTHY J CRNA	5/3/2006	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4501 BIRCH ST	None	NEWPORT BEACH	CA	92660	1990	30	06059	33.66902484	-117.8655315	Orange County
161805	Fee-for-Service	1306005046	1306005046	1	1	LEE, RICHARD A MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141791	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
161807	Fee-for-Service	1144271818	1144271818	1	1	LIFE CARE CENTERS OF AMERICA	8/1/2019	314000000X	NA	Skilled Nursing Facility	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	1	Border provider	None	2450 S 19TH AVE	None	YUMA	AZ	85364	6919	00	None	32.683203	-114.6430665	Yuma County
161809	Fee-for-Service	1255008421	1255008421	1	1	LEE, DERRIC	9/25/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
161811	Fee-for-Service	1942257191	1942257191	1	6	LONG BEACH MEMORIAL PATHOLOG	5/9/2024	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1301 ROSE DR	None	PLACENTIA	CA	92870	3802	30	06059	33.8868003	-117.8420447	Orange County
161879	Fee-for-Service	1245693639	1245693639	1	1	LAMB, MARIE CLAIRE MD	10/15/2019	207R00000X	NA	Other	026	PHYSICIANS	158359	41	Internal Medicine	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
161920	Fee-for-Service	1588755722	1588755722	1	1	LUONG, HING B MD	1/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41630	41	Internal Medicine	0	In state provider	None	3240 E OLIVE AVE	None	FRESNO	CA	93702	1033	10	06019	36.75769018	-119.7707246	Fresno County
161931	Fee-for-Service	1265506232	1265506232	1	1	LAMB, MARGARET A	1/24/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
161937	Fee-for-Service	1841955317	1841955317	1	1	LIN, YUNG-AN NP	10/23/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
161946	Fee-for-Service	1518082015	1518082015	1	1	LONDO, DAVID R MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69814	02	General Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
162018	Fee-for-Service	1396848792	1396848792	1	1	LEE, ROBERT J OD	10/5/2010	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 E SECOND ST	STE 2	POMONA	CA	91766	2020	19	06037	34.05845654	-117.7423951	Los Angeles County
162029	Fee-for-Service	1598999609	1598999609	1	1	LARSON, PAUL W MD	7/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
162045	Fee-for-Service	1417210592	1417210592	1	1	LUZ, JAMES J MD	3/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128235	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
162046	Fee-for-Service	1366783193	1366783193	1	1	LERNER, SETH D MD	4/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122163	05	Anesthesiology	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	92823	4671	34	06067	38.470392	-121.4223975	Sacramento County
162053	Fee-for-Service	1043645641	1043645641	1	1	LAGUNA BEACH PEDIATRIC	2/17/2016	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	54529	40	Pediatrics	0	In state provider	ASSOCIATES INC	18 ENDEAVOR	STE 101	IRVINE	CA	92618	3180	30	06059	33.6675519	-117.7622659	Orange County
162076	Fee-for-Service	1811911209	1811911209	1	1	LOVELL ROSE, STEPHANIE MD	8/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53689	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
162104	Fee-for-Service	1417282856	1417282856	1	1	LOPEZ, MARIA G LCSW	11/30/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	355 ABBOTT ST STE 201	STE 201	SALINAS	CA	93901	4483	27	06053	36.66552031	-121.6439174	Monterey County
162115	Fee-for-Service	1154638906	1154638906	1	1	LOU, GABRIELLE PSYD	1/21/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1040 NOEL DR, 106	None	MENLO PARK	CA	94025	3358	41	06081	37.45539303	-122.1809836	San Mateo County
162125	Fee-for-Service	1417583279	1417583279	1	1	LEWIS, MALLORY LMFT	6/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6276 N 1ST ST	103	FRESNO	CA	93710	5400	10	06019	36.82794977	-119.7721574	Fresno County
162140	Fee-for-Service	1912080615	1912080615	1	1	LOWELL, MARK J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 E MEDICAL CENTER DR	None	ANN ARBOR	MI	48109	5000	00	None	42.28391347	-83.72716554	Washtenaw County
162167	Fee-for-Service	1992125637	1992125637	1	1	LAI, NGAN K MD	11/24/2019	207RE0101X	NA	Endocrinology	026	PHYSICIANS	140593	67	Endocrinology	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
162186	Fee-for-Service	1386841500	1386841500	1	2	LATIF, NABI G MD	11/4/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	111501	-	NOT APPLICABLE	0	In state provider	None	3115 REDHILL AVENUE	None	COSTA MESA	CA	92626	4517	30	06059	33.6763772	-117.8776418	Orange County
162204	Fee-for-Service	1588755722	1588755722	1	1	LUONG, HING B MD	1/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41630	01	General Practice	0	In state provider	None	3240 E OLIVE AVE	None	FRESNO	CA	93702	1033	10	06019	36.75769018	-119.7707246	Fresno County
162215	Fee-for-Service	1821101643	1821101643	1	1	LOS ANGELES COUNTY-DHS	12/27/2010	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	LAKE LA COMMUNITY CLINIC	16921 E AVENUE O	SPC 6	PALMDALE	CA	93591	3045	19	06037	34.6165615	-117.8278065	Los Angeles County
162225	Fee-for-Service	1235135633	1235135633	1	1	LE, CHAU M MD	1/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	48923	41	Internal Medicine	0	In state provider	None	9206 VALLEY BLVD	None	ROSEMEAD	CA	91770	1900	19	06037	34.08092133	-118.0692935	Los Angeles County
162246	Fee-for-Service	1134311905	1134311905	1	1	LIM, WAYLAND MD	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	105972	41	Internal Medicine	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
162251	Fee-for-Service	1477528859	1477528859	1	1	LOZANO, ALEXANDER J MD	5/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	89355	84	Surgery-Head and Neck	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
162259	Fee-for-Service	1528045671	1528045671	2	1	LEGACY HOMECARE, INC	3/26/2007	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11036 WASHINGTON BLVD	STE A	WHITTIER	CA	90606	3006	19	06037	33.97250965	-118.0741252	Los Angeles County
162267	Fee-for-Service	1336206648	1336206648	1	1	LAZANSKY, CORY M PHD	3/9/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
162274	Fee-for-Service	1871594267	1871594267	1	1	LOVEJOY, ALAN S CRNA	12/14/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1025 N DOUTY STREET	None	HANFORD	CA	93230	0480	16	06031	36.33611794	-119.6460191	Kings County
162281	Fee-for-Service	1023463288	1023463288	1	1	LAI, OLIVIA Y MD	11/9/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	168546	None	None	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
162282	Fee-for-Service	1447318092	1447318092	1	1	LORIAN HOME SYSTEMS INC	4/24/2002	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	9325 SKY PARK COURT	SUITE 310	SAN DIEGO	CA	92123	4368	37	06073	32.81656138	-117.1244388	San Diego County
162286	Fee-for-Service	1922524693	1922524693	1	1	LAI, MELISSA	11/15/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
162307	Fee-for-Service	1598925901	1598925901	1	1	LANGHAM, KATHRYN A MD	10/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	112928	36	Psychiatry	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
162317	Fee-for-Service	1912224635	1912224635	1	1	LEE, ESTHER J MD	7/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120551	None	None	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
162335	Fee-for-Service	1568799179	1568799179	1	1	LEE, CHOON K OT	9/16/2011	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9353 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
162340	Fee-for-Service	1881698447	1881698447	1	2	LIVINGSTON MEMORIAL VNA	5/22/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE	202-A CANADA ST	STE 2	OJAI	CA	93023	5010	56	06111	34.44864063	-119.2494706	Ventura County
162355	Fee-for-Service	1790786580	1790786580	1	1	LUCUS, PETER M MD	9/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86863	05	Anesthesiology	0	In state provider	None	332 S JUNIPER ST	STE 108	ESCONDIDO	CA	92025	4941	37	06073	33.12066536	-117.0770413	San Diego County
162375	Fee-for-Service	1740846641	1740846641	1	1	LANRE-AMOS, OLUWATOMI A MD	9/1/2024	390200000X	NA	Other	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
162390	Fee-for-Service	1063807238	1063807238	1	1	LIPPERT, KATELYN	2/26/2025	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
162404	Fee-for-Service	1609849074	1609849074	1	5	LA MAESTRA FAMILY CLINIC INC	5/2/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4175 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	0000	37	06073	32.75267528	-117.1008	San Diego County
162412	Fee-for-Service	1760195838	1760195838	1	1	LA VID TREE OF LIFE MARRIAGE	2/6/2023	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	AND FAMILY THERAPY SERV	8273 WHITE OAK AVE	B	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10329677	-117.5642466	San Bernardino County
162438	Fee-for-Service	1366747644	1366747644	1	1	LEMLER, ARICA C MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138464	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
162485	Fee-for-Service	1093157984	1093157984	1	1	LENNON, JESSICA M MD	8/1/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	148377	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4053 LONE TREE WAY	STE 100,101,102,200,201	ANTIOCH	CA	94531	6200	07	06013	37.97569499	-121.800733	Contra Costa County
162493	Fee-for-Service	1588755722	1588755722	1	1	LUONG, HING B MD	1/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41630	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3240 E OLIVE AVE	None	FRESNO	CA	93702	1033	10	06019	36.75769018	-119.7707246	Fresno County
162503	Fee-for-Service	1821101643	1821101643	1	1	LOS ANGELES COUNTY-DHS	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	LAKE LA COMMUNITY CLINIC	16921 E AVENUE O	SPC 6	PALMDALE	CA	93591	3045	19	06037	34.6165615	-117.8278065	Los Angeles County
162504	Fee-for-Service	1649534900	1649534900	1	1	LIZCANO, JENNIFER O DO	11/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13132	41	Internal Medicine	0	In state provider	None	155 GLASSON WAY	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
162515	Fee-for-Service	1699985317	1699985317	1	1	LIN, NANCY T MD	9/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95247	25	Physical Medicine and Rehabilitation	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
162516	Fee-for-Service	1235135633	1235135633	1	1	LE, CHAU M MD	1/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	48923	67	Endocrinology	0	In state provider	None	9206 VALLEY BLVD	None	ROSEMEAD	CA	91770	1900	19	06037	34.08092133	-118.0692935	Los Angeles County
162534	Fee-for-Service	1134311905	1134311905	1	1	LIM, WAYLAND MD	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	105972	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
162556	Fee-for-Service	1053809343	1053809343	1	1	LANDVATTER, MARSHA M MD	1/15/2021	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
162558	Fee-for-Service	1083854822	1083854822	1	1	LONGS DRUG STORES CA LLC	12/14/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	291 S. COOMBS ST	None	NAPA	CA	94559	4528	28	06055	38.28208591	-122.2890223	Napa County
162567	Fee-for-Service	1841652989	1841652989	1	1	LEON, EMILY N LMFT	11/2/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
162583	Fee-for-Service	1073684833	1073684833	1	1	LIM, MEERANA MD	7/31/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79998	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
162619	Fee-for-Service	1467668053	1467668053	1	1	LATHER, TUYET T DO	4/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	9180	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
162627	Fee-for-Service	1881698447	1881698447	1	2	LIVINGSTON MEMORIAL VNA	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE	202-A CANADA ST	STE 2	OJAI	CA	93023	5010	56	06111	34.44864063	-119.2494706	Ventura County
162654	Fee-for-Service	1780646364	1780646364	1	1	LEVIN, DAVID E MD	6/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	68582	22	Pathology (M.D. only)	0	In state provider	None	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
162656	Fee-for-Service	1649703174	1649703174	1	1	LEE, SEUNG AH MD	7/28/2023	208200000X	NA	General Surgery	026	PHYSICIANS	159001	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
162663	Fee-for-Service	1851307631	1851307631	1	1	LIN, LUDWIG H MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60120	None	None	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
162684	Fee-for-Service	1578624656	1578624656	1	1	LUCAS, SHANNON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1615 DELAWARE ST	None	LONGVIEW	WA	98632	2367	00	None	46.1309207	-122.9408931	Cowlitz County
162691	Fee-for-Service	1609849074	1609849074	1	5	LA MAESTRA FAMILY CLINIC INC	5/2/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4175 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	0000	37	06073	32.75267528	-117.1008	San Diego County
162709	Fee-for-Service	1730547639	1730547639	1	1	LORENZANA, CHRISELYN B NP	3/16/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
162727	Fee-for-Service	1447388251	1447388251	1	1	LASALLE MEDICAL ASSOC	5/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	565 N MOUNT VERNON AVE	None	SAN BERNARDINO	CA	92411	2661	36	06071	34.109406	-117.313813	San Bernardino County
162737	Fee-for-Service	1659410819	1659410819	1	1	LIU, LUCY S OD	3/30/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10525 S DE ANZA BLVD	STE 190	CUPERTINO	CA	95014	4448	43	06085	37.31526	-122.032408	Santa Clara County
162760	Fee-for-Service	1497017719	1497017719	1	1	LYNCH, ALISON B MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126673	01	General Practice	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
162772	Fee-for-Service	1174699904	1174699904	1	1	LAGUNA HONDA HOSPITAL	7/1/1971	No Taxonomy Provided	NA	None	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
162791	Fee-for-Service	1821101643	1821101643	1	1	LOS ANGELES COUNTY-DHS	7/1/2000	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	LAKE LA COMMUNITY CLINIC	16921 E AVENUE O	SPC 6	PALMDALE	CA	93591	3045	19	06037	34.6165615	-117.8278065	Los Angeles County
162794	Fee-for-Service	1194081869	1194081869	1	1	LEE, JEAN S MD	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128749	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
162812	Fee-for-Service	1255362406	1255362406	1	1	LYG APMC/LINCOLN S YEE	12/2/2008	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	48746	20	Orthopedic Surgery	0	In state provider	MD	275 W SAN BERNARDINO RD	None	COVINA	CA	91723	1516	19	06037	34.08992941	-117.8943195	Los Angeles County
162820	Fee-for-Service	1942629597	1942629597	1	1	LIN, LISA YUAN T	4/30/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	638 W DUARTE RD	STE 7	ARCADIA	CA	91007	9201	19	06037	34.12629888	-118.0532077	Los Angeles County
162847	Fee-for-Service	1275867996	1275867996	1	1	LIMCAY, TIFFANY H OD	2/12/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
162859	Fee-for-Service	1548280423	1548280423	1	1	LYNN, KENNETH R MD	8/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	59849	25	Physical Medicine and Rehabilitation	0	In state provider	#690	24411 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3651	30	06059	33.6087201	-117.7076948	Orange County
162870	Fee-for-Service	1073684833	1073684833	1	1	LIM, MEERANA MD	7/31/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79998	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
162895	Fee-for-Service	1992020127	1992020127	1	1	LINOS, ELENI MD	10/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110791	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
162904	Fee-for-Service	1215962758	1215962758	1	1	LONGWELL, KATHLEEN PHD	10/26/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	75 SELBORNE DR	None	PIEDMONT	CA	94611	3618	01	06001	37.81605588	-122.2149665	Alameda County
162960	Fee-for-Service	1912958893	1912958893	1	1	LE, HOANG T MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	73035	None	None	0	In state provider	None	FRESNO & R STREET	None	FRESNO	CA	93715	0000	10	06019	36.741663	-119.7841005	Fresno County
162962	Fee-for-Service	1679612287	1679612287	2	1	LAKS, HILLEL MD	3/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	37669	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
162971	Fee-for-Service	1205903317	1205903317	1	1	LLADO, CARMENCITA J MD	4/28/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	52371	None	None	0	In state provider	None	505 N MAIN ST	None	SANTA ANA	CA	92701	4619	30	06059	33.74945303	-117.8675386	Orange County
162995	Fee-for-Service	1750814083	1750814083	1	1	LUONG, ANGELINE MD	1/7/2019	207R00000X	NA	Other	026	PHYSICIANS	157225	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
163060	Fee-for-Service	1174699904	1174699904	1	1	LAGUNA HONDA HOSPITAL	7/1/1971	No Taxonomy Provided	NA	None	060	COUNTY HOSPITAL INPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
163081	Fee-for-Service	1881697951	1881697951	1	1	LOPRESTI, JOSEPH S MD	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	56295	02	General Surgery	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
163133	Fee-for-Service	1982623674	1982623674	1	1	LEONG, JASON R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2801 N GANTENBEIN AVE	None	PORTLAND	OR	97227	1623	00	None	45.54387841	-122.6696022	Multnomah County
163144	Fee-for-Service	1952509861	1952509861	1	1	LEUNG, PETER K MD	7/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105070	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	SUITE 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
163169	Fee-for-Service	1104206317	1104206317	1	1	LLERA, DEBRA L LMFT	1/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29995 TECHNOLOGY DR	101	MURRIETA	CA	92563	2633	33	06065	33.56041691	-117.1370428	Riverside County
163180	Fee-for-Service	1295993012	1295993012	1	1	LITWILLER, ABIGAIL R MD	9/27/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	175189	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
163182	Fee-for-Service	1982712386	1982712386	1	1	LECHUGA, DAVID M PHD	10/15/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
163218	Fee-for-Service	1447273149	1447273149	1	1	LIM, HOLLY MD	6/30/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	43072	40	Pediatrics	0	In state provider	None	1135 S SUNSET AVE	STE 210	WEST COVINA	CA	91790	3938	19	06037	34.06215064	-117.9453997	Los Angeles County
163235	Fee-for-Service	1639614233	1639614233	1	1	LAGUNA PHARMACY INC	3/1/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8112 SHELDON RD	SUITE 300	ELK GROVE	CA	95758	5913	34	06067	38.436273	-121.4081325	Sacramento County
163245	Fee-for-Service	1275522211	1275522211	1	1	LIND, GREGAR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2827 FORT MISSOULA RD	None	MISSOULA	MT	59804	7408	00	None	46.847151	-114.0480405	Missoula County
163251	Fee-for-Service	1225473226	1225473226	1	1	LONG, PAUL M MD	9/28/2021	207R00000X	NA	Other	026	PHYSICIANS	169774	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
163279	Fee-for-Service	1407496383	1407496383	1	1	LEE, CHRISTINA N	1/20/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1019 S MAIN ST	None	MANTECA	CA	95337	5703	39	06077	37.78880388	-121.2161899	San Joaquin County
163300	Fee-for-Service	1346225968	1346225968	1	1	LERMAN AND SONS	7/1/1996	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	8710 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	2791	19	06037	34.06656718	-118.3817996	Los Angeles County
163310	Fee-for-Service	1881919587	1881919587	1	1	LIM, ANTHONY E MD	1/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118022	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
163312	Fee-for-Service	1558823021	1558823021	1	1	LAO, BRYAN K MD	8/20/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	192475	36	Psychiatry	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
163313	Fee-for-Service	1881742047	1881742047	2	1	LIEPA, DAGMAR MD	8/23/2016	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	47889	01	General Practice	0	In state provider	None	14407 HAMLIN ST	STE A	VAN NUYS	CA	91401	6200	19	06037	34.1887	-118.4468781	Los Angeles County
163319	Fee-for-Service	1427073444	1427073444	1	1	LAW, NATHANIEL CARLTON	5/1/1996	207L00000X	NA	Other	026	PHYSICIANS	82294	None	None	0	In state provider	None	16795 LARK AVE	STE 230	LOS GATOS	CA	95032	7650	43	06085	37.25302151	-121.966891	Santa Clara County
163323	Fee-for-Service	1902329923	1902329923	1	1	LIM, ARNOLD DO INC	11/14/2017	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	9349	20	Orthopedic Surgery	0	In state provider	None	420 34TH STREET	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
163368	Fee-for-Service	1447272281	1447272281	1	1	LUNA-FINEMAN, SANDRA MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	44996	01	General Practice	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
163376	Fee-for-Service	1861412470	1861412470	2	1	LONGS DRUG STORES CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1311 S MAIN ST	None	WEAVERVILLE	CA	96093	1370	53	06105	40.7250754	-122.9314476	Trinity County
163387	Fee-for-Service	1386687127	1386687127	2	1	LONGS DRUG STORES CA LLC	7/29/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	490 RODRIGUEZ ST	None	WATSONVILLE	CA	95076	4522	44	06087	36.91009879	-121.7599041	Santa Cruz County
163433	Fee-for-Service	1922265008	1922265008	1	1	LEE, MICHAEL J MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	112975	05	Anesthesiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
163439	Fee-for-Service	1083933659	1083933659	1	1	LAI, SYLVIA K	5/27/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	568 NORTH SUNRISE BLVD	STE 100	ROSEVILLE	CA	95661	3097	31	06061	38.7576732	-121.2534645	Placer County
163450	Fee-for-Service	1427060060	1427060060	1	1	LEVINSON, GARY A MD	3/15/2011	2084P0805X	NA	Psychiatry	026	PHYSICIANS	15765	36	Psychiatry	0	In state provider	None	41750 RANCHO LAS PALMAS	#K-5	RANCHO MIRAGE	CA	92270	5114	33	06065	33.74239866	-116.4106945	Riverside County
163486	Fee-for-Service	1871515163	1871515163	1	1	LU, CHAO-MING MD	1/1/1998	207RN0300X	NA	Nephrology	026	PHYSICIANS	51490	45	Nephrology (Renal-Kidney)	0	In state provider	None	1850 S AZUSA AVE	STE 306	HACIENDA HEIGHTS	CA	91745	6854	19	06037	33.98895597	-117.9322797	Los Angeles County
163514	Fee-for-Service	1922467265	1922467265	1	1	LOS ANGELES CENTERS FOR	3/7/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	ALCOHOL AND DRUG ABUSE	11111 BLOOMFIELD AVE.	None	SANTA FE SPRINGS	CA	90670	3429	19	06037	33.93042217	-118.0640491	Los Angeles County
163573	Fee-for-Service	1083140172	1083140172	1	1	LAM, JEREMY D MD	7/1/2020	207R00000X	NA	Other	026	PHYSICIANS	157228	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
163594	Fee-for-Service	1942897103	1942897103	1	1	LUCENCE HEALTH INC.	4/23/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	3520 W BAYSHORE RD	None	PALO ALTO	CA	94303	4228	43	06085	37.43410398	-122.1079735	Santa Clara County
163613	Fee-for-Service	1003300450	1003300450	1	1	LAUNIO, MELJORIE-ELEONORE C	8/1/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	166829	None	None	0	In state provider	MD	1686 BARTON ROAD	None	REDLANDS	CA	92373	7761	36	06071	34.04833901	-117.2120103	San Bernardino County
163615	Fee-for-Service	1548714538	1548714538	1	1	LA FIRST HOSPICE CARE	5/19/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7100 HAYVENHURST AVE	STE PD1	VAN NUYS	CA	91406	3804	19	06037	34.199064	-118.4923845	Los Angeles County
163635	Fee-for-Service	1619021052	1619021052	1	1	LAM, DANNY C PT	6/26/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	24331 EL TORO ROAD	SUITE 200	LAGUNA WOODS	CA	92637	3116	30	06059	33.60928782	-117.7295058	Orange County
163639	Fee-for-Service	1396273793	1396273793	1	1	LIN, ANN MD	10/18/2023	208600000X	NA	General Surgery	026	PHYSICIANS	162633	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
163656	Fee-for-Service	1821368101	1821368101	1	1	LABORATORY CORPORATION OF AM	1/1/2012	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	ERICA	2111 IOWA AVE	STE G	RIVERSIDE	CA	92507	7414	33	06065	33.991659	-117.3398675	Riverside County
163673	Fee-for-Service	1225579006	1225579006	1	2	LG AGUILAR TABORA MD INC	1/22/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
163684	Fee-for-Service	1528217478	1528217478	1	1	LAUWERS, SUSAN LMFT	10/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9829 BLUE LARKSPUR LN	SUITE 2	MONTEREY	CA	93940	6535	27	06053	36.57109892	-121.8021077	Monterey County
163708	Fee-for-Service	1255419081	1255419081	1	1	LIM,JOANNE B MD	6/21/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75264	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
163740	Fee-for-Service	1972719557	1972719557	1	1	LIU, LIDE MD	7/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96669	None	None	0	In state provider	None	4580 CALIFORNIA AVE	None	BAKERSFIELD	CA	93309	1104	15	06029	35.36605632	-119.0531502	Kern County
163755	Fee-for-Service	1356357636	1356357636	1	1	LEM, CHRISTOPHER C MD	9/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76095	24	Plastic Surgery	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
163767	Fee-for-Service	1336381607	1336381607	2	1	LE, TAM C MD	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117637	41	Internal Medicine	0	In state provider	None	9746 WESTMINSTER AVE	STE D3	GARDEN GROVE	CA	92844	2906	30	06059	33.75949073	-117.9590728	Orange County
163775	Fee-for-Service	1871515163	1871515163	1	1	LU, CHAO-MING MD	1/1/1998	207RN0300X	NA	Nephrology	026	PHYSICIANS	51490	41	Internal Medicine	0	In state provider	None	1850 S AZUSA AVE	STE 306	HACIENDA HEIGHTS	CA	91745	6854	19	06037	33.98895597	-117.9322797	Los Angeles County
163832	Fee-for-Service	1104985795	1104985795	1	1	LEVER, ERIC L MD	3/9/1999	207RC0200X	NA	Other	026	PHYSICIANS	58086	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
163848	Fee-for-Service	1205273794	1205273794	1	1	LIN, KELLY Y MD	1/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129679	07	Dermatology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
163868	Fee-for-Service	1679128953	1679128953	1	2	LAND OF PEACE 2	4/10/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6636 SALE AVE	None	WEST HILLS	CA	91307	3628	19	06037	34.1912495	-118.6185709	Los Angeles County
163887	Fee-for-Service	1063731255	1063731255	1	1	LABWEST INC	6/24/2010	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	4201 TORRANCE BLVD	STE 240	TORRANCE	CA	90503	4542	19	06037	33.8375955	-118.358748	Los Angeles County
163905	Fee-for-Service	1548714538	1548714538	1	1	LA FIRST HOSPICE CARE	5/19/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7100 HAYVENHURST AVE	STE PD1	VAN NUYS	CA	91406	3804	19	06037	34.199064	-118.4923845	Los Angeles County
163921	Fee-for-Service	1659717767	1659717767	1	1	LUCAS, JENNIFER D LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
163941	Fee-for-Service	1497983621	1497983621	1	1	LAM, EUGENE C MD INC	1/26/2010	193400000X	NA	Other	026	PHYSICIANS	83230	10	Gastroenterology (M.D. only)	0	In state provider	None	2001 SANTA MONICA BLVD	STE 360W	SANTA MONICA	CA	90404	2175	19	06037	34.02891163	-118.4797466	Los Angeles County
163970	Fee-for-Service	1154407468	1154407468	1	1	LOLLAR, LESTER L DC	11/16/2018	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1255 LIBERTY STREET	None	REDDING	CA	96001	0814	45	06089	40.58769807	-122.3879041	Shasta County
163973	Fee-for-Service	1477014918	1477014918	1	1	LIANG, JONATHAN DO	7/25/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	20938	None	None	0	In state provider	None	4320 MARICOPA ST	None	TORRANCE	CA	90503	4314	19	06037	33.83949675	-118.3597243	Los Angeles County
164005	Fee-for-Service	1801101365	1801101365	1	1	LIN, TIMOTHY C DO	7/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12097	None	None	0	In state provider	None	100 WEST CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
164007	Fee-for-Service	1104377951	1104377951	1	1	LE, SUSAN PT	2/24/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
164011	Fee-for-Service	1982615837	1982615837	1	1	LISSIN, LYNETTE W MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	60327	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
164017	Fee-for-Service	1902045180	1902045180	1	1	LIM, ERIC L MD	12/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	45208	41	Internal Medicine	0	In state provider	None	1149 W 190TH ST	None	TORRANCE	CA	90248	4321	19	06037	33.85834052	-118.2958065	Los Angeles County
164045	Fee-for-Service	1790978716	1790978716	1	1	LAMMERSVILLE UNIFIED SD	5/17/2006	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	111 S DE ANZA BLVD	None	MOUNTAIN HOUSE	CA	95391	7900	39	06077	37.77769878	-121.5347197	San Joaquin County
164074	Fee-for-Service	1386643997	1386643997	1	1	LUND, PHILIP L. MD	12/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	202 N DIVISION ST	None	AUBURN	WA	98001	4939	00	None	47.308698	-122.2297715	King County
164082	Fee-for-Service	1841785862	1841785862	1	1	LEE, ERIC Y DPM	8/9/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
164109	Fee-for-Service	1134983679	1134983679	1	1	LAURA M HERNANDEZ LICENSED C	12/23/2024	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	611 WILSHIRE BLVD	#900	LOS ANGELES	CA	90017	2905	19	06037	34.04818746	-118.2563214	Los Angeles County
164116	Fee-for-Service	1821221003	1821221003	1	1	LEE, YE N MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109269	40	Pediatrics	0	In state provider	None	1430 TRUXTUN AVE	STE 400	BAKERSFIELD	CA	93302	1559	15	06029	35.37345768	-119.0173312	Kern County
164120	Fee-for-Service	1174630305	1174630305	1	2	LARDON, MICHAEL T MD	2/4/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	48664	36	Psychiatry	0	In state provider	None	3750 CONVOY ST	STE 318	SAN DIEGO	CA	92111	3741	37	06073	32.81201122	-117.1531108	San Diego County
164150	Fee-for-Service	1477612075	1477612075	1	1	LIN, TONY C MD	1/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87027	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
164198	Fee-for-Service	1649358375	1649358375	1	1	LEUNG, NANCY J MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70541	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
164223	Fee-for-Service	1790017648	1790017648	1	1	LONGS DRUG STORES CA LLC	6/25/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2780 ESPLANADE	None	CHICO	CA	95973	1115	04	06007	39.76067086	-121.8652716	Butte County
164227	Fee-for-Service	1548313760	1548313760	1	1	LIN, BERWYN J MD	5/31/1986	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	40981	40	Pediatrics	0	In state provider	None	600 N GARFIELD AVE	STE 203	MONTEREY PARK	CA	91754	1169	19	06037	34.06820797	-118.1228835	Los Angeles County
164269	Fee-for-Service	1770043812	1770043812	1	1	LINDSAY, CATHERINE C MD	7/7/2023	207R00000X	NA	Other	026	PHYSICIANS	177377	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
164286	Fee-for-Service	1124024062	1124024062	1	1	LOOMER, DON C MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	83923	30	Radiology	0	In state provider	None	6191 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.826362	-119.7831265	Fresno County
164287	Fee-for-Service	1013370378	1013370378	1	1	LADNER, TRAVIS R MD	8/1/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	184499	None	None	0	In state provider	None	23929 MCBEAN PKWY	STE 215	VALENCIA	CA	91355	4468	19	06037	34.39588575	-118.5538975	Los Angeles County
164300	Fee-for-Service	1982615837	1982615837	1	1	LISSIN, LYNETTE W MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	60327	08	Family Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
164314	Fee-for-Service	1306916770	1306916770	1	1	LEM, MICHAEL MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	32531	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1127 WILSHIRE BLVD	SUITE 710	LOS ANGELES	CA	90017	3908	19	06037	34.05270508	-118.2641005	Los Angeles County
164321	Fee-for-Service	1225180441	1225180441	1	1	LUAN, XUDONG MD	5/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81893	05	Anesthesiology	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
164326	Fee-for-Service	1487695581	1487695581	1	1	LUCAS HANSEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	505 S 336TH ST	SUITE 600	FEDERAL WAY	WA	98003	0000	00	None	47.30005468	-122.3272224	King County
164328	Fee-for-Service	1811921604	1811921604	1	1	LAGUNDA, MIA M MD	11/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51016	None	None	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
164381	Fee-for-Service	1649347535	1649347535	1	1	LUO, EVA Q MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61727	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
164400	Fee-for-Service	1548767585	1548767585	1	1	LAW, KENNY T MD	8/10/2023	390200000X	NA	Other	026	PHYSICIANS	187876	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
164415	Fee-for-Service	1679646277	1679646277	1	1	LAKAMP, MARIANNE E NP	1/22/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
164416	Fee-for-Service	1861878902	1861878902	1	2	LAU AND NGUYEN, INC	1/30/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12650 SABRE SPRINGS PKWY	SUITES 203	SAN DIEGO	CA	92128	4114	37	06073	32.94887812	-117.0963903	San Diego County
164428	Fee-for-Service	1205995875	1205995875	1	1	LEVY, VERONICA A MD	7/1/1998	207ZP0102X	NA	Other	026	PHYSICIANS	72184	22	Pathology (M.D. only)	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
164456	Fee-for-Service	1740449172	1740449172	1	1	LUBAS, ADAM M LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
164478	Fee-for-Service	1245716802	1245716802	1	1	LOZANO, JACQUELINE D LCSW	7/15/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14075 HESPERIA ROAD	SUITE 101	VICTORVILLE	CA	92395	4500	36	06071	34.50679185	-117.296399	San Bernardino County
164513	Fee-for-Service	1740207521	1740207521	1	1	LOOK, ADAIR K MD	1/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92125	36	Psychiatry	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
164553	Fee-for-Service	1689332397	1689332397	1	1	LI, HAO PT	3/29/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9333 GENESSE AVE	STE 350	SAN DIEGO	CA	92121	2103	37	06073	32.875668	-117.2139225	San Diego County
164611	Fee-for-Service	1043742604	1043742604	1	1	LIN, LEO MD	10/31/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
164632	Fee-for-Service	1710444377	1710444377	1	1	LEE, JONGHYEOK LCSW	4/10/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6 CENTERPOINTE DR	STE 700	LA PALMA	CA	90621	4229	30	06059	33.86052378	-118.0296232	Orange County
164635	Fee-for-Service	1578677670	1578677670	3	1	LILIUM HEALTHCARE INC	5/28/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3580 SANTA ANITA AVE	UNIT B	EL MONTE	CA	91731	2455	19	06037	34.07443832	-118.0414722	Los Angeles County
164657	Fee-for-Service	1306882493	1306882493	1	1	LO, WILLIAM K MD INC	5/25/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	29815	05	Anesthesiology	0	In state provider	None	9212 MIRA ESTE CT	STE 204	SAN DIEGO	CA	92126	6337	37	06073	32.88927901	-117.1482338	San Diego County
164704	Fee-for-Service	1932586534	1932586534	1	1	LESZCZYNSKI, BARTOSZ P DO	9/26/2022	207P00000X	NA	Other	026	PHYSICIANS	20209	None	None	0	In state provider	None	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
164722	Fee-for-Service	1316384951	1316384951	1	1	LEONE, JUDITH PSYD	9/25/2019	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
164739	Fee-for-Service	1154579431	1154579431	1	1	LI, TORNA PHD	8/8/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
164748	Fee-for-Service	1053337055	1053337055	1	1	LI, CAROLYN YI MD	9/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76693	22	Pathology (M.D. only)	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
164763	Fee-for-Service	1285694497	1285694497	1	1	LUEBBERT,ERIC E DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2720 STONE PARK BLVD	None	SIOUX CITY	IA	51104	0000	00	None	42.51879554	-96.40625864	Woodbury County
164801	Fee-for-Service	1477782753	1477782753	1	1	LONG, JENNIFER R MD	5/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115096	18	Ophthalmology	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
164814	Fee-for-Service	1083222988	1083222988	1	1	LY, MALICA AU	9/23/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4725 B HOEN AVE	SUITE B	SANTA ROSA	CA	95405	9405	49	06097	38.442564	-122.664141	Sonoma County
164837	Fee-for-Service	1467016139	1467016139	1	1	LIU, TIANCI MD	7/1/2023	390200000X	NA	Other	026	PHYSICIANS	182191	None	None	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
164854	Fee-for-Service	1942862289	1942862289	1	1	LION-CACHET, TRACEY PSYD	3/14/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
164863	Fee-for-Service	1043534803	1043534803	1	1	LIM, PHYU P MD	4/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	110218	41	Internal Medicine	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
164899	Fee-for-Service	1992116388	1992116388	1	1	LIVINGSTON, BRIANA J MD	7/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140949	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3828 SCHAUFELE AVE	STE 200	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
164919	Fee-for-Service	1669882254	1669882254	1	1	LIU, YONG W MD	7/6/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	145185	30	Radiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
164927	Fee-for-Service	1982752937	1982752937	1	1	LIM-GAW, EMELINE C MD	8/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	61632	05	Anesthesiology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
164931	Fee-for-Service	1871789289	1871789289	1	1	LIVESAY, FELISHA LCSW	3/6/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
164972	Fee-for-Service	1760587018	1760587018	1	1	LOOMIS, RICHARD B JR MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	64311	40	Pediatrics	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
164974	Fee-for-Service	1659350387	1659350387	1	1	LINDFORS, KAREN K MD	1/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	50275	30	Radiology	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
164979	Fee-for-Service	1508931635	1508931635	1	1	LAURI A GOODELL	4/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 ROBERT WOOD JOHNSON PL	None	NEW BRUNSWICK	NJ	08901	1928	00	None	40.49580805	-74.45050729	Middlesex County
164990	Fee-for-Service	1255404224	1255404224	1	1	LANG, HOWARD G MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	16058	41	Internal Medicine	0	In state provider	None	4950 BARRANCA PKWY	STE 307	IRVINE	CA	92604	4689	30	06059	33.67620851	-117.7948348	Orange County
164994	Fee-for-Service	1346400306	1346400306	1	1	LUMAPAS, SARINA C MD	12/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	114681	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
164997	Fee-for-Service	1922091362	1922091362	1	1	LODEWICK, MATTHEW J MD	9/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	88222	03	Allergy	0	In state provider	None	370 N WIGET LANE	STE 210	WALNUT CREEK	CA	94598	2452	07	06013	37.92948925	-122.0275099	Contra Costa County
165011	Fee-for-Service	1326146937	1326146937	1	1	LIN, VICKI Y MD	2/28/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	None	None	0	In state provider	None	18693 BROOKHURST ST	None	FOUNTAIN VALLEY	CA	92708	6749	30	06059	33.6908199	-117.954288	Orange County
165013	Fee-for-Service	1972726222	1972726222	1	1	LUDWIG, BENJAMIN MD	7/24/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	184440	None	None	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
165076	Fee-for-Service	1891737623	1891737623	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3440 LA SIERRA AVE	None	RIVERSIDE	CA	92503	5204	33	06065	33.89849377	-117.4722022	Riverside County
165079	Fee-for-Service	1053469858	1053469858	1	1	LE-NGUYEN, MY-LAN MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	77741	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
165080	Fee-for-Service	1962454157	1962454157	1	1	LI, DESCARTES MD	6/19/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	80376	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
165082	Fee-for-Service	1679762595	1679762595	1	1	LA SAULLE, BROOKE A CNM	9/15/2022	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
165120	Fee-for-Service	1407142243	1407142243	1	1	LEONG, CURTIS W MD	7/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124565	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
165128	Fee-for-Service	1548513849	1548513849	1	1	LISA A DAVIDSON, PHD, APC	2/3/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	15525 POMERADO RD	C-7	POWAY	CA	92064	2435	37	06073	32.99479918	-117.0579468	San Diego County
165176	Fee-for-Service	1629616255	1629616255	1	1	LORENA FUENTES NP, PSYCHIATR	4/8/2020	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	IC NURSING COR	415 W ROUTE 66	STE 202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
165178	Fee-for-Service	1356319446	1356319446	1	1	LIRA, JOSE A MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	33913	66	Emergency Medicine (Urgent Care)	0	In state provider	None	841 KUHN DR	STE 200	CHULA VISTA	CA	91914	3552	37	06073	32.65289649	-116.9665862	San Diego County
165197	Fee-for-Service	1245873520	1245873520	1	1	LIM, JENNIFER W CRNA	6/25/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
165228	Fee-for-Service	1497275705	1497275705	1	1	LEE, HEE JIN NP	10/19/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
165233	Fee-for-Service	1780617845	1780617845	1	1	LARGMAN, CAROL E LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	532 OREGON ST	None	VALLEJO	CA	94590	3254	48	06095	38.1183693	-122.2491848	Solano County
165251	Fee-for-Service	1962109033	1962109033	1	12	LOS ANGELES COUNTY DEPARTMEN	2/8/2024	261QP0905X	NA	Other	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	2509 PICO BLVD	ROOM 325	SANTA MONICA	CA	90405	1828	19	06037	34.02287459	-118.4631175	Los Angeles County
165263	Fee-for-Service	1760587018	1760587018	1	1	LOOMIS, RICHARD B JR MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	64311	01	General Practice	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
165277	Fee-for-Service	1255404224	1255404224	1	1	LANG, HOWARD G MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	16058	07	Dermatology	0	In state provider	None	4950 BARRANCA PKWY	STE 307	IRVINE	CA	92604	4689	30	06059	33.67620851	-117.7948348	Orange County
165293	Fee-for-Service	1427110329	1427110329	1	7	LIVINGSTON COMMUNITY HEALTH	4/26/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	125 EAST 18TH STREET	None	MERCED	CA	95340	5062	24	06047	37.29875058	-120.4726368	Merced County
165328	Fee-for-Service	1700964392	1700964392	1	1	LEE, JENNIFER Y MD	8/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90176	30	Radiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
165340	Fee-for-Service	1780122986	1780122986	1	1	LA JOLLA OBSERVATION	3/15/2017	252Y00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9888 GENESEE AVENUE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
165394	Fee-for-Service	1083627285	1083627285	1	1	LOWE, STANLEY DPM	2/25/2013	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	19066 MAGNOLIA ST	None	HUNTINGTON BEACH	CA	92646	2232	30	06059	33.68568661	-117.9714001	Orange County
165395	Fee-for-Service	1205853850	1205853850	1	1	LERAMO, YVONNE I MD	3/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	64161	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
165415	Fee-for-Service	1043964232	1043964232	1	1	LUONG, PHOEBE N OD	11/8/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
165461	Fee-for-Service	1083666259	1083666259	1	1	LIU, STEPHEN J MD	4/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84304	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
165469	Fee-for-Service	1356319446	1356319446	1	1	LIRA, JOSE A MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	33913	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	841 KUHN DR	STE 200	CHULA VISTA	CA	91914	3552	37	06073	32.65289649	-116.9665862	San Diego County
165478	Fee-for-Service	1285863837	1285863837	1	1	LIN, WEN MD	5/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110906	13	Neurology (M.D. only)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
165487	Fee-for-Service	1295098390	1295098390	1	1	LEZCANO, SHEILA D MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130548	41	Internal Medicine	0	In state provider	None	153 B PIONEER LANE	None	BISHOP	CA	93514	2517	14	06027	37.3624356	-118.4073711	Inyo County
165492	Fee-for-Service	1386077279	1386077279	1	1	LE, TRUNG B MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133171	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
165518	Fee-for-Service	1083625701	1083625701	1	1	LAM, GARY MAN MD	4/13/2007	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	84812	20	Orthopedic Surgery	0	In state provider	None	2216 BUENAVENTURA BLVD	STE B	REDDING	CA	96001	3838	45	06089	40.55453352	-122.3904825	Shasta County
165527	Fee-for-Service	1639884687	1639884687	1	1	LOTUS VILLA AFFILIATE LLC	10/2/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	9448 CITRUS AVE	None	FONTANA	CA	92335	0001	36	06071	34.0822293	-117.4537682	San Bernardino County
165538	Fee-for-Service	1609849074	1609849074	1	12	LA MAESTRA FAMILY CLINIC INC	8/29/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1242 E MAIN ST	None	EL CAJON	CA	92021	7205	37	06073	32.79495945	-116.938566	San Diego County
165574	Fee-for-Service	1659467892	1659467892	1	1	LODI UROLOGICAL MED GRP	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	830 S HAM LN	STE 26	LODI	CA	95242	7510	39	06077	38.123568	-121.2882225	San Joaquin County
165579	Fee-for-Service	1427110329	1427110329	1	7	LIVINGSTON COMMUNITY HEALTH	4/26/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	125 EAST 18TH STREET	None	MERCED	CA	95340	5062	24	06047	37.29875058	-120.4726368	Merced County
165594	Fee-for-Service	1649375957	1649375957	1	1	LOEWY, JOSEPH MD	8/31/1989	207R00000X	NA	Other	026	PHYSICIANS	37690	41	Internal Medicine	0	In state provider	None	8631 W 3RD ST	SUITE 825E	LOS ANGELES	CA	90048	5983	19	06037	34.07361928	-118.3803143	Los Angeles County
165598	Fee-for-Service	1215104369	1215104369	1	1	LAI, KEITH K MD	9/21/2023	207ZP0102X	NA	Other	026	PHYSICIANS	166661	None	None	0	In state provider	None	8700 BEVERLY BLVD	ROOM 3719	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
165616	Fee-for-Service	1194711952	1194711952	1	3	LOMPOC VALLEY MEDICAL	4/20/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1201 E OCEAN AVE	STE A	LOMPOC	CA	93436	7082	42	06083	34.63888288	-120.4436487	Santa Barbara County
165639	Fee-for-Service	1962668806	1962668806	1	1	LIN, SPENCER MD	7/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103303	38	Geriatrics	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
165643	Fee-for-Service	1245764661	1245764661	1	1	LIU, XINWEI MD	4/1/2019	207P00000X	NA	Other	026	PHYSICIANS	159840	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
165664	Fee-for-Service	1225004450	1225004450	1	1	LOZIER, JEFFREY R MD	9/30/1986	207W00000X	NA	Ophthalmology	026	PHYSICIANS	54719	01	General Practice	0	In state provider	None	15025 INNOVATION DR	None	SAN DIEGO	CA	92128	3409	37	06073	32.98956795	-117.0767228	San Diego County
165690	Fee-for-Service	1376633149	1376633149	1	1	LEE, WES S MD	6/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82213	78	Neoplastic Diseases/Oncology	0	In state provider	None	3555 ROUND BARN CIR	None	SANTA ROSA	CA	95403	1757	49	06097	38.478717	-122.729715	Sonoma County
165736	Fee-for-Service	1912224692	1912224692	1	2	LIN, ESTELLE MD	8/12/2024	207R00000X	NA	Other	026	PHYSICIANS	120352	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
165755	Fee-for-Service	1356319446	1356319446	1	1	LIRA, JOSE A MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	33913	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	841 KUHN DR	STE 200	CHULA VISTA	CA	91914	3552	37	06073	32.65289649	-116.9665862	San Diego County
165765	Fee-for-Service	1285863837	1285863837	1	1	LIN, WEN MD	5/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110906	30	Radiology	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
165774	Fee-for-Service	1295098390	1295098390	1	1	LEZCANO, SHEILA D MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130548	83	Rheumatology	0	In state provider	None	153 B PIONEER LANE	None	BISHOP	CA	93514	2517	14	06027	37.3624356	-118.4073711	Inyo County
165778	Fee-for-Service	1063594562	1063594562	1	1	LASKOWSKI, KIMBERLY A LMFT	2/8/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	404 W PINE ST	STE 1	LODI	CA	95240	2048	39	06077	38.13437954	-121.2780387	San Joaquin County
165782	Fee-for-Service	1538365309	1538365309	1	1	LACORTE, LARISSA MD	8/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115028	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
165820	Fee-for-Service	1396836094	1396836094	1	1	LOPEZ, ROBERT MD	10/1/1999	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	75281	None	None	0	In state provider	None	12586 CENTRAL AVE	None	CHINO	CA	91710	3507	36	06071	34.02451515	-117.6895186	San Bernardino County
165826	Fee-for-Service	1609849074	1609849074	1	12	LA MAESTRA FAMILY CLINIC INC	8/29/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1242 E MAIN ST	None	EL CAJON	CA	92021	7205	37	06073	32.79495945	-116.938566	San Diego County
165833	Fee-for-Service	1942769054	1942769054	1	1	LIBAN, KRISTOPHER	1/3/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	19609	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
165887	Fee-for-Service	1144713363	1144713363	1	1	LOGOS HOME HEALTH CARE	1/29/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	209 E ALAMEDA AVE	UNIT 106	BURBANK	CA	91502	2672	19	06037	34.17496555	-118.2993463	Los Angeles County
165910	Fee-for-Service	1477545176	1477545176	1	2	LICHT, NURIT MD	7/5/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	90977	-	NOT APPLICABLE	0	In state provider	None	5900 STATE FARM DRIVE	SUITE 200	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
165927	Fee-for-Service	1962668806	1962668806	1	1	LIN, SPENCER MD	7/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103303	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
165933	Fee-for-Service	1285138131	1285138131	1	1	LEVINSOHN, ERIK A MD	8/2/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
166003	Fee-for-Service	1740644509	1740644509	1	1	LEVERONE, DANIELLE M MD	8/17/2020	208M00000X	NA	Other	026	PHYSICIANS	152693	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
166034	Fee-for-Service	1508040577	1508040577	1	1	LEEK, BRYAN T MD	8/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87780	20	Orthopedic Surgery	0	In state provider	None	6719 ALVARADO RD	STE 200	SAN DIEGO	CA	92120	5256	37	06073	32.77684978	-117.055137	San Diego County
166045	Fee-for-Service	1992713028	1992713028	1	1	LOK, KWOK-FAI MD	7/31/1988	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	39849	41	Internal Medicine	0	In state provider	None	11160 WARNER AVE	STE 323	SANTA ANA	CA	92708	4055	30	06059	33.71630854	-117.934317	Orange County
166083	Fee-for-Service	1891939237	1891939237	1	1	LEE, SORA MD	11/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107136	45	Nephrology (Renal-Kidney)	0	In state provider	None	1400 S GRAND AVE	STE 800	LOS ANGELES	CA	90015	3048	19	06037	34.03692236	-118.2655238	Los Angeles County
166099	Fee-for-Service	1619364338	1619364338	1	1	LIPOF, JODI J MD	2/18/2025	207RH0003X	NA	Oncology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
166119	Fee-for-Service	1497834527	1497834527	1	1	LANE, WENDY MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	62103	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
166130	Fee-for-Service	1780094334	1780094334	1	1	LAVI, PEYMAN MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141672	02	General Surgery	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
166134	Fee-for-Service	1871712349	1871712349	1	1	LIAN, THOMAS C MD APC	1/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	60506	None	None	0	In state provider	None	550 WASHINGTON ST	STE 635	SAN DIEGO	CA	92103	2229	37	06073	32.75003652	-117.1603431	San Diego County
166168	Fee-for-Service	1649201914	1649201914	1	1	LOCKE, JASON PT	11/13/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1120 HUTCHINSON DRIVE	None	DAVIS	CA	95616	5270	57	06113	38.53834973	-121.7626055	Yolo County
166205	Fee-for-Service	1265631808	1265631808	1	1	LYNCH, CHRISTOPHER MD	10/17/2024	207P00000X	NA	Other	026	PHYSICIANS	107549	70	Clinic (mixed specialty)	0	In state provider	None	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
166208	Fee-for-Service	1982768578	1982768578	1	1	LANNIN, JOHN V MD	2/28/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	52779	20	Orthopedic Surgery	0	In state provider	None	2900 WHIPPLE AVE	None	REDWOOD CITY	CA	94062	2843	41	06081	37.4783072	-122.2551089	San Mateo County
166227	Fee-for-Service	1215480694	1215480694	1	1	LIM, IRENE M	9/2/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	25165	-	NOT APPLICABLE	0	In state provider	None	5000 SUNSET BLVD	SUITE 701	LOS ANGELES	CA	90027	5861	19	06037	34.0981066	-118.2986382	Los Angeles County
166241	Fee-for-Service	1275856023	1275856023	1	1	LAU, ABIGAIL D	9/3/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5893 COPLEY DRIVE	None	SAN DIEGO	CA	92111	7906	37	06073	32.84332697	-117.1728709	San Diego County
166280	Fee-for-Service	1588214019	1588214019	1	1	LONG, COLETTE NP	8/20/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
166309	Fee-for-Service	1629009949	1629009949	1	1	LOWENTHAL, RICHARD M MD	2/8/2015	2084N0400X	NA	Neurology	026	PHYSICIANS	21879	13	Neurology (M.D. only)	0	In state provider	None	2431 CASTILLO STREET	None	SANTA BARBARA	CA	93105	4301	42	06083	34.43123954	-119.7252384	Santa Barbara County
166316	Fee-for-Service	1184025496	1184025496	1	1	LEE, MEGAN PT	6/7/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1529 SEABRIGHT AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.97862009	-122.0098896	Santa Cruz County
166333	Fee-for-Service	1992713028	1992713028	1	1	LOK, KWOK-FAI MD	7/31/1988	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	39849	77	Infectious Disease	0	In state provider	None	11160 WARNER AVE	STE 323	SANTA ANA	CA	92708	4055	30	06059	33.71630854	-117.934317	Orange County
166336	Fee-for-Service	1013014752	1013014752	1	1	LIFSCHUTZ, HARRY MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	42802	02	General Surgery	0	In state provider	None	81812 DR CARREON BLVD	STE C	INDIO	CA	92201	5594	33	06065	33.70742848	-116.236728	Riverside County
166359	Fee-for-Service	1417144395	1417144395	1	1	LOW, LAWRENCE K MD	2/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120947	22	Pathology (M.D. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
166365	Fee-for-Service	1023209798	1023209798	1	1	LEVIN, MARINA MD	9/23/2020	208M00000X	NA	Other	026	PHYSICIANS	167635	None	None	0	In state provider	None	2185 CITRACADO PARKWAY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
166369	Fee-for-Service	1891939237	1891939237	1	1	LEE, SORA MD	11/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107136	41	Internal Medicine	0	In state provider	None	1400 S GRAND AVE	STE 800	LOS ANGELES	CA	90015	3048	19	06037	34.03692236	-118.2655238	Los Angeles County
166385	Fee-for-Service	1295009678	1295009678	1	1	LINDSAY, HOLLY B MD	6/1/2021	2080P0207X	NA	Hematology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
166391	Fee-for-Service	1588813455	1588813455	1	1	LOFTUS, SHAY T PHD	9/11/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1761 BROADWAY STREET	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
166396	Fee-for-Service	1851612675	1851612675	1	1	LIM, JOANNA C MD	9/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	119225	02	General Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
166423	Fee-for-Service	1366436768	1366436768	1	1	LARRE DEAN EGBERT, M. D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 E 100 N	None	PAYSON	UT	84651	1600	00	None	40.04472385	-111.7145663	Utah County
166442	Fee-for-Service	1598749079	1598749079	1	1	LEWIS, DANIEL R MD	4/1/1986	207RH0003X	NA	Oncology	026	PHYSICIANS	57020	41	Internal Medicine	0	In state provider	None	715 TANK FARM RD	STE C	SAN LUIS OBISPO	CA	93401	7068	40	06079	35.24853234	-120.642458	San Luis Obispo County
166491	Fee-for-Service	1265631808	1265631808	1	1	LYNCH, CHRISTOPHER MD	10/17/2024	207P00000X	NA	Other	026	PHYSICIANS	107549	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
166502	Fee-for-Service	1033176979	1033176979	1	1	LAY, SACARLET O MD	5/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84662	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
166517	Fee-for-Service	1669979001	1669979001	1	1	LIAO, SHARON OD	3/5/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 N 13TH AVE	None	UPLAND	CA	91786	4904	36	06071	34.10042233	-117.6335451	San Bernardino County
166532	Fee-for-Service	1972519767	1972519767	1	1	LUTTMER, COLLETTE M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	LEGACY GOOD SAM HOSP.	1015 NW. 22ND AVENUE	None	PORTLAND	OR	97210	0000	00	None	45.53024175	-122.6966202	Multnomah County
166534	Fee-for-Service	1952877268	1952877268	1	1	LE, MAN MINH	11/1/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	6109 VISTA AVENUE	None	SACRAMENTO	CA	95824	3915	34	06067	38.514564	-121.4497305	Sacramento County
166560	Fee-for-Service	1467506691	1467506691	1	2	LITTLEFIELD PHYSICAL THERAPY	6/9/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	, INC.	41421 DATE STREET	101	MURRIETA	CA	92562	7079	33	06065	33.53012372	-117.174507	Riverside County
166572	Fee-for-Service	1922503846	1922503846	1	1	LANDHOLM, DAIN MD	6/27/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
166584	Fee-for-Service	1033665526	1033665526	1	2	LAGS RECOVERY CENTERS, INC.	6/10/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	135 CARMEN LANE	None	SANTA MARIA	CA	93458	7729	42	06083	34.92484952	-120.4374645	Santa Barbara County
166594	Fee-for-Service	1285931105	1285931105	3	1	LAVIAN, DAVID MD INC	10/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	46370	08	Family Practice	0	In state provider	None	14600 SHERMAN WAY	STE 215	VAN NUYS	CA	91405	5050	19	06037	34.20025916	-118.4500763	Los Angeles County
166607	Fee-for-Service	1467698118	1467698118	1	1	LONG PHI DANG, MD, INC	2/11/2011	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	80593	None	None	0	In state provider	None	7891 WESTMINSTER BLVD	None	WESTMINSTER	CA	92683	4043	30	06059	33.75929129	-117.9913404	Orange County
166619	Fee-for-Service	1487098844	1487098844	1	1	LAPIANA, LAURA A PSYD	7/5/2018	193400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	A PROF CORP	5012 CHESEBRO RD	STE 100	AGOURA HILLS	CA	91301	2271	19	06037	34.14123897	-118.7393414	Los Angeles County
166621	Fee-for-Service	1417905522	1417905522	1	1	LUCAS, DANIEL N MD	5/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	62395	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
166626	Fee-for-Service	1013014752	1013014752	1	1	LIFSCHUTZ, HARRY MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	42802	33	Thoracic Surgery	0	In state provider	None	81812 DR CARREON BLVD	STE C	INDIO	CA	92201	5594	33	06065	33.70742848	-116.236728	Riverside County
166646	Fee-for-Service	1417144395	1417144395	1	1	LOW, LAWRENCE K MD	2/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120947	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
166685	Fee-for-Service	1083253553	1083253553	1	3	LAMBERT HOME CARE LLC	6/27/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	10609 PLEASANT VALLEY DR	None	BAKERSFIELD	CA	93311	9153	15	06029	35.29678954	-119.1210255	Kern County
166705	Fee-for-Service	1891718615	1891718615	1	1	LEE,CURTIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2800 10TH AVE N	None	BILLINGS	MT	59101	0703	00	None	45.789696	-108.5132835	Yellowstone County
166706	Fee-for-Service	1467808410	1467808410	1	1	L&R HOME HEALTH INC	11/19/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	224 E OLIVE AVE	SUITE 202	BURBANK	CA	91505	1234	19	06037	34.18109046	-118.3084839	Los Angeles County
166718	Fee-for-Service	1578591459	1578591459	1	1	LEE, MICHAEL C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	81265	05	Anesthesiology	0	In state provider	None	500 S MAIN ST	STE 1210	ORANGE	CA	92868	4556	30	06059	33.77991974	-117.8674745	Orange County
166736	Fee-for-Service	1598749079	1598749079	1	1	LEWIS, DANIEL R MD	4/1/1986	207RH0003X	NA	Oncology	026	PHYSICIANS	57020	68	Hematology	0	In state provider	None	715 TANK FARM RD	STE C	SAN LUIS OBISPO	CA	93401	7068	40	06079	35.24853234	-120.642458	San Luis Obispo County
166758	Fee-for-Service	1386006641	1386006641	1	1	LOCKE, CAMERON	8/25/2024	207R00000X	NA	Other	026	PHYSICIANS	153139	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
166824	Fee-for-Service	1952877268	1952877268	1	1	LE, MAN MINH	11/1/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	6109 VISTA AVENUE	None	SACRAMENTO	CA	95824	3915	34	06067	38.514564	-121.4497305	Sacramento County
166829	Fee-for-Service	1568789048	1568789048	1	1	LAU, RICHARD A MD	8/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119679	83	Rheumatology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
166849	Fee-for-Service	1467506691	1467506691	1	2	LITTLEFIELD PHYSICAL THERAPY	7/26/2023	225X00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	, INC.	41421 DATE STREET	101	MURRIETA	CA	92562	7079	33	06065	33.53012372	-117.174507	Riverside County
166881	Fee-for-Service	1285931105	1285931105	3	1	LAVIAN, DAVID MD INC	10/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	46370	01	General Practice	0	In state provider	None	14600 SHERMAN WAY	STE 215	VAN NUYS	CA	91405	5050	19	06037	34.20025916	-118.4500763	Los Angeles County
166885	Fee-for-Service	1265648471	1265648471	1	1	LEE, BRIAN MD	12/28/2007	207L00000X	NA	Other	026	PHYSICIANS	89665	05	Anesthesiology	0	In state provider	None	501 S BUENA VISTA	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
166894	Fee-for-Service	1346314085	1346314085	1	1	LEE, BRENDA C PT	3/12/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
166897	Fee-for-Service	1548222813	1548222813	1	1	LAU, STANLEY MD	3/31/1996	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	46648	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	140 W VALLEY BLVD	STE 219	SAN GABRIEL	CA	91776	3787	19	06037	34.07958215	-118.1021957	Los Angeles County
166901	Fee-for-Service	1104811942	1104811942	1	1	LANFLISI, ROBERT	3/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	71110	02	General Surgery	0	In state provider	None	1245 TRAVIS BLVD	None	FAIRFIELD	CA	94533	4898	48	06095	38.25816453	-122.048325	Solano County
166935	Fee-for-Service	1407183320	1407183320	1	1	LANG, LAURA H MD	4/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111336	None	None	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
166982	Fee-for-Service	1588684500	1588684500	1	1	LITTLE, DALE P	8/21/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1495 VICTOR AVE	SUITE D	REDDING	CA	96003	4093	45	06089	40.586022	-122.338834	Shasta County
166990	Fee-for-Service	1699032821	1699032821	1	1	LIN,VIVIAN MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127990	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
167007	Fee-for-Service	1629032891	1629032891	1	1	LEVINE, BRIAN M MD	11/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31809	05	Anesthesiology	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
167017	Fee-for-Service	1922325935	1922325935	1	1	LOVE, JEANETTE L LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
167018	Fee-for-Service	1265475438	1265475438	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16922 BOLSA CHICA ST	None	HUNTINGTON BEACH	CA	92649	3569	30	06059	33.71592038	-118.0413116	Orange County
167028	Fee-for-Service	1487803458	1487803458	1	1	LAIBLIN, MEGAN A PHD	1/30/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
167036	Fee-for-Service	1467837740	1467837740	1	1	LABHA, JOEL A DO	2/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15809	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94354395	-117.394926	Riverside County
167042	Fee-for-Service	1841585312	1841585312	1	1	LOJEWSKI, STEPHEN J MD DO	1/1/2022	207PE0004X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	400 OLD RIVER ROAD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
167064	Fee-for-Service	1144292335	1144292335	1	1	LIAO, JANIE C MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95765	41	Internal Medicine	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	8589	30	06059	33.62421676	-117.9309656	Orange County
167080	Fee-for-Service	1124300207	1124300207	1	1	LIVINGSTON COMMUNITY HEALTH	10/25/2013	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	7970 N LANDER AVE	SUITE A & B	HILMAR	CA	95324	8350	24	06047	37.403703	-120.850121	Merced County
167100	Fee-for-Service	1497849608	1497849608	1	1	LEVY, JODY D MD	12/28/2020	207R00000X	NA	Other	026	PHYSICIANS	41413	None	None	0	In state provider	None	18133 VENTURA BLVD	204 & 402	TARZANA	CA	91335	0000	19	06037	34.1657808	-118.5283188	Los Angeles County
167127	Fee-for-Service	1851611396	1851611396	1	1	LUBY, STEPHANIE CRNA	8/2/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
167138	Fee-for-Service	1467506691	1467506691	1	2	LITTLEFIELD PHYSICAL THERAPY	6/9/2020	225X00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	, INC.	41421 DATE STREET	101	MURRIETA	CA	92562	7079	33	06065	33.53012372	-117.174507	Riverside County
167141	Fee-for-Service	1871695759	1871695759	1	1	LARA, ADRIENNE E MD INC	5/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	51906	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1700 N ROSE AVE	STE 470	OXNARD	CA	93030	7659	56	06111	34.21746	-119.155545	Ventura County
167145	Fee-for-Service	1669731295	1669731295	1	1	LEE, JENNIFER J MD	9/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129163	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
167151	Fee-for-Service	1144615253	1144615253	1	1	LARSON, ANDREW R MD	8/4/2022	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	148212	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
167158	Fee-for-Service	1588956387	1588956387	1	1	LEE-ANG, LORRAINE MD	12/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150222	01	General Practice	0	In state provider	None	390 N SELULVEDA BLVD	STE 1000	EL SEGUNDO	CA	90245	4475	19	06037	33.92077214	-118.3960953	Los Angeles County
167161	Fee-for-Service	1407869977	1407869977	1	1	LEVI, DANIEL S MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67198	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
167172	Fee-for-Service	1215311634	1215311634	1	1	LEBRUN, MICHELLE MD	6/28/2018	207R00000X	NA	Other	026	PHYSICIANS	151827	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
167181	Fee-for-Service	1205230125	1205230125	1	1	LIZARDO, ALICE T N	8/16/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
167185	Fee-for-Service	1063447811	1063447811	1	1	LEWIS, GREG D MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	75591	41	Internal Medicine	0	In state provider	None	4077 5TH ST	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
167221	Fee-for-Service	1164623054	1164623054	1	1	LOW, LESLIE A DPM	6/17/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
167230	Fee-for-Service	1780890178	1780890178	1	1	LUNN, MICHAEL L DO	5/5/2023	207K00000X	NA	Other	026	PHYSICIANS	20974	None	None	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
167279	Fee-for-Service	1902819964	1902819964	1	1	LOGAN, MARK E	8/31/1989	207NS0135X	NA	Dermatology	026	PHYSICIANS	59298	07	Dermatology	0	In state provider	None	5600 STONERIDGE MALL RD	None	PLEASANTON	CA	94588	2820	01	06001	37.6921981	-121.9276072	Alameda County
167319	Fee-for-Service	1972546976	1972546976	1	1	LIN, KENNETH S MD	11/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78927	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
167335	Fee-for-Service	1104960558	1104960558	1	1	LOS ANGELES VASCULAR	8/6/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ACCESS CENTER MEDICAL GR	323 N PRAIRIE AVE	STE 114	INGLEWOOD	CA	90301	4503	19	06037	33.966333	-118.3439975	Los Angeles County
167342	Fee-for-Service	1376938845	1376938845	1	1	LU, JASON Y MD	3/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147527	01	General Practice	0	In state provider	None	191 S BUENA VISTA ST	STE 150	BURBANK	CA	91505	4522	19	06037	34.15872557	-118.3283863	Los Angeles County
167365	Fee-for-Service	1124300207	1124300207	1	1	LIVINGSTON COMMUNITY HEALTH	10/25/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	7970 N LANDER AVE	SUITE A & B	HILMAR	CA	95324	8350	24	06047	37.403703	-120.850121	Merced County
167390	Fee-for-Service	1699174854	1699174854	1	1	LANGFORD, MELLERIE NP	2/12/2022	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
167424	Fee-for-Service	1437260775	1437260775	2	1	LIN, WEI-CHIEN M MD	3/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	86136	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
167452	Fee-for-Service	1659482552	1659482552	1	1	LING, RICHARD T MD INC	10/31/1988	207W00000X	NA	Ophthalmology	026	PHYSICIANS	65452	18	Ophthalmology	0	In state provider	None	2325 17TH ST	None	BAKERSFIELD	CA	93301	3503	15	06029	35.37432252	-119.0289375	Kern County
167469	Fee-for-Service	1194755470	1194755470	1	1	LIDY, CYNTHIA Y NP	8/15/2005	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3737 MARTIN LUTHER KING	None	LYNWOOD	CA	90262	3513	19	06037	33.92872742	-118.2006921	Los Angeles County
167470	Fee-for-Service	1750301339	1750301339	1	1	LAHIJI, PEJMAN MD	1/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85860	05	Anesthesiology	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	4809	19	06037	34.158213	-118.328112	Los Angeles County
167478	Fee-for-Service	1053406850	1053406850	1	1	LEHMAN, SAMUEL M MD	1/31/1996	2080P0203X	NA	Other	026	PHYSICIANS	60446	40	Pediatrics	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
167494	Fee-for-Service	1962799932	1962799932	1	1	LUU, JENNY W T OD	6/26/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
167513	Fee-for-Service	1548897143	1548897143	1	1	LEE, DANIEL J MD	8/17/2023	207P00000X	NA	Other	026	PHYSICIANS	181389	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
167524	Fee-for-Service	1811290679	1811290679	1	1	LEY, JOHN T MD	10/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111233	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
167547	Fee-for-Service	1881310597	1881310597	1	1	LEE, JEFFREY PT	5/26/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
167564	Fee-for-Service	1306045802	1306045802	1	1	LEE, JIMMY K MD	2/19/2021	207WX0120X	NA	Ophthalmology	026	PHYSICIANS	118202	None	None	0	In state provider	None	4300 LONG BEACH BLVD	SUITE 400	LONG BEACH	CA	90807	2008	19	06037	33.83662572	-118.1900605	Los Angeles County
167605	Fee-for-Service	1972546976	1972546976	1	1	LIN, KENNETH S MD	11/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78927	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
167609	Fee-for-Service	1255453304	1255453304	1	1	LIAO, KUANG CHENG MD INC	8/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79007	05	Anesthesiology	0	In state provider	None	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
167635	Fee-for-Service	1407899297	1407899297	2	1	LONGS DRUG STORES CA LLC	12/26/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4785 GRANITE DR	None	ROCKLIN	CA	95677	2853	31	06061	38.79101497	-121.2207824	Placer County
167647	Fee-for-Service	1477732014	1477732014	2	1	LONGS DRUG STORES CA LLC.	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6800 N MILBURN AVE	None	FRESNO	CA	93722	2155	10	06019	36.83652253	-119.8788602	Fresno County
167654	Fee-for-Service	1124300207	1124300207	1	1	LIVINGSTON COMMUNITY HEALTH	10/25/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	7970 N LANDER AVE	SUITE A & B	HILMAR	CA	95324	8350	24	06047	37.403703	-120.850121	Merced County
167683	Fee-for-Service	1356409072	1356409072	1	1	L & G MEDICAL GROUP INC	1/31/1995	207L00000X	NA	Other	026	PHYSICIANS	74551	05	Anesthesiology	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
167689	Fee-for-Service	1841454824	1841454824	1	1	LARKY, JANNINE B AU	2/11/2025	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
167695	Fee-for-Service	1942436878	1942436878	1	1	LOPEZ-DOWREY, PATRICE J LMFT	1/19/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	REY LMFT	78060 CALLE ESTADO	None	LA QUINTA	CA	92253	2960	33	06065	33.67599507	-116.303034	Riverside County
167696	Fee-for-Service	1710911284	1710911284	1	1	LEE, DELPHINE J MD	2/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80992	07	Dermatology	0	In state provider	None	200 UCLA MEDICAL PLZ	STE 465	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
167701	Fee-for-Service	1548741911	1548741911	1	1	LALA, STEVEN LAC	7/27/2021	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	7373 UNIVERSITY AVE	211	LA MESA	CA	91942	0524	37	06073	32.75647376	-117.03895	San Diego County
167703	Fee-for-Service	1336560481	1336560481	1	1	LEUNG, DEREK T MD	11/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123947	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
167728	Fee-for-Service	1265405526	1265405526	1	1	LE, TAM C MD	10/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54205	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5555 GROSSMONT CENTER	None	LA MESA	CA	95128	1425	37	06073	32.781483	-117.007182	San Diego County
167743	Fee-for-Service	1598932980	1598932980	1	1	LOWERY, JIEYU MD	6/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113868	08	Family Practice	0	In state provider	None	5525 GROSSMONT CENTER DR	#200	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
167770	Fee-for-Service	1851489033	1851489033	1	1	LARSEN, RONALD K	11/8/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2087 GRAND CANAL BLVD	STE 17	STOCKTON	CA	95207	6651	39	06077	37.98552607	-121.3315122	San Joaquin County
167816	Fee-for-Service	1801474283	1801474283	1	1	LIANG-CHANG, LAUREN S OD	8/15/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1845 W REDLANDS BLVD	101	REDLANDS	CA	92373	3124	36	06071	34.06287653	-117.215955	San Bernardino County
167831	Fee-for-Service	1437121415	1437121415	1	1	LAQUI, ELIZABETH C MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	39839	40	Pediatrics	0	In state provider	None	1970 UNIVERSITY AVE	None	RIVERSIDE	CA	92507	5202	33	06065	33.97555819	-117.3545428	Riverside County
167854	Fee-for-Service	1578186037	1578186037	1	1	LEE, ELIZABETH L MD	7/21/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20614	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
167860	Fee-for-Service	1942343918	1942343918	1	1	LAI, HA THAO	2/28/1995	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	367 JACKLIN RD	None	MILPITAS	CA	95035	3225	43	06085	37.44649418	-121.9026388	Santa Clara County
167899	Fee-for-Service	1003839846	1003839846	1	1	LU, ALLEN P MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82726	20	Orthopedic Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
167900	Fee-for-Service	1932426152	1932426152	1	1	LALCHANDANI, RINKU M PHD	8/16/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
167931	Fee-for-Service	1194892083	1194892083	1	1	LORENZO, FELICIO S MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	71996	08	Family Practice	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
167941	Fee-for-Service	1336225853	1336225853	1	1	LAKSHMI, SUBBU MD	1/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81423	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
167944	Fee-for-Service	1124300207	1124300207	1	1	LIVINGSTON COMMUNITY HEALTH	12/4/2013	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	7970 N LANDER AVE	SUITE A & B	HILMAR	CA	95324	8350	24	06047	37.403703	-120.850121	Merced County
167947	Fee-for-Service	1497816359	1497816359	1	1	LAMKE, VALERIE A LMFT	3/28/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2101 GEER RD	STE 102A	TURLOCK	CA	95382	1142	50	06099	37.512324	-120.8489985	Stanislaus County
167971	Fee-for-Service	1770620429	1770620429	1	1	LANCASTER RHEUMATOLOGY &	1/24/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	OSTEOPOROSIS CENTER INC	44835 DATE AVE	None	LANCASTER	CA	93534	3102	19	06037	34.69706565	-118.1406679	Los Angeles County
167992	Fee-for-Service	1295796753	1295796753	1	1	LIM, VIVIAN MD	3/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	58509	30	Radiology	0	In state provider	None	10666 N TORREY PINES RD	# 100C	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
168032	Fee-for-Service	1063501880	1063501880	1	1	LANTRY, SELENA C MD	10/1/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55968	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1505 WILSON TER	STE 130	GLENDALE	CA	91206	4074	19	06037	34.14960934	-118.2313491	Los Angeles County
168053	Fee-for-Service	1295158632	1295158632	1	1	LI, DAVID X MD	4/21/2020	208M00000X	NA	Other	026	PHYSICIANS	159069	41	Internal Medicine	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
168068	Fee-for-Service	1376935726	1376935726	1	1	LIN, ALBERT B MD	10/16/2023	207L00000X	NA	Other	026	PHYSICIANS	163727	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
168077	Fee-for-Service	1043527096	1043527096	1	1	LEE, TRACY NP	4/25/2018	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
168085	Fee-for-Service	1417287079	1417287079	1	1	LABORATORY CORP OF AMERICA	2/2/2010	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	1350 O STREET	#101	FRESNO	CA	93721	1828	10	06019	36.74132042	-119.7891324	Fresno County
168110	Fee-for-Service	1073657367	1073657367	1	1	LA MERS, JULIET MD	10/1/1998	207P00000X	NA	Other	026	PHYSICIANS	52640	66	Emergency Medicine (Urgent Care)	0	In state provider	None	768 MOUNTAIN RANCH RD	None	SAN ANDREAS	CA	95249	9707	05	06009	38.19058212	-120.6709481	Calaveras County
168114	Fee-for-Service	1336224757	1336224757	1	1	LANGE, DENNIS T MD	6/30/1992	207R00000X	NA	Other	026	PHYSICIANS	68910	45	Nephrology (Renal-Kidney)	0	In state provider	None	5260 POMONA BLVD	None	LOS ANGELES	CA	90022	1713	19	06037	34.03331153	-118.150434	Los Angeles County
168148	Fee-for-Service	1164400131	1164400131	1	1	LEHIGH VALLEY HOSPITAL	3/24/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1200 S CEDAR CREST BLVD	None	ALLENTOWN	PA	18105	6202	00	None	40.566627	-75.5237925	Lehigh County
168165	Fee-for-Service	1467727552	1467727552	1	1	LAM, KATRINA H MD	4/26/2020	207R00000X	NA	Other	026	PHYSICIANS	128888	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
168190	Fee-for-Service	1952326654	1952326654	1	1	LEE, JAY M MD	8/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96666	33	Thoracic Surgery	0	In state provider	None	10833 LE CONTE AVE	RM 64-128	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
168203	Fee-for-Service	1588856371	1588856371	1	1	LI, JI ZE	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	24218 HAWTHORNE BLVD	None	TORRANCE	CA	90505	6597	19	06037	33.803523	-118.3510305	Los Angeles County
168212	Fee-for-Service	1750336350	1750336350	1	1	LEBARON, ALARIC C MD	7/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89399	None	None	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
168219	Fee-for-Service	1194892083	1194892083	1	1	LORENZO, FELICIO S MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	71996	01	General Practice	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
168234	Fee-for-Service	1497816359	1497816359	1	1	LAMKE, VALERIE A LMFT	3/28/2018	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2101 GEER RD	STE 102A	TURLOCK	CA	95382	1142	50	06099	37.512324	-120.8489985	Stanislaus County
168248	Fee-for-Service	1215037122	1215037122	1	1	LAMBERTON, HENRY H PHD	5/1/1998	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11320 MOUNTAIN VIEW AVE	STE B	LOMA LINDA	CA	92354	3860	36	06071	34.0472495	-117.2436911	San Bernardino County
168254	Fee-for-Service	1467472092	1467472092	1	1	LEUNG, SAMSON MD	9/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85052	05	Anesthesiology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
168257	Fee-for-Service	1093093791	1093093791	1	1	LINDSAY, SHEILA N NP	2/9/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
168349	Fee-for-Service	1790012912	1790012912	1	1	LE, KHANH MD INC	11/23/2009	193400000X	NA	Other	026	PHYSICIANS	96418	05	Anesthesiology	0	In state provider	None	9920 TALBERT AVENUE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
168373	Fee-for-Service	1225432941	1225432941	1	1	LIAO, YANTING DO	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14633	01	General Practice	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
168375	Fee-for-Service	1669869111	1669869111	1	1	LB SURGICAL CENTER LLC	10/25/2022	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	699 COLUMBIA ST.	180	SIGNAL HILL	CA	90755	1714	19	06037	33.8089893	-118.1843726	Los Angeles County
168381	Fee-for-Service	1568098556	1568098556	1	1	LERMAN-SINKOFF, DOV B MD	5/29/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	179243	36	Psychiatry	0	In state provider	None	150 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.0653632	-118.4458393	Los Angeles County
168395	Fee-for-Service	1174611263	1174611263	1	1	LEONG, JOY A MD	5/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77572	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7630 PAINTER AVE	STE A	WHITTIER	CA	90602	2357	19	06037	33.972534	-118.032652	Los Angeles County
168398	Fee-for-Service	1073657367	1073657367	1	1	LA MERS, JULIET MD	10/1/1998	207P00000X	NA	Other	026	PHYSICIANS	52640	08	Family Practice	0	In state provider	None	768 MOUNTAIN RANCH RD	None	SAN ANDREAS	CA	95249	9707	05	06009	38.19058212	-120.6709481	Calaveras County
168422	Fee-for-Service	1508341702	1508341702	1	1	LAMBERT, GINA M RCP	11/12/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
168423	Fee-for-Service	1588085328	1588085328	1	1	LINA SUCHOV A PROFESSIONAL	1/27/2017	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYCHOLOGY CORPORATION	16260 VENTURA BLVD	SUITE LL30	ENCINO	CA	91436	2203	19	06037	34.15687678	-118.4876342	Los Angeles County
168438	Fee-for-Service	1164400131	1164400131	1	1	LEHIGH VALLEY HOSPITAL	2/1/1998	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1200 S CEDAR CREST BLVD	None	ALLENTOWN	PA	18105	6202	00	None	40.566627	-75.5237925	Lehigh County
168445	Fee-for-Service	1568743722	1568743722	1	1	LOEFFLER-SIU, NICOLE R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116209	40	Pediatrics	0	In state provider	None	1 COLBY PLAZA AT ASHBY	None	BERKELEY	CA	94705	0000	01	06001	37.856412	-122.2579485	Alameda County
168464	Fee-for-Service	1023454238	1023454238	1	1	LINDSEY, MICHAEL W MD	6/8/2017	207P00000X	NA	Other	026	PHYSICIANS	148269	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
168525	Fee-for-Service	1376931295	1376931295	1	5	LIFELONG MEDICAL CARE	7/1/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	9933 MACARTHUR BLVD	None	OAKLAND	CA	94605	4853	01	06001	37.74646247	-122.1566447	Alameda County
168538	Fee-for-Service	1093240939	1093240939	1	1	LO, ALICIA A MD	11/23/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158772	None	None	0	In state provider	None	1133 E STANLEY BLVD	STE 203	LIVERMORE	CA	94550	4246	01	06001	37.67914693	-121.7810206	Alameda County
168551	Fee-for-Service	1386608065	1386608065	1	1	LIN, MIMI C W MD	5/30/2007	174400000X	NA	Other	026	PHYSICIANS	64114	30	Radiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
168573	Fee-for-Service	1962664409	1962664409	1	1	LEBED, BRETT D MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55845	34	Urology and Urological Surgery	0	In state provider	None	525 EAST PLAZA DRIVE	STE 304	SANTA MARIA	CA	93454	6955	42	06083	34.9373822	-120.4296004	Santa Barbara County
168581	Fee-for-Service	1588684724	1588684724	1	1	LY, PETER P MD	7/10/2000	207L00000X	NA	Other	026	PHYSICIANS	65780	05	Anesthesiology	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3101	30	06059	33.80318353	-118.0666665	Orange County
168660	Fee-for-Service	1326378373	1326378373	1	1	LATTO, IRA S MD MEDICAL	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	12260	18	Ophthalmology	0	In state provider	CORPORATION	19180 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91351	3364	19	06037	34.41567392	-118.4697994	Los Angeles County
168666	Fee-for-Service	1578562740	1578562740	1	1	LEE, SUSAN H MD	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	73608	30	Radiology	0	In state provider	None	1100 W STEWART DRIVE	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
168678	Fee-for-Service	1053130898	1053130898	1	1	LOGAN, RAQUEL I CRNA	1/3/2025	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
168681	Fee-for-Service	1285823898	1285823898	1	1	LOLAK, SERMSAK MD	5/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53657	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
168682	Fee-for-Service	1265559959	1265559959	1	1	LIMON, KARMA B LMFT	10/15/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18837 BROOKHURST ST	None	FOUNTAIN VALLEY	CA	92708	7308	30	06059	33.68919119	-117.9542204	Orange County
168684	Fee-for-Service	1902904493	1902904493	1	1	LEBELL, DAVID MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	47731	01	General Practice	0	In state provider	None	1434 E OJAI AVE	None	OJAI	CA	93023	9623	56	06111	34.44886875	-119.2278983	Ventura County
168686	Fee-for-Service	1528182532	1528182532	1	1	LEVIN, JOSHUA H MD	5/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129385	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
168699	Fee-for-Service	1154408854	1154408854	1	1	LILLY, ADRIANA LCSW	6/4/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7121 MAGNOLIA AVE	J	RIVERSIDE	CA	92504	3805	33	06065	33.9455319	-117.4027101	Riverside County
168727	Fee-for-Service	1265654172	1265654172	1	1	LESKOVAR, TOMISLAV MD	12/1/2003	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	50132	30	Radiology	0	In state provider	None	3450 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98818077	-121.7817767	Contra Costa County
168732	Fee-for-Service	1720166549	1720166549	1	1	LAMBERT, SUSAN D MD	11/27/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	28499	01	General Practice	0	In state provider	None	2908 ELLSWORTH ST	None	BERKELEY	CA	94705	1912	01	06001	37.85696797	-122.2614554	Alameda County
168747	Fee-for-Service	1679829741	1679829741	1	1	LOTUS HOME HEALTH CARE INC	9/16/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6740 KESTER AVE	UNIT 202	NORTH HOLLYWOOD	CA	91405	4559	19	06037	34.193232	-118.457411	Los Angeles County
168771	Fee-for-Service	1700206182	1700206182	1	1	LAFIAN, ANNA M DO	10/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14592	41	Internal Medicine	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4897	36	06071	34.03717616	-117.2046115	San Bernardino County
168801	Fee-for-Service	1144253352	1144253352	1	1	LOEFFLER, JOYCE A MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	84054	34	Urology and Urological Surgery	0	In state provider	None	370 DEL NORTE AVE	SUITE 201	YUBA CITY	CA	95991	4142	51	06101	39.14466521	-121.6166961	Sutter County
168812	Fee-for-Service	1376931295	1376931295	1	5	LIFELONG MEDICAL CARE	7/1/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	9933 MACARTHUR BLVD	None	OAKLAND	CA	94605	4853	01	06001	37.74646247	-122.1566447	Alameda County
168816	Fee-for-Service	1902317985	1902317985	1	1	LIN, CHUN Y	7/24/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	18350 MOUNT LANGLEY ST	None	FOUNTAIN VALLEY	CA	92708	9623	30	06059	33.69633523	-117.9420534	Orange County
168900	Fee-for-Service	1215949995	1215949995	1	1	LAMM, ROBERT L MD	8/20/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	75559	30	Radiology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
168920	Fee-for-Service	1609849074	1609849074	1	11	LA MAESTRA FAMILY CLINIC INC	6/1/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1609	37	06073	32.750523	-117.100927	San Diego County
168929	Fee-for-Service	1225218043	1225218043	1	1	LI, GORDON H MD	7/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	92298	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
168967	Fee-for-Service	1316011794	1316011794	2	1	LUCERNE PHARMACY INC	5/31/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6244 E HIGHWAY 20	None	LUCERNE	CA	95458	1316	17	06033	39.089988	-122.7955937	Lake County
168971	Fee-for-Service	1073757654	1073757654	1	1	LATHARI, AYDIN A MD	6/21/2023	207R00000X	NA	Other	026	PHYSICIANS	183151	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
168973	Fee-for-Service	1043300650	1043300650	1	1	LANTZ,KAREN E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 N MEDICAL DR	None	SALT LAKE CITY	UT	84113	1103	00	None	40.77069459	-111.8370155	Salt Lake County
168974	Fee-for-Service	1528182532	1528182532	1	1	LEVIN, JOSHUA H MD	5/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129385	25	Physical Medicine and Rehabilitation	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
169007	Fee-for-Service	1013508746	1013508746	1	1	LA FOREST, KACIE	12/19/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
169026	Fee-for-Service	1851303671	1851303671	1	1	LIMJOCO, BETTINA T MD	10/31/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	51899	25	Physical Medicine and Rehabilitation	0	In state provider	None	2601 OSWELL STREET	STE 101	BAKERSFIELD	CA	93306	3173	15	06029	35.39259632	-118.9496489	Kern County
169033	Fee-for-Service	1215974068	1215974068	1	1	LEE, JENNIFER H MD	6/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99829	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
169034	Fee-for-Service	1174548481	1174548481	1	1	LIM, STEVE	9/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	71526	08	Family Practice	0	In state provider	None	1646 BROADWAY ST	None	VALLEJO	CA	94590	2405	48	06095	38.12536599	-122.2503047	Solano County
169048	Fee-for-Service	1467612739	1467612739	1	1	LEE, JENNIFER Y MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125587	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
169066	Fee-for-Service	1689858094	1689858094	1	1	LEE, CHARLES K MD INC	3/29/2010	193200000X	NA	Other	026	PHYSICIANS	82918	24	Plastic Surgery	0	In state provider	None	2250 HAYES ST	STE 508	SAN FRANCISCO	CA	94117	1078	38	06075	37.77302042	-122.45342	San Francisco County
169121	Fee-for-Service	1407350218	1407350218	1	1	LUCIER, JESSICA L MD	9/8/2023	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	166184	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
169125	Fee-for-Service	1245321751	1245321751	1	1	LAVANDA HOME HEALTH CARE	6/16/2006	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY, INC	3033 N AVON ST	SUITE A	BURBANK	CA	91504	2014	19	06037	34.2057003	-118.3477203	Los Angeles County
169127	Fee-for-Service	1881909141	1881909141	1	1	LINDENBERG, DAVID A	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14958	None	None	0	In state provider	None	2850 TELEGRAPH AVE	SUITE 120	BERKELEY	CA	94705	1159	01	06001	37.85808554	-122.2594469	Alameda County
169130	Fee-for-Service	1073880902	1073880902	1	1	LOS ALAMITOS UNIFIED SD	11/9/1999	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	10293 BLOOMFIELD ST	None	LOS ALAMITOS	CA	90720	2264	30	06059	33.81611491	-118.0631985	Orange County
169193	Fee-for-Service	1447679329	1447679329	1	1	LIFE SKILLS AWARENESS	2/12/2021	251S00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16501 WALNUT STREET	SUITE 12	HESPERIA	CA	92345	3684	36	06071	34.42057564	-117.3026653	San Bernardino County
169265	Fee-for-Service	1023435153	1023435153	1	1	LANGSTON, SETH MD	7/9/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	140354	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
169271	Fee-for-Service	1952622110	1952622110	1	1	LIU, JOHN K C MD	5/16/2016	207LP3000X	NA	Other	026	PHYSICIANS	130832	05	Anesthesiology	0	In state provider	None	2425 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2215	34	06067	38.553012	-121.45545	Sacramento County
169278	Fee-for-Service	1831132166	1831132166	2	1	LONGS DRUG STORES CA LLC	12/26/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2085 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	0000	34	06067	38.575053	-121.4161515	Sacramento County
169279	Fee-for-Service	1760891139	1760891139	1	1	LI, TSUNG LMFT	10/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
169285	Fee-for-Service	1578974259	1578974259	1	1	LAM, MICHAEL T MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141055	41	Internal Medicine	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
169298	Fee-for-Service	1326024704	1326024704	1	1	LEONARD, BARRY W OD INC	9/15/1985	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14425 CHASE ST	None	PANORAMA CITY	CA	91402	3017	19	06037	34.22478036	-118.4477576	Los Angeles County
169346	Fee-for-Service	1083958912	1083958912	1	1	LARRY, ASAL LMFT	4/9/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4701 VON KARMAN AVENUE	SUITE 330	NEWPORT BEACH	CA	92660	8136	30	06059	33.66894215	-117.8600003	Orange County
169375	Fee-for-Service	1376571745	1376571745	1	1	LAGER, MICHAEL H MD	9/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	28551	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
169409	Fee-for-Service	1629611439	1629611439	1	1	LISING, MIKAELA D	4/1/2025	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
169445	Fee-for-Service	1184890063	1184890063	1	1	LUND, GREGG C DO	8/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11500	40	Pediatrics	0	In state provider	None	160 GLEN COVE MARINA	SUITE 103	VALLEJO	CA	94591	7290	48	06095	38.07062486	-122.2124251	Solano County
169476	Fee-for-Service	1952321085	1952321085	1	1	LEVSKY, MARC E MD	10/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100429	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1900 SULLIVAN AVENUE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
169501	Fee-for-Service	1013375294	1013375294	1	1	LEHMAN, JAYNA C	5/9/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVE	None	LOS ANGELES	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
169534	Fee-for-Service	1194734103	1194734103	1	1	LIM, LOUIS G MD	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90708	15	Obstetrics (D.O. only)	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
169547	Fee-for-Service	1750498309	1750498309	1	1	LI, NANYING MD	3/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82617	41	Internal Medicine	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
169557	Fee-for-Service	1780647693	1780647693	1	1	LANDECKER, JULIE K PT	8/30/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7840 OLD REDWOOD HWY	None	COTATI	CA	94931	5106	49	06097	38.32994079	-122.7093541	Sonoma County
169566	Fee-for-Service	1588712368	1588712368	1	1	LE-PHAM, CHANTAL	9/21/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	67678	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
169583	Fee-for-Service	1811992134	1811992134	1	1	LEVINS, ANTHONY MD	6/1/1998	204D00000X	NA	Other	026	PHYSICIANS	80608	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
169611	Fee-for-Service	1518128552	1518128552	1	1	LOGAN A MCLEAN MD	6/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5444 S GREEN ST	None	MURRAY	UT	84123	5632	00	None	40.651605	-111.90357	Salt Lake County
169614	Fee-for-Service	1053461871	1053461871	1	1	LEFEVRE, ROBERT E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31430	08	Family Practice	0	In state provider	None	601 MCHENRY AVE	None	MODESTO	CA	95350	5411	50	06099	37.653102	-120.993808	Stanislaus County
169641	Fee-for-Service	1871701672	1871701672	1	1	LEWIS, JEFFREY A DO	7/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10761	05	Anesthesiology	0	In state provider	None	2 W FERN AVENUE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
169643	Fee-for-Service	1801956198	1801956198	1	1	LYTLE, MARK S PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11280 TRIBUNA AVE	None	SAN DIEGO	CA	92131	1929	37	06073	32.90555546	-117.0895715	San Diego County
169649	Fee-for-Service	1922356914	1922356914	1	1	LEE, AUSTIN T OD	10/6/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1033 HIGHLAND AVE	None	NATIONAL CITY	CA	91950	3515	37	06073	32.67616613	-117.0977972	San Diego County
169668	Fee-for-Service	1710419007	1710419007	1	1	LECHNER, SARAH	9/12/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	157003	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
169692	Fee-for-Service	1477588176	1477588176	1	1	LITWER, CYNTHIA A MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	67587	30	Radiology	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
169747	Fee-for-Service	1568633881	1568633881	1	1	LIEU, VI T MD	8/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102135	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
169748	Fee-for-Service	1750805859	1750805859	1	1	LINCKS, MELISSA D NP	8/1/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
169752	Fee-for-Service	1922413277	1922413277	1	1	LEFLORE, NICOLETTE A M MFT	2/6/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27247 MADISON AVE	SUITE 108	TEMECULA	CA	92590	5674	33	06065	33.52637406	-117.1675119	Riverside County
169787	Fee-for-Service	1487865184	1487865184	1	2	LOS ANGELES COUNTY	10/28/2020	No Taxonomy Provided	NA	None	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
169805	Fee-for-Service	1598329641	1598329641	1	1	LONGINO, ELIZABETH S MD	3/9/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
169820	Fee-for-Service	1457531311	1457531311	1	1	LEE-MESSER, CHRISTOPHER W MD	5/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93208	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
169849	Fee-for-Service	1851824445	1851824445	1	1	LAWRENCE, YANCEY MD	11/11/2023	207P00000X	NA	Other	026	PHYSICIANS	188161	None	None	0	In state provider	None	347 ANDRIEUX ST	None	SONOMA	CA	95476	6811	49	06097	38.28843573	-122.4651035	Sonoma County
169875	Fee-for-Service	1861121824	1861121824	1	1	LECAROS, CESAR NP	7/20/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
169908	Fee-for-Service	1558536573	1558536573	1	1	LOS ANGELES COUNTY	12/7/2006	261Q00000X	NA	Other	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	LONG BEACH COMPREHENSIVE	1333 CHESTNUT AVE	None	LONG BEACH	CA	90813	2944	19	06037	33.78354312	-118.1963702	Los Angeles County
169935	Fee-for-Service	1023452794	1023452794	1	1	LO, ANDERSON J DO	9/9/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	18068	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
169976	Fee-for-Service	1881882124	1881882124	1	1	LEIGH, MARY JACENA SLY MD	10/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101355	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
169984	Fee-for-Service	1881891042	1881891042	1	1	LINEHAN, JENNIFER A MD	10/19/2010	208800000X	NA	Other	026	PHYSICIANS	111812	34	Urology and Urological Surgery	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
169999	Fee-for-Service	1942463310	1942463310	1	1	LEWIS, HEATHER R LMFT	7/6/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	78636	-	NOT APPLICABLE	0	In state provider	None	44443 N 10TH ST WEST	None	LANCASTER	CA	93534	3346	19	06037	34.69074211	-118.1480945	Los Angeles County
170042	Fee-for-Service	1639263411	1639263411	1	1	LANDRY, KEALA K MD	2/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98390	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVENUE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
170052	Fee-for-Service	1659422285	1659422285	1	1	LIN, DENNIS OD	4/5/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	537 S ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	3815	19	06037	34.05506574	-118.1355856	Los Angeles County
170062	Fee-for-Service	1861445470	1861445470	1	1	LAJIDE OMOLULU, OLAYINKA	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84268	41	Internal Medicine	0	In state provider	None	400 OAK ST	None	VISALIA	CA	93291	5034	54	06107	36.332253	-119.288691	Tulare County
170074	Fee-for-Service	1194359760	1194359760	1	1	LEHECKA, KYSSERIA K OT	2/25/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
170096	Fee-for-Service	1396720355	1396720355	1	1	LANG, MAYNARD F MD	10/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	29340	01	General Practice	0	In state provider	None	1805 N CALIFORNIA ST	STE 201	STOCKTON	CA	95204	6032	39	06077	37.9711691	-121.2894221	San Joaquin County
170101	Fee-for-Service	1710057583	1710057583	1	1	LIU, JING LAC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	115 PLAZA PROFESSIONAL	BLDG	EL CERRITO	CA	94530	0000	07	06013	37.89859764	-122.2991542	Contra Costa County
170122	Fee-for-Service	1205882503	1205882503	1	1	LAS CRUCES MEDICAL CENTER LL	6/9/2020	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	AL CENTER	4311 E LOHMAN AVE	None	LAS CRUCES	NM	88011	8255	00	None	32.32287382	-106.7280204	Doña Ana County
170155	Fee-for-Service	1790197929	1790197929	1	1	LULLA, DINESH S MD	5/23/2024	2084N0402X	NA	Neurology	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
170156	Fee-for-Service	1659341709	1659341709	1	1	LIM, ALAN A MD	7/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88260	24	Plastic Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 465	LOS ANGELES	CA	90024	7002	19	06037	34.06527974	-118.4462792	Los Angeles County
170170	Fee-for-Service	1992065361	1992065361	1	1	LIM, JINA J MD	10/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121375	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
170173	Fee-for-Service	1114997772	1114997772	1	1	LIU, EDWIN M OD	9/15/1983	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3901B SANTA RITA RD	None	PLEASANTON	CA	94588	3462	01	06001	37.69535683	-121.8775886	Alameda County
170176	Fee-for-Service	1437847340	1437847340	1	1	LEGACY ADULT CARE LLC	9/8/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2348 E HARVARD AVENUE	None	FRESNO	CA	93703	1812	10	06019	36.77404572	-119.782837	Fresno County
170181	Fee-for-Service	1841361896	1841361896	1	1	LONKY, NEAL	12/16/1988	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	50278	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	742 W GARDENA BLVD	None	GARDENA	CA	90247	5024	19	06037	33.88165193	-118.2885204	Los Angeles County
170228	Fee-for-Service	1114312931	1114312931	1	1	LEVY, REBECCA J MD	6/20/2022	2084N0402X	NA	Neurology	026	PHYSICIANS	143989	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
170232	Fee-for-Service	1548794506	1548794506	1	1	LIU, JI LPT	2/21/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
170254	Fee-for-Service	1710272224	1710272224	1	1	LI, BO MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134239	None	None	0	In state provider	None	10833 LE CONTE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
170280	Fee-for-Service	1366460453	1366460453	1	1	LAGANA, VICTOR DPM	7/25/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	355 ABBOTT STREET	SUITE 100	SALINAS	CA	93901	4310	27	06053	36.66552031	-121.6439174	Monterey County
170291	Fee-for-Service	1619179462	1619179462	1	1	LAU, KAREN PHD	8/26/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
170341	Fee-for-Service	1396465258	1396465258	1	1	LUONG, VALERIE OD	12/22/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	15100 HESPERIAN BLVD	STE 120	SAN LEANDRO	CA	94578	3600	01	06001	37.70115661	-122.129841	Alameda County
170387	Fee-for-Service	1104318013	1104318013	1	1	LOUIS J GALLIA,MD A MEDICAL	6/7/2024	261QS0112X	NA	Other	026	PHYSICIANS	None	84	Surgery-Head and Neck	0	In state provider	CORP	87 SCRIPPS DR	112	SACRAMENTO	CA	95825	6379	34	06067	38.572092	-121.410261	Sacramento County
170388	Fee-for-Service	1457749244	1457749244	1	1	LONDON, TYLER C LMFT	1/10/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28494 WESTINGHOUSE PL	SUITE 213	VALENCIA	CA	91355	0930	19	06037	34.44221561	-118.5989564	Los Angeles County
170401	Fee-for-Service	1831504232	1831504232	1	1	LE, TAM T MD	9/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140531	66	Emergency Medicine (Urgent Care)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
170409	Fee-for-Service	1205882503	1205882503	1	1	LAS CRUCES MEDICAL CENTER LL	6/9/2020	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	AL CENTER	4311 E LOHMAN AVE	None	LAS CRUCES	NM	88011	8255	00	None	32.32287382	-106.7280204	Doña Ana County
170413	Fee-for-Service	1861432023	1861432023	1	1	LEWIS, ANDREW H DO	11/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	8147	None	None	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
170547	Fee-for-Service	1699986331	1699986331	1	3	LOS ANGELES COUNTY	11/12/2020	No Taxonomy Provided	NA	None	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	2010 ZONAL AVE	None	LOS ANGELES	CA	90033	1026	19	06037	34.05986523	-118.2057472	Los Angeles County
170554	Fee-for-Service	1689614224	1689614224	1	1	LEVINE, GARY M MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	64219	30	Radiology	0	In state provider	None	16300 SAND CANYON AVE	STE 102	IRVINE	CA	92618	3704	30	06059	33.66115075	-117.7742405	Orange County
170586	Fee-for-Service	1386922011	1386922011	1	1	LIN, AYE T MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126452	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
170589	Fee-for-Service	1891120689	1891120689	1	1	LIMBU, SUSANG N MD	1/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	154140	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
170633	Fee-for-Service	1285104570	1285104570	1	1	LIFESTAR HOME HEALTH INC	9/14/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6320 VAN NUYS BLVD	SUITE 310	VAN NUYS	CA	91401	2617	19	06037	34.18545203	-118.4487091	Los Angeles County
170638	Fee-for-Service	1073919700	1073919700	1	1	LEE, AMY OT	2/2/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	911 BERN CT	STE 140	SAN JOSE	CA	95112	1242	43	06085	37.37594797	-121.8941096	Santa Clara County
170641	Fee-for-Service	1912084955	1912084955	1	1	LATTIN, GRANT MD	4/9/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	91663	None	None	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
170676	Fee-for-Service	1023193794	1023193794	1	1	LIU, KINGSWAY MD	6/21/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75266	02	General Surgery	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
170686	Fee-for-Service	1417061185	1417061185	1	1	LEWIS, KARA MD	7/17/2018	2084N0402X	NA	Neurology	026	PHYSICIANS	-	13	Neurology (M.D. only)	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
170690	Fee-for-Service	1669414496	1669414496	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8490 BEVERLY BLVD	None	LOS ANGELES	CA	90048	3414	19	06037	34.07603451	-118.3756545	Los Angeles County
170712	Fee-for-Service	1295790277	1295790277	1	1	LEE, RAYMOND H MD	12/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	65112	41	Internal Medicine	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
170727	Fee-for-Service	1497834352	1497834352	1	1	LEE, GARY T MD	8/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74496	01	General Practice	0	In state provider	None	101 S SAN MATEO DR	FL 4	SAN MATEO	CA	94401	3845	41	06081	37.56590481	-122.325549	San Mateo County
170740	Fee-for-Service	1043360852	1043360852	1	1	LEE, SU-MAY MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73539	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
170748	Fee-for-Service	1316213705	1316213705	1	1	LYNCH, MEGAN T DO	5/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	13924	83	Rheumatology	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
170751	Fee-for-Service	1164580296	1164580296	2	1	LEE, FRANKLIN OD	5/5/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	15100 HESPERIAN BLVD	STE 120	SAN LEANDRO	CA	94578	3600	01	06001	37.70115661	-122.129841	Alameda County
170766	Fee-for-Service	1730267378	1730267378	1	1	LO, BUTHCAU MD	10/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	66507	41	Internal Medicine	0	In state provider	None	27212 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63229023	-122.0896425	Alameda County
170779	Fee-for-Service	1790218816	1790218816	1	1	LARIMER, EMILY L MD	7/8/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	160679	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
170783	Fee-for-Service	1336898261	1336898261	1	1	LUCKANAVANICH, WASIN CRNA	7/24/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
170845	Fee-for-Service	1689614224	1689614224	1	1	LEVINE, GARY M MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	64219	01	General Practice	0	In state provider	None	16300 SAND CANYON AVE	STE 102	IRVINE	CA	92618	3704	30	06059	33.66115075	-117.7742405	Orange County
170852	Fee-for-Service	1649214479	1649214479	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	325 SHARON PARK DR	None	MENLO PARK	CA	94025	6805	41	06081	37.42411455	-122.1983028	San Mateo County
170853	Fee-for-Service	1336462183	1336462183	1	1	LE, LUAT N MD	7/30/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	14404	None	None	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
170857	Fee-for-Service	1003445677	1003445677	1	1	LURLAY, GESSIE MD	8/9/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187969	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
170946	Fee-for-Service	1497982227	1497982227	1	1	LENZEN, CHRISTIANE MD	12/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143617	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
170948	Fee-for-Service	1922330455	1922330455	1	1	LUC, TRANG M MD	3/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11102	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3025	30	06059	33.85429563	-117.8166478	Orange County
170966	Fee-for-Service	1558541383	1558541383	1	1	LEE, SULGGI A MD	8/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105131	41	Internal Medicine	0	In state provider	None	995 POTRERO AVE	BLDG 80 RM WD84	SAN FRANCISCO	CA	94110	3518	38	06075	37.75729541	-122.4066641	San Francisco County
171011	Fee-for-Service	1053767459	1053767459	1	1	LUSCOMB, THOMAS A	7/7/2022	207L00000X	NA	Other	026	PHYSICIANS	168545	None	None	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
171043	Fee-for-Service	1487929162	1487929162	1	2	LA GUARDIAN HEALTH CARE, INC	5/19/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6501 FOOTHILL BLVD	SUITE 203B	TUJUNGA	CA	91042	2768	19	06037	34.24497265	-118.2734363	Los Angeles County
171052	Fee-for-Service	1790251619	1790251619	1	1	LENITY HOME CARE LLC	11/12/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	315 W OAK AVENUE	None	VISALIA	CA	93291	4928	54	06107	36.331857	-119.2952025	Tulare County
171081	Fee-for-Service	1043316540	1043316540	1	1	LIEBERMAN, ROGER A MD	6/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	17702	41	Internal Medicine	0	In state provider	None	777 CAMPUS COMMONS ROAD	SUITE 120	SACRAMENTO	CA	95825	8343	34	06067	38.571021	-121.416786	Sacramento County
171093	Fee-for-Service	1679900906	1679900906	1	1	LAFAELE, BERNADETTE OT	3/26/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1901 CARNEGIE AVE	SUITE 1-C	SANTA ANA	CA	92705	5504	30	06059	33.711615	-117.8416035	Orange County
171110	Fee-for-Service	1942261912	1942261912	1	1	LA, HOANGTIEN H DO	12/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	8145	05	Anesthesiology	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
171118	Fee-for-Service	1306174875	1306174875	1	1	LUCEY, MELISSA MD	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111556	08	Family Practice	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
171142	Fee-for-Service	1386178002	1386178002	1	1	LIU, ROBERT MD	9/16/2019	207R00000X	NA	Other	026	PHYSICIANS	162213	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
171158	Fee-for-Service	1689692808	1689692808	1	1	LUU, QUOC THAI AN MD	8/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73125	78	Neoplastic Diseases/Oncology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
171164	Fee-for-Service	1558345314	1558345314	1	1	LEVAI, LEVENTE MD	8/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6490 S MCDCARRAN BLVD	STE 13	RENO	NV	89509	0000	00	None	39.47672552	-119.796471	Washoe County
171176	Fee-for-Service	1639321771	1639321771	1	1	LIM, CHRISTINE C MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121509	36	Psychiatry	0	In state provider	None	3454 HILLCREST AVENUE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
171213	Fee-for-Service	1427588672	1427588672	1	1	LUA, CYNTHIA G LMFT	9/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 SANTA MONICA	370W, 380W, 860W, 1070	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
171225	Fee-for-Service	1417024852	1417024852	1	1	LAWRENCE, BRUCE R DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2119 S EL CAMINO REAL	None	OCEANSIDE	CA	92054	6202	37	06073	33.18935666	-117.3283002	San Diego County
171247	Fee-for-Service	1518143478	1518143478	1	1	LEE, MAXIMILIAN F MD	3/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	92442	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
171255	Fee-for-Service	1952564320	1952564320	1	1	LEITHEM, DESIREE S NP	10/1/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
171271	Fee-for-Service	1508895103	1508895103	1	1	LEKHT, ILYA MD	8/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91325	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
171280	Fee-for-Service	1073589156	1073589156	1	1	LUNN, ROBERT J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1305 W 18TH ST	None	SIOUX FALLS	SD	57105	0401	00	None	43.535484	-96.7428585	Minnehaha County
171333	Fee-for-Service	1760254841	1760254841	1	1	LUCERU HEALINGS	11/1/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
171367	Fee-for-Service	1043316540	1043316540	1	1	LIEBERMAN, ROGER A MD	6/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	17702	45	Nephrology (Renal-Kidney)	0	In state provider	None	777 CAMPUS COMMONS ROAD	SUITE 120	SACRAMENTO	CA	95825	8343	34	06067	38.571021	-121.416786	Sacramento County
171385	Fee-for-Service	1124062567	1124062567	2	1	LONGS DRUG STORE CAL LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9280 SIERRA COLLEGE BLVD	None	ROSEVILLE	CA	95661	5919	31	06061	38.72986814	-121.2261367	Placer County
171417	Fee-for-Service	1821593112	1821593112	1	1	LEWIS, JERA L MD	8/12/2021	208M00000X	NA	Other	026	PHYSICIANS	166680	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
171432	Fee-for-Service	1699770370	1699770370	1	1	LE, TAM H MD	11/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	59425	02	General Surgery	0	In state provider	None	10760 WARNER AVE	STE 200	FOUNTAIN VALLEY	CA	92708	3825	30	06059	33.71627097	-117.9410205	Orange County
171444	Fee-for-Service	1316479686	1316479686	1	1	LAFLAM, TAYLOR N MD	5/29/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	159988	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	6E/6D37	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
171462	Fee-for-Service	1609849074	1609849074	1	2	LA MAESTRA FAMILY CLINIC INC	4/6/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4074 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	37	06073	32.75098505	-117.1009103	San Diego County
171481	Fee-for-Service	1316160880	1316160880	1	1	LLAMBIAS, MARIA S	5/16/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
171483	Fee-for-Service	1457728669	1457728669	1	1	LANDMARK MEDICAL OF CALIFORN	6/16/2021	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IA PC	21750 CENTER COURT DR S	None	CERRITOS	CA	90703	5425	19	06037	33.86812545	-118.0597442	Los Angeles County
171496	Fee-for-Service	1184894776	1184894776	1	1	LARTIGUE, ALAIN M MD	9/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104204	None	None	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
171500	Fee-for-Service	1477520120	1477520120	2	1	LENG, POH H MD	7/21/2020	207RS0012X	NA	Other	026	PHYSICIANS	55572	41	Internal Medicine	0	In state provider	None	845 JACKSON ST	None	SAN FRANCISCO	CA	94133	4851	38	06075	37.79571919	-122.4089166	San Francisco County
171520	Fee-for-Service	1750391710	1750391710	1	1	LODI MEMORIAL HOSPITAL	8/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	MEDICAL GROUP	305 PRESTON AVE	None	IONE	CA	95640	9158	03	06005	38.35319813	-120.93512	Amador County
171534	Fee-for-Service	1356822373	1356822373	1	1	LEE, JENNIFER J CRNA	10/24/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
171554	Fee-for-Service	1235798984	1235798984	1	1	LEUPP, SOPHIA M LCSW	2/9/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
171574	Fee-for-Service	1548483464	1548483464	1	1	LENNOX SCHOOL DISTRICT	10/25/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	10319 FIRMONA AVE	None	LENNOX	CA	90304	1419	19	06037	33.94243892	-118.3570368	Los Angeles County
171605	Fee-for-Service	1164685624	1164685624	1	1	LU, JERRY P MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116961	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
171610	Fee-for-Service	1699194456	1699194456	1	1	LI, YIPING MD	12/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138376	02	General Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
171616	Fee-for-Service	1194364273	1194364273	1	1	LEROY, BRANDON J CRNA	8/27/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
171658	Fee-for-Service	1427091289	1427091289	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	699 LEWELLING BLVD	None	SAN LEANDRO	CA	94579	1870	01	06001	37.68957	-122.1378705	Alameda County
171693	Fee-for-Service	1043506090	1043506090	1	1	LEACH, KRISTIN G MD	3/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152387	01	General Practice	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
171744	Fee-for-Service	1295259109	1295259109	1	1	LAO, SAMUEL	3/20/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PARKWA	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
171750	Fee-for-Service	1609849074	1609849074	1	2	LA MAESTRA FAMILY CLINIC INC	4/6/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4074 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	37	06073	32.75098505	-117.1009103	San Diego County
171757	Fee-for-Service	1265874010	1265874010	1	1	LALITHAKUMARI, ARYA MD	12/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140646	41	Internal Medicine	0	In state provider	None	26960 CHERRY HILLS BLVD	None	SUN CITY	CA	92588	2512	33	06065	33.71084821	-117.1899782	Riverside County
171781	Fee-for-Service	1588850879	1588850879	1	1	LWIN, TIN M MD	6/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116284	41	Internal Medicine	0	In state provider	None	1180 EAST SHAW	#125	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
171789	Fee-for-Service	1871730036	1871730036	1	1	LYLE BERRY	4/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3741 W 12600 S	None	RIVERTON	UT	84065	7215	00	None	40.520232	-111.980151	Salt Lake County
171805	Fee-for-Service	1750929634	1750929634	1	1	LOFTON, KENYERA L LPCC	4/17/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
171808	Fee-for-Service	1992883607	1992883607	1	1	LE, HUONG T MD	2/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80652	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
171837	Fee-for-Service	1306157367	1306157367	1	1	LUOH, TAMMY T MD	10/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119719	08	Family Practice	0	In state provider	None	250 E YALE LOOP	STE 200	IRVINE	CA	92604	4697	30	06059	33.67473753	-117.7880547	Orange County
171845	Fee-for-Service	1659306710	1659306710	1	1	LIU, YI MD	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84623	08	Family Practice	0	In state provider	None	25455 BARTON RD	STE 204	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
171860	Fee-for-Service	1750440368	1750440368	1	1	LARSON, ROBIN W MD	10/31/1995	207R00000X	NA	Other	026	PHYSICIANS	36081	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
171922	Fee-for-Service	1760530729	1760530729	1	1	LEW, DENNIS W MD	1/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	55145	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
171928	Fee-for-Service	1487814349	1487814349	1	1	LIFELONG MEDICAL CARE	7/3/2008	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MARIN ADULT DAY HLTH CTR	1905 NOVATO BLVD	None	NOVATO	CA	94947	2912	21	06041	38.11015614	-122.5877717	Marin County
171936	Fee-for-Service	1184834046	1184834046	1	1	LEONG, DEBORAH L	9/12/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4700 SUNSET BLVD	None	LOS ANGELES	CA	90027	6082	19	06037	34.09812055	-118.2921165	Los Angeles County
171946	Fee-for-Service	1003091422	1003091422	1	1	LIN, CHERIE DO	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
171963	Fee-for-Service	1487224978	1487224978	1	1	LU, HOPE X CRNA	8/9/2023	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
172008	Fee-for-Service	1326176397	1326176397	1	1	LU, ZHEN MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87636	41	Internal Medicine	0	In state provider	None	1520 STOCKTON STREET	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
172070	Fee-for-Service	1669414470	1669414470	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2151 MEEKER AVE	None	RICHMOND	CA	94804	6410	07	06013	37.91977649	-122.3486325	Contra Costa County
172092	Fee-for-Service	1841486792	1841486792	1	1	LIU, ALICE MD	10/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87988	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
172115	Fee-for-Service	1740342484	1740342484	1	1	LAM, AMANDA C	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
172122	Fee-for-Service	1225534753	1225534753	1	1	LUN, MELODY MD	1/25/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	164522	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
172148	Fee-for-Service	1427031103	1427031103	1	1	L.A. MEDICAL SUPPLY INC	2/15/1997	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	966 S WESTERN AVE	STE 104	LOS ANGELES	CA	90006	1014	19	06037	34.053777	-118.3090505	Los Angeles County
172160	Fee-for-Service	1619533791	1619533791	1	1	LANE, GREGORY CNP	3/18/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	626 MAIN	None	DELANO	CA	93215	2934	15	06029	35.76497762	-119.2446332	Kern County
172170	Fee-for-Service	1285606434	1285606434	1	1	LIU, XIAO J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	759 CHESTNUT ST	None	SPRINGFIELD	MA	01199	1001	00	None	42.122601	-72.602856	Hampden County
172205	Fee-for-Service	1326210311	1326210311	1	1	LITTLE-WIENERT, KIM J MD	10/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
172209	Fee-for-Service	1760530729	1760530729	1	1	LEW, DENNIS W MD	1/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	55145	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
172216	Fee-for-Service	1487814349	1487814349	1	1	LIFELONG MEDICAL CARE	7/3/2008	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MARIN ADULT DAY HLTH CTR	1905 NOVATO BLVD	None	NOVATO	CA	94947	2912	21	06041	38.11015614	-122.5877717	Marin County
172222	Fee-for-Service	1831625896	1831625896	1	1	LEE, JOY MD	9/7/2023	207R00000X	NA	Other	026	PHYSICIANS	159256	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
172224	Fee-for-Service	1700665320	1700665320	1	1	LOVELACE, JAZSMINE	9/25/2024	251K00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
172259	Fee-for-Service	1528411071	1528411071	1	1	LEE, JOHN A T NP	1/28/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
172267	Fee-for-Service	1881909489	1881909489	1	1	LANNS, CHERYSSE AU	8/21/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda County
172272	Fee-for-Service	1740881804	1740881804	1	1	LUCUS, PAIGE PT	12/30/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
172291	Fee-for-Service	1518350602	1518350602	1	1	LEE, JEONGROK LAC	9/20/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1401 S BROOKHURST RD	SUITE 107	FULLERTON	CA	92833	4471	30	06059	33.85761255	-117.9593114	Orange County
172308	Fee-for-Service	1881838662	1881838662	1	1	LEE, ONECHANG W MD	10/26/2018	207T00000X	NA	General Surgery	026	PHYSICIANS	143259	14	Neurological Surgery	0	In state provider	None	18035 BROOKHURST ST	SUITE 1700	FOUNTAIN VALLEY	CA	92708	6738	30	06059	33.701184	-117.9544385	Orange County
172324	Fee-for-Service	1972670883	1972670883	1	1	LUGO, RONALD J MD	12/31/1984	207P00000X	NA	Other	026	PHYSICIANS	38880	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	3939 IOWA ST	None	SAN DIEGO	CA	92104	3008	37	06073	32.749398	-117.1264015	San Diego County
172328	Fee-for-Service	1386680718	1386680718	1	1	LASKY III, JOSEPH L MD	3/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82345	78	Neoplastic Diseases/Oncology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
172331	Fee-for-Service	1861746612	1861746612	1	1	LOS ANGELES CHRISTIAN HEALTH	6/30/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTERS	600 ST PAUL AVENUE	SUITE 100	LOS ANGELES	CA	90017	5658	19	06037	34.05324991	-118.2609994	Los Angeles County
172334	Fee-for-Service	1871774125	1871774125	1	1	LEONILA R PADILLA	5/26/2006	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	11 MARSHALL WAY	None	VALLEJO	CA	94589	1946	48	06095	38.14167399	-122.2616563	Solano County
172343	Fee-for-Service	1366519266	1366519266	1	1	LEONG, KENNETH MD	1/31/1995	2086S0105X	NA	General Surgery	026	PHYSICIANS	81070	None	None	0	In state provider	None	17821 PIONEER BLVD	None	ARTESIA	CA	90701	3901	19	06037	33.8691791	-118.0823685	Los Angeles County
172353	Fee-for-Service	1548398142	1548398142	1	1	LASALLE MEDICAL ASSOC	7/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1505 W 17TH ST	None	SAN BERNARDINO	CA	92411	1202	36	06071	34.13045153	-117.31869	San Bernardino County
172358	Fee-for-Service	1124131958	1124131958	1	1	LOGANI, SANJAY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	73456	18	Ophthalmology	0	In state provider	None	8383 WILSHIRE BLVD	STE 440	BEVERLY HILLS	CA	90211	2411	19	06037	34.06457438	-118.3736146	Los Angeles County
172366	Fee-for-Service	1265165559	1265165559	1	1	LIEU, DEBBIE OD	1/25/2024	390200000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10906 VALLEY MALL	None	EL MONTE	CA	91731	2616	19	06037	34.07569098	-118.0370272	Los Angeles County
172368	Fee-for-Service	1881637676	1881637676	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4020 FREMONT HUB	None	FREMONT	CA	94538	1322	01	06001	37.54694613	-121.9875608	Alameda County
172378	Fee-for-Service	1841486792	1841486792	1	1	LIU, ALICE MD	10/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87988	67	Endocrinology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
172408	Fee-for-Service	1942654108	1942654108	1	1	LIN, CHRIS J MD	9/18/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	166950	25	Physical Medicine and Rehabilitation	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
172409	Fee-for-Service	1013343979	1013343979	1	2	LUM, KRISTEN L H MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127332	40	Pediatrics	0	In state provider	None	1800 HARRISON ST	7TH FL	OAKLAND	CA	94612	3429	01	06001	37.80593773	-122.2656714	Alameda County
172413	Fee-for-Service	1083790984	1083790984	1	1	LEE, YANG W MD INC	1/1/1979	193400000X	NA	Other	026	PHYSICIANS	30367	01	General Practice	0	In state provider	None	5981 ATLANTIC AVE	None	LONG BEACH	CA	90805	3510	19	06037	33.86335743	-118.1850869	Los Angeles County
172434	Fee-for-Service	1669630711	1669630711	1	1	LAU, JOSEPHINE S F MD	12/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105500	40	Pediatrics	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
172439	Fee-for-Service	1952863474	1952863474	1	1	LEPPEK, TYLER S MD	5/17/2024	207P00000X	NA	Other	026	PHYSICIANS	180472	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3330 LOMITA	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
172445	Fee-for-Service	1003114463	1003114463	1	1	LECOMPTE, DENISE G LAC	5/11/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
172450	Fee-for-Service	1225116049	1225116049	1	1	LOPEZ, LORRAINE MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68012	40	Pediatrics	0	In state provider	None	2651 HIGHLAND AVE	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
172483	Fee-for-Service	1417977661	1417977661	1	1	LEVIN, PHILLIP M MD	4/20/1972	2086S0129X	NA	General Surgery	026	PHYSICIANS	21219	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	435 N BEDFORD DR	None	BEVERLY HILLS	CA	90210	4321	19	06037	34.06851281	-118.4056736	Los Angeles County
172487	Fee-for-Service	1790209245	1790209245	1	1	LOPEZ VALENZUELA, REYNA LCS	9/1/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
172490	Fee-for-Service	1194884833	1194884833	1	1	LAU, ALICE MD	10/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78425	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4050 BARRANCA PKWY	STE 160	IRVINE	CA	92604	4785	30	06059	33.68293726	-117.8067799	Orange County
172498	Fee-for-Service	1245430396	1245430396	1	1	LAU, AMY X MD	11/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97434	41	Internal Medicine	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
172514	Fee-for-Service	1669583191	1669583191	1	1	LANE, JOHN G MD	12/31/1991	174400000X	NA	Other	026	PHYSICIANS	64552	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
172515	Fee-for-Service	1043217615	1043217615	2	1	LONG BEACH SURGERY CENTER LP	10/3/2011	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2880 ATLANTIC AVENUE	SUITE 160	LONG BEACH	CA	90806	1715	19	06037	33.809382	-118.185001	Los Angeles County
172526	Fee-for-Service	1144491176	1144491176	1	1	LIN, MICHAEL P MD	8/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102900	24	Plastic Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
172535	Fee-for-Service	1033297791	1033297791	1	1	LOVELY, MICHAEL MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	50119	01	General Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
172549	Fee-for-Service	1679705560	1679705560	1	1	LESTER, JESSICA L PHD	12/7/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
172557	Fee-for-Service	1033109947	1033109947	1	1	LANCASTER HOSPITAL	6/10/2019	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	REHABILITATION	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
172565	Fee-for-Service	1346604451	1346604451	1	1	LAPUT, GIERIC MD	9/9/2022	207R00000X	NA	Other	026	PHYSICIANS	153862	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
172590	Fee-for-Service	1629409644	1629409644	1	1	LOCK, STEVEN S MD	4/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6900 N DURANGO DR	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
172606	Fee-for-Service	1598150450	1598150450	1	1	LIOU, ANGELA MD	9/1/2024	2080P0207X	NA	Hematology	026	PHYSICIANS	148431	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
172607	Fee-for-Service	1225471253	1225471253	1	1	LIX, COLLEEN M PHD	2/25/2014	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2417 CARLETON ST	None	BERKELEY	CA	94704	3310	01	06001	37.86229264	-122.259327	Alameda County
172619	Fee-for-Service	1861746612	1861746612	1	1	LOS ANGELES CHRISTIAN HEALTH	6/30/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTERS	600 ST PAUL AVENUE	SUITE 100	LOS ANGELES	CA	90017	5658	19	06037	34.05324991	-118.2609994	Los Angeles County
172620	Fee-for-Service	1386680718	1386680718	1	1	LASKY III, JOSEPH L MD	3/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82345	68	Hematology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
172629	Fee-for-Service	1841230190	1841230190	1	1	LOMA LINDA RAD MED GRP	7/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	INC	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
172665	Fee-for-Service	1518045285	1518045285	1	1	LAVI, EFRAIM MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35580	03	Allergy	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
172666	Fee-for-Service	1952317489	1952317489	1	1	LIANG, WAYNE W MD	12/27/2007	207L00000X	NA	Other	026	PHYSICIANS	95536	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
172689	Fee-for-Service	1508856535	1508856535	1	1	LANCASTER HOSPITAL	2/1/1981	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
172705	Fee-for-Service	1952147977	1952147977	1	1	LAGUNA RX CORP	10/10/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	23016 LAKE FOREST DR	SUITE E	LAGUNA HILLS	CA	92653	1324	30	06059	33.62873041	-117.7247398	Orange County
172706	Fee-for-Service	1720166903	1720166903	1	1	LUU, JENNIFER K PSYD	10/7/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8710 MONROE CT	SUITE 150	RANCHO CUCAMONGA	CA	91730	4883	36	06071	34.09544496	-117.5747968	San Bernardino County
172728	Fee-for-Service	1083094817	1083094817	1	1	LATREIA HEALTHCARE SERVICES	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	3090 FITE CIRCLE	SUITE 101	SACRAMENTO	CA	95827	1810	34	06067	38.574702	-121.323915	Sacramento County
172735	Fee-for-Service	1841247178	1841247178	1	1	LUISETTI, THOMAS W MD	6/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84365	05	Anesthesiology	0	In state provider	None	155 GLASSON WAY	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
172775	Fee-for-Service	1639132392	1639132392	1	1	LARA, GUSTAVO MD	11/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77165	02	General Surgery	0	In state provider	None	6927 BROCKTON AVE	STE 1A	RIVERSIDE	CA	92506	3806	33	06065	33.948063	-117.396776	Riverside County
172785	Fee-for-Service	1245430396	1245430396	1	1	LAU, AMY X MD	11/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97434	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
172826	Fee-for-Service	1922102029	1922102029	1	1	LIAO, YU-CHENG MD	8/31/1992	2084N0400X	NA	Neurology	026	PHYSICIANS	49777	13	Neurology (M.D. only)	0	In state provider	None	1700 N ROSE AVE	STE 480	OXNARD	CA	93030	7660	56	06111	34.21746	-119.155545	Ventura County
172831	Fee-for-Service	1235252354	1235252354	1	1	LENZEN, MARC WESLEY OPT	5/31/1990	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4210 E HIGHLAND AVE	None	HIGHLAND	CA	92346	2742	36	06071	34.137684	-117.1947915	San Bernardino County
172870	Fee-for-Service	1205576410	1205576410	1	1	LAM, WINNIE DO	10/1/2024	207P00000X	NA	Other	026	PHYSICIANS	21878	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
172871	Fee-for-Service	1801997721	1801997721	1	1	LONDON, STUART S MD INC	3/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	27002	30	Radiology	0	In state provider	None	3330 TELEGRAPH AVE	None	OAKLAND	CA	94609	3028	01	06001	37.82202586	-122.2663483	Alameda County
172895	Fee-for-Service	1598150450	1598150450	1	1	LIOU, ANGELA MD	9/1/2024	2080P0207X	NA	Hematology	026	PHYSICIANS	148431	68	Hematology	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
172904	Fee-for-Service	1386680718	1386680718	1	1	LASKY III, JOSEPH L MD	3/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82345	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
172908	Fee-for-Service	1992814917	1992814917	1	1	LEVY, NICHOLAS B MD	7/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	41787	40	Pediatrics	0	In state provider	None	477 N EL CAMINO REAL	None	ENCINITAS	CA	92024	1328	37	06073	33.05700866	-117.262449	San Diego County
172925	Fee-for-Service	1205321221	1205321221	1	1	LONG, CARRIE L	7/3/2018	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	3980 W FLORIDA AVE	STE 102	HEMET	CA	92545	5258	33	06065	33.74575495	-117.0140414	Riverside County
172935	Fee-for-Service	1356469985	1356469985	1	1	LANG, JEANNI C CMF	8/4/2022	225000000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	612 D ST	None	SAN RAFAEL	CA	94901	3708	21	06041	37.97030652	-122.5324786	Marin County
172975	Fee-for-Service	1205996501	1205996501	1	1	LALA, VIMAL S DO	5/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8461	None	None	0	In state provider	None	7230 MEDICAL CENTER DR	STE 500	WEST HILLS	CA	91307	4024	19	06037	34.20172814	-118.6294322	Los Angeles County
173015	Fee-for-Service	1477848471	1477848471	1	1	LUHAR, AARTI P MD	6/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	125877	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
173019	Fee-for-Service	1083094817	1083094817	1	1	LATREIA HEALTHCARE SERVICES	6/12/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	3090 FITE CIRCLE	SUITE 101	SACRAMENTO	CA	95827	1810	34	06067	38.574702	-121.323915	Sacramento County
173035	Fee-for-Service	1417049099	1417049099	1	1	LIMBO, PABLO C JR MD	10/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	38249	01	General Practice	0	In state provider	None	1736 NOGALES ST	None	ROWLAND HEIGHTS	CA	91748	2943	19	06037	33.9859083	-117.8891953	Los Angeles County
173061	Fee-for-Service	1417453606	1417453606	1	1	LEVITT, ALLISON C MD	9/24/2021	208M00000X	NA	Other	026	PHYSICIANS	166510	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
173071	Fee-for-Service	1275951485	1275951485	1	1	LAU, HUBERT D MD	1/16/2021	207ZP0102X	NA	Other	026	PHYSICIANS	139006	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
173090	Fee-for-Service	1053367383	1053367383	1	1	LIPMAN, BRIAN J MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	901 RANCHO LN	STE 265	LAS VEGAS	NV	89106	3819	00	None	36.16025414	-115.1711566	Clark County
173121	Fee-for-Service	1760740575	1760740575	1	1	LEITER, PATRICK D MD	7/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126771	05	Anesthesiology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
173123	Fee-for-Service	1750816310	1750816310	1	1	LOW, JENNIFER K OT	3/25/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
173132	Fee-for-Service	1427169820	1427169820	1	1	LOCKWOOD-CONLAN, BEVERLY LC	9/18/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6425 SAN FERNANDO RD	None	GLENDALE	CA	91201	3624	19	06037	34.16660022	-118.2892691	Los Angeles County
173153	Fee-for-Service	1003444290	1003444290	1	1	LIU, JENNY	7/7/2023	207R00000X	NA	Other	026	PHYSICIANS	19744	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
173158	Fee-for-Service	1427110329	1427110329	1	9	LIVINGSTON COMMUNITY HEALTH	4/16/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1617 MAIN STREET	ROOM 200 AND 201	LIVINGSTON	CA	95334	1250	24	06047	37.37645459	-120.7233764	Merced County
173178	Fee-for-Service	1760470546	1760470546	1	1	LEVINE, ELLYN S MD	10/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86297	41	Internal Medicine	0	In state provider	None	6280 JACKSON DR	STE 8	SAN DIEGO	CA	92119	3436	37	06073	32.79264272	-117.0182026	San Diego County
173183	Fee-for-Service	1013025915	1013025915	1	1	LEE, YONG L MD	4/4/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53089	08	Family Practice	0	In state provider	None	1400 E PALOMAR ST	None	CHULA VISTA	CA	91931	1800	37	06073	32.62382113	-116.9960539	San Diego County
173194	Fee-for-Service	1790772978	1790772978	1	1	LIPKIS, DONALD C MD	1/26/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	27123	41	Internal Medicine	0	In state provider	None	6719 ALVARADO RD	STE 206	SAN DIEGO	CA	92120	5261	37	06073	32.77684978	-117.055137	San Diego County
173258	Fee-for-Service	1306049218	1306049218	1	1	L&L HOME HEALTH CARE	10/21/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	13505 YORBA AVE	UNIT X	CHINO	CA	91710	5073	36	06071	34.007751	-117.702222	San Bernardino County
173294	Fee-for-Service	1881122315	1881122315	2	1	LIN, EDWARD T DO	5/23/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17219	None	None	0	In state provider	None	5000 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
173310	Fee-for-Service	1992767487	1992767487	1	1	LU, CONRAD H MD	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	72715	22	Pathology (M.D. only)	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
173326	Fee-for-Service	1407524119	1407524119	1	1	LEI, SHARON OD	1/24/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5991 E SPRING ST	None	LONG BEACH	CA	90808	3752	19	06037	33.81062147	-118.1154555	Los Angeles County
173331	Fee-for-Service	1497736706	1497736706	1	1	LAKHANI, SAQUIB A MD	12/4/2024	2080P0203X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
173340	Fee-for-Service	1083606602	1083606602	1	1	LONGO, JAMES MD	7/31/1985	2085R0001X	NA	Other	026	PHYSICIANS	50881	None	None	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
173419	Fee-for-Service	1053339788	1053339788	1	1	LOMBARDI, DONALD P MD	12/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88129	68	Hematology	0	In state provider	None	2752 HARRISON AVE	STE A	EUREKA	CA	95501	4738	12	06023	40.7831071	-124.139684	Humboldt County
173446	Fee-for-Service	1427110329	1427110329	1	9	LIVINGSTON COMMUNITY HEALTH	4/16/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1617 MAIN STREET	ROOM 200 AND 201	LIVINGSTON	CA	95334	1250	24	06047	37.37645459	-120.7233764	Merced County
173485	Fee-for-Service	1790772978	1790772978	1	1	LIPKIS, DONALD C MD	1/26/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	27123	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6719 ALVARADO RD	STE 206	SAN DIEGO	CA	92120	5261	37	06073	32.77684978	-117.055137	San Diego County
173517	Fee-for-Service	1225579006	1225579006	1	1	LG AGUILAR TABORA MD INC	1/22/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	None	None	None	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
173596	Fee-for-Service	1821038522	1821038522	1	1	LEVINSON, GERSHON MD	8/21/1996	207L00000X	NA	Other	026	PHYSICIANS	20781	05	Anesthesiology	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
173638	Fee-for-Service	1578191177	1578191177	1	1	LI, GUIYU LUTETIA MD	8/8/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185625	None	None	0	In state provider	None	11420 WARNER AVE.	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
173700	Fee-for-Service	1780073130	1780073130	1	1	LEE, ELENA K LAC	5/4/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
173707	Fee-for-Service	1407046386	1407046386	1	1	LE, GIAP N OD	12/16/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	13192 HARBOR BLVD	None	GARDEN GROVE	CA	92848	1740	30	06059	33.77163713	-117.9202936	Orange County
173708	Fee-for-Service	1053339788	1053339788	1	1	LOMBARDI, DONALD P MD	12/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88129	78	Neoplastic Diseases/Oncology	0	In state provider	None	2752 HARRISON AVE	STE A	EUREKA	CA	95501	4738	12	06023	40.7831071	-124.139684	Humboldt County
173737	Fee-for-Service	1821330226	1821330226	1	1	LERRIGO, ROBERT MD	9/3/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	141182	10	Gastroenterology (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
173756	Fee-for-Service	1548605215	1548605215	1	1	LE, MAI U MD	6/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135615	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
173770	Fee-for-Service	1790772978	1790772978	1	1	LIPKIS, DONALD C MD	1/26/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	27123	10	Gastroenterology (M.D. only)	0	In state provider	None	6719 ALVARADO RD	STE 206	SAN DIEGO	CA	92120	5261	37	06073	32.77684978	-117.055137	San Diego County
173784	Fee-for-Service	1215202585	1215202585	1	1	LEE, AMY DO	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13909	01	General Practice	0	In state provider	None	4940 VAN NUYS BLVD	SUITE 200	SHERMAN OAKS	CA	91403	1741	19	06037	34.160589	-118.4486715	Los Angeles County
173802	Fee-for-Service	1679582670	1679582670	1	1	LAMEL, ELLEN MD	10/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	48353	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
173805	Fee-for-Service	1881697381	1881697381	1	4	LAKE COUNTY TRIBAL HEALTH	10/16/2024	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	MOBILE CLINIC #1	925 BEVINS COURT	None	LAKEPORT	CA	95453	1900	17	06033	39.03772106	-122.9223338	Lake County
173831	Fee-for-Service	1174022834	1174022834	1	1	LOPEZ, KAREN LMFT	1/18/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17777 VENTURA BLVD	STE 105	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
173839	Fee-for-Service	1396130050	1396130050	1	1	LIEBMAN, RACHAEL R NP	6/9/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
173859	Fee-for-Service	1003983958	1003983958	1	1	LAI, ANDREW S MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	60440	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
173868	Fee-for-Service	1891873006	1891873006	1	1	LIMB CRAFT INC	4/4/2007	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	810 E CHAPMAN AVE	STE C	FULLERTON	CA	92831	3852	30	06059	33.8740115	-117.911547	Orange County
173870	Fee-for-Service	1093757825	1093757825	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1300 MADONNA ROAD	None	SAN LUIS OBISPO	CA	93405	6503	40	06079	35.25757842	-120.689081	San Luis Obispo County
173884	Fee-for-Service	1649595257	1649595257	1	1	LIM, KELVIN K Y MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	49108	20	Orthopedic Surgery	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
173886	Fee-for-Service	1124100367	1124100367	1	1	LEE, GORDON E MD	7/1/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	29794	10	Gastroenterology (M.D. only)	0	In state provider	None	1505 SOQUEL DR	STE 8	SANTA CRUZ	CA	95065	1716	44	06087	36.98803429	-121.9848045	Santa Cruz County
173948	Fee-for-Service	1891353108	1891353108	1	1	LERMAN, BENJAMIN J MD	3/20/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	177395	68	Hematology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
173971	Fee-for-Service	1912930512	1912930512	1	2	LAWRENCE A. MORA MD INC	4/15/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5901 W OLYMPIC BLVD STE	None	LOS ANGELES	CA	90036	4669	19	06037	34.05764121	-118.3603115	Los Angeles County
174015	Fee-for-Service	1700939097	1700939097	1	1	LOPEZ, RICHARD R JR MD	3/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77986	02	General Surgery	0	In state provider	None	2200 W 3RD ST	STE 500	LOS ANGELES	CA	90057	1938	19	06037	34.06329642	-118.2739484	Los Angeles County
174019	Fee-for-Service	1962412403	1962412403	1	1	LEE, TIMOTHY H MD	8/31/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86676	41	Internal Medicine	0	In state provider	None	3555 KENYON ST	STE 200	SAN DIEGO	CA	92110	5341	37	06073	32.75016963	-117.2160064	San Diego County
174027	Fee-for-Service	1821330226	1821330226	1	1	LERRIGO, ROBERT MD	9/3/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	141182	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
174046	Fee-for-Service	1689279994	1689279994	1	1	LAWRENCE, BEVERLEY Y NP	10/7/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
174066	Fee-for-Service	1497878607	1497878607	1	1	LE, MAI T MD	8/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98060	41	Internal Medicine	0	In state provider	None	3132 W MARCH LN	STE 5	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
174090	Fee-for-Service	1366514184	1366514184	1	1	LU, SHU-HUA MD	12/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93826	01	General Practice	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
174092	Fee-for-Service	1184668915	1184668915	2	1	LONGS DRUG STORE CAL LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	470 BLOSSOM HILL RD	None	SAN JOSE	CA	95123	3301	43	06085	37.25117506	-121.8332128	Santa Clara County
174094	Fee-for-Service	1881697381	1881697381	1	4	LAKE COUNTY TRIBAL HEALTH	10/16/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE CLINIC #1	925 BEVINS COURT	None	LAKEPORT	CA	95453	1900	17	06033	39.03772106	-122.9223338	Lake County
174098	Fee-for-Service	1962109033	1962109033	1	7	LOS ANGELES COUNTY DEPARTMEN	2/8/2024	261QP0905X	NA	Other	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	330 W MAPLE AVE	None	MONROVIA	CA	91016	3332	19	06037	34.14142555	-118.0060965	Los Angeles County
174106	Fee-for-Service	1679513238	1679513238	2	1	LALEZARY, ARASH MD	3/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	92384	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	7218 GARFIELD AVE	None	BELL GARDENS	CA	90201	4812	19	06037	33.96583518	-118.1512554	Los Angeles County
174145	Fee-for-Service	1245888775	1245888775	1	1	LA PAIN AND PERFORMANCE	8/24/2020	208VP0014X	NA	Other	026	PHYSICIANS	None	25	Physical Medicine and Rehabilitation	0	In state provider	CAL GROUP	7855 SANTA MONICA BLVD	None	LOS ANGELES	CA	90046	5344	19	06037	34.0908873	-118.36044	Los Angeles County
174166	Fee-for-Service	1780739227	1780739227	1	1	LOS ANGELES COUNTY CCS	6/14/1994	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	PASADENA MTU	315 N PASADENA AVE	None	PASADENA	CA	91103	3567	19	06037	34.15118357	-118.1572237	Los Angeles County
174176	Fee-for-Service	1053468546	1053468546	1	1	LIANG, LI MD	6/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	96420	36	Psychiatry	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
174180	Fee-for-Service	1477226173	1477226173	1	1	LI, CHUNNU MD	8/30/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
174183	Fee-for-Service	1225220965	1225220965	1	1	LUH, HUNG-YUAN MD	1/1/1979	207R00000X	NA	Other	026	PHYSICIANS	29557	41	Internal Medicine	0	In state provider	None	500 N GARFIELD AVE	STE 106	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
174211	Fee-for-Service	1073594727	1073594727	1	1	LIM, JACKSON M DPM	5/25/2000	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	812 4TH ST	STE D	MARYSVILLE	CA	95901	5667	58	06115	39.13860196	-121.5959755	Yuba County
174264	Fee-for-Service	1336186857	1336186857	1	1	LOGAR,CHRISTINE M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	MS 359110 C/UWP	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
174268	Fee-for-Service	1326588450	1326588450	1	1	LA FRANO, ERIKA G LCSW	12/18/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
174278	Fee-for-Service	1083627798	1083627798	2	1	LEONG, JASMINE K MD	4/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	67304	41	Internal Medicine	0	In state provider	None	1280 CORONA POINTE CT	STE 118	CORONA	CA	92879	1770	33	06065	33.87039079	-117.5408442	Riverside County
174313	Fee-for-Service	1083196166	1083196166	1	2	LOBBAN MARRIAGE AND FAMILY T	6/18/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1845 BUSINESS CENTER DR	215	SAN BERNARDINO	CA	92408	3467	36	06071	34.06865027	-117.2832038	San Bernardino County
174365	Fee-for-Service	1184982308	1184982308	1	1	LIGGINS, NICHOLE D MD	12/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143316	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
174405	Fee-for-Service	1992010490	1992010490	1	1	LAM, WENDY OD	3/28/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	119 SOUTH L ST	None	DINUBA	CA	93618	2324	54	06107	36.54055651	-119.3899159	Tulare County
174426	Fee-for-Service	1538144910	1538144910	1	1	LABORATORY CORP OF AMERICA	4/23/2009	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	1447 YORK COURT	None	BURLINGTON	NC	27215	3361	00	None	36.101583	-79.488891	Alamance County
174456	Fee-for-Service	1740309095	1740309095	1	1	LEAVENWORTH, JENNIFER LMFT	8/22/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1066 E AVENUE J	None	LANCASTER	CA	93535	3870	19	06037	34.68927415	-118.1100041	Los Angeles County
174472	Fee-for-Service	1831277409	1831277409	1	1	LIAO, BEEN S MD	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	68231	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
174499	Fee-for-Service	1033476072	1033476072	1	1	LEE, CHIN C MD	6/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127470	41	Internal Medicine	0	In state provider	None	200 ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.06481928	-118.3836235	Los Angeles County
174519	Fee-for-Service	1093822769	1093822769	1	1	LAMBIE,DAVID S DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13355 E 10 MILE ROAD	None	WARREN	MI	48089	2048	00	None	42.4783293	-82.98744618	Macomb County
174533	Fee-for-Service	1710410840	1710410840	1	1	LUO, CHRISTINE T MD	7/1/2022	207P00000X	NA	Other	026	PHYSICIANS	177755	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
174564	Fee-for-Service	1740224187	1740224187	2	1	LONGS DRUG STORE CAL LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9479 MADISON AVE	None	FOLSOM	CA	95630	2092	34	06067	38.677401	-121.1974965	Sacramento County
174572	Fee-for-Service	1518318773	1518318773	1	1	LI, MINGXI MD	8/10/2020	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
174593	Fee-for-Service	1497713762	1497713762	1	1	LUH, HENRY H DO	11/20/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	7160 SMOKE RANCH RD	None	LAS VEGAS	NV	89128	1117	00	None	36.20345229	-115.248101	Clark County
174599	Fee-for-Service	1336334820	1336334820	1	1	LIM, LISA H MD	12/31/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94495	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
174614	Fee-for-Service	1346399466	1346399466	1	1	LAWRENCE, JOHN F MD	4/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	9783	20	Orthopedic Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
174620	Fee-for-Service	1770654741	1770654741	1	1	LEUNG, VERNA S MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73653	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
174626	Fee-for-Service	1083259220	1083259220	1	1	LA CARDIOLOGY, INC.	8/27/2020	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11546 DOWNEY AVE	None	DOWNEY	CA	90241	4955	19	06037	33.93652675	-118.135345	Los Angeles County
174651	Fee-for-Service	1518346493	1518346493	1	2	LIFE CARE MEDICAL TRANSPORT,	9/12/2021	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	270 E. DOUGLAS AVE	110E	EL CAJON	CA	92020	4514	37	06073	32.7938777	-116.9592516	San Diego County
174716	Fee-for-Service	1407927437	1407927437	1	1	LITZENBERGER, CHRISTA MD	4/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74055	18	Ophthalmology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
174733	Fee-for-Service	1013256775	1013256775	1	1	LAS VIRGENES UNIFIED SCHOOL	2/1/2012	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	4111 N LAS VIRGENES ROAD	None	CALABASAS	CA	91302	1929	19	06037	34.13436743	-118.7029572	Los Angeles County
174738	Fee-for-Service	1134656432	1134656432	1	1	LANG, MONICA LMFT	1/24/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17777 VENTURA BLVD	STE 105	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
174742	Fee-for-Service	1275576001	1275576001	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1792 GARNET AVE	None	SAN DIEGO	CA	92109	3350	37	06073	32.80054833	-117.2374979	San Diego County
174744	Fee-for-Service	1053544569	1053544569	1	1	LI, DORIS S MD	9/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108821	02	General Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
174787	Fee-for-Service	1720283419	1720283419	1	1	LAROSA, MARIA M LMFT	1/7/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
174836	Fee-for-Service	1104866391	1104866391	1	1	LEININGER,RICHARD G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 HARRISON BLVD	None	OGDEN	UT	84403	3195	00	None	41.18328	-111.9536955	Weber County
174934	Fee-for-Service	1891741815	1891741815	1	1	LUMB, PHILLIP D MD	8/22/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50648	05	Anesthesiology	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90089	0287	19	06037	34.05855992	-118.209755	Los Angeles County
174974	Fee-for-Service	1245895945	1245895945	1	1	LUCENO, CARVY FLOYD O MD	7/1/2022	207R00000X	NA	Other	026	PHYSICIANS	176606	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
174986	Fee-for-Service	1699201459	1699201459	1	1	LINDSAY, DENISE LMFT	10/22/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	854 MAGNOLIA AVE	STE 201	CORONA	CA	92879	3109	33	06065	33.8605591	-117.5513844	Riverside County
175026	Fee-for-Service	1578674461	1578674461	1	1	LEE, SANDRA YOUNG MD	8/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82989	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
175057	Fee-for-Service	1841345790	1841345790	1	1	LINDA R VARGHESE	1/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6401 FRANCE AVE S	None	MINNEAPOLIS	MN	55435	2104	00	None	44.88704016	-93.32668847	Hennepin County
175060	Fee-for-Service	1194467787	1194467787	1	1	L & M CLINICAL AND FORENSIC	6/12/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYCHOLOGY	1050 LAKES DR	225	WEST COVINA	CA	91790	2910	19	06037	34.07127962	-117.9226429	Los Angeles County
175075	Fee-for-Service	1700560885	1700560885	1	1	LILAC PHARMACY INC	9/11/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2139 TAPO ST	STE 213	SIMI VALLEY	CA	93063	3476	56	06111	34.27388603	-118.7089725	Ventura County
175116	Fee-for-Service	1982613931	1982613931	1	1	LEE, TE-IE I MD	1/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88220	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
175145	Fee-for-Service	1861431181	1861431181	1	1	LALL, CHANDANA MD	4/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53071	30	Radiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
175148	Fee-for-Service	1427205061	1427205061	1	1	LOCK, CHRISTOPHER B MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53678	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
175180	Fee-for-Service	1003182007	1003182007	1	1	LENING, CHRISTOPHER B MD	5/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130816	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	8346	19	06037	34.06473399	-118.445865	Los Angeles County
175221	Fee-for-Service	1215428784	1215428784	1	2	LAKSHMI K AVALA MD INC	6/25/2024	2251P0200X	NA	Physical Therapist	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	6341 AUBURN BLVD	STE A	CITRUS HEIGHTS	CA	95621	5203	34	06067	38.682126	-121.3165035	Sacramento County
175264	Fee-for-Service	1902916737	1902916737	1	1	LIND, RICHARD C MA	12/31/1990	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1007 LIVE OAK BLVD	STE A3	YUBA CITY	CA	95991	3454	51	06101	39.14368281	-121.6207923	Sutter County
175291	Fee-for-Service	1922631480	1922631480	1	1	LAIL, RAMIN NP	4/9/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1524 MCHENRY AVE	STE 135	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
175300	Fee-for-Service	1932163839	1932163839	1	1	LEE, FRANK C MD	10/1/2017	207W00000X	NA	Ophthalmology	026	PHYSICIANS	95487	18	Ophthalmology	0	In state provider	None	12550 HESPERIA RD	220	VICTORVILLE	CA	92395	5873	36	06071	34.47928534	-117.2909553	San Bernardino County
175331	Fee-for-Service	1053518548	1053518548	1	1	LIN, YA LI MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	99719	41	Internal Medicine	0	In state provider	None	1107 W POPLAR AVE	None	PORTERVILLE	CA	93257	5839	54	06107	36.05128153	-119.0422344	Tulare County
175339	Fee-for-Service	1972967065	1972967065	1	1	LEE, SUSAN DO	6/13/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16917	08	Family Practice	0	In state provider	None	1212 WEST 17TH STREET	None	SANTA ANA	CA	92706	3418	30	06059	33.75995152	-117.883521	Orange County
175349	Fee-for-Service	1417023227	1417023227	1	1	LEE, KENNETH W MD	7/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79488	10	Gastroenterology (M.D. only)	0	In state provider	None	160 E ARTESIA	SUITE 225	POMONA	CA	91767	2925	19	06037	34.07556833	-117.7507835	Los Angeles County
175371	Fee-for-Service	1578682167	1578682167	1	1	LLETGET, VALERIA	6/16/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	30500 ARRASTRE CANYON RD	None	ACTON	CA	93510	2160	19	06037	34.449291	-118.1973465	Los Angeles County
175394	Fee-for-Service	1083777320	1083777320	1	1	LINDSTROM, KRISTEN E PT	5/25/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
175414	Fee-for-Service	1780605071	1780605071	1	1	LAROSA, JULIUS B MD	12/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145910	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
175533	Fee-for-Service	1790772861	1790772861	1	1	LEE, EDMOND MD	2/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	47887	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5301 F ST	STE 117	SACRAMENTO	CA	95819	3220	34	06067	38.571354	-121.4368695	Sacramento County
175560	Fee-for-Service	1568559342	1568559342	1	1	LEE, SIEW-MING MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	54322	None	None	0	In state provider	None	7202 N MILLBROOK AVE	STE 105	FRESNO	CA	93720	3341	10	06019	36.83958089	-119.7645538	Fresno County
175626	Fee-for-Service	1669733796	1669733796	1	1	LU, DARREN A MD	7/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	127774	30	Radiology	0	In state provider	None	3700 EAST SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.8601747	-118.148313	Los Angeles County
175627	Fee-for-Service	1316324924	1316324924	1	1	LEE, EUNJOO MD	10/8/2019	2084P0804X	NA	Psychiatry	026	PHYSICIANS	141045	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
175651	Fee-for-Service	1245237833	1245237833	2	1	LANDMAN, MICHAEL D MD	7/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	22817	04	Otology, Laryngology, Rhinology	0	In state provider	None	5525 ETIWANDA AVE	STE 312	TARZANA	CA	91356	6126	19	06037	34.17046451	-118.5308463	Los Angeles County
175667	Fee-for-Service	1255367843	1255367843	1	1	LIFEWATCH SERVICES INC	4/23/2014	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	33 NEW MONTGOMERY ST	STE 450, 4TH FLOOR	SAN FRANCISCO	CA	94105	4535	38	06075	37.78845959	-122.4016766	San Francisco County
175683	Fee-for-Service	1598784969	1598784969	1	1	LAPIN, RICHARD MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72623	None	None	0	In state provider	None	6255 W SUNSET BLVD	STE 2100	LOS ANGELES	CA	90028	7403	19	06037	34.09802749	-118.3255515	Los Angeles County
175726	Fee-for-Service	1487945952	1487945952	1	1	LEE, SANG NP	12/15/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
175729	Fee-for-Service	1497814578	1497814578	1	1	LILLIE, KAREN H NP	2/9/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 CALIFORNIA AVE	SUITE 200	BAKERSFIELD	CA	93309	7024	15	06029	35.36440586	-119.0562732	Kern County
175766	Fee-for-Service	1760986756	1760986756	1	1	LIAO, ERIC J MD	12/31/2020	390200000X	NA	Other	026	PHYSICIANS	164900	None	None	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
175813	Fee-for-Service	1679050975	1679050975	1	1	LUHMANN, BRIAN T PSYD	3/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5871 PINE AVE	SUITE 230	CHINO HILLS	CA	91709	6545	36	06071	33.94767013	-117.6754339	San Bernardino County
175818	Fee-for-Service	1770781361	1770781361	1	1	LIPSITZ, DAVID PHD	5/6/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	36	Psychiatry	0	In state provider	None	4715 VIEWRIDGE AVE	230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
175821	Fee-for-Service	1700070869	1700070869	1	1	LOGVINOVA, ANNA V MD	1/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100819	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DRIVE	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
175839	Fee-for-Service	1003201922	1003201922	1	1	LEE, ALEXANDER S MD	7/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155554	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
175844	Fee-for-Service	1699718486	1699718486	2	1	LONGS DRUG STORES CA LLC	11/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3320 FRUITVALE AVE	None	OAKLAND	CA	94602	2316	01	06001	37.79915816	-122.2166016	Alameda County
175860	Fee-for-Service	1124050471	1124050471	1	1	LAW, GREGORY MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	89053	08	Family Practice	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
175864	Fee-for-Service	1407818370	1407818370	1	1	LO, JUSTIN L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77343	05	Anesthesiology	0	In state provider	None	2101 FOREST AVE	STE 117	SAN JOSE	CA	95128	1472	43	06085	37.3270795	-121.93731	Santa Clara County
175926	Fee-for-Service	1790958387	1790958387	1	1	LOS ANGELES EAR, NOSE	6/1/1996	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	AND THROAT ASSOCIATES	1245 WILSHIRE BLVD	STE 603	LOS ANGELES	CA	90017	4806	19	06037	34.05362775	-118.2661889	Los Angeles County
175938	Fee-for-Service	1245237833	1245237833	2	1	LANDMAN, MICHAEL D MD	7/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	22817	24	Plastic Surgery	0	In state provider	None	5525 ETIWANDA AVE	STE 312	TARZANA	CA	91356	6126	19	06037	34.17046451	-118.5308463	Los Angeles County
175950	Fee-for-Service	1326092867	1326092867	1	1	LAMBA, RAMIT MD	8/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87976	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
175966	Fee-for-Service	1255748802	1255748802	1	1	LEE, KAO LMFT	3/18/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1300 E SHAW AVE	171	FRESNO	CA	93710	7917	10	06019	36.80872147	-119.765979	Fresno County
176000	Fee-for-Service	1881746691	1881746691	1	1	LI, AI XIA J MD	9/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78733	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	39400 PASEO PADRE PRKW	None	FREMONT	CA	94538	0000	01	06001	37.55102172	-121.9759026	Alameda County
176012	Fee-for-Service	1063636439	1063636439	1	1	LAUER, TERRESA J LMFT	7/15/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	542 OCEAN STREET	SUITE A	SANTA CRUZ	CA	95060	6622	44	06087	36.97580546	-122.0193667	Santa Cruz County
176020	Fee-for-Service	1184944639	1184944639	1	1	LIANG, JACK Y MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112255	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
176042	Fee-for-Service	1255536942	1255536942	1	1	LAM, AMANDA S MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105967	41	Internal Medicine	0	In state provider	None	555 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
176048	Fee-for-Service	1457390155	1457390155	1	1	LEWIS, DANIEL G MD	3/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	29803	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	15322 LAKESHORE DRIVE	SUITE 102	CLEAR LAKE	CA	95422	9815	17	06033	38.95045805	-122.6255271	Lake County
176050	Fee-for-Service	1245097872	1245097872	1	1	LAMBERT, MATTHEW CNP	9/1/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	39	06077	37.744011	-121.4349725	San Joaquin County
176060	Fee-for-Service	1265614986	1265614986	1	1	LAM, SUSANNE T MD	9/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110652	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
176075	Fee-for-Service	1477597201	1477597201	2	1	LONGS DRUG STORE CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	268 RESERVATION RD	None	MARINA	CA	93933	3178	27	06053	36.68523476	-121.7948863	Monterey County
176090	Fee-for-Service	1356557722	1356557722	1	1	LOYDS LIBERTY HOMES INC	3/11/1997	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4304 CHARTER OAKS AVE	None	BAKERSFIELD	CA	93309	1181	15	06029	35.36549623	-119.0505885	Kern County
176124	Fee-for-Service	1770073850	1770073850	1	1	LE, BAOCHUONG Q DO	11/3/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17928	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
176125	Fee-for-Service	1225065659	1225065659	1	1	LEE, JAMES J MD	4/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84130	24	Plastic Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
176126	Fee-for-Service	1215288048	1215288048	1	1	LIEP, CATAREYA MD INC	1/1/2013	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	78275	40	Pediatrics	0	In state provider	None	437 N CAMPUS AVE	None	ONTARIO	CA	91764	4229	36	06071	34.06797	-117.6415695	San Bernardino County
176138	Fee-for-Service	1003856675	1003856675	1	1	LICHMAN, JAY P MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	21067	30	Radiology	0	In state provider	None	355 PLACENTIA AVE	None	NEWPORT BEACH	CA	92663	3311	30	06059	33.62672719	-117.9312941	Orange County
176148	Fee-for-Service	1891931564	1891931564	1	1	LAKEVIEW HOSPICE CARE INC	11/23/2011	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	140 N VICTORY BLVD	#105	BURBANK	CA	91502	1848	19	06037	34.17453625	-118.3169651	Los Angeles County
176159	Fee-for-Service	1881742047	1881742047	2	3	LIEPA, DAGMAR	8/23/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	47889	-	NOT APPLICABLE	0	In state provider	None	6180 LAUREL CANYON BLVD	STE 275	NORTH HOLLYWOOD	CA	91606	3215	19	06037	34.18258805	-118.3964946	Los Angeles County
176162	Fee-for-Service	1932735925	1932735925	1	1	LOVE, NICHOLAS R MD	6/12/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	181102	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
176178	Fee-for-Service	1609897404	1609897404	1	1	LEUM, LINDA L MD	4/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	66110	05	Anesthesiology	0	In state provider	None	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
176234	Fee-for-Service	1891055091	1891055091	1	1	LESHIN, BENJAMIN A MD	5/9/2018	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	142191	25	Physical Medicine and Rehabilitation	0	In state provider	None	1400 S. GRAND AVE	SUITE 707	LOS ANGELES	CA	90015	2881	19	06037	34.03692236	-118.2655238	Los Angeles County
176236	Fee-for-Service	1073017315	1073017315	1	1	LEDBETTER, ALEX DO	6/15/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	20454	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
176252	Fee-for-Service	1871121608	1871121608	1	1	LIOU, CHRISTINA DO	6/28/2023	207P00000X	NA	Other	026	PHYSICIANS	20712	None	None	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
176264	Fee-for-Service	1083602338	1083602338	1	1	LANE, JILL A MD	4/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88121	10	Gastroenterology (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
176301	Fee-for-Service	1649293317	1649293317	1	1	LAM, MARY MD	6/8/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	54398	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
176315	Fee-for-Service	1861472045	1861472045	1	1	LITMAN, TCHIA PHD	11/16/2012	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	30	Radiology	0	In state provider	None	1460 WESTWOOD BLVD	STE 205	LOS ANGELES	CA	90024	4976	19	06037	34.05427431	-118.4408444	Los Angeles County
176332	Fee-for-Service	1982351565	1982351565	1	1	LA DOWNTOWN MEDICAL CENTER	4/4/2022	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	LLC	1711 W TEMPLE ST	RM 801-813	LOS ANGELES	CA	90026	7329	19	06037	34.06891181	-118.2638033	Los Angeles County
176334	Fee-for-Service	1831529700	1831529700	1	1	LANGWELL, KORY	12/16/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39141 CIVIC CENTER DR	SUITE #120	FREMONT	CA	94538	5831	01	06001	37.55436307	-121.9764708	Alameda County
176352	Fee-for-Service	1417293143	1417293143	1	1	LAI, SHINGHWA NP	4/27/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
176388	Fee-for-Service	1215273859	1215273859	1	2	LUCERO, SHANNA RITA OT	2/20/2018	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
176436	Fee-for-Service	1891931564	1891931564	1	1	LAKEVIEW HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	140 N VICTORY BLVD	#105	BURBANK	CA	91502	1848	19	06037	34.17453625	-118.3169651	Los Angeles County
176439	Fee-for-Service	1477096717	1477096717	1	1	LYONS, CORINNE R	6/19/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12062 VALLEY VIEW STREET	137	GARDEN GROVE	CA	92845	1741	30	06059	33.78720885	-118.028413	Orange County
176448	Fee-for-Service	1295823755	1295823755	1	1	LEE, DANIEL MD	8/30/1990	207W00000X	NA	Ophthalmology	026	PHYSICIANS	46141	18	Ophthalmology	0	In state provider	None	880 DELBON AVE	None	TURLOCK	CA	95382	2005	50	06099	37.51046554	-120.8381799	Stanislaus County
176452	Fee-for-Service	1639364029	1639364029	1	1	LAU, ROSEMARY TAMARGO	2/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
176483	Fee-for-Service	1134409253	1134409253	1	1	LOEHR, GRACE NP	6/8/2022	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
176501	Fee-for-Service	1881156503	1881156503	1	1	LYES, MATTHEW A MD	9/26/2023	207L00000X	NA	Other	026	PHYSICIANS	178624	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
176504	Fee-for-Service	1295847267	1295847267	1	1	LIN, JAMES J MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81564	41	Internal Medicine	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
176516	Fee-for-Service	1013065929	1013065929	1	1	LAM, JENNIFER W MD	3/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80484	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
176572	Fee-for-Service	1326042391	1326042391	1	1	LIU, KENNETH MD	2/28/1985	207RN0300X	NA	Nephrology	026	PHYSICIANS	39960	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
176573	Fee-for-Service	1194229906	1194229906	1	1	LU, ZIANG MD	6/13/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	164515	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
176602	Fee-for-Service	1861472045	1861472045	1	1	LITMAN, TCHIA PHD	11/16/2012	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	02	General Surgery	0	In state provider	None	1460 WESTWOOD BLVD	STE 205	LOS ANGELES	CA	90024	4976	19	06037	34.05427431	-118.4408444	Los Angeles County
176605	Fee-for-Service	1437591377	1437591377	1	1	LYNCH, SCOTT C MD	10/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132847	41	Internal Medicine	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
176625	Fee-for-Service	1245301225	1245301225	1	1	LIN, LINDA I DO	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7656	08	Family Practice	0	In state provider	ATTN MGA OFFICE	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
176631	Fee-for-Service	1326346552	1326346552	1	1	LILY HOLDINGS LLC	6/7/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3510 E SHIELDS AVE	None	FRESNO	CA	93726	6909	10	06019	36.77948647	-119.7658665	Fresno County
176659	Fee-for-Service	1881154037	1881154037	1	1	LOYOLA, MARY ANN P NP	10/7/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8851 CENTER DR	STE 505	LA MESA	CA	91942	3032	37	06073	32.78189749	-117.0075062	San Diego County
176689	Fee-for-Service	1003857525	1003857525	1	1	LEE, CHERYL MD	11/30/1986	207P00000X	NA	Other	026	PHYSICIANS	59426	66	Emergency Medicine (Urgent Care)	0	In state provider	None	171 W BORT ST	None	LONG BEACH	CA	90805	2111	19	06037	33.87046199	-118.2050591	Los Angeles County
176697	Fee-for-Service	1558572032	1558572032	1	1	LAU, WEI LING MD	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	98505	45	Nephrology (Renal-Kidney)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
176738	Fee-for-Service	1285165340	1285165340	1	1	LI, HEWENFEI MD	2/11/2021	207L00000X	NA	Other	026	PHYSICIANS	159523	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
176744	Fee-for-Service	1508944364	1508944364	1	1	LUM, TONI MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66635	05	Anesthesiology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
176748	Fee-for-Service	1356532261	1356532261	1	1	LIN, CHUN H MD	3/31/2025	207RA0002X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
176777	Fee-for-Service	1881655769	1881655769	1	1	LEVINE, JOEL B MD	3/14/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	38002	30	Radiology	0	In state provider	None	8515 FLORENCE AVE	STE 100	DOWNEY	CA	90240	4043	19	06037	33.94969111	-118.1214708	Los Angeles County
176805	Fee-for-Service	1346735578	1346735578	1	1	LANNING, RACHEL L LMFT	9/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
176807	Fee-for-Service	1457844839	1457844839	1	1	LI, JENNIFER MD	1/13/2023	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	173883	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
176849	Fee-for-Service	1164779377	1164779377	1	1	LAE FAMILY COUNSELING	10/17/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	45080 GOLF CENTER PRKWY	SUITE H	INDIO	CA	92201	7310	33	06065	33.72165553	-116.2064097	Riverside County
176894	Fee-for-Service	1982847851	1982847851	1	1	LEE, JOHNSON C-S MD	5/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138353	24	Plastic Surgery	0	In state provider	None	1311 EAST DATE STREET	None	SAN BERNARDINO	CA	92404	4233	36	06071	34.14124247	-117.2585115	San Bernardino County
176918	Fee-for-Service	1356449045	1356449045	1	1	LAI, SHIAU-YENG MD	11/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90475	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
176921	Fee-for-Service	1922188069	1922188069	1	1	LEKAWA, MICHAEL EDWARD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74848	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
176934	Fee-for-Service	1073678454	1073678454	1	1	LEE, HENRY CHONG MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72757	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
176939	Fee-for-Service	1558326801	1558326801	1	1	LEE, EMMET W MD	3/31/1992	207R00000X	NA	Other	026	PHYSICIANS	50563	41	Internal Medicine	0	In state provider	None	625 E GRAND AVE	None	ESCONDIDO	CA	92025	4402	37	06073	33.12475309	-117.0733326	San Diego County
176940	Fee-for-Service	1811908403	1811908403	1	1	LA PHARMACEUTICALS INC	11/25/1998	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3030 W OLYMPIC BLVD	STE 118	LOS ANGELES	CA	90006	6508	19	06037	34.05260995	-118.3015825	Los Angeles County
176954	Fee-for-Service	1124400528	1124400528	1	1	LIN, STEPHANIE PSYD	4/28/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
177005	Fee-for-Service	1750587515	1750587515	1	1	LEDESMA, ESMERALDA LCSW	6/23/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
177021	Fee-for-Service	1013435775	1013435775	1	1	LEPORATI, GABRIEL LPCC	2/18/2025	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
177024	Fee-for-Service	1811045610	1811045610	1	1	LEE, FRANCES MD	1/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	47448	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
177030	Fee-for-Service	1689133514	1689133514	1	1	LIN, MICHELLE MD	7/5/2022	208M00000X	NA	Other	026	PHYSICIANS	177302	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
177045	Fee-for-Service	1174618920	1174618920	1	1	LEE, LAI-HEUNG C MD	6/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	43354	40	Pediatrics	0	In state provider	None	151 N SUNRISE AVE	STE 1310	ROSEVILLE	CA	95661	2933	31	06061	38.74746043	-121.2655348	Placer County
177065	Fee-for-Service	1881655769	1881655769	1	1	LEVINE, JOEL B MD	3/14/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	38002	40	Pediatrics	0	In state provider	None	8515 FLORENCE AVE	STE 100	DOWNEY	CA	90240	4043	19	06037	33.94969111	-118.1214708	Los Angeles County
177071	Fee-for-Service	1316389729	1316389729	1	2	LEITE, LORENA MD	3/10/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	138285	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
177145	Fee-for-Service	1205155488	1205155488	1	1	LEMBERG, OLGA MD	6/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112250	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
177148	Fee-for-Service	1356600605	1356600605	1	1	LUCAS, JUSTIN F MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	127423	20	Orthopedic Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
177174	Fee-for-Service	1255427076	1255427076	1	1	LUBINSKY, PAUL S MD	7/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	41539	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
177193	Fee-for-Service	1255954020	1255954020	1	1	LEE, SHERRY DO	9/29/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	20480	None	None	0	In state provider	None	260 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.65808446	-121.6456618	Monterey County
177194	Fee-for-Service	1528165263	1528165263	1	1	LEVY-GANTT, REBECCA A DO	10/20/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	8707	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1100 TRANCAS STREET	#351	NAPA	CA	94558	2959	28	06055	38.32316569	-122.2981938	Napa County
177217	Fee-for-Service	1215327804	1215327804	1	1	LAKE COUNTY TRIBAL HEALTH	5/18/2017	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CONSORTIUM INC	359 LAKEPORT BLVD	None	LAKEPORT	CA	95453	9754	17	06033	39.03457855	-122.9181731	Lake County
177221	Fee-for-Service	1386841500	1386841500	1	1	LATIF, NABI G MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111501	36	Psychiatry	0	In state provider	None	1686 BARTON RD	None	REDLANDS	CA	92373	7761	36	06071	34.04833901	-117.2120103	San Bernardino County
177228	Fee-for-Service	1598855652	1598855652	1	1	LEE-LOUIE, ROXANNE M OD	1/1/1982	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9098 LAGUNA MAIN ST	STE 3	ELK GROVE	CA	95758	7449	34	06067	38.427129	-121.47138	Sacramento County
177262	Fee-for-Service	1497220073	1497220073	1	1	LEE, ZHUO-YAN PT	2/3/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
177273	Fee-for-Service	1144211350	1144211350	1	1	LU, CHIEN C MD	5/1/1999	207R00000X	NA	Other	026	PHYSICIANS	65680	41	Internal Medicine	0	In state provider	None	33 CREEK RD	None	IRVINE	CA	92604	4791	30	06059	33.67506955	-117.796973	Orange County
177282	Fee-for-Service	1801569793	1801569793	1	1	LYNCH, MARGARET E CRNA	8/2/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
177313	Fee-for-Service	1669409678	1669409678	1	1	LI CURTIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1300 EAST A STREET	STE 209	CASPER	WY	92601	0000	00	None	42.851736	-106.3081305	Natrona County
177341	Fee-for-Service	1134548217	1134548217	1	1	LEACH, JOSEPH R MD	5/10/2018	390200000X	NA	Other	026	PHYSICIANS	133699	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
177354	Fee-for-Service	1881655769	1881655769	1	1	LEVINE, JOEL B MD	3/14/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	38002	01	General Practice	0	In state provider	None	8515 FLORENCE AVE	STE 100	DOWNEY	CA	90240	4043	19	06037	33.94969111	-118.1214708	Los Angeles County
177377	Fee-for-Service	1992798599	1992798599	1	1	LARSON, DAVID P. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9327 N 3RD ST	STE 206	PHOENIX	AZ	85020	2473	00	None	33.571089	-112.069287	Maricopa County
177440	Fee-for-Service	1053754143	1053754143	1	1	LU, ANDREA A MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134146	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
177445	Fee-for-Service	1952988925	1952988925	1	1	LAMPARTER, LAUREN E MD	6/27/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
177457	Fee-for-Service	1558682963	1558682963	1	1	LEE, IRIS DO	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12537	45	Nephrology (Renal-Kidney)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
177459	Fee-for-Service	1053353755	1053353755	1	1	LYUBANSKYY, YURI MD	11/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85686	41	Internal Medicine	0	In state provider	None	3701 J ST	STE 201	SACRAMENTO	CA	95816	5542	34	06067	38.571237	-121.4566245	Sacramento County
177497	Fee-for-Service	1821016452	1821016452	1	1	LIN, FRANK P MD	5/1/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	78083	13	Neurology (M.D. only)	0	In state provider	None	223 N GARFIELD AVE	STE 302	MONTEREY PARK	CA	91754	1700	19	06037	34.0646166	-118.1228948	Los Angeles County
177505	Fee-for-Service	1215327804	1215327804	1	1	LAKE COUNTY TRIBAL HEALTH	4/23/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CONSORTIUM INC	359 LAKEPORT BLVD	None	LAKEPORT	CA	95453	9754	17	06033	39.03457855	-122.9181731	Lake County
177529	Fee-for-Service	1174560171	1174560171	1	1	LOPEZ, ARTURO MD	1/30/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51768	08	Family Practice	0	In state provider	None	17821 PIONEER BLVD	None	ARTESIA	CA	90701	3901	19	06037	33.8691791	-118.0823685	Los Angeles County
177554	Fee-for-Service	1881988962	1881988962	1	1	LEE, TIMOTHY M MD	8/7/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	154790	02	General Surgery	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
177573	Fee-for-Service	1851547459	1851547459	1	1	LIU, COLLINS Y MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113042	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO STREET	SUITE 3000	LOS ANGELES	CA	90033	4606	19	06037	34.06269295	-118.2030006	Los Angeles County
177578	Fee-for-Service	1821133836	1821133836	1	1	LOCK, JAMES D MD	12/31/1992	2084P0800X	NA	Psychiatry	026	PHYSICIANS	64940	36	Psychiatry	0	In state provider	None	1350 WILLOW RD	None	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
177608	Fee-for-Service	1235841396	1235841396	1	1	LINDHOLM, KARL P MD	1/10/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
177612	Fee-for-Service	1366875213	1366875213	1	1	LEE, JANET MD	5/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133458	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
177620	Fee-for-Service	1740231653	1740231653	1	1	LATTOS, WILLIAM E JR MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	40649	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1025 S ANAHEIM BLVD	None	ANAHEIM	CA	92805	5806	30	06059	33.81994338	-117.9087416	Orange County
177636	Fee-for-Service	1831378850	1831378850	1	1	LEE, CHARLEEN K MD	9/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95969	02	General Surgery	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3194	07	06013	37.9141514	-122.0422089	Contra Costa County
177671	Fee-for-Service	1669600011	1669600011	1	1	LAU, DIANA G MD	10/29/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	124135	None	None	0	In state provider	None	3851 KATELLA AVENUE	SUITE 150	LOS ALAMITOS	CA	90720	3363	30	06059	33.80319053	-118.0657305	Orange County
177678	Fee-for-Service	1447293279	1447293279	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	63 LINCOLN BLVD	None	LINCOLN	CA	95648	9389	31	06061	38.87781365	-121.2959664	Placer County
177744	Fee-for-Service	1780847533	1780847533	1	1	LEWIS, MICHAEL J MD	8/19/2022	208G00000X	NA	General Surgery	026	PHYSICIANS	175438	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
177745	Fee-for-Service	1396979126	1396979126	1	1	LEE, ANN J MD	1/5/2016	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	136160	41	Internal Medicine	0	In state provider	None	805 E MOUNTAIN VIEW	None	BARSTOW	CA	92311	3033	36	06071	34.89343047	-117.0171832	San Bernardino County
177749	Fee-for-Service	1770580268	1770580268	2	1	LAKE HEALTH SERVICES INC	4/10/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15230 LAKESHORE DR	None	CLEARLAKE	CA	95422	8107	17	06033	38.95005226	-122.6264492	Lake County
177750	Fee-for-Service	1598024796	1598024796	1	1	LANGLEY, KATHLEEN A LMFT	5/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
177768	Fee-for-Service	1407403595	1407403595	1	1	LOEFFLER, LAURIE PT	5/8/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4969 MCKINLEY AVE	107	FRESNO	CA	93727	1968	10	06019	36.76528751	-119.728755	Fresno County
177792	Fee-for-Service	1215327804	1215327804	1	1	LAKE COUNTY TRIBAL HEALTH	8/26/2021	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	CONSORTIUM INC	359 LAKEPORT BLVD	None	LAKEPORT	CA	95453	9754	17	06033	39.03457855	-122.9181731	Lake County
177839	Fee-for-Service	1881988962	1881988962	1	1	LEE, TIMOTHY M MD	8/7/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	154790	33	Thoracic Surgery	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
177844	Fee-for-Service	1831624733	1831624733	1	1	LEONG, JONATHAN A MD	10/31/2020	208M00000X	NA	Other	026	PHYSICIANS	167230	41	Internal Medicine	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
177855	Fee-for-Service	1437568672	1437568672	1	1	LOS FELIZ HEALTHCARE	10/11/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	& WELLNESS CENTRE LP	3002 ROWENA AVE	None	LOS ANGELES	CA	90039	2005	19	06037	34.10865219	-118.2694196	Los Angeles County
177862	Fee-for-Service	1699718460	1699718460	2	1	LONGS DRUG STORES CA LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1822 E AVENIDA DE LOS AR	None	THOUSAND OAKS	CA	91362	1303	56	06111	34.21121929	-118.8449599	Ventura County
177920	Fee-for-Service	1316978083	1316978083	1	1	LIU, GRACE Y MD	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48127	18	Ophthalmology	0	In state provider	None	801 W VALLEY BLVD	STE 103	ALHAMBRA	CA	91803	3256	19	06037	34.07808133	-118.1319851	Los Angeles County
177924	Fee-for-Service	1265693485	1265693485	1	1	LEE, JESSICA MD	4/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125337	36	Psychiatry	0	In state provider	None	2060 FAIRMONT DRIVE	None	SAN LEANDRO	CA	94578	1001	01	06001	37.71083326	-122.1208841	Alameda County
177925	Fee-for-Service	1023059458	1023059458	1	1	LING, CAROL A MD	5/8/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	102862	18	Ophthalmology	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
177932	Fee-for-Service	1295021640	1295021640	1	1	LELAND, HYUMA A MD	10/14/2019	208200000X	NA	General Surgery	026	PHYSICIANS	123120	24	Plastic Surgery	0	In state provider	None	2950 RESEARCH PARK DR	None	SOQUEL	CA	95073	2000	44	06087	36.98692657	-121.9685264	Santa Cruz County
177945	Fee-for-Service	1518212117	1518212117	1	1	LOS ANGELES CENTERS FOR	8/30/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	ALCOHOL AND DRUG ABUSE	9800 SOUTH MILLS AVENUE	CLASSROOM M5	WHITTIER	CA	90604	1030	19	06037	33.942528	-118.0212795	Los Angeles County
177951	Fee-for-Service	1104925874	1104925874	1	1	LEUNG, ANN N MD	4/30/1992	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	52329	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
177953	Fee-for-Service	1275641482	1275641482	1	1	LOH, CHRISTOPHER W MD	8/1/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	31056	06	Cardiovascular Disease (M.D. only)	0	In state provider	A PROFESSIONAL CORP	2438 N PONDEROSA DR	STE C201	CAMARILLO	CA	93010	2374	56	06111	34.24219545	-119.0227012	Ventura County
177973	Fee-for-Service	1376726059	1376726059	1	1	LEI, AMY Q MD	7/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	102303	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
177976	Fee-for-Service	1407221740	1407221740	1	1	LIGHTBOURNE, ADRIENNE S MD	6/9/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	177293	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
178048	Fee-for-Service	1881738003	1881738003	1	1	LEE, MARK MD	9/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75891	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
178073	Fee-for-Service	1235344607	1235344607	1	1	LEE, EUNICE J MD	12/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103616	None	None	0	In state provider	None	77 CADILLAC DR	STE 200	SACRAMENTO	CA	95825	5453	34	06067	38.572551	-121.4181585	Sacramento County
178078	Fee-for-Service	1619036688	1619036688	1	1	LACKMAN, MARGERY A MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	63812	40	Pediatrics	0	In state provider	None	2970 HILLTOP MALL RD	STE 305	RICHMOND	CA	94806	5274	07	06013	37.97819764	-122.329244	Contra Costa County
178107	Fee-for-Service	1891298675	1891298675	1	1	LOPEZ, CLAUDIA L MD	8/22/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	164335	None	None	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
178116	Fee-for-Service	1942215686	1942215686	1	1	LATIF, SEEMA T MD	1/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52771	40	Pediatrics	0	In state provider	None	11401 PATTON RD	None	DOWNEY	CA	90241	5273	19	06037	33.93619248	-118.1286234	Los Angeles County
178137	Fee-for-Service	1154473965	1154473965	1	1	LEMAITRE, JOEL W MD	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39293	40	Pediatrics	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
178148	Fee-for-Service	1982711909	1982711909	1	1	LEVY, MARK A MD	8/1/1984	207R00000X	NA	Other	026	PHYSICIANS	47736	41	Internal Medicine	0	In state provider	None	2600 CAPITOL AVE	STE 305	SACRAMENTO	CA	95816	5915	34	06067	38.570805	-121.473162	Sacramento County
178151	Fee-for-Service	1922184019	1922184019	1	1	LIU, EDMOND L MD	2/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	83422	08	Family Practice	0	In state provider	None	1 SHRADER ST	STE 500	SAN FRANCISCO	CA	94117	1044	38	06075	37.77467326	-122.4529451	San Francisco County
178156	Fee-for-Service	1336424928	1336424928	1	1	LUONG, NANCY OD	7/30/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	477 E COLORADO BLVD	None	PASADENA	CA	91101	2024	19	06037	34.14587948	-118.140561	Los Angeles County
178174	Fee-for-Service	1821141243	1821141243	1	1	LUCE, KRISTINE H PHD	9/26/2005	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
178227	Fee-for-Service	1841228228	1841228228	1	1	LEVINSON, GARY A MD	5/17/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	15765	-	NOT APPLICABLE	0	In state provider	None	7885 ANNANDALE AVE	None	DSRT HOT SPGS	CA	92240	1419	33	06065	33.99048848	-116.5242885	Riverside County
178265	Fee-for-Service	1760419055	1760419055	1	1	LONDERVILLE, SUSAN B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	71492	41	Internal Medicine	0	In state provider	None	2361 E 29TH ST	None	OAKLAND	CA	94606	3511	01	06001	37.79522292	-122.2250412	Alameda County
178288	Fee-for-Service	1033134465	1033134465	1	1	LIM, PERRY F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53996	40	Pediatrics	0	In state provider	None	1206 N CAPITOL AVE	STE 204	SAN JOSE	CA	95132	2572	43	06085	37.38856532	-121.8624654	Santa Clara County
178355	Fee-for-Service	1932736485	1932736485	1	1	LIPPI, MATTHEW	7/1/2024	207P00000X	NA	Other	026	PHYSICIANS	191038	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
178364	Fee-for-Service	1598079410	1598079410	1	2	LEE, HUBERT S MD	7/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120643	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
178365	Fee-for-Service	1639443104	1639443104	1	1	LONG, KATHARINE C MD	6/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119576	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8762	20	06039	36.88437894	-119.8003484	Madera County
178389	Fee-for-Service	1508905159	1508905159	1	1	LAI, CHRISTOPHER C MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	66701	20	Orthopedic Surgery	0	In state provider	None	196 W LEGION RD	None	BRAWLEY	CA	92227	7713	13	06025	32.95996431	-115.5523437	Imperial County
178391	Fee-for-Service	1427234806	1427234806	1	1	LEE, DENISE A LMFT	8/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
178398	Fee-for-Service	1366026841	1366026841	1	1	LAYUG, JESSICA G NP	11/30/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	701 HOWE AVE	SUITE C-5	SACRAMENTO	CA	95825	4604	34	06067	38.578716	-121.416228	Sacramento County
178421	Fee-for-Service	1619398872	1619398872	1	1	LIU, TIMOTHY Y	11/14/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
178431	Fee-for-Service	1952314601	1952314601	1	1	LIN, ALEXANDER S MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	38003	30	Radiology	0	In state provider	None	301 VICTORIA ST	None	COSTA MESA	CA	92627	1995	30	06059	33.65258952	-117.9121545	Orange County
178440	Fee-for-Service	1083230841	1083230841	1	1	LL AND HH HOME HEALTH CARE	9/29/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	1492 W COLORADO BLVD	STE 210	PASADENA	CA	91105	1465	19	06037	34.14086703	-118.1796369	Los Angeles County
178463	Fee-for-Service	1508091257	1508091257	1	1	LEE- ANDERSON, ANDREA E MD	5/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113535	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
178464	Fee-for-Service	1609849074	1609849074	1	7	LA MAESTRA FAMILY CLINIC INC	5/2/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INC	4185 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1609	37	06073	32.752908	-117.1008345	San Diego County
178535	Fee-for-Service	1427286418	1427286418	1	1	LEE, CHRISTINA A MD	5/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106424	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
178541	Fee-for-Service	1689883183	1689883183	1	1	LOCKE, DANA E LMFT	6/10/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2501 HARRISON STREET	None	OAKLAND	CA	94612	3811	01	06001	37.81349235	-122.2609539	Alameda County
178574	Fee-for-Service	1154511491	1154511491	2	1	LONGS DRUG STORE CAL LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3171 BALFOUR RD	None	BRENTWOOD	CA	94513	2962	07	06013	37.92545637	-121.721208	Contra Costa County
178576	Fee-for-Service	1245531649	1245531649	1	2	LOC DAC BUI M.D., A PROFESSI	3/17/2024	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ONAL CORPORATION	8900 BOLSA AVE	STE B	WESTMINSTER	CA	92683	5475	30	06059	33.74480556	-117.9740439	Orange County
178616	Fee-for-Service	1982787206	1982787206	1	1	LINCOLN HEIGHTS FAMILY	7/27/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	WEST COAST MED CTR INC	1501 E HOLT AVE	None	POMONA	CA	91767	5823	19	06037	34.06321709	-117.7205804	Los Angeles County
178617	Fee-for-Service	1811006869	1811006869	2	1	LA MAGNOLIA MEDICAL GROUP	12/9/2013	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	INC	14571 MAGNOLIA STREET	SUITE 210	WESTMINSTER	CA	92683	5576	30	06059	33.75097286	-117.9723502	Orange County
178625	Fee-for-Service	1508879537	1508879537	1	1	LAREAU, VIKKI MD	10/1/1998	207R00000X	NA	Other	026	PHYSICIANS	81423	41	Internal Medicine	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
178653	Fee-for-Service	1801089578	1801089578	1	1	LOWE, LIBERTY G MD	9/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93401	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
178666	Fee-for-Service	1639169345	1639169345	1	1	LAWRENCE, JAMES P MD	8/3/1995	207RP1001X	NA	Pulmonology	026	PHYSICIANS	-	None	None	1	Border provider	None	3003 HIWAY 95	STE 101	BULLHEAD CITY	AZ	86442	7802	00	None	35.075763	-114.593787	Mohave County
178674	Fee-for-Service	1235454182	1235454182	1	1	LEWIS, MATTHEW A MD	8/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131557	07	Dermatology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
178675	Fee-for-Service	1225407919	1225407919	1	1	LIVINGSTON, IAN LPCC	1/23/2025	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	415 KNOLLCREST DR	STE 101	REDDING	CA	96002	0181	45	06089	40.57267376	-122.3643496	Shasta County
178676	Fee-for-Service	1356684542	1356684542	1	1	LIU, DAVID D MD	7/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133410	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
178692	Fee-for-Service	1740578087	1740578087	1	1	LATINO COMMISSION ON ALCOHOL	2/19/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	AND DRUG ABUSE SERVICES	401 BRIARFIELD WAY	None	BELMONT	CA	94002	2712	41	06081	37.52724368	-122.2743832	San Mateo County
178754	Fee-for-Service	1609849074	1609849074	1	7	LA MAESTRA FAMILY CLINIC INC	5/2/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INC	4185 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1609	37	06073	32.752908	-117.1008345	San Diego County
178815	Fee-for-Service	1659664654	1659664654	1	1	LOMA LINDA UNIVERSITY	6/14/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	PATHOLOGY MEDICAL GROUP	28062 BAXTER RD	None	MURRIETA	CA	92563	1401	33	06065	33.61350847	-117.1691225	Riverside County
178873	Fee-for-Service	1700244647	1700244647	1	1	LANHAM, SHADI M MD	5/3/2022	208M00000X	NA	Other	026	PHYSICIANS	175556	None	None	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
178902	Fee-for-Service	1982787206	1982787206	1	1	LINCOLN HEIGHTS FAMILY	7/27/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	WEST COAST MED CTR INC	1501 E HOLT AVE	None	POMONA	CA	91767	5823	19	06037	34.06321709	-117.7205804	Los Angeles County
178919	Fee-for-Service	1013098516	1013098516	2	1	LU, CHONG-PING C MD	4/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	35128	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1000 E LATHAM AVE	STE E	HEMET	CA	92543	4409	33	06065	33.74942449	-116.961741	Riverside County
178962	Fee-for-Service	1871555250	1871555250	1	1	LAIRD, NATASHA E MD	2/28/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	156672	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1111 N CHINA LAKE BLVD	STE 190	RIDGECREST	CA	93555	3130	15	06029	35.64171	-117.669847	Kern County
178975	Fee-for-Service	1952459265	1952459265	1	5	LIMBERG EYE SURGERY, INC	1/1/1999	193400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	959 LAS TABLAS RD	STE B4	TEMPLETON	CA	93465	9703	40	06079	35.55436153	-120.7148265	San Luis Obispo County
178978	Fee-for-Service	1336171107	1336171107	1	1	LOOS, STEPHEN J MD	8/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	2874 N CARSON STREET	None	CARSON CITY	NV	89706	1684	00	None	39.185271	-119.7710595	Consolidated Municipality of Carson City
178986	Fee-for-Service	1114389137	1114389137	1	1	LU, LANCY MD	7/1/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	153017	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
179008	Fee-for-Service	1255319893	1255319893	1	1	LAM, CHING MD	3/24/2008	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	75722	25	Physical Medicine and Rehabilitation	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
179015	Fee-for-Service	1669009742	1669009742	1	1	LOPEZ, KATRINA	9/24/2023	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
179027	Fee-for-Service	1629274238	1629274238	1	1	LEE, JENNY I MD	5/18/2015	207RN0300X	NA	Nephrology	026	PHYSICIANS	110984	41	Internal Medicine	0	In state provider	None	1313 LAUREL STREET	SUITE 106	SAN CARLOS	CA	94070	5013	41	06081	37.49782611	-122.2507762	San Mateo County
179032	Fee-for-Service	1316064546	1316064546	1	1	LONG, WEN MD	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113444	02	General Surgery	0	In state provider	None	3000 Q ST	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
179086	Fee-for-Service	1942664552	1942664552	1	1	LANAM, CAROLYN R MD	7/1/2020	207P00000X	NA	Other	026	PHYSICIANS	167875	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6501 COYLE AVENUE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
179108	Fee-for-Service	1750449211	1750449211	1	1	LANNING, DOUGLAS H OD	2/1/2012	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2437 BUHNE ST	None	EUREKA	CA	95501	3206	12	06023	40.78597343	-124.1405296	Humboldt County
179114	Fee-for-Service	1316015779	1316015779	1	1	LEV, CECILIA P MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	42251	40	Pediatrics	0	In state provider	None	333 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	4501	19	06037	33.9670722	-118.3439911	Los Angeles County
179163	Fee-for-Service	1861133563	1861133563	1	1	LIU, DEREK MD	5/5/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	188691	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
179172	Fee-for-Service	1255772737	1255772737	1	1	LEVI, TEISHA Y LMFT	6/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
179192	Fee-for-Service	1982787206	1982787206	1	1	LINCOLN HEIGHTS FAMILY	7/27/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	WEST COAST MED CTR INC	1501 E HOLT AVE	None	POMONA	CA	91767	5823	19	06037	34.06321709	-117.7205804	Los Angeles County
179208	Fee-for-Service	1013098516	1013098516	2	1	LU, CHONG-PING C MD	4/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	35128	33	Thoracic Surgery	0	In state provider	None	1000 E LATHAM AVE	STE E	HEMET	CA	92543	4409	33	06065	33.74942449	-116.961741	Riverside County
179211	Fee-for-Service	1639271638	1639271638	1	1	LO, RONALD MD	12/22/2022	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	98161	None	None	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
179220	Fee-for-Service	1437321155	1437321155	1	1	LAUGHLIN, SHARON M MD INC	10/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	55524	01	General Practice	0	In state provider	None	3838 SHERMAN DRIVE	SUITE 3	RIVERSIDE	CA	92503	4001	33	06065	33.92678822	-117.4368632	Riverside County
179254	Fee-for-Service	1235524224	1235524224	1	1	LEE, JULIEANN C MD	7/29/2019	207ZN0500X	NA	Other	026	PHYSICIANS	149319	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
179307	Fee-for-Service	1912297177	1912297177	1	1	LEE, ERIC J	9/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137796	36	Psychiatry	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
179314	Fee-for-Service	1629274238	1629274238	1	1	LEE, JENNY I MD	5/18/2015	207RN0300X	NA	Nephrology	026	PHYSICIANS	110984	45	Nephrology (Renal-Kidney)	0	In state provider	None	1313 LAUREL STREET	SUITE 106	SAN CARLOS	CA	94070	5013	41	06081	37.49782611	-122.2507762	San Mateo County
179339	Fee-for-Service	1508856535	1508856535	1	3	LANCASTER HOSPITAL	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
179365	Fee-for-Service	1710977731	1710977731	1	1	LINDSEY, SHARON L	7/22/2008	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
179388	Fee-for-Service	1700842119	1700842119	1	1	LEUNG, JACQUELINE M	1/31/1987	207L00000X	NA	Other	026	PHYSICIANS	56254	None	None	0	In state provider	None	533 PARNASSUS AVE	# 648	SAN FRANCISCO	CA	94143	2208	38	06075	37.76304484	-122.4592904	San Francisco County
179393	Fee-for-Service	1639558745	1639558745	1	1	LI, WEI-TE	8/1/2021	208600000X	NA	General Surgery	026	PHYSICIANS	144084	None	None	0	In state provider	None	197 E CAROLINE ST	None	SAN BERNARDINO	CA	92408	3731	36	06071	34.06143353	-117.2822085	San Bernardino County
179408	Fee-for-Service	1386910560	1386910560	1	1	LIN, DAVID MD	7/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	127907	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
179448	Fee-for-Service	1376830596	1376830596	1	1	LUCE, JOHN C DO	6/22/2017	2081P0010X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	14626	25	Physical Medicine and Rehabilitation	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
179454	Fee-for-Service	1649358441	1649358441	1	1	LAI, JANET A MD	8/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90319	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
179473	Fee-for-Service	1780918615	1780918615	1	1	LI, NA MD	1/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106349	41	Internal Medicine	0	In state provider	None	1350 S ELISEO DRIVE	STE 220	GREENBRAE	CA	94904	2011	21	06041	37.94490653	-122.537021	Marin County
179495	Fee-for-Service	1013098516	1013098516	2	1	LU, CHONG-PING C MD	4/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	35128	41	Internal Medicine	0	In state provider	None	1000 E LATHAM AVE	STE E	HEMET	CA	92543	4409	33	06065	33.74942449	-116.961741	Riverside County
179500	Fee-for-Service	1407277155	1407277155	1	1	LIN, BINGTAO MD	6/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141761	None	None	0	In state provider	None	6401 TRUXTUN AVE	SUITE B	BAKERSFIELD	CA	93309	7098	15	06029	35.36227673	-119.07391	Kern County
179525	Fee-for-Service	1427110329	1427110329	1	6	LIVINGSTON COMMUNITY HEALTH	4/22/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2412 3RD ST	SUITE B	HUGHSON	CA	95326	9310	50	06099	37.596078	-120.866634	Stanislaus County
179532	Fee-for-Service	1801879077	1801879077	1	1	LAU, DERICK MD	12/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	56030	68	Hematology	0	In state provider	None	2525 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
179541	Fee-for-Service	1184034654	1184034654	1	1	LEONARD, ADAM J NP	3/13/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
179543	Fee-for-Service	1134788730	1134788730	1	1	LEBENSOHN-CHIALVO, FLORENCIA	10/11/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PHD	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
179590	Fee-for-Service	1891718144	1891718144	1	1	LEVY, JAY M MD INC	2/8/2015	207T00000X	NA	General Surgery	026	PHYSICIANS	22776	14	Neurological Surgery	0	In state provider	None	1163 TRANCAS ST	None	NAPA	CA	94558	2907	28	06055	38.32300857	-122.2987558	Napa County
179631	Fee-for-Service	1871519892	1871519892	1	1	LAURIE HELMS	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST JOHN'S MEDICAL CENTER	1615 DELAWARE ST	None	LONGVIEW	WA	98632	0000	00	None	46.1309207	-122.9408931	Cowlitz County
179633	Fee-for-Service	1710747407	1710747407	1	1	LOULA PERINATAL HEALTH SERVI	8/13/2024	171W00000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
179643	Fee-for-Service	1699180265	1699180265	1	1	LACSINA, JAMIE L DO	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13268	36	Psychiatry	0	In state provider	None	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
179644	Fee-for-Service	1528001799	1528001799	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1451 SHATTUCK AVE	None	BERKELEY	CA	94709	1410	01	06001	37.88119342	-122.2692104	Alameda County
179656	Fee-for-Service	1619969847	1619969847	1	1	LEE, JU H MD	5/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48924	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
179669	Fee-for-Service	1083658413	1083658413	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2690 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	2923	15	06029	35.39673	-118.967627	Kern County
179715	Fee-for-Service	1881920478	1881920478	1	1	LUCY, AMANDA L PT	6/10/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	577 EAST ELDER STREET	SUITE I	FALLBROOK	CA	92028	3079	37	06073	33.3801147	-117.2456536	San Diego County
179737	Fee-for-Service	1336230952	1336230952	1	1	LAIPRASERT-TANTISIRA, JOANN	9/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89664	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MD	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
179745	Fee-for-Service	1265580245	1265580245	1	1	LOBEL, EFRAT Z MD	3/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67199	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
179754	Fee-for-Service	1386728939	1386728939	1	1	LONGWOOD ENTERPRISES INC	1/1/1979	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1900 S LONGWOOD AVE	None	LOS ANGELES	CA	90016	1408	19	06037	34.03964952	-118.3455081	Los Angeles County
179781	Fee-for-Service	1407380975	1407380975	1	1	LAM, VINH Q MD	8/19/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	160617	08	Family Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
179814	Fee-for-Service	1427110329	1427110329	1	6	LIVINGSTON COMMUNITY HEALTH	4/22/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2412 3RD ST	SUITE B	HUGHSON	CA	95326	9310	50	06099	37.596078	-120.866634	Stanislaus County
179816	Fee-for-Service	1386837367	1386837367	1	1	LIFE FLIGHT NETWORK LLC	12/26/2017	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	22285 YELLOW GATE LANE	STE 102	AURORA	OR	97002	8400	00	None	45.244944	-122.767596	Marion County
179819	Fee-for-Service	1801879077	1801879077	1	1	LAU, DERICK MD	12/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	56030	41	Internal Medicine	0	In state provider	None	2525 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
179857	Fee-for-Service	1871542126	1871542126	1	1	LEON, PABLO MD	2/8/1997	208600000X	NA	General Surgery	026	PHYSICIANS	75080	24	Plastic Surgery	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
179871	Fee-for-Service	1215431903	1215431903	1	1	LOPES, RACHEL LMFT	11/22/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MILY	28362 VINCENT MORAGA DR	SUITE D	TEMECULA	CA	92590	3655	33	06065	33.49778146	-117.1570464	Riverside County
179880	Fee-for-Service	1619914785	1619914785	1	1	LEWIS GALE MEDICAL CENTER	9/25/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	LLC	1900 ELECTRIC RD	None	SALEM	VA	24153	7474	00	None	37.26349481	-80.03332848	Salem city
179889	Fee-for-Service	1033110671	1033110671	1	1	LAI, YEN I MD	5/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63942	08	Family Practice	0	In state provider	None	1770 N ORANGE GROVE AVE	STE 101	POMONA	CA	91767	3027	19	06037	34.07637624	-117.7492622	Los Angeles County
179891	Fee-for-Service	1619000189	1619000189	1	1	LARBIE, REGINA K BOCP	9/11/2019	1744P3200X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	5321 PIRRONE RD	SUITE B	SALIDA	CA	95368	9089	50	06099	37.71667518	-121.0923136	Stanislaus County
179975	Fee-for-Service	1912356577	1912356577	1	1	LEE, VINCENT M MD	10/2/2019	207R00000X	NA	Other	026	PHYSICIANS	162843	41	Internal Medicine	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
179983	Fee-for-Service	1508944372	1508944372	1	1	LU, XIANGPING MD	9/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51571	22	Pathology (M.D. only)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
179995	Fee-for-Service	1255314100	1255314100	1	1	LIBRATY, DANIEL H MD	10/27/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	69918	None	None	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
180008	Fee-for-Service	1861531113	1861531113	1	1	LEE, IRENE P MD	3/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53384	01	General Practice	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
180028	Fee-for-Service	1073708541	1073708541	1	1	LIU, VINCENT MD	10/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95120	41	Internal Medicine	0	In state provider	None	3466 MT DIABLO BLVD	STE C100	LAFAYETTE	CA	94549	3952	07	06013	37.89256947	-122.1150289	Contra Costa County
180042	Fee-for-Service	1235758467	1235758467	1	1	LUJANO, JOSE C MD	7/17/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
180061	Fee-for-Service	1659862720	1659862720	1	1	LI, ANG LMFT	5/5/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
180063	Fee-for-Service	1831551860	1831551860	1	1	LOPEZ, ALEXIS MD	8/2/2023	207YP0228X	NA	ENT/Otolaryngology	026	PHYSICIANS	175710	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
180082	Fee-for-Service	1144607375	1144607375	1	1	LIU, YI-WEI J MD	8/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144642	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5810	19	06037	34.06269295	-118.2030006	Los Angeles County
180107	Fee-for-Service	1801879077	1801879077	1	1	LAU, DERICK MD	12/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	56030	78	Neoplastic Diseases/Oncology	0	In state provider	None	2525 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
180109	Fee-for-Service	1639306426	1639306426	1	1	LIU, GENE-FU F MD	12/23/2020	2085R0203X	NA	Other	026	PHYSICIANS	127908	None	None	0	In state provider	None	27800 MEDICAL CENTER RD	STE 160	MISSION VIEJO	CA	92691	6442	30	06059	33.55952733	-117.6645199	Orange County
180132	Fee-for-Service	1316094717	1316094717	1	1	LASSER, THEODORE D PHD	8/21/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1660 E ROSEVILLE PARKWAY	BLDG C	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
180141	Fee-for-Service	1801266747	1801266747	1	1	LEGACY COMFORT CARE HOSPICE	5/14/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	20944 SHERMAN WAY	STE 105	CANOGA PARK	CA	91303	1742	19	06037	34.20095151	-118.5900435	Los Angeles County
180146	Fee-for-Service	1790281053	1790281053	1	1	LYON, LEANDRA DO	7/21/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17756	None	None	0	In state provider	None	3123 PROFESSIONAL DR	STE 210	AUBURN	CA	95603	2400	31	06061	38.9412	-121.100888	Placer County
180150	Fee-for-Service	1154463149	1154463149	1	1	LI, LEO L MD INC	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	82244	41	Internal Medicine	0	In state provider	None	101 E BEVERLY BLVD	STE 400	MONTEBELLO	CA	90640	4317	19	06037	34.01556395	-118.0983878	Los Angeles County
180168	Fee-for-Service	1619914785	1619914785	1	1	LEWIS GALE MEDICAL CENTER	9/25/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	LLC	1900 ELECTRIC RD	None	SALEM	VA	24153	7474	00	None	37.26349481	-80.03332848	Salem city
180177	Fee-for-Service	1275681140	1275681140	1	1	LI, JAMES C MD	7/31/1995	207R00000X	NA	Other	026	PHYSICIANS	79005	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
180214	Fee-for-Service	1780918094	1780918094	1	1	LEE, YEUN HWA S OD	6/16/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
180217	Fee-for-Service	1730157215	1730157215	1	1	LOS ROBLES RADIOLOGIC	2/23/2011	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ASSOCIATES	215 W JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
180261	Fee-for-Service	1669622965	1669622965	1	1	LEIBOWITZ, MELISSA L LCSW	7/23/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	206 N JACKSON ST	SUITE 202	GLENDALE	CA	91206	4330	19	06037	34.14852285	-118.2501237	Los Angeles County
180294	Fee-for-Service	1518901818	1518901818	1	1	LOEHNEN,PAUL P	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 W BROADWAY	None	MISSOULA	MT	59802	0000	00	None	46.874889	-114.000444	Missoula County
180301	Fee-for-Service	1205817822	1205817822	1	1	LABORATORY CORPORATION	5/7/2004	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	OF AMERICA	1725 GOLD ST	None	REDDING	CA	96001	1820	45	06089	40.57882435	-122.3927908	Shasta County
180303	Fee-for-Service	1114252954	1114252954	1	1	LY, NHU Q	5/27/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 LAGUNA ROAD	SUITE C	FULLERTON	CA	92835	3634	30	06059	33.89326085	-117.9300987	Orange County
180329	Fee-for-Service	1487033353	1487033353	1	1	LOS ANGELES KIDNEY CENTER A	8/11/2015	207RN0300X	NA	Nephrology	026	PHYSICIANS	11899	45	Nephrology (Renal-Kidney)	0	In state provider	PROFESSIONAL MEDICAL COR	1127 WILSHIRE BLVD	STE 510	LOS ANGELES	CA	90017	3901	19	06037	34.05270508	-118.2641005	Los Angeles County
180333	Fee-for-Service	1659459402	1659459402	1	1	LIN, BEN MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75629	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
180354	Fee-for-Service	1215694377	1215694377	1	1	LIU, KENNY PT	1/28/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
180369	Fee-for-Service	1942592522	1942592522	1	1	LAI, ERIC J MD	8/1/2017	207RN0300X	NA	Nephrology	026	PHYSICIANS	143755	45	Nephrology (Renal-Kidney)	0	In state provider	None	20055 LAKE CHABOT RD	STE 230	CASTRO VALLEY	CA	94546	5333	01	06001	37.69836512	-122.0873587	Alameda County
180371	Fee-for-Service	1346289089	1346289089	1	1	LEUNG, PUI F	12/2/2006	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3150 CALIFORNIA	STE 1	SAN FRANCISCO	CA	94115	2464	38	06075	37.78733575	-122.4463031	San Francisco County
180380	Fee-for-Service	1275653560	1275653560	1	1	LONG, MICHAEL L OD	4/1/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3621 VISTA WAY	None	OCEANSIDE	CA	92056	4522	37	06073	33.18174298	-117.3099981	San Diego County
180397	Fee-for-Service	1528081155	1528081155	1	1	LEE, ROBERT S MD	1/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89811	41	Internal Medicine	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
180403	Fee-for-Service	1841619830	1841619830	1	1	LEVINE, SARAH J MD	7/6/2017	2080P0204X	NA	Other	026	PHYSICIANS	141140	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
180413	Fee-for-Service	1467506873	1467506873	1	1	LOW, NELMAN C MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	51585	04	Otology, Laryngology, Rhinology	0	In state provider	None	21311 MADRONA AVE	SUITE 100-A	TORRANCE	CA	90503	5970	19	06037	33.835599	-118.3450965	Los Angeles County
180425	Fee-for-Service	1316170459	1316170459	1	1	LI, ZHE MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110654	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
180428	Fee-for-Service	1801266747	1801266747	1	1	LEGACY COMFORT CARE HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	20944 SHERMAN WAY	STE 105	CANOGA PARK	CA	91303	1742	19	06037	34.20095151	-118.5900435	Los Angeles County
180439	Fee-for-Service	1154463149	1154463149	1	1	LI, LEO L MD INC	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	82244	77	Infectious Disease	0	In state provider	None	101 E BEVERLY BLVD	STE 400	MONTEBELLO	CA	90640	4317	19	06037	34.01556395	-118.0983878	Los Angeles County
180480	Fee-for-Service	1841297280	1841297280	1	1	LEE, IRVIN J CRNA	9/23/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
180498	Fee-for-Service	1619068210	1619068210	1	1	LIN, AMY CHING-AN MD	10/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80344	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
180514	Fee-for-Service	1558450700	1558450700	1	1	LAHANA, DANIEL A MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13371	10	Gastroenterology (M.D. only)	0	In state provider	None	465 N ROXBURY DR	STE 1007	BEVERLY HILLS	CA	90210	4213	19	06037	34.06832918	-118.4072114	Los Angeles County
180523	Fee-for-Service	1083253553	1083253553	1	2	LAMBERT HOME CARE LLC	4/28/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6001 ROYALIST DRIVE	None	HUNTINGTON BEACH	CA	92647	3256	30	06059	33.73173662	-118.0237761	Orange County
180535	Fee-for-Service	1891702312	1891702312	1	1	LEE, HOWARD E MD	8/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84911	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
180619	Fee-for-Service	1487033353	1487033353	1	1	LOS ANGELES KIDNEY CENTER A	8/11/2015	207RN0300X	NA	Nephrology	026	PHYSICIANS	11899	41	Internal Medicine	0	In state provider	PROFESSIONAL MEDICAL COR	1127 WILSHIRE BLVD	STE 510	LOS ANGELES	CA	90017	3901	19	06037	34.05270508	-118.2641005	Los Angeles County
180627	Fee-for-Service	1215124938	1215124938	1	1	LEUNG, MARGARET W MD	10/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	105248	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
180639	Fee-for-Service	1841800018	1841800018	1	1	LUMINOPTIX OPTOMETRY	8/1/2024	193400000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	655 SATURN BLVD	SUITE H	SAN DIEGO	CA	92154	4734	37	06073	32.58472439	-117.0925745	San Diego County
180652	Fee-for-Service	1518074319	1518074319	1	1	LAWRENCE, JODY MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	81873	77	Infectious Disease	0	In state provider	None	1001 POTRERO AVE	BLDG 30	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
180664	Fee-for-Service	1881785285	1881785285	1	1	LAZARUS, JEFFREY E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40298	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
180686	Fee-for-Service	1356432637	1356432637	1	1	LAWREN A MERIDETH, M D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	901 N PORTER AVE	None	NORMAN	OK	73071	6404	00	None	35.23022019	-97.44110859	Cleveland County
180757	Fee-for-Service	1073927703	1073927703	1	1	LIU, YU MD	10/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145017	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
180762	Fee-for-Service	1255387320	1255387320	1	1	LEE, PHILIP W MD	2/1/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54896	66	Emergency Medicine (Urgent Care)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
180772	Fee-for-Service	1760811442	1760811442	1	1	LIM, GEORGE W MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136077	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	3075	19	06037	34.06633051	-118.4452686	Los Angeles County
180804	Fee-for-Service	1912583113	1912583113	1	1	LOTUS BLOOM HOSPICE INC	8/9/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	127 S BRAND BLVD	STE 211	GLENDALE	CA	91204	1372	19	06037	34.145289	-118.255096	Los Angeles County
180823	Fee-for-Service	1891702312	1891702312	1	1	LEE, HOWARD E MD	8/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84911	68	Hematology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
180832	Fee-for-Service	1992960967	1992960967	1	1	LANDAU, MICHAEL D MD	4/8/2008	202K00000X	NA	Other	026	PHYSICIANS	58711	None	None	0	In state provider	PROF CORP	6221 WILSHIRE BLVD	STE 612	LOS ANGELES	CA	90048	5215	19	06037	34.06329534	-118.3640031	Los Angeles County
180886	Fee-for-Service	1124560008	1124560008	1	1	LIU, YAJING PT	12/23/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	5730	27	06053	36.57482436	-121.8101797	Monterey County
180903	Fee-for-Service	1902167901	1902167901	1	1	LAZARUS, JENNY MD	2/12/2024	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	168579	None	None	0	In state provider	None	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	19	06037	34.13998921	-118.7070142	Los Angeles County
180905	Fee-for-Service	1689701807	1689701807	1	1	LAI, SANDY Y MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	67557	40	Pediatrics	0	In state provider	None	15725 WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
180913	Fee-for-Service	1710020755	1710020755	1	1	LONG BEACH - LAKEWOOD ORTHOP	11/15/1994	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	EDIC INSTITUTE	5750 DOWNEY AVE	STE 308	LAKEWOOD	CA	90712	1482	19	06037	33.859611	-118.1511435	Los Angeles County
180940	Fee-for-Service	1518074319	1518074319	1	1	LAWRENCE, JODY MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	81873	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	BLDG 30	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
180962	Fee-for-Service	1982374062	1982374062	1	1	LEE, JUHYEONG PT	5/24/2022	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	520 S. VIRGIL AVE	201	LOS ANGELES	CA	90020	1425	19	06037	34.064487	-118.2870305	Los Angeles County
180965	Fee-for-Service	1750396230	1750396230	1	1	LIFE CARE PHARMACY	10/28/2003	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	947 S ANAHEIM BLVD	STE 108	ANAHEIM	CA	92805	5583	30	06059	33.82164135	-117.909385	Orange County
180970	Fee-for-Service	1760779201	1760779201	1	1	LIN, VICTORIA MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134402	25	Physical Medicine and Rehabilitation	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
180977	Fee-for-Service	1265827752	1265827752	1	1	LANE, JESSICA R MD	6/7/2022	207T00000X	NA	General Surgery	026	PHYSICIANS	178025	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
180982	Fee-for-Service	1801004916	1801004916	1	1	LIU, HENG YEN CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	700 S WESTERN AVE	STE 201	LOS ANGELES	CA	90005	5114	19	06037	34.059456	-118.3090615	Los Angeles County
181038	Fee-for-Service	1346998945	1346998945	1	1	LAWSON, KYLIE NP	4/20/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	726 MEDICAL CENTER DR E	221	CLOVIS	CA	93611	6811	10	06019	36.84186593	-119.6624867	Fresno County
181051	Fee-for-Service	1053323626	1053323626	1	1	LEVY, HOWARD P MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	57370 29 PALMS HWY	None	YUCCA VALLEY	CA	92284	2900	36	06071	34.1240866	-116.4121506	San Bernardino County
181090	Fee-for-Service	1356877633	1356877633	1	1	LEYVA, ELENA LPCC	12/9/2021	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7365 CARNELIAN ST	STE 202	RANCHO CUCAMONGA	CA	91730	1100	36	06071	34.12038413	-117.6160525	San Bernardino County
181092	Fee-for-Service	1912583113	1912583113	1	1	LOTUS BLOOM HOSPICE INC	8/9/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	127 S BRAND BLVD	STE 211	GLENDALE	CA	91204	1372	19	06037	34.145289	-118.255096	Los Angeles County
181097	Fee-for-Service	1558637710	1558637710	1	1	LAN, VICTOR J MD	5/18/2020	207L00000X	NA	Other	026	PHYSICIANS	140484	05	Anesthesiology	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
181129	Fee-for-Service	1700084134	1700084134	1	1	LIANG, RUOMEI MD	5/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120883	08	Family Practice	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
181148	Fee-for-Service	1225062797	1225062797	1	1	LEACH, GARY E MD	1/1/1982	208800000X	NA	Other	026	PHYSICIANS	34675	34	Urology and Urological Surgery	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
181162	Fee-for-Service	1649379256	1649379256	1	1	LIANG, LORINDA CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	405 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1201	19	06037	34.066431	-118.122906	Los Angeles County
181221	Fee-for-Service	1447698477	1447698477	1	1	LINAREZ, MARIE R NP	1/4/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
181229	Fee-for-Service	1063054849	1063054849	1	1	LIFE HOME HEALTH SERVICES	2/26/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	17337 VENTURA BLVD	STE 304	ENCINO	CA	91316	4902	19	06037	34.16102943	-118.5108514	Los Angeles County
181242	Fee-for-Service	1578195954	1578195954	1	1	LUTTIK, TIMOTHY A PT	12/7/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3760 CONVOY STREET	100	SAN DIEGO	CA	92111	3743	37	06073	32.81197521	-117.1531278	San Diego County
181245	Fee-for-Service	1275620353	1275620353	1	1	LEE, THOMAS C MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87847	18	Ophthalmology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
181279	Fee-for-Service	1982236006	1982236006	1	1	LINDSTROM, DANIEL W PT	8/27/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
181281	Fee-for-Service	1275600132	1275600132	1	1	LIN, MARGARET T MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69219	36	Psychiatry	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
181283	Fee-for-Service	1003837386	1003837386	1	1	LIU, MARINE JEE-WUN MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70793	05	Anesthesiology	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
181290	Fee-for-Service	1710927272	1710927272	1	1	LEUNG, WAI K MD	10/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	80551	05	Anesthesiology	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
181300	Fee-for-Service	1033151840	1033151840	2	1	LONGS DRUG STORES CA LLC	12/8/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2973 STATE ST	None	SANTA BARBARA	CA	93105	3424	42	06083	34.44034254	-119.7278415	Santa Barbara County
181339	Fee-for-Service	1053323626	1053323626	1	1	LEVY, HOWARD P MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	57370 29 PALMS HWY	None	YUCCA VALLEY	CA	92284	2900	36	06071	34.1240866	-116.4121506	San Bernardino County
181341	Fee-for-Service	1568648608	1568648608	1	1	LEE, JOHN Y MD	1/31/2019	208800000X	NA	Other	026	PHYSICIANS	112929	34	Urology and Urological Surgery	0	In state provider	None	421 E MERCED AVE	None	WEST COVINA	CA	91790	5023	19	06037	34.05463589	-117.9377705	Los Angeles County
181360	Fee-for-Service	1770789604	1770789604	1	1	LIPTON, EDWARD H MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79152	66	Emergency Medicine (Urgent Care)	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
181405	Fee-for-Service	1609849074	1609849074	1	4	LA MAESTRA FAMILY CLINIC INC	5/2/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4189 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	0000	37	06073	32.7529672	-117.1007904	San Diego County
181413	Fee-for-Service	1891889127	1891889127	1	1	LINDBERG, GORDON K MD	3/30/2023	207RC0200X	NA	Other	026	PHYSICIANS	65676	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
181431	Fee-for-Service	1043356413	1043356413	1	1	LOWE, ELIZABETH H MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70427	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
181470	Fee-for-Service	1942305982	1942305982	1	1	LOVELL, TIMOTHY C MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61365	08	Family Practice	0	In state provider	None	310 SANTA FE DR	None	ENCINITAS	CA	92024	5110	37	06073	33.038406	-117.285354	San Diego County
181524	Fee-for-Service	1902824550	1902824550	1	1	LAKOWSKY, ALEXANDER MD	7/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86437	41	Internal Medicine	0	In state provider	None	1595 SOQUEL DR	None	SANTA CRUZ	CA	95065	1719	44	06087	36.98879599	-121.9826354	Santa Cruz County
181545	Fee-for-Service	1467956144	1467956144	1	1	LU, ALICIA MD	7/1/2022	207P00000X	NA	Other	026	PHYSICIANS	175513	None	None	0	In state provider	None	2825 CAPITOL AVENUE	None	SACRAMENTO	CA	95816	6039	34	06067	38.570805	-121.4696385	Sacramento County
181601	Fee-for-Service	1093125551	1093125551	1	1	LIFESTYLES FAMILY COUNSELING	9/11/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	AND CONSULTATION INC	8350 ARCHIBALD AVE	STE 100	RANCHO CUCAMONGA	CA	91730	3670	36	06071	34.10202623	-117.5935082	San Bernardino County
181610	Fee-for-Service	1598708851	1598708851	2	1	LONGS DRUG STORES CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3375 PLACER ST	None	REDDING	CA	96001	2364	45	06089	40.57486726	-122.4161885	Shasta County
181645	Fee-for-Service	1568778595	1568778595	1	1	LEUNG, TIFFANY OD	12/10/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	611 BROADWAY	None	SAN FRANCISCO	CA	94133	4405	38	06075	37.79779175	-122.4073064	San Francisco County
181674	Fee-for-Service	1477654408	1477654408	1	1	LEE, CHIEH J OD	11/14/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	SUPERVISION OPTOMETRY	1200 S SUNSET AVE	STE 1	WEST COVINA	CA	91790	3903	19	06037	34.06105293	-117.9463886	Los Angeles County
181687	Fee-for-Service	1609849074	1609849074	1	4	LA MAESTRA FAMILY CLINIC INC	5/2/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4189 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	0000	37	06073	32.7529672	-117.1007904	San Diego County
181743	Fee-for-Service	1356594675	1356594675	1	1	LE, KEVIN T MD	2/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	104086	41	Internal Medicine	0	In state provider	None	26732 CROWN VALLEY PKWY	STE 151	MISSION VIEJO	CA	92691	6337	30	06059	33.56347704	-117.66546	Orange County
181763	Fee-for-Service	1417193145	1417193145	1	1	LARSEN, MELISSA E MD INC	3/12/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	80218	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
181803	Fee-for-Service	1437469921	1437469921	1	1	LORENTZ, CLAUDIU C CRNA	9/13/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
181847	Fee-for-Service	1790865939	1790865939	1	1	LIN, FRITZ MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	43222	22	Pathology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
181883	Fee-for-Service	1043304280	1043304280	1	1	LIANG, KEITH MD	6/30/1994	193200000X	NA	Other	026	PHYSICIANS	69355	18	Ophthalmology	0	In state provider	None	2620 HURLEY WAY	STE C	SACRAMENTO	CA	95864	3789	34	06067	38.58822	-121.400838	Sacramento County
181892	Fee-for-Service	1144308909	1144308909	1	1	LI, MARCIA JOYCE MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70274	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
181913	Fee-for-Service	1598784340	1598784340	2	1	LIANG, HONG MD	9/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	66820	41	Internal Medicine	0	In state provider	None	3105 DEL MAR AVE	None	ROSEMEAD	CA	91770	2336	19	06037	34.06460204	-118.0995274	Los Angeles County
181960	Fee-for-Service	1922561588	1922561588	1	1	LEE, ALBERT L MD	7/6/2022	207P00000X	NA	Other	026	PHYSICIANS	176224	None	None	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
181990	Fee-for-Service	1386098309	1386098309	1	1	LEE, TRAVIS S MD	8/20/2020	207R00000X	NA	Other	026	PHYSICIANS	15912	41	Internal Medicine	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
181994	Fee-for-Service	1205850864	1205850864	1	1	LO, LARRY J MD	2/7/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	54156	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	447 W EATON AVE	None	TRACY	CA	95376	3420	39	06077	37.74338833	-121.432305	San Joaquin County
182029	Fee-for-Service	1447460977	1447460977	1	1	LOS ANGELES COUNTY	5/23/2007	No Taxonomy Provided	NA	None	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	DEPT OF HEALTH SERVICES	7601 E IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
182035	Fee-for-Service	1942642343	1942642343	1	1	LUCAS, LARISSA A LMFT	5/12/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2555 E. COLORADO BLVD	101	PASADENA	CA	91107	6617	19	06037	34.14612746	-118.0979505	Los Angeles County
182037	Fee-for-Service	1588026934	1588026934	1	1	LEASURE, ALEXANDER S MD	2/2/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158356	None	None	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
182044	Fee-for-Service	1164404307	1164404307	1	1	LABORATORY CORP OF AMERI	4/7/2005	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	LABORATORY CORP OF AMERI	19951 MARINER AVE	STE 175	TORRANCE	CA	90503	1739	19	06037	33.85129396	-118.3504889	Los Angeles County
182081	Fee-for-Service	1013495316	1013495316	1	1	LOVE HOME HEALTH AGENCY INC	9/18/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1554 S SEPULVEDA BLVD	STE 110A	LOS ANGELES	CA	90025	3334	19	06037	34.04932139	-118.4457323	Los Angeles County
182084	Fee-for-Service	1972511186	1972511186	1	1	LUCERO, DAVID M MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74961	08	Family Practice	0	In state provider	None	40971 WINCHESTER RD	None	TEMECULA	CA	92591	6031	33	06065	33.52537142	-117.1594672	Riverside County
182101	Fee-for-Service	1942520325	1942520325	1	1	LACEY ARMSTRONG	10/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
182107	Fee-for-Service	1902069453	1902069453	1	1	LU, ALYSIA T MD	1/27/2011	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	103618	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
182120	Fee-for-Service	1639103344	1639103344	1	1	LEONG, CRAIG J MD	9/30/1988	207W00000X	NA	Ophthalmology	026	PHYSICIANS	28041	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	1515 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3063	07	06013	37.91352028	-122.0431023	Contra Costa County
182147	Fee-for-Service	1093089047	1093089047	1	1	LINDSAY, JOY E LPCC	7/8/2019	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	406 E MAIN ST	#K	GRASS VALLEY	CA	95945	9561	29	06057	39.22143651	-121.0544352	Nevada County
182169	Fee-for-Service	1316933252	1316933252	1	1	LOISEAU, LESLY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SPOKANE AUDIOLOGY CLINIC	801 W 5TH SUITE 112	None	SPOKANE	WA	99204	0000	00	None	47.651175	-117.4235175	Spokane County
182174	Fee-for-Service	1740805050	1740805050	1	1	LANG, STEVEN PT	8/12/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2908 E WHITMORE AVE	STE E	CERES	CA	95307	2800	50	06099	37.59473048	-120.9412035	Stanislaus County
182188	Fee-for-Service	1679512347	1679512347	1	1	LARSON,JENNIFER MD	2/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1700 E 19TH ST	None	DALLES	OR	97058	0000	00	None	45.58806554	-121.164498	Wasco County
182265	Fee-for-Service	1831301399	1831301399	1	1	LOWE, HENRY J MD	8/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	50735	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
182267	Fee-for-Service	1407388564	1407388564	1	1	LEVERONE, NICHOLAS MD	7/9/2020	208M00000X	NA	Other	026	PHYSICIANS	159232	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
182280	Fee-for-Service	1740544980	1740544980	1	1	LIN, KATRINA J MD	11/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127014	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
182304	Fee-for-Service	1538620612	1538620612	1	1	LU, AMANDA J MD	5/31/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	180292	None	None	0	In state provider	None	1807 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5790	19	06037	34.03033333	-118.4846072	Los Angeles County
182311	Fee-for-Service	1265791529	1265791529	1	1	LEE, DAVID J DO	12/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12909	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
182333	Fee-for-Service	1770111049	1770111049	1	1	LEE, ALEXIS MD	8/12/2024	207L00000X	NA	Other	026	PHYSICIANS	186795	05	Anesthesiology	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
182340	Fee-for-Service	1457545154	1457545154	1	1	LANDIVAR, JENNIFER P LCSW	12/1/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2601 E MAIN STREET	None	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
182354	Fee-for-Service	1922687623	1922687623	1	1	LANCASTER, LIAN MD	10/11/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
182369	Fee-for-Service	1043224884	1043224884	1	1	LOHNE, JENNIFER OD	6/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8386	08	Family Practice	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
182371	Fee-for-Service	1972511186	1972511186	1	1	LUCERO, DAVID M MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74961	66	Emergency Medicine (Urgent Care)	0	In state provider	None	40971 WINCHESTER RD	None	TEMECULA	CA	92591	6031	33	06065	33.52537142	-117.1594672	Riverside County
182381	Fee-for-Service	1376073023	1376073023	1	1	LU, GEORGE M MD	7/1/2020	207R00000X	NA	Other	026	PHYSICIANS	167336	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
182389	Fee-for-Service	1629367891	1629367891	1	1	LUTHRA, NIJEE, S MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124217	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
182411	Fee-for-Service	1376561241	1376561241	1	1	LADNER, HEIDI E MD	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	82614	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
182439	Fee-for-Service	1609849074	1609849074	1	8	LA MAESTRA FAMILY CLINIC INC	5/2/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4179 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1609	37	06073	32.75273377	-117.1007972	San Diego County
182447	Fee-for-Service	1366577785	1366577785	1	1	LOUTIT, CARRIE W MD	2/28/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45931	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
182472	Fee-for-Service	1316026461	1316026461	1	1	LEE, GENE MD	11/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95439	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
182501	Fee-for-Service	1063693653	1063693653	1	1	LAGUNA-DANA URGENT CARE INC	5/9/2020	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	24060 CAMINO DEL AVION S	None	DANA POINT	CA	92629	4006	30	06059	33.48898379	-117.709133	Orange County
182540	Fee-for-Service	1700975976	1700975976	1	1	LIU, DAVID M MD	1/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56003	40	Pediatrics	0	In state provider	None	2201 SOUTH AVE	SUITE B	SOUTH LAKE TAHOE	CA	96150	7025	09	06017	38.91235444	-119.996422	El Dorado County
182619	Fee-for-Service	1871750604	1871750604	1	1	LOZANO, JUAN D MD	1/6/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	144652	30	Radiology	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
182632	Fee-for-Service	1912351420	1912351420	1	1	LEE, JAMIE DO	8/8/2022	390200000X	NA	Other	026	PHYSICIANS	19638	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
182659	Fee-for-Service	1043224884	1043224884	1	1	LOHNE, JENNIFER OD	6/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8386	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
182722	Fee-for-Service	1124472121	1124472121	1	1	LE, BRANDY N	9/27/2019	390200000X	NA	Other	026	PHYSICIANS	150970	40	Pediatrics	0	In state provider	None	25170 HANCOCK AVE	SUITE 200	MURRIETA	CA	92562	5969	33	06065	33.565149	-117.1823815	Riverside County
182729	Fee-for-Service	1609849074	1609849074	1	8	LA MAESTRA FAMILY CLINIC INC	5/2/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4179 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1609	37	06073	32.75273377	-117.1007972	San Diego County
182800	Fee-for-Service	1629078969	1629078969	1	1	LARNER, ALLAN I MD	8/8/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	28596	01	General Practice	0	In state provider	None	4270 LINDA VISTA DR	None	FALLBROOK	CA	92028	9494	37	06073	33.31447417	-117.2066734	San Diego County
182805	Fee-for-Service	1487652996	1487652996	1	1	LE, DAI B MD	2/17/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	167482	None	None	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
182807	Fee-for-Service	1831241801	1831241801	1	1	LIN, KAREN OD	1/3/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
182813	Fee-for-Service	1508416561	1508416561	1	1	LIEU, TIFFANY OD	12/19/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4200 CHINO HILLS PKWY	STE 390	CHINO HILLS	CA	91709	5825	36	06071	33.98274451	-117.7129305	San Bernardino County
182817	Fee-for-Service	1356503866	1356503866	1	1	LETTIERI, CHRISTINA K MD	1/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145682	68	Hematology	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
182830	Fee-for-Service	1700975976	1700975976	1	1	LIU, DAVID M MD	1/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56003	41	Internal Medicine	0	In state provider	None	2201 SOUTH AVE	SUITE B	SOUTH LAKE TAHOE	CA	96150	7025	09	06017	38.91235444	-119.996422	El Dorado County
182839	Fee-for-Service	1477581783	1477581783	1	1	LIN, MEI-LING CNP	12/6/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8850 VALLEY VIEW ST	None	BUENA PARK	CA	90620	3562	30	06059	33.833988	-118.0282915	Orange County
182851	Fee-for-Service	1942464136	1942464136	1	1	LATRONICA, CORNELIA G MD	12/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97290	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
182860	Fee-for-Service	1437619855	1437619855	1	1	LE, VINCENT P MD	7/1/2022	390200000X	NA	Other	026	PHYSICIANS	177772	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
182893	Fee-for-Service	1174059513	1174059513	1	1	LAKE FOREST HOSPICE	2/6/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	22772 CENTRE DRIVE	SUITE 200	LAKE FOREST	CA	92630	6303	30	06059	33.63155928	-117.7169152	Orange County
182904	Fee-for-Service	1003877002	1003877002	1	1	LITKOUHI, BABAK MD	2/20/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	160189	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
182907	Fee-for-Service	1457409674	1457409674	1	1	LOS ANGELES HEMATOLOGY/	8/14/2006	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	1245 WILSHIRE BLVD	STE 303	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
182946	Fee-for-Service	1952459265	1952459265	1	1	LIMBERG EYE SURGERY, INC	7/29/1996	193400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1270 PEACH ST	STE 100	SAN LUIS OBISPO	CA	93401	2856	40	06079	35.28673322	-120.6595429	San Luis Obispo County
182947	Fee-for-Service	1245272368	1245272368	1	1	LEWIS, NANCY C MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52148	40	Pediatrics	0	In state provider	None	1479 YGNACIO VALLEY RD	STE 208	WALNUT CREEK	CA	94598	2945	07	06013	37.91301169	-122.0438513	Contra Costa County
182952	Fee-for-Service	1134130651	1134130651	1	1	LEVINE, GAIL L MD	6/12/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65972	40	Pediatrics	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
182981	Fee-for-Service	1619562774	1619562774	1	1	LOPEZ, YURI C LPCC	7/22/2024	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
183005	Fee-for-Service	1508883422	1508883422	1	1	LAWRENCE MEMORIAL HOSP	5/1/2003	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	325 MAINE ST	None	LAWRENCE	KS	66044	1360	00	None	38.978937	-95.24835	Douglas County
183018	Fee-for-Service	1710017298	1710017298	1	1	LEE, MELODY Y N MD	7/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93242	08	Family Practice	0	In state provider	None	350 PARNASSUS AVE	None	SAN FRANCISCO	CA	94117	3608	38	06075	37.76403932	-122.4561371	San Francisco County
183024	Fee-for-Service	1760912588	1760912588	1	1	LE, HUY D MD	7/8/2022	207R00000X	NA	Other	026	PHYSICIANS	174066	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
183041	Fee-for-Service	1336976844	1336976844	1	1	LEE, MATTHEW PT	12/13/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
183042	Fee-for-Service	1508809377	1508809377	2	1	LONGS DRUG STORES CA LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	987 E HILLSDALE BLVD	None	FOSTER CITY	CA	94404	2112	41	06081	37.55686846	-122.273705	San Mateo County
183045	Fee-for-Service	1437313095	1437313095	1	1	LEE, JOE MD	10/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	100813	20	Orthopedic Surgery	0	In state provider	None	300 W HUNTINGTON DRIVE	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
183065	Fee-for-Service	1821435116	1821435116	1	1	LUBINSKY, WILLIAM DO	2/1/2024	207P00000X	NA	Other	026	PHYSICIANS	18720	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 MCDOWELL BLVD	None	PETALUMA	CA	94954	2339	49	06097	38.25477	-122.63175	Sonoma County
183066	Fee-for-Service	1932272903	1932272903	1	1	LOH, YU-PING N MD	3/1/1999	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	80840	30	Radiology	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
183080	Fee-for-Service	1508220906	1508220906	1	1	LUU, RANDY MD	3/15/2018	207R00000X	NA	Other	026	PHYSICIANS	152515	41	Internal Medicine	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
183098	Fee-for-Service	1396720041	1396720041	1	1	LAND, GARY A	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
183102	Fee-for-Service	1548551872	1548551872	1	1	LEATHERS, MICHAEL P MD	3/9/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	125586	02	General Surgery	0	In state provider	None	2800 L STREET	200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
183107	Fee-for-Service	1356503866	1356503866	1	1	LETTIERI, CHRISTINA K MD	1/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145682	78	Neoplastic Diseases/Oncology	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
183120	Fee-for-Service	1235373192	1235373192	1	1	LIU, YUEYI MD	7/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113397	30	Radiology	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
183170	Fee-for-Service	1063705309	1063705309	1	1	LIN, MICHAEL MD	9/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146844	01	General Practice	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
183183	Fee-for-Service	1174059513	1174059513	1	1	LAKE FOREST HOSPICE	2/6/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	22772 CENTRE DRIVE	SUITE 200	LAKE FOREST	CA	92630	6303	30	06059	33.63155928	-117.7169152	Orange County
183193	Fee-for-Service	1457409674	1457409674	1	1	LOS ANGELES HEMATOLOGY/	8/13/1991	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	1245 WILSHIRE BLVD	STE 303	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
183208	Fee-for-Service	1528357217	1528357217	1	1	LEE, MICHAEL MD	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133798	25	Physical Medicine and Rehabilitation	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
183234	Fee-for-Service	1245272368	1245272368	1	1	LEWIS, NANCY C MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52148	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1479 YGNACIO VALLEY RD	STE 208	WALNUT CREEK	CA	94598	2945	07	06013	37.91301169	-122.0438513	Contra Costa County
183240	Fee-for-Service	1134130651	1134130651	1	1	LEVINE, GAIL L MD	6/12/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65972	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
183245	Fee-for-Service	1780818161	1780818161	1	1	LIN, CHARLES C MD	5/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107705	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
183247	Fee-for-Service	1467417279	1467417279	1	1	LAURA JEAN COLLINS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
183273	Fee-for-Service	1922328111	1922328111	1	1	LU, JENNY MD	5/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120508	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
183285	Fee-for-Service	1346283512	1346283512	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	110 EAST STETSON AVE	None	HEMET	CA	92543	7139	33	06065	33.72940131	-116.9710489	Riverside County
183291	Fee-for-Service	1609501576	1609501576	1	1	LICHTERMAN, ANA J NP	10/19/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
183297	Fee-for-Service	1508883422	1508883422	1	1	LAWRENCE MEMORIAL HOSP	5/1/2003	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	325 MAINE ST	None	LAWRENCE	KS	66044	1360	00	None	38.978937	-95.24835	Douglas County
183301	Fee-for-Service	1194091165	1194091165	1	1	LEEPER, CONNIE C MD	11/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127011	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	122 E SAN ANTONIO DR	None	KING CITY	CA	93930	2518	27	06053	36.22193886	-121.1268537	Monterey County
183325	Fee-for-Service	1275807281	1275807281	1	1	LUO, JENNY MD	7/18/2017	390200000X	NA	Other	026	PHYSICIANS	148325	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
183345	Fee-for-Service	1649613712	1649613712	1	1	LIN, YIJIE MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149827	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
183352	Fee-for-Service	1285228056	1285228056	1	1	LOS ANGELES CARDIOVASCULAR C	4/27/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	None	None	0	In state provider	ARE	50 BELLEFONTAINE	301	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
183358	Fee-for-Service	1265503965	1265503965	1	1	LAI, JASON S MD	2/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	86130	34	Urology and Urological Surgery	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
183374	Fee-for-Service	1215140629	1215140629	1	1	LUDLOW, KIMBERLEY MD	10/25/2018	174400000X	NA	Other	026	PHYSICIANS	40146	01	General Practice	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
183391	Fee-for-Service	1548551872	1548551872	1	1	LEATHERS, MICHAEL P MD	3/9/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	125586	20	Orthopedic Surgery	0	In state provider	None	2800 L STREET	200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
183394	Fee-for-Service	1356503866	1356503866	1	1	LETTIERI, CHRISTINA K MD	1/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145682	40	Pediatrics	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
183395	Fee-for-Service	1700279411	1700279411	1	1	LEFEVRE, MARY LMFT	10/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
183398	Fee-for-Service	1790305167	1790305167	1	1	LOJI, CHELSEA	9/3/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	22416	36	Psychiatry	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
183407	Fee-for-Service	1538665864	1538665864	1	1	LEAN, ALEXA N MD	10/26/2022	207L00000X	NA	Other	026	PHYSICIANS	180324	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
183457	Fee-for-Service	1063705309	1063705309	1	1	LIN, MICHAEL MD	9/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146844	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
183493	Fee-for-Service	1710509807	1710509807	1	1	LUJAN, KIMBERLY H LMFT	8/28/2020	103TC1900X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18886 SANTA MARTA ST.	None	FOUNTAIN VALLEY	CA	92708	6230	30	06059	33.68837871	-117.9760462	Orange County
183532	Fee-for-Service	1174010219	1174010219	1	1	LIPINSKY DEGETTE, RAPHAELA	4/13/2021	390200000X	NA	Other	026	PHYSICIANS	165391	None	None	0	In state provider	MD	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
183545	Fee-for-Service	1598965568	1598965568	1	1	LAO, JIA OD	8/28/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1701 LUNDY AVE	STE 120	SAN JOSE	CA	95131	1860	43	06085	37.38788073	-121.8866632	Santa Clara County
183551	Fee-for-Service	1992811913	1992811913	1	1	LANDIS, RICHARD E PHD	1/15/2016	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1440 E CHAPMAN AVE	None	ORANGE	CA	92866	2221	30	06059	33.7877945	-117.83817	Orange County
183552	Fee-for-Service	1194537399	1194537399	1	1	LITTLEJOHN, KAYLA LCSW	4/14/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
183570	Fee-for-Service	1518073857	1518073857	1	1	LITTLE, ANNE E MD	2/1/1995	207R00000X	NA	Other	026	PHYSICIANS	81429	41	Internal Medicine	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
183576	Fee-for-Service	1447754940	1447754940	1	1	LIM, YOO WON MD	12/17/2021	207R00000X	NA	Other	026	PHYSICIANS	163729	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
183580	Fee-for-Service	1083253553	1083253553	1	1	LAMBERT HOME CARE LLC	8/6/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	8191 LAMBERT DRIVE	None	HUNTINGTON BEACH	CA	94647	4816	30	06059	33.7201044	-117.9858757	Orange County
183583	Fee-for-Service	1134870728	1134870728	1	1	LANE, SCOTT NP	1/4/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	301 VICTORIA STREET	None	COSTA MESA	CA	92627	1995	30	06059	33.65258952	-117.9121545	Orange County
183587	Fee-for-Service	1205879038	1205879038	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7241 BOULDER AVE	None	HIGHLAND	CA	92346	3347	36	06071	34.12227239	-117.1954006	San Bernardino County
183605	Fee-for-Service	1114293180	1114293180	1	1	LAI, CHEUK YIN MD	9/10/2021	207L00000X	NA	Other	026	PHYSICIANS	173813	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
183643	Fee-for-Service	1528519725	1528519725	1	1	LIMAN, ANDREW Y MD	5/8/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	165463	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
183645	Fee-for-Service	1619988292	1619988292	3	1	LUCKY HEALTH INC	9/15/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1108 S BALDWIN AVE	#8 & 9	ARCADIA	CA	91007	7508	19	06037	34.12728684	-118.0547427	Los Angeles County
183661	Fee-for-Service	1447933312	1447933312	1	1	L&G LABORATORY INC	12/18/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	14546 HAMLIN ST	UNIT 110	VAN NUYS	CA	91411	1629	19	06037	34.18866762	-118.4504031	Los Angeles County
183717	Fee-for-Service	1023026838	1023026838	1	1	LOGAN, JAMES NORMAN MD	5/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41625	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
183747	Fee-for-Service	1063705309	1063705309	1	1	LIN, MICHAEL MD	9/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146844	10	Gastroenterology (M.D. only)	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
183778	Fee-for-Service	1205937133	1205937133	1	1	LA, ANDREW C	5/1/2001	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1510 S CENTRAL AVE	STE 120	GLENDALE	CA	91204	2576	19	06037	34.12709764	-118.2577911	Los Angeles County
183838	Fee-for-Service	1952344210	1952344210	2	1	LONGS DRUG STORES	12/2/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA LLC	649 W OLIVE AVENUE	None	MERCED	CA	95348	2424	24	06047	37.31940051	-120.4796855	Merced County
183880	Fee-for-Service	1417935776	1417935776	1	1	LAYTE, THOMAS M LCSW	6/13/1999	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	VICES	3094 W RAMSEY ST	None	BANNING	CA	92220	3724	33	06065	33.92559782	-116.9101711	Riverside County
183891	Fee-for-Service	1679516421	1679516421	2	1	LONGS DRUG STORES CALIFORNIA	12/15/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1005 SUTTON WAY	None	GRASS VALLEY	CA	95945	5182	29	06057	39.23669778	-121.0339943	Nevada County
183900	Fee-for-Service	1033481593	1033481593	1	1	LOPEZ, MATTHEW J MD	7/1/2017	207P00000X	NA	Other	026	PHYSICIANS	148590	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7500 HOSPITAL DRIVE	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
183911	Fee-for-Service	1295887024	1295887024	2	1	LA LIBERTAD MEDICAL	7/1/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CLINIC INC	8225 LONG BEACH BLVD	STE C	SOUTH GATE	CA	90280	2010	19	06037	33.96371607	-118.2251842	Los Angeles County
183928	Fee-for-Service	1922530526	1922530526	1	1	LEE, TREVOR G MD	3/8/2022	207R00000X	NA	Other	026	PHYSICIANS	169919	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
183931	Fee-for-Service	1427136050	1427136050	1	1	LEONG, MARKUS T MD	11/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81198	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
183954	Fee-for-Service	1962174532	1962174532	1	1	LOTTO, SAMANTHA N PT	11/30/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
183957	Fee-for-Service	1962567958	1962567958	1	1	LAWRENCE, SHELLEY M MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131290	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
183965	Fee-for-Service	1043292444	1043292444	1	1	LIPINSKI, CHRISTOPHER A MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141880	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
183993	Fee-for-Service	1710928999	1710928999	1	1	LO, ROBERT MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71003	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
184000	Fee-for-Service	1124300207	1124300207	1	4	LIVINGSTON COMMUNITY HEALTH	12/1/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2116 EAST ORANGEBURG AVE	None	MODESTO	CA	95355	3370	50	06099	37.66354152	-120.958056	Stanislaus County
184005	Fee-for-Service	1023026838	1023026838	1	1	LOGAN, JAMES NORMAN MD	5/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41625	41	Internal Medicine	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
184032	Fee-for-Service	1457635120	1457635120	1	1	LJMP LP	1/15/2012	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	44726 CERISA STREET	None	LANCASTER	CA	93535	1705	19	06037	34.696017	-118.0842535	Los Angeles County
184041	Fee-for-Service	1013057561	1013057561	1	1	LEE, DAMIEN BENNETT MD	12/1/1998	207P00000X	NA	Other	026	PHYSICIANS	66354	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
184068	Fee-for-Service	1427091958	1427091958	1	1	LIM, GERALD U MD	12/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90080	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
184153	Fee-for-Service	1114099157	1114099157	1	1	LEONARD, KALI J OD	12/6/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	421 PIONEER AVE	STE B	WOODLAND	CA	95776	4948	57	06113	38.6759259	-121.7468988	Yolo County
184157	Fee-for-Service	1508094723	1508094723	1	1	LE, DUNGNGHI N MD	4/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116172	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
184162	Fee-for-Service	1134105497	1134105497	1	1	LEOS CATALINA DRUG STORE INC	10/22/2004	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	401 CRESCENT AVE	None	AVALON	CA	90704	1543	19	06037	33.34380805	-118.3258585	Los Angeles County
184176	Fee-for-Service	1598868549	1598868549	1	1	LIM, ARNOLD K DO	10/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	9349	20	Orthopedic Surgery	0	In state provider	None	6501 COYLE AVENUE	None	CARMICHAEL	CA	95608	6337	34	06067	38.669562	-121.31379	Sacramento County
184184	Fee-for-Service	1225212244	1225212244	1	1	LUNA, ESPERANZA S LCSW	10/7/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
184217	Fee-for-Service	1770016354	1770016354	1	1	LAWRENCE, MADELYN MD	11/10/2023	207P00000X	NA	Other	026	PHYSICIANS	190094	None	None	0	In state provider	None	347 ANDRIEUX ST	None	SONOMA	CA	95476	6811	49	06097	38.28843573	-122.4651035	Sonoma County
184246	Fee-for-Service	1962567958	1962567958	1	1	LAWRENCE, SHELLEY M MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131290	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
184249	Fee-for-Service	1447519350	1447519350	1	1	LI, DAVID MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129341	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
184260	Fee-for-Service	1639174899	1639174899	1	1	LOPEZ, RACHAEL L MD	3/1/2000	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	61814	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	24411 HEALTH CENTER DR	STE 640	LAGUNA HILLS	CA	92653	3633	30	06059	33.6087201	-117.7076948	Orange County
184265	Fee-for-Service	1932257862	1932257862	1	1	LEMM, MICHAEL D DPM	7/6/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	250 TRAVELODGE DRIVE	None	EL CAJON	CA	92020	4126	37	06073	32.79312432	-116.980275	San Diego County
184276	Fee-for-Service	1215938188	1215938188	1	1	LEHMKUHL, RACHEL J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 JAMES SIMPSON JR WA	None	COVINGTON	KY	41011	0801	00	None	39.0715176	-84.51775131	Kenton County
184287	Fee-for-Service	1124300207	1124300207	1	4	LIVINGSTON COMMUNITY HEALTH	4/20/2023	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2116 EAST ORANGEBURG AVE	None	MODESTO	CA	95355	3370	50	06099	37.66354152	-120.958056	Stanislaus County
184308	Fee-for-Service	1861835928	1861835928	1	1	LEE, LISA Q MD	5/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143073	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
184311	Fee-for-Service	1407417934	1407417934	1	1	LAING, JACQUELYN R CCC-SLP	3/23/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MEDICAL PLAZA	STE 550	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
184316	Fee-for-Service	1881175891	1881175891	1	1	LO, HOPE NP	4/1/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3751 E SHIELDS AVE	None	FRESNO	CA	93726	0000	10	06019	36.7796958	-119.7618088	Fresno County
184400	Fee-for-Service	1275644130	1275644130	1	1	LOOK, KELLY A MD	10/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72882	40	Pediatrics	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
184417	Fee-for-Service	1023898566	1023898566	1	1	LAZO, MAYRA C OD	2/13/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6765 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91606	1696	19	06037	34.19368795	-118.3878213	Los Angeles County
184438	Fee-for-Service	1861435125	1861435125	2	1	LONGS DRUG STORES CA LLC	12/2/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	691 3RD AVE	None	CHULA VISTA	CA	91910	5703	37	06073	32.62788873	-117.0746104	San Diego County
184440	Fee-for-Service	1427140482	1427140482	1	1	LIN, IRENE MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64706	08	Family Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
184477	Fee-for-Service	1144211665	1144211665	1	1	LAU, BENJAMIN C MD	1/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	60654	25	Physical Medicine and Rehabilitation	0	In state provider	None	4306 GEARY BLVD	STE 201	SAN FRANCISCO	CA	94118	3067	38	06075	37.78104545	-122.4655475	San Francisco County
184545	Fee-for-Service	1699112136	1699112136	1	1	LAM, LUKE MD	11/9/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	132694	None	None	0	In state provider	None	506 W VALLEY BLVD	None	SAN GABRIEL	CA	91776	3731	19	06037	34.07936003	-118.1070139	Los Angeles County
184568	Fee-for-Service	1306879549	1306879549	1	1	LA ROCQUE, MICHAEL A MD	2/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	34614	34	Urology and Urological Surgery	0	In state provider	None	215 S HICKORY ST	STE 114	ESCONDIDO	CA	92025	4360	37	06073	33.12335985	-117.0753842	San Diego County
184575	Fee-for-Service	1124300207	1124300207	1	4	LIVINGSTON COMMUNITY HEALTH	12/1/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2116 EAST ORANGEBURG AVE	None	MODESTO	CA	95355	3370	50	06099	37.66354152	-120.958056	Stanislaus County
184595	Fee-for-Service	1750449856	1750449856	1	1	LOH, IRVING K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	26812	None	None	0	In state provider	None	2230 LYNN RD	STE 320	THOUSAND OAKS	CA	91360	1973	56	06111	34.20894685	-118.885185	Ventura County
184645	Fee-for-Service	1649490657	1649490657	1	1	LUISA A ORRICO, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7435 W TALCOTT AVE	None	CHICAGO	IL	60631	0000	00	None	41.98844808	-87.81251188	Cook County
184654	Fee-for-Service	1952356917	1952356917	1	1	LE, HOA T MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69089	41	Internal Medicine	0	In state provider	None	100 S ELLSWORTH AVE	STE 308	SAN MATEO	CA	94401	3931	41	06081	37.56665635	-122.3247743	San Mateo County
184711	Fee-for-Service	1841531159	1841531159	1	1	LOZANO MARTHA E MD INC	2/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	48551	41	Internal Medicine	0	In state provider	None	841 KUHN DR	STE 200	CHULA VISTA	CA	91914	4523	37	06073	32.65289649	-116.9665862	San Diego County
184718	Fee-for-Service	1235543943	1235543943	1	1	LYMAN, DANIEL T DO	2/10/2020	207P00000X	NA	Other	026	PHYSICIANS	17388	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
184751	Fee-for-Service	1801556618	1801556618	1	1	LANGHANS, HESSENA P LPCC	6/9/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
184767	Fee-for-Service	1871799486	1871799486	1	1	LU, BINA S MD	6/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	95250	41	Internal Medicine	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
184812	Fee-for-Service	1760434963	1760434963	2	1	LEE, JOSEPH W JR MD	5/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	43266	05	Anesthesiology	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
184824	Fee-for-Service	1952812844	1952812844	1	1	LIKE FAMILY HOME HEALTH CARE	12/13/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	269 W ALAMEDA AVE	None	BURBANK	CA	91502	2520	19	06037	34.16723083	-118.3075057	Los Angeles County
184864	Fee-for-Service	1124300207	1124300207	1	4	LIVINGSTON COMMUNITY HEALTH	6/15/2023	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2116 EAST ORANGEBURG AVE	None	MODESTO	CA	95355	3370	50	06099	37.66354152	-120.958056	Stanislaus County
184918	Fee-for-Service	1932526688	1932526688	1	1	LA CRESCENTA HOSPICE CARE	2/3/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3130 FOOTHILL BLVD	SUITE 11	LA CRESCENTA	CA	91214	4220	19	06037	34.22879124	-118.247468	Los Angeles County
184928	Fee-for-Service	1396185799	1396185799	1	1	LEE, ANNE OD	6/4/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9333 E ROSECRANS AVE	None	BELLFLOWER	CA	90706	2141	19	06037	33.90413858	-118.1346616	Los Angeles County
184960	Fee-for-Service	1518987833	1518987833	1	1	LEE, IN SOO MD INC	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	29341	05	Anesthesiology	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
184965	Fee-for-Service	1801231576	1801231576	1	1	LIU, BO MD	10/19/2021	2085R0204X	NA	Other	026	PHYSICIANS	165579	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
184982	Fee-for-Service	1760790349	1760790349	1	1	LEE, SCOTT I MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121741	20	Orthopedic Surgery	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
185001	Fee-for-Service	1841531159	1841531159	1	1	LOZANO MARTHA E MD INC	2/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	48551	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	841 KUHN DR	STE 200	CHULA VISTA	CA	91914	4523	37	06073	32.65289649	-116.9665862	San Diego County
185016	Fee-for-Service	1407971906	1407971906	1	1	LI, JIELI MD	1/8/2008	207R00000X	NA	Other	026	PHYSICIANS	92012	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
185020	Fee-for-Service	1679691703	1679691703	1	1	LIFE SPIRIT SPEECH PATHOLOGY	9/4/2015	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	26284 OSO ROAD	STE 114	SAN JUAN CAPISTRA	CA	92675	1629	30	06059	33.5155829	-117.6717393	Orange County
185046	Fee-for-Service	1548286958	1548286958	1	1	LEICHTER, RHODA FAY MD	2/8/2015	2086S0129X	NA	General Surgery	026	PHYSICIANS	68230	None	None	0	In state provider	None	8631 W 3RD ST	STE 940E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
185082	Fee-for-Service	1609459353	1609459353	1	1	LEE, MICHELLE MD	7/30/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
185107	Fee-for-Service	1457758294	1457758294	1	1	LYNN-HELFRICH, SARAH E	7/18/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	18700 BEACH BLVD	STE 120	HUNTINGTON BEACH	CA	92648	2030	30	06059	33.69070037	-117.9886896	Orange County
185176	Fee-for-Service	1144778838	1144778838	1	1	LOPEZ, MARIA	9/27/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 NORTH BEGONIA AVE.	SUITE 1009	ONTARIO	CA	91762	4274	36	06071	34.076493	-117.672147	San Bernardino County
185184	Fee-for-Service	1598111387	1598111387	1	1	LIN, MICHAEL MD	12/15/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	174873	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
185192	Fee-for-Service	1902936768	1902936768	1	1	LE, TINA MD	5/7/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	182979	36	Psychiatry	0	In state provider	None	75 ROWLAND WAY	SUITE 200	NOVATO	CA	94945	5037	21	06041	38.09501878	-122.5589434	Marin County
185202	Fee-for-Service	1285879106	1285879106	1	1	LAQUEY, LAURIE J LMFT	6/14/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	9024 SNIKTAW LN	None	FORT JONES	CA	96032	9408	47	06093	41.59983924	-122.9748122	Siskiyou County
185203	Fee-for-Service	1508885856	1508885856	1	1	LOPEZ, JUAN M MD	7/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80785	None	None	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
185204	Fee-for-Service	1932526688	1932526688	1	1	LA CRESCENTA HOSPICE CARE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3130 FOOTHILL BLVD	SUITE 11	LA CRESCENTA	CA	91214	4220	19	06037	34.22879124	-118.247468	Los Angeles County
185260	Fee-for-Service	1639254956	1639254956	1	1	LEVY, SCOTT C MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90816	01	General Practice	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
185287	Fee-for-Service	1841531159	1841531159	1	1	LOZANO MARTHA E MD INC	2/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	48551	66	Emergency Medicine (Urgent Care)	0	In state provider	None	841 KUHN DR	STE 200	CHULA VISTA	CA	91914	4523	37	06073	32.65289649	-116.9665862	San Diego County
185319	Fee-for-Service	1659691723	1659691723	1	1	LONGMIRE, MICHELLE R MD	9/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119812	07	Dermatology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
185345	Fee-for-Service	1134659311	1134659311	1	1	LI, YI-XIAN PSYD	9/15/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
185394	Fee-for-Service	1437348695	1437348695	1	1	LIU, SONIA Y MD	12/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101704	08	Family Practice	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
185422	Fee-for-Service	1659696508	1659696508	1	1	LO, DIANA P MD	10/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130970	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
185478	Fee-for-Service	1962672790	1962672790	1	1	LE, NHIEN M DO	12/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13026	01	General Practice	0	In state provider	None	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
185486	Fee-for-Service	1497105951	1497105951	1	1	LEE, PAUL J MD	10/29/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165295	08	Family Practice	0	In state provider	None	12550 HESPERIA RD	SUITE 100	VICTORVILLE	CA	92395	5873	36	06071	34.47928534	-117.2909553	San Bernardino County
185513	Fee-for-Service	1346998788	1346998788	1	1	LAVALLEE, JENNA LCSW	3/12/2025	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11408 BEECHNUT ST	None	VENTURA	CA	93004	4341	56	06111	34.29458276	-119.1522889	Ventura County
185528	Fee-for-Service	1881973675	1881973675	1	1	LUNA, JACOB LMFT	3/26/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	4825 SPEAK LN	None	SAN JOSE	CA	95118	3769	43	06085	37.2616948	-121.8796109	Santa Clara County
185531	Fee-for-Service	1942290762	1942290762	1	1	LE, SON H MD	12/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	42423	41	Internal Medicine	0	In state provider	None	9143 VALLEY BLVD	SUITE 101A	ROSEMEAD	CA	91770	1991	19	06037	34.08096534	-118.0700742	Los Angeles County
185559	Fee-for-Service	1922417369	1922417369	1	1	LACHINI, JENNIFER M LMFT	5/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
185568	Fee-for-Service	1053374611	1053374611	2	1	LOEFFLER, ANN MD	9/5/2023	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	79609	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
185576	Fee-for-Service	1568624906	1568624906	1	1	LEE, LISA LCSW	3/28/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
185585	Fee-for-Service	1063567592	1063567592	1	1	LOS ANGELES COUNTY CCS	10/15/1993	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	NORWALK MTU	14821 JERSEY AVE	None	NORWALK	CA	90650	5850	19	06037	33.89587651	-118.0869747	Los Angeles County
185600	Fee-for-Service	1245710391	1245710391	1	1	LUM, SALINA V CNP	6/30/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
185635	Fee-for-Service	1457543241	1457543241	1	1	LANE, RONDALL K MD	4/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81415	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	FL 3	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
185662	Fee-for-Service	1841386141	1841386141	1	1	LAM, ANSELM O MD	9/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	31127	08	Family Practice	0	In state provider	None	1520 STOCKTON STREET	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
185683	Fee-for-Service	1538319785	1538319785	1	1	LOOMIS UNION SCHOOL DIST	7/24/2007	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	3290 HUMPHREY ROAD	None	LOOMIS	CA	95650	9043	31	06061	38.83069567	-121.2010447	Placer County
185700	Fee-for-Service	1619038247	1619038247	1	1	LAKE CUMBERLAND REG HOSPITAL	1/17/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	305 LANGDON ST	None	SOMERSET	KY	42503	2750	00	None	37.08527351	-84.61986749	Pulaski County
185703	Fee-for-Service	1174831614	1174831614	1	1	LEVY, ADI LMFT	10/24/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
185726	Fee-for-Service	1598880577	1598880577	1	1	LICHTENSTEIN, GREGG A MD	7/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	44467	08	Family Practice	0	In state provider	None	5500 CAMPANILE DR	None	SAN DIEGO	CA	92182	4701	37	06073	32.77590585	-117.0722922	San Diego County
185762	Fee-for-Service	1134171754	1134171754	1	1	LIN, ANGELA MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80222	22	Pathology (M.D. only)	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
185771	Fee-for-Service	1598059651	1598059651	1	1	LYNCH, ALLISON M MD	6/2/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	146262	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
185778	Fee-for-Service	1306382726	1306382726	1	2	LEY, MARYKATHRINE NP	5/1/2017	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6403 COYLE AVE	SUITE 450	CARMICHAEL	CA	95608	0361	34	06067	38.668347	-121.3148745	Sacramento County
185787	Fee-for-Service	1487026415	1487026415	1	1	LINKE, SARAH E PHD	1/8/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
185804	Fee-for-Service	1588711709	1588711709	1	1	LOBO, CAROLYN M MD	8/8/1997	208600000X	NA	General Surgery	026	PHYSICIANS	63239	02	General Surgery	0	In state provider	None	1617 CANYON DR	STE 102	PINOLE	CA	94564	2134	07	06013	37.99537501	-122.3019132	Contra Costa County
185807	Fee-for-Service	1508899493	1508899493	1	1	LIM, JOHN C MD	6/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	52785	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3465 TORRANCE BLVD	SUITE S	TORRANCE	CA	90503	5804	19	06037	33.83763045	-118.346256	Los Angeles County
185871	Fee-for-Service	1013617703	1013617703	1	1	LOS ANGELES COUNTY DEPARTMEN	12/30/2024	193200000X	NA	Other	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CE	9320 TELSTAR AVE	200	EL MONTE	CA	91731	2816	19	06037	34.06878549	-118.066401	Los Angeles County
185873	Fee-for-Service	1902057565	1902057565	1	1	LATIMER, JENNIFER L LCSW	10/18/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
185881	Fee-for-Service	1033784442	1033784442	1	1	LIU, FAN MD	11/12/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191671	08	Family Practice	0	In state provider	None	3612 DALE RD	None	MODESTO	CA	95356	0500	50	06099	37.69097901	-121.0498748	Stanislaus County
185912	Fee-for-Service	1346478617	1346478617	1	1	LIBRIZZI, JAMIE L MD	8/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS ROAD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
185916	Fee-for-Service	1972893204	1972893204	1	1	LEE, DAVID S MD	7/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125174	07	Dermatology	0	In state provider	None	1450 SAN PABLO STREET	SUITE 2000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
185938	Fee-for-Service	1114912888	1114912888	1	1	LAURIE M MCCORMICK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	0000	00	None	41.659929	-91.548099	Johnson County
185940	Fee-for-Service	1124199542	1124199542	3	1	LAMONT HEALTHCARE INC	3/19/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10400 MAIN STREET	D	LAMONT	CA	93241	1727	15	06029	35.260929	-118.9145165	Kern County
185952	Fee-for-Service	1043226897	1043226897	1	1	LEPEJIAN, GARINE A MD	9/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84666	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	9761	20	06039	36.88437894	-119.8003484	Madera County
185960	Fee-for-Service	1427585108	1427585108	1	1	LOO, STEVEN DO	12/16/2021	207L00000X	NA	Other	026	PHYSICIANS	16947	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
185986	Fee-for-Service	1922309012	1922309012	1	1	LCTC INCORPORATED	2/25/2013	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	5084 N FRUIT AVE	STE 105	FRESNO	CA	93711	3000	10	06019	36.80974919	-119.8173837	Fresno County
186072	Fee-for-Service	1740540236	1740540236	1	1	LEMMA, KEWAKEBT M MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136478	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
186088	Fee-for-Service	1033184973	1033184973	1	1	LITTENBERG, GLENN MD	7/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	27849	10	Gastroenterology (M.D. only)	0	In state provider	None	10 CONGRESS ST	STE 201	PASADENA	CA	91105	3023	19	06037	34.13396893	-118.1528162	Los Angeles County
186159	Fee-for-Service	1457414856	1457414856	1	1	LUCERO, PETER MD	6/30/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	41993	13	Neurology (M.D. only)	0	In state provider	LOS ANGELES MEDICAL CTR	679 S WESTLAKE AVE	None	LOS ANGELES	CA	90057	3505	19	06037	34.05635295	-118.2754139	Los Angeles County
186172	Fee-for-Service	1609842079	1609842079	1	1	LEE, THOMAS C MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64595	41	Internal Medicine	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
186180	Fee-for-Service	1386919850	1386919850	1	1	LANDOLIN, CHELSEA S NP	2/10/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
186196	Fee-for-Service	1437326691	1437326691	1	1	LAUBACH, JUSTIN E MD	2/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114432	05	Anesthesiology	0	In state provider	None	555 E VALLEY PARKWAY	None	ESCONDIDO	CA	92025	9468	37	06073	33.12542915	-117.0764725	San Diego County
186222	Fee-for-Service	1609280940	1609280940	1	1	LIM, KHIN SANDAR MD	9/9/2019	207R00000X	NA	Other	026	PHYSICIANS	148532	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
186230	Fee-for-Service	1548209711	1548209711	1	1	LAUGHLIN, ROBERT L MD	12/4/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	36927	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
186247	Fee-for-Service	1932193760	1932193760	1	1	LIEU, CHERYL L MD	3/8/1995	207L00000X	NA	Other	026	PHYSICIANS	74287	05	Anesthesiology	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
186258	Fee-for-Service	1740821156	1740821156	1	1	LOWE, JAMIE T PT	3/9/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
186268	Fee-for-Service	1366178964	1366178964	1	1	LOPEZ, DANIELLE CNP	8/26/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
186270	Fee-for-Service	1043367832	1043367832	1	1	LO, ANDY L P MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116640	22	Pathology (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
186271	Fee-for-Service	1083782494	1083782494	1	1	LEE, THOMAS C MD	11/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80328	None	None	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
186279	Fee-for-Service	1043328818	1043328818	1	1	LIN, CHUEN-FU MD	10/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108935	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
186289	Fee-for-Service	1184798159	1184798159	1	1	LIU, KATRINA R MD	5/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	55738	40	Pediatrics	0	In state provider	None	1520 STOCKTON STREET	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
186355	Fee-for-Service	1649205543	1649205543	1	1	LIPSHUTZ, GERALD S MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	81326	01	General Practice	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
186384	Fee-for-Service	1669886545	1669886545	1	1	LONGFELLOW, WILLIAM H MD	10/6/2022	207R00000X	NA	Other	026	PHYSICIANS	169852	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
186418	Fee-for-Service	1841359684	1841359684	1	1	LEE, MICHAEL L OD	1/2/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	748 SACRAMENTO ST	None	SAN FRANCISCO	CA	94108	2505	38	06075	37.79350993	-122.4055036	San Francisco County
186435	Fee-for-Service	1659769107	1659769107	1	1	LI, ZHI MD	2/27/2022	207R00000X	NA	Other	026	PHYSICIANS	174759	None	None	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
186449	Fee-for-Service	1457414856	1457414856	1	1	LUCERO, PETER MD	6/30/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	41993	40	Pediatrics	0	In state provider	LOS ANGELES MEDICAL CTR	679 S WESTLAKE AVE	None	LOS ANGELES	CA	90057	3505	19	06037	34.05635295	-118.2754139	Los Angeles County
186460	Fee-for-Service	1578534590	1578534590	1	1	LITTMAN, MARSHALL J MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	36620	40	Pediatrics	0	In state provider	None	1001 E GRAND AVE	None	ESCONDIDO	CA	92025	4604	37	06073	33.12634291	-117.0682058	San Diego County
186476	Fee-for-Service	1215218995	1215218995	1	1	LIMURTI, JOYCE DO	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11935	41	Internal Medicine	0	In state provider	None	8510 BALBOA BLVD	STE 150	NORTHRIDGE	CA	91325	5810	19	06037	34.224507	-118.5026015	Los Angeles County
186485	Fee-for-Service	1376173245	1376173245	1	1	LI, STEPHENIE PT	12/4/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
186494	Fee-for-Service	1568451110	1568451110	1	1	LLOYD, RICHARD L MD	10/25/2018	207R00000X	NA	Other	026	PHYSICIANS	16365	01	General Practice	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
186514	Fee-for-Service	1548209711	1548209711	1	1	LAUGHLIN, ROBERT L MD	12/4/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	36927	41	Internal Medicine	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
186548	Fee-for-Service	1356050272	1356050272	1	1	LOCKWOOD, ELLERY J OT	2/16/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	805 AEROVISTA PL	SUITE 101	SAN LUIS OBISPO	CA	93401	7919	40	06079	35.24101691	-120.643055	San Luis Obispo County
186562	Fee-for-Service	1487884607	1487884607	1	1	LEE, JASON H MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113696	20	Orthopedic Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
186591	Fee-for-Service	1457535346	1457535346	1	1	LESSEN, AARON Y. MD	7/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
186606	Fee-for-Service	1962693168	1962693168	1	1	LEE, PAUL S MD	2/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121837	04	Otology, Laryngology, Rhinology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
186607	Fee-for-Service	1053870410	1053870410	1	1	LUTZEIER, KATHARINE E	8/9/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7090 MIRATECH DR	None	SAN DIEGO	CA	92121	3109	37	06073	32.89821825	-117.1711874	San Diego County
186626	Fee-for-Service	1346878501	1346878501	1	1	LAI, PETER Y MD	10/24/2023	207R00000X	NA	Other	026	PHYSICIANS	182702	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
186637	Fee-for-Service	1790911394	1790911394	1	1	LUCAS, DONALD J MD	9/1/2021	2086S0120X	NA	General Surgery	026	PHYSICIANS	156613	None	None	0	In state provider	None	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
186638	Fee-for-Service	1376964668	1376964668	1	1	LAFOLLETTE, ANITA M LMFT	7/2/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	132 LELAND ST	None	SANTA ROSA	CA	95404	4030	49	06097	38.445525	-122.7031155	Sonoma County
186653	Fee-for-Service	1538301171	1538301171	1	1	LIN, DANA T MD	5/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118251	01	General Practice	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
186676	Fee-for-Service	1346929619	1346929619	1	1	LEACH, BRONC NP	12/1/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
186688	Fee-for-Service	1740661297	1740661297	1	1	LAU, KAREN LCSW	4/21/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD ROAD	STE 140	PLEASANTON	CA	94566	8528	01	06001	37.683009	-121.9036935	Alameda County
186721	Fee-for-Service	1003279860	1003279860	1	1	LALCHANDANI, GOPAL R MD	9/19/2022	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	152165	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
186727	Fee-for-Service	1013204759	1013204759	1	1	LEE, RURI R MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141287	30	Radiology	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
186732	Fee-for-Service	1851433544	1851433544	1	1	LIU, WEILING PSYD	9/26/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
186742	Fee-for-Service	1396771739	1396771739	1	1	LUBMAN, RICHARD L MD	12/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70389	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
186766	Fee-for-Service	1154471969	1154471969	1	1	LAZARUS, LYNNE J MD	4/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93964	08	Family Practice	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
186776	Fee-for-Service	1285975060	1285975060	1	1	LIVE WELL MEDICAL CENTER INC	12/16/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	515 MICHIGAN BLVD	None	WEST SACRAMENTO	CA	95691	2705	57	06113	38.58298316	-121.5265736	Yolo County
186831	Fee-for-Service	1336600535	1336600535	1	1	LO, NATHAN MD	8/22/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	178776	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
186870	Fee-for-Service	1932155165	1932155165	1	1	LOMA LINDA UNIV PHYS	6/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL GRP, INC.	11234 ANDERSON ST	STE 1405	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
186887	Fee-for-Service	1225561608	1225561608	1	1	LARSEN, JILLIAN P MD	7/29/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	170174	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
186937	Fee-for-Service	1396925822	1396925822	1	1	LOEWY, RACHEL L PHD	5/23/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
186941	Fee-for-Service	1538301171	1538301171	1	1	LIN, DANA T MD	5/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118251	67	Endocrinology	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
186954	Fee-for-Service	1942520077	1942520077	1	1	LAPAN, YELENA DO	10/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11844	01	General Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
187053	Fee-for-Service	1700082864	1700082864	1	1	LEAHY, KATHERINE LMFT	3/9/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	135 E. THIRD AVE.	STE. B	ESCONDIDO	CA	92025	4252	37	06073	33.12022391	-117.0793824	San Diego County
187078	Fee-for-Service	1962109033	1962109033	1	5	LOS ANGELES COUNTY DEPARTMEN	2/8/2024	261QP0905X	NA	Other	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	NTER	5205 MELROSE AVE	None	LOS ANGELES	CA	90038	3144	19	06037	34.08354051	-118.314009	Los Angeles County
187112	Fee-for-Service	1982966925	1982966925	1	1	LIN, YIHAN MD	7/5/2022	208G00000X	NA	General Surgery	026	PHYSICIANS	179703	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
187125	Fee-for-Service	1144585514	1144585514	1	1	LASH, JEREMY W MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135005	41	Internal Medicine	0	In state provider	None	317 W PUEBLO STREET	None	SANTA BARBARA	CA	93105	4310	42	06083	34.42967671	-119.7228362	Santa Barbara County
187143	Fee-for-Service	1376655696	1376655696	1	1	LUIG, TIINA MD	1/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80545	08	Family Practice	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
187156	Fee-for-Service	1902023831	1902023831	1	1	LUU, MARTIN T MD	3/15/2022	207ZP0102X	NA	Other	026	PHYSICIANS	113542	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
187184	Fee-for-Service	1043487226	1043487226	1	1	LAUER, RYAN E MD	2/26/2009	207L00000X	NA	Other	026	PHYSICIANS	89580	05	Anesthesiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
187241	Fee-for-Service	1942520077	1942520077	1	1	LAPAN, YELENA DO	10/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11844	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
187259	Fee-for-Service	1770507709	1770507709	1	1	LIN, CALVIN C	8/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92616	40	Pediatrics	0	In state provider	None	2438 N PONDEROSA DRIVE	SUITE C 209	CAMARILLO	CA	93010	2369	56	06111	34.24219545	-119.0227012	Ventura County
187262	Fee-for-Service	1518050608	1518050608	1	1	LAZARUS, PETER S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
187274	Fee-for-Service	1235340308	1235340308	1	1	LIM, DAVID MD	10/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96161	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
187294	Fee-for-Service	1053684555	1053684555	1	1	LA PAZ REGIONAL HOSPITAL INC	6/12/2014	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	1200 W MOHAVE RD	None	PARKER	AZ	85344	6349	00	None	34.13580083	-114.2842352	La Paz County
187317	Fee-for-Service	1548243389	1548243389	1	1	LEVY, MARK MD	6/4/2007	207T00000X	NA	General Surgery	026	PHYSICIANS	85330	13	Neurology (M.D. only)	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
187320	Fee-for-Service	1649307638	1649307638	1	1	LIANG, SCOTT MD INC	5/11/2011	207R00000X	NA	Other	026	PHYSICIANS	86197	None	None	0	In state provider	None	900 S 1ST AVENUE	STE G	ARCADIA	CA	91006	3919	19	06037	34.13024371	-118.028126	Los Angeles County
187335	Fee-for-Service	1861780835	1861780835	1	1	LOY, GILLIAN E LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
187353	Fee-for-Service	1255406252	1255406252	1	1	LEE, THOMAS W MD INC	11/1/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	930 E FOOTHILL BLVD	STE 2	UPLAND	CA	91786	4051	36	06071	34.10687051	-117.6387075	San Bernardino County
187361	Fee-for-Service	1750401824	1750401824	1	1	LODISH, MAYA B MD	6/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155103	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
187363	Fee-for-Service	1437192226	1437192226	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	600 W MAIN ST	None	SANTA PAULA	CA	93060	3124	56	06111	34.343667	-119.080557	Ventura County
187365	Fee-for-Service	1396817193	1396817193	1	3	LOS ALAMITOS OB GYN MEDICAL	7/27/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	6917	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	GROUP INC	8615 KNOTT	5	BUENA PARK	CA	90620	3841	30	06059	33.83765695	-118.0111408	Orange County
187376	Fee-for-Service	1629455167	1629455167	1	1	LEE, PATRICK J MD	9/23/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	148805	18	Ophthalmology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
187388	Fee-for-Service	1295354413	1295354413	1	1	LOCKE, LAUREN T MD	11/4/2024	207L00000X	NA	Other	026	PHYSICIANS	190350	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
187391	Fee-for-Service	1962579862	1962579862	1	1	LAU, RICHARD C MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	30629	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
187401	Fee-for-Service	1902215999	1902215999	1	1	LUO LIM, ALICIA M NP	2/1/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
187438	Fee-for-Service	1548562150	1548562150	1	1	LITTLE HOUSE	7/26/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	9718 HARVARD ST	None	BELLFLOWER	CA	90706	3635	19	06037	33.88840012	-118.1268132	Los Angeles County
187451	Fee-for-Service	1356716708	1356716708	1	1	LONGEUAY, DAVID J	3/16/2016	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	3855 E LA PALMA AVE	SUITE 116	ANAHEIM	CA	92807	1721	30	06059	33.85575977	-117.834261	Orange County
187467	Fee-for-Service	1588920979	1588920979	1	1	LIN, YI MD	10/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127471	01	General Practice	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
187505	Fee-for-Service	1487219358	1487219358	1	1	LEDIG, ROXANA A MD	9/16/2022	207R00000X	NA	Other	026	PHYSICIANS	178541	None	None	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
187509	Fee-for-Service	1043342330	1043342330	1	1	LINDLEY, DONNA L LMFT	7/17/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29748 RANCHO CALIFORNIA	RD	TEMECULA	CA	92591	5286	33	06065	33.50662849	-117.1428887	Riverside County
187530	Fee-for-Service	1073614079	1073614079	1	1	LEE, JAE H MD	9/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90775	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
187566	Fee-for-Service	1962633982	1962633982	1	1	LAGUNA, ALICIA LMFT	5/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	801 CRESCENT WAY	SUITE.#3	ARCATA	CA	95521	6781	12	06023	40.85906241	-124.0735719	Humboldt County
187579	Fee-for-Service	1053684555	1053684555	1	1	LA PAZ REGIONAL HOSPITAL INC	6/12/2014	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	1200 W MOHAVE RD	None	PARKER	AZ	85344	6349	00	None	34.13580083	-114.2842352	La Paz County
187582	Fee-for-Service	1295892925	1295892925	1	1	LONG, ISRAEL R	9/21/2005	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2530 PROFESSIONAL PKWY	None	SANTA MARIA	CA	93455	1602	42	06083	34.91417616	-120.4383527	Santa Barbara County
187584	Fee-for-Service	1902841166	1902841166	1	1	LYN, KYAW MD	4/20/2009	207R00000X	NA	Other	026	PHYSICIANS	54425	47	Miscellaneous	0	In state provider	None	1740 W CAMERON AVE	STE 110	WEST COVINA	CA	91790	2719	19	06037	34.07030019	-117.9445341	Los Angeles County
187599	Fee-for-Service	1285612291	1285612291	1	1	LOREMAN,LORIE DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3811 E BELL RD# 110	None	PHOENIX	AZ	85032	0000	00	None	33.639732	-111.998763	Maricopa County
187627	Fee-for-Service	1295933190	1295933190	1	1	LOWRY, DEBRA M MD	7/26/2022	2086S0102X	NA	General Surgery	026	PHYSICIANS	171263	None	None	0	In state provider	None	2335 E KASHIAN LANE	STE 220	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
187650	Fee-for-Service	1750401824	1750401824	1	1	LODISH, MAYA B MD	6/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155103	67	Endocrinology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
187664	Fee-for-Service	1528095049	1528095049	1	1	LA JOLLA CARDIOVASCULAR	5/1/1982	174400000X	NA	Other	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	BUEHLER, DONALD L MD	9850 GENESEE AVE	STE 560	LA JOLLA	CA	92037	1229	37	06073	32.882913	-117.226341	San Diego County
187672	Fee-for-Service	1710959259	1710959259	1	1	L E C HOME CARE MEDICAL	12/1/1997	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	CATALASAN, LEONARDO V	10732 LOS VAQUEROS CIR	None	LOS ALAMITOS	CA	90720	2515	30	06059	33.80835486	-118.0594443	Orange County
187696	Fee-for-Service	1245629039	1245629039	1	1	LAVISTA CONGREGATE LIVING	4/12/2017	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7805 CLEARFIELD AVE	None	PANORAMA CITY	CA	91402	6509	19	06037	34.21174323	-118.4349438	Los Angeles County
187704	Fee-for-Service	1649345646	1649345646	1	1	LUCILE SALTER PACKARD	6/9/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CHILD. HOSP AT STANFORD	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
187745	Fee-for-Service	1326721473	1326721473	1	1	LLOYD, DINA M NP	11/22/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	75 ROWLAND WAY	230	NOVATO	CA	94945	5037	21	06041	38.09501878	-122.5589434	Marin County
187762	Fee-for-Service	1780811281	1780811281	1	1	LEE, ANITA L O OD	11/20/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1290 HAMNER AVE	None	NORCO	CA	92860	3117	33	06065	33.901182	-117.5648715	Riverside County
187768	Fee-for-Service	1487650412	1487650412	1	1	LIN, YUAN H MD	4/30/1994	208600000X	NA	General Surgery	026	PHYSICIANS	43050	33	Thoracic Surgery	0	In state provider	None	765 MEDICAL CENTER CT	STE 216	CHULA VISTA	CA	91911	6600	37	06073	32.619069	-117.020835	San Diego County
187772	Fee-for-Service	1356008379	1356008379	1	1	LEE, SHANAE K LPCC	10/22/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27412 ENTERPRISE CIR W	STE. 205	TEMECULA	CA	92590	4875	33	06065	33.51594134	-117.1669025	Riverside County
187820	Fee-for-Service	1427217876	1427217876	1	1	LIN, GRACE H MD	11/30/2009	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	108359	30	Radiology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
187847	Fee-for-Service	1538320395	1538320395	1	1	LAVERTY, CHAMINDRA G MD	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	101351	None	None	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
187898	Fee-for-Service	1508200874	1508200874	1	1	LYMAN, MATTHEW T	1/8/2019	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
187907	Fee-for-Service	1063534865	1063534865	1	1	LOWE, MARY M LMFT	5/24/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	36473	-	NOT APPLICABLE	0	In state provider	None	704 MILL ST	None	LOYALTON	CA	96118	0265	46	06091	39.67395553	-120.241026	Sierra County
187935	Fee-for-Service	1184266389	1184266389	1	1	LEMOS, CYNTHIA R OT	7/10/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
187950	Fee-for-Service	1992880652	1992880652	1	1	LEVINSON, DAVID H MD	10/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	48149	41	Internal Medicine	0	In state provider	None	1515 FRUITVALE AVE	None	OAKLAND	CA	94601	2322	01	06001	37.77910723	-122.2251233	Alameda County
187951	Fee-for-Service	1528095049	1528095049	1	1	LA JOLLA CARDIOVASCULAR	5/1/1982	174400000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	BUEHLER, DONALD L MD	9850 GENESEE AVE	STE 560	LA JOLLA	CA	92037	1229	37	06073	32.882913	-117.226341	San Diego County
187989	Fee-for-Service	1639162076	1639162076	1	1	LEE, FANNY OD	8/25/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1558 PLAZA DR	None	WEST COVINA	CA	91790	2829	19	06037	34.06975752	-117.9277234	Los Angeles County
188035	Fee-for-Service	1326093758	1326093758	1	1	LAURIE L HILYER MD	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	389 S 900 E	None	SALT LAKE CTY	UT	84102	2310	00	None	40.761207	-111.865313	Salt Lake County
188056	Fee-for-Service	1487650412	1487650412	1	1	LIN, YUAN H MD	4/30/1994	208600000X	NA	General Surgery	026	PHYSICIANS	43050	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	765 MEDICAL CENTER CT	STE 216	CHULA VISTA	CA	91911	6600	37	06073	32.619069	-117.020835	San Diego County
188076	Fee-for-Service	1285615864	1285615864	1	1	LEON, MALLORY M DO	3/4/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	7476	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
188078	Fee-for-Service	1891739249	1891739249	2	1	LONGS DRUG STORES CA LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9120 ALCOSTA BLVD	None	SAN RAMON	CA	94583	3863	07	06013	37.7296915	-121.9314352	Contra Costa County
188115	Fee-for-Service	1104045749	1104045749	1	1	LABORATORY CORP OF AMERI	12/24/2001	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	LABORATORY CORP OF AMERI	13112 EVENING CREEK DR S	# 300	SAN DIEGO	CA	92128	4108	37	06073	32.95589602	-117.0983666	San Diego County
188120	Fee-for-Service	1437259223	1437259223	1	1	LOEB, ROBERT G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
188128	Fee-for-Service	1053354845	1053354845	2	1	LONGS DRUG STORES CA LLC	7/29/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1700 MCHENRY AVE	None	MODESTO	CA	95350	4310	50	06099	37.668681	-120.991734	Stanislaus County
188135	Fee-for-Service	1427649318	1427649318	1	1	LIBERTY, LESLIE S LCSW	8/7/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1981 CHEROKEE RD	None	STOCKTON	CA	95205	2720	39	06077	37.97936569	-121.2634936	San Joaquin County
188136	Fee-for-Service	1720171507	1720171507	1	1	LEUTE, ERIC J MD	10/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80832	08	Family Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
188145	Fee-for-Service	1245761766	1245761766	1	1	LOW, ERIC E	5/10/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	160707	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
188153	Fee-for-Service	1447382023	1447382023	1	1	LENTZ, AMELIA A CRNA	4/20/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
188158	Fee-for-Service	1699969477	1699969477	1	1	LOPEZ, AILEEN J MD	2/7/2012	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	118113	08	Family Practice	0	In state provider	None	12586 AVENUE 408	None	OROSI	CA	93647	9454	54	06107	36.53030229	-119.2915122	Tulare County
188189	Fee-for-Service	1649255282	1649255282	1	1	LEE, GREGORY W MD	6/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54517	08	Family Practice	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
188194	Fee-for-Service	1902240229	1902240229	1	1	LIM, FREDDY MD	3/29/2020	207R00000X	NA	Other	026	PHYSICIANS	144043	41	Internal Medicine	0	In state provider	None	4070 E. OLYMPIC BLVD	None	LOS ANGELES	CA	90023	3332	19	06037	34.01885853	-118.186938	Los Angeles County
188221	Fee-for-Service	1316979602	1316979602	1	1	LEE, ERIN M MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65587	40	Pediatrics	0	In state provider	None	27400 HESPERIN BLVD	None	HAYWARD	CA	94545	0000	01	06001	37.63011596	-122.0960694	Alameda County
188267	Fee-for-Service	1154583250	1154583250	1	1	LUCY ELIZABETH HANSEN, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CITY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
188275	Fee-for-Service	1366504680	1366504680	1	1	LEONG, CHRISTINE P OD	9/30/1992	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
188294	Fee-for-Service	1245761717	1245761717	1	1	LIBUIT, ERIN S MD	9/8/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	159578	None	None	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
188306	Fee-for-Service	1013351550	1013351550	1	1	LUCKETT, ANDREW J MD	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137210	01	General Practice	0	In state provider	None	3883 AIRWAY DR	STE 202	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
188310	Fee-for-Service	1528293826	1528293826	1	1	LIN, NANCY MD	11/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121575	41	Internal Medicine	0	In state provider	None	1600 E CITRUS AVE	STE A	REDLANDS	CA	92374	4802	36	06071	34.05557272	-117.1468659	San Bernardino County
188314	Fee-for-Service	1437319761	1437319761	1	1	LEE, JIN P MD	10/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104296	08	Family Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
188320	Fee-for-Service	1922319979	1922319979	1	1	LUNA, LICIA L LMFT	9/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
188401	Fee-for-Service	1235132580	1235132580	1	1	LAW, DAVID MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	45477	13	Neurology (M.D. only)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
188417	Fee-for-Service	1073509030	1073509030	1	1	LLOYD, RICHARD E MD	9/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	34902	78	Neoplastic Diseases/Oncology	0	In state provider	None	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3404	30	06059	33.89344341	-117.9338865	Orange County
188464	Fee-for-Service	1750498267	1750498267	1	1	LEON, REBECCA A MD	11/30/1989	207R00000X	NA	Other	026	PHYSICIANS	68038	01	General Practice	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
188468	Fee-for-Service	1659399582	1659399582	1	1	LOZINSKI, GRACE M MD	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77966	41	Internal Medicine	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
188512	Fee-for-Service	1679762074	1679762074	1	1	LEE, GINA Y MD	5/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103864	18	Ophthalmology	0	In state provider	None	100 STEIN PLAZA	STE 1-340	LOS ANGELES	CA	90095	0001	19	06037	34.06489065	-118.4443287	Los Angeles County
188527	Fee-for-Service	1467128561	1467128561	1	1	LUXOR HOME HEALTH INC	5/11/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	15600 DEVONSHIRE ST	STE 214	GRANADA HILLS	CA	91344	7252	19	06037	34.25730352	-118.473084	Los Angeles County
188544	Fee-for-Service	1093945578	1093945578	1	1	LOMA LINDA UNIVERSITY	6/28/2010	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	RADIATION MEDICINE INC	81 S HIGHLAND SPRINGS AV	None	BEAUMONT	CA	92223	2511	33	06065	33.919204	-116.9467869	Riverside County
188575	Fee-for-Service	1922757814	1922757814	1	1	LOPEZ, AMANDA A MD	2/12/2025	208M00000X	NA	Other	026	PHYSICIANS	189848	41	Internal Medicine	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
188577	Fee-for-Service	1578639993	1578639993	1	1	LAU, RONALD D MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	37542	41	Internal Medicine	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
188580	Fee-for-Service	1558395244	1558395244	1	1	LEE, STEVE P MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	71943	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	STE 120	LOS ANGELES	CA	90024	1234	19	06037	34.06527974	-118.4462792	Los Angeles County
188600	Fee-for-Service	1629123823	1629123823	1	1	LA VIDA-KPC	11/28/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	MEDICAL GROUP INC	1045 W REDONDO BEACH BLV	None	GARDENA	CA	90247	4128	19	06037	33.89247044	-118.2931941	Los Angeles County
188631	Fee-for-Service	1538454277	1538454277	1	1	LEE, LING NP	12/21/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	767 N HILL ST	STE 200	LOS ANGELES	CA	90012	2365	19	06037	34.06255157	-118.2397077	Los Angeles County
188691	Fee-for-Service	1235132580	1235132580	1	1	LAW, DAVID MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	45477	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
188703	Fee-for-Service	1073509030	1073509030	1	1	LLOYD, RICHARD E MD	9/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	34902	68	Hematology	0	In state provider	None	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3404	30	06059	33.89344341	-117.9338865	Orange County
188704	Fee-for-Service	1982776787	1982776787	1	1	LEVAN, ROBERT T MD	9/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75958	08	Family Practice	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
188711	Fee-for-Service	1417093105	1417093105	1	1	LATINO COMMISSION ON ALCOHOL	12/22/2014	193200000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	AND DRUG ABUSE SERVICES	1001 SNEATH LANE	SUITE 210	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
188732	Fee-for-Service	1356886642	1356886642	1	1	LIN, MICHELLE MD	1/8/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	180199	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
188746	Fee-for-Service	1932828860	1932828860	1	1	LONDON, ROBIN LMFT	11/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8740 PUEBLO AVE	SUITE 205	ATASCADERO	CA	93422	4604	40	06079	35.4798192	-120.6591944	San Luis Obispo County
188752	Fee-for-Service	1750498267	1750498267	1	1	LEON, REBECCA A MD	11/30/1989	207R00000X	NA	Other	026	PHYSICIANS	68038	41	Internal Medicine	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
188771	Fee-for-Service	1629021704	1629021704	1	1	LEBOVITS, MARC J MD	7/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	30908	04	Otology, Laryngology, Rhinology	0	In state provider	None	2023 W VISTA WAY	STE J	VISTA	CA	92083	6030	37	06073	33.18569169	-117.2846332	San Diego County
188795	Fee-for-Service	1841514403	1841514403	1	1	LEUNG, CHERYL S MD	6/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110585	01	General Practice	0	In state provider	None	1000 FRANKLIN PKWY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
188822	Fee-for-Service	1780962043	1780962043	1	1	LANDA, ALLISON M LMFT	9/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
188830	Fee-for-Service	1750386801	1750386801	1	1	LERNER, DIEGO F MD	1/1/2000	2084P0800X	NA	Psychiatry	026	PHYSICIANS	73218	None	None	0	In state provider	None	24050 MADISON STREET	205	TORRANCE	CA	90505	6015	19	06037	33.80594851	-118.348558	Los Angeles County
188837	Fee-for-Service	1093945578	1093945578	1	1	LOMA LINDA UNIVERSITY	6/28/2010	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	RADIATION MEDICINE INC	81 S HIGHLAND SPRINGS AV	None	BEAUMONT	CA	92223	2511	33	06065	33.919204	-116.9467869	Riverside County
188854	Fee-for-Service	1114993813	1114993813	1	1	LALCHANDANI, RAM MD	4/13/1994	207RH0003X	NA	Oncology	026	PHYSICIANS	45543	41	Internal Medicine	0	In state provider	None	6401 COYLE AVE	STE 410	CARMICHAEL	CA	95608	0310	34	06067	38.668698	-121.3148745	Sacramento County
188860	Fee-for-Service	1508515396	1508515396	1	1	LASLOVICH, JESSICA M CRNA	6/12/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
188864	Fee-for-Service	1588754931	1588754931	1	1	LEVINE, S DUBE, D MD	6/1/1986	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2100 WEBSTER ST	STE 427	SAN FRANCISCO	CA	94115	2380	38	06075	37.7904826	-122.4324477	San Francisco County
188868	Fee-for-Service	1578639993	1578639993	1	1	LAU, RONALD D MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	37542	30	Radiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
188893	Fee-for-Service	1982608444	1982608444	1	1	LEUNG,MELISSA	6/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 E 149TH STREET	None	BRONX	NY	10451	5504	00	None	40.817538	-73.9240965	Bronx County
188939	Fee-for-Service	1619401031	1619401031	1	1	LOMAX, JERICA M DO	10/26/2021	390200000X	NA	Other	026	PHYSICIANS	18953	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
188978	Fee-for-Service	1275597718	1275597718	1	1	LAUDERT, SUSAN E MD	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	87674	40	Pediatrics	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
188984	Fee-for-Service	1629267117	1629267117	1	1	LINER, ROBERT I MD	5/31/1986	174400000X	NA	Other	026	PHYSICIANS	21240	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1180 GUERRERO ST	None	SAN FRANCISCO	CA	94110	2933	38	06075	37.7522657	-122.4229243	San Francisco County
188990	Fee-for-Service	1356880983	1356880983	1	1	LEWIS, JENNIFER W MD	8/31/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	147238	None	None	0	In state provider	None	2185 CITRACADA PARKWAY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
189003	Fee-for-Service	1851346100	1851346100	1	1	LEE, SANG H MD	6/30/2014	207RH0003X	NA	Oncology	026	PHYSICIANS	33164	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 JOSE FIGUERES AVE	STE 430	SAN JOSE	CA	95116	1593	43	06085	37.36122014	-121.8505998	Santa Clara County
189018	Fee-for-Service	1386640092	1386640092	1	1	LOVELL, DIANE M MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74619	30	Radiology	0	In state provider	None	6600 MADISON AVE	STE 11	CARMICHAEL	CA	95608	0645	34	06067	38.663028	-121.310271	Sacramento County
189022	Fee-for-Service	1134391295	1134391295	1	1	LEE, ANNIE C MD	10/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116507	18	Ophthalmology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
189038	Fee-for-Service	1740268523	1740268523	1	1	LE, QUANG T MD	1/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97920	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2623 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	19	06037	33.98921547	-118.2242565	Los Angeles County
189080	Fee-for-Service	1508854225	1508854225	1	1	LEKKOS, APOSTOLOS A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 N MACARTHUR BLVD	None	IRVING	TX	75061	2220	00	None	32.834691	-96.95924802	Dallas County
189100	Fee-for-Service	1639738529	1639738529	1	1	LEE, ERIK DO	3/24/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	2007 WILSHIRE BLVD	FL 3, 1A	LOS ANGELES	CA	90057	3519	19	06037	34.05752718	-118.2749855	Los Angeles County
189104	Fee-for-Service	1184146151	1184146151	1	1	LIVERS, ANYEA CCC-SLP	4/17/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	527 23RD AVE	204	OAKLAND	CA	94606	5346	01	06001	37.77531381	-122.2362499	Alameda County
189128	Fee-for-Service	1770937021	1770937021	1	1	LEVY, JUSTIN K MD	9/2/2022	207R00000X	NA	Other	026	PHYSICIANS	144311	None	None	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
189143	Fee-for-Service	1306207212	1306207212	1	1	LU, THANH TRUC T MD	8/6/2019	208M00000X	NA	Other	026	PHYSICIANS	161146	41	Internal Medicine	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
189148	Fee-for-Service	1366079782	1366079782	1	1	LOVIO, MARISSA MD	5/3/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	184977	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
189152	Fee-for-Service	1629154281	1629154281	1	1	LISA BAILEY & ASSOCIATES	1/25/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	3300 WEBSTER ST	STE 212	OAKLAND	CA	94609	3120	01	06001	37.82132826	-122.2621843	Alameda County
189155	Fee-for-Service	1427183672	1427183672	1	1	LONGAKER, MICHAEL T MD	3/31/1994	208200000X	NA	General Surgery	026	PHYSICIANS	57362	24	Plastic Surgery	0	In state provider	None	10833 LE CONTE AVE	RM 64140	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
189173	Fee-for-Service	1285006874	1285006874	1	1	LE, ANN N OD	11/21/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	82227 US HIGHWAY 111	STE B2	INDIO	CA	92201	5668	33	06065	33.71471443	-116.2312195	Riverside County
189213	Fee-for-Service	1275591554	1275591554	1	1	LO, WANDA LIZA MD	6/30/1986	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45357	40	Pediatrics	0	In state provider	None	2238 BAYVIEW HEIGHTS DR	None	LOS OSOS	CA	93402	3921	40	06079	35.31038553	-120.8334714	San Luis Obispo County
189242	Fee-for-Service	1386600211	1386600211	1	1	LEVITT, LEE J MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	46155	01	General Practice	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
189254	Fee-for-Service	1841278348	1841278348	1	1	LOTT, SUSAN A MD	2/28/1991	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	61609	30	Radiology	0	In state provider	None	969 PLUMAS ST	STE 101	YUBA CITY	CA	95991	4011	51	06101	39.14263634	-121.6176593	Sutter County
189280	Fee-for-Service	1255444535	1255444535	1	1	LARSON, DAVID D MD	6/21/2000	207L00000X	NA	Other	026	PHYSICIANS	55863	05	Anesthesiology	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
189292	Fee-for-Service	1851346100	1851346100	1	1	LEE, SANG H MD	6/30/2014	207RH0003X	NA	Oncology	026	PHYSICIANS	33164	68	Hematology	0	In state provider	None	200 JOSE FIGUERES AVE	STE 430	SAN JOSE	CA	95116	1593	43	06085	37.36122014	-121.8505998	Santa Clara County
189310	Fee-for-Service	1831254754	1831254754	1	1	LYNSTEB INC	3/1/1995	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	WORLD TRANSPORTATION SVS	18422 GAULT ST	None	RESEDA	CA	91335	4315	19	06037	34.19927151	-118.5342615	Los Angeles County
189312	Fee-for-Service	1871648055	1871648055	1	1	LASSEN COUNTY BEHAVIORAL	2/4/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 CHESTNUT STREET	SUITES A & B	SUSANVILLE	CA	96130	3777	18	06035	40.4239334	-120.649295	Lassen County
189321	Fee-for-Service	1801187786	1801187786	1	1	LOUIE, MICHAEL DO	12/12/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	12788	36	Psychiatry	0	In state provider	None	1101 BRYAN AVE	STE E	TUSTIN	CA	92780	4401	30	06059	33.74272355	-117.8149529	Orange County
189372	Fee-for-Service	1407087091	1407087091	1	1	LOPEZ, JANET A LMFT	9/16/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
189380	Fee-for-Service	1366939274	1366939274	1	1	LIU, JESSICA MD	8/9/2021	2086S0120X	NA	General Surgery	026	PHYSICIANS	165702	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
189388	Fee-for-Service	1184817785	1184817785	1	1	LEATHERS, LANDON S LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
189402	Fee-for-Service	1992116263	1992116263	1	1	LAJIN, MICHAEL MD INC	6/27/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	8860 CENTER DRIVE	SUITE 330	LA MESA	CA	91942	7001	37	06073	32.78189749	-117.0075062	San Diego County
189441	Fee-for-Service	1538399746	1538399746	1	1	LOTT, YESENIA LCSW	3/24/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
189446	Fee-for-Service	1598740391	1598740391	1	1	LI, SU-TING T MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84363	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
189470	Fee-for-Service	1497870844	1497870844	1	1	LEE, SONHO MD	11/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87891	40	Pediatrics	0	In state provider	None	18321 CLARK STREET	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
189472	Fee-for-Service	1669475273	1669475273	2	1	LICHT, AMNON MD	3/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	32682	41	Internal Medicine	0	In state provider	None	9808 VENICE BLVD	SUITE 706	CULVER CITY	CA	90232	6827	19	06037	34.0236396	-118.3980847	Los Angeles County
189503	Fee-for-Service	1194577379	1194577379	1	1	LOS ANGELES PHARMACY LLC	5/9/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2405 N BROADWAY	None	LOS ANGELES	CA	90031	2218	19	06037	34.07365023	-118.216762	Los Angeles County
189510	Fee-for-Service	1972684348	1972684348	1	1	LYNCH, CHARLES T MD	12/31/1992	207RN0300X	NA	Nephrology	026	PHYSICIANS	43429	None	None	0	In state provider	STE 202	2100 WEBSTER ST	None	SAN FRANCISCO	CA	94115	2373	38	06075	37.7904826	-122.4324477	San Francisco County
189520	Fee-for-Service	1538454392	1538454392	1	1	LEE, RICHARD H DO	11/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	12434	01	General Practice	0	In state provider	None	3460 KATELLA AVENUE	None	LOS ALAMITOS	CA	90720	2334	30	06059	33.8029707	-118.073517	Orange County
189557	Fee-for-Service	1881637650	1881637650	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14830 HIGHWAY 4	None	BYRON	CA	94505	2236	07	06013	37.88948849	-121.6220895	Contra Costa County
189627	Fee-for-Service	1205132628	1205132628	1	1	LEVY, MYA E MD	6/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114065	34	Urology and Urological Surgery	0	In state provider	None	19950 RINALDI STREET	None	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
189646	Fee-for-Service	1083938591	1083938591	1	1	LONDON, EMILY A LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
189651	Fee-for-Service	1245477280	1245477280	1	1	LEE, JEROME MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114709	25	Physical Medicine and Rehabilitation	0	In state provider	None	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
189659	Fee-for-Service	1013698208	1013698208	1	1	LEVI, LEESHY CRNA	10/22/2024	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
189673	Fee-for-Service	1033260203	1033260203	1	1	LIBERMAN, ALAN L	2/28/1994	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	QUALITY OPTICAL	14210 PALM DR	# A2	DESERT HOT SPRING	CA	92240	6873	33	06065	33.94544616	-116.5011825	Riverside County
189695	Fee-for-Service	1760828438	1760828438	1	1	LEE, HYUN D MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136209	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
189699	Fee-for-Service	1326127069	1326127069	1	1	LE, HA QUI MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63534	41	Internal Medicine	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
189716	Fee-for-Service	1730348251	1730348251	1	1	LIN, JONATHAN H MD	6/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87892	22	Pathology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
189738	Fee-for-Service	1710041421	1710041421	1	1	LEE, SOO M	1/24/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
189778	Fee-for-Service	1588043970	1588043970	1	1	LAM, ANDY W MD	10/4/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145756	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
189808	Fee-for-Service	1669542841	1669542841	1	1	LENT, GRETCHEN S MD	4/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	101115	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
189821	Fee-for-Service	1174621320	1174621320	1	3	LOUWRENS, NEIL A MD	1/26/2021	207R00000X	NA	Other	026	PHYSICIANS	52662	41	Internal Medicine	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
189840	Fee-for-Service	1578531570	1578531570	2	1	LAUFER, MARLA MD	11/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
189872	Fee-for-Service	1689200313	1689200313	1	1	LUNDIN-CRITTENDEN, ROXANNE A	4/26/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	583 SUMMERFIELD RD	None	SANTA ROSA	CA	95405	5239	49	06097	38.45268	-122.672088	Sonoma County
189885	Fee-for-Service	1396777264	1396777264	1	1	LINFOOT, PETER A MD	11/30/1992	207RE0101X	NA	Endocrinology	026	PHYSICIANS	71944	08	Family Practice	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
189889	Fee-for-Service	1659502136	1659502136	1	1	LOBANA, SONYA MD	2/28/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	121247	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
189898	Fee-for-Service	1457428427	1457428427	1	4	LONIKA'S HOME, INC	7/3/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LONIKA HOME MINOS	25622 MINOS ST	None	MISSION VIEJO	CA	92691	4659	30	06059	33.60256355	-117.6830803	Orange County
189911	Fee-for-Service	1619675253	1619675253	1	1	LEUENBERGER, ARIANE E CRNA	8/3/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
189935	Fee-for-Service	1508937426	1508937426	1	1	LIMB, JONG SOO J MD	5/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67825	34	Urology and Urological Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
189978	Fee-for-Service	1124300207	1124300207	1	3	LIVINGSTON COMMUNITY HEALTH	5/7/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2412 3RD STREET	SUITE B	HUGHSON	CA	95326	9310	50	06099	37.596078	-120.866634	Stanislaus County
189984	Fee-for-Service	1912138801	1912138801	1	1	LOWE, VERONICA LCSW	6/28/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
189987	Fee-for-Service	1134270960	1134270960	1	1	LOS BANOS UNIFIED SCHOOL	3/11/1998	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1717 S 11TH ST	None	LOS BANOS	CA	93635	4800	24	06047	37.05319084	-120.8397427	Merced County
190015	Fee-for-Service	1851621312	1851621312	1	1	LOO, JONATHAN K OD A	7/26/2010	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	1111 W ROBINHOOD DR	STE L	STOCKTON	CA	95207	5626	39	06077	37.99974764	-121.3205303	San Joaquin County
190045	Fee-for-Service	1528713054	1528713054	1	1	LEATH, MARCELLA NP	9/26/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
190052	Fee-for-Service	1164450870	1164450870	1	1	LOYD, LEAH C	12/10/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	740 S PLACENTIA AVE	STE 100	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
190067	Fee-for-Service	1902250822	1902250822	1	1	LAWSON, KATHERYNE C MD	4/15/2025	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
190122	Fee-for-Service	1528238839	1528238839	1	1	LEE, HO H MD	8/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106920	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
190153	Fee-for-Service	1881952737	1881952737	1	1	LEE, FRANCES OD	7/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13027	10	Gastroenterology (M.D. only)	0	In state provider	None	2702 LOW CT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23678474	-122.0847463	Solano County
190159	Fee-for-Service	1063590602	1063590602	1	1	LEVINE, TODD MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63768	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
190189	Fee-for-Service	1588954937	1588954937	1	1	LEE, MATTHEW K MD	7/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116546	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	8635 W 3RD STREET	None	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
190204	Fee-for-Service	1346431202	1346431202	1	1	LVGS CORP	3/21/2001	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	DAILY DREAMS ADHC	1320 W MAGNOLIA BLVD	None	BURBANK	CA	91506	1832	19	06037	34.17577239	-118.3233615	Los Angeles County
190219	Fee-for-Service	1740537851	1740537851	1	1	LLOYD, MICHAEL K MD INC	9/26/2013	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	113655	None	None	0	In state provider	None	460 N GREENFIELD AVE	SUITE 3	HANFORD	CA	93230	3500	16	06031	36.3296463	-119.6581535	Kings County
190228	Fee-for-Service	1982611919	1982611919	1	1	LOS ANGELES COUNTY	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HUMPHREY COMPREHENSIVE	5850 S MAIN ST	None	LOS ANGELES	CA	90003	1215	19	06037	33.988536	-118.2739135	Los Angeles County
190266	Fee-for-Service	1124300207	1124300207	1	3	LIVINGSTON COMMUNITY HEALTH	10/8/2020	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2412 3RD STREET	SUITE B	HUGHSON	CA	95326	9310	50	06099	37.596078	-120.866634	Stanislaus County
190287	Fee-for-Service	1285178491	1285178491	1	2	LIGHT OF HOPE COUNSELING SER	3/4/2020	251S00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	VICES	108 ORANGE ST	8	REDLANDS	CA	92373	4719	36	06071	34.056972	-117.182554	San Bernardino County
190291	Fee-for-Service	1649592668	1649592668	1	1	LEE, NANCY MD	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125918	18	Ophthalmology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
190321	Fee-for-Service	1457690950	1457690950	1	1	LO, RACHELLE M MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124429	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2614	43	06085	37.313433	-121.9318385	Santa Clara County
190361	Fee-for-Service	1659306371	1659306371	1	1	LANGSTON, JAMES W MD	8/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	21759	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
190370	Fee-for-Service	1316408479	1316408479	1	1	LO, ROBIN H MD	7/24/2023	208M00000X	NA	Other	026	PHYSICIANS	178205	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
190375	Fee-for-Service	1851711402	1851711402	1	1	LI, BIN MD	12/16/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	159521	04	Otology, Laryngology, Rhinology	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
190472	Fee-for-Service	1457567364	1457567364	1	1	LIN, HARRISON W MD	1/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121122	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
190478	Fee-for-Service	1588954937	1588954937	1	1	LEE, MATTHEW K MD	7/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116546	01	General Practice	0	In state provider	None	8635 W 3RD STREET	None	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
190511	Fee-for-Service	1396830345	1396830345	1	1	LIN, ANNICA Y MD	8/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79122	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
190521	Fee-for-Service	1982611919	1982611919	1	1	LOS ANGELES COUNTY	7/1/2000	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HUMPHREY COMPREHENSIVE	5850 S MAIN ST	None	LOS ANGELES	CA	90003	1215	19	06037	33.988536	-118.2739135	Los Angeles County
190556	Fee-for-Service	1528186772	1528186772	1	1	LI, SHU P CA	5/10/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1329 E. THOUSAND OAKS BL	118	THOUSAND OAKS	CA	91362	2824	56	06111	34.17831141	-118.8566489	Ventura County
190561	Fee-for-Service	1164451753	1164451753	1	1	LEE, DANIEL W MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68837	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
190563	Fee-for-Service	1356503791	1356503791	1	1	LULIC, DZENAN MD	1/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121406	02	General Surgery	0	In state provider	None	6145 N THESTA AVE	None	FRESNO	CA	93710	5266	10	06019	36.82545273	-119.7831405	Fresno County
190570	Fee-for-Service	1720408206	1720408206	1	1	LEE, CALVIN MD	11/5/2019	207L00000X	NA	Other	026	PHYSICIANS	160831	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
190600	Fee-for-Service	1063983815	1063983815	1	1	LET'S TALK SPEECH THERAPY, I	1/3/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	3017 DOUGLAS BLVD.	220	ROSEVILLE	CA	95661	3836	31	06061	38.74412077	-121.232331	Placer County
190615	Fee-for-Service	1093936403	1093936403	1	1	LE,NGUYEN,TRAM,NGUYEN	6/28/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	& TRAN MEDICAL CORP	15355 BROOKHURST ST	STE 102-108	WESTMINSTER	CA	92683	7077	30	06059	33.73998831	-117.9548789	Orange County
190650	Fee-for-Service	1659306371	1659306371	1	1	LANGSTON, JAMES W MD	8/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	21759	01	General Practice	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
190665	Fee-for-Service	1659065001	1659065001	1	1	LUU, TIFFANY OD	10/5/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3451 S DOGWOOD AVE	SUITE 1334	EL CENTRO	CA	92243	7906	13	06025	32.762997	-115.530678	Imperial County
190696	Fee-for-Service	1538185046	1538185046	1	1	LESLY BENODIN	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7026 OLD KATY RD	STE 276	HOUSTON	TX	77024	2187	00	None	29.78388299	-95.44503208	Harris County
190697	Fee-for-Service	1710483201	1710483201	1	1	LAMA, TENZING T MD	6/22/2022	207L00000X	NA	Other	026	PHYSICIANS	177110	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
190702	Fee-for-Service	1477603355	1477603355	1	1	LONGINOTTI, MINDYN K MD	7/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94120	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
190717	Fee-for-Service	1275672321	1275672321	1	1	LEE, PUI WAN	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	614 KEARNY ST	None	SAN FRANCISCO	CA	94108	1805	38	06075	37.79389675	-122.4046399	San Francisco County
190742	Fee-for-Service	1801240742	1801240742	1	1	LAWTON, RACHEL PHD	2/13/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
190797	Fee-for-Service	1396830345	1396830345	1	1	LIN, ANNICA Y MD	8/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79122	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
190802	Fee-for-Service	1194081372	1194081372	1	1	LAWRENCE, KEITH MFT	12/8/2015	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5199 E PACIFIC COAST HWY	SUITE 504	LONG BEACH	CA	90804	3371	19	06037	33.78293818	-118.1329326	Los Angeles County
190805	Fee-for-Service	1982611919	1982611919	1	1	LOS ANGELES COUNTY	6/18/2013	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	HUMPHREY COMPREHENSIVE	5850 S MAIN ST	None	LOS ANGELES	CA	90003	1215	19	06037	33.988536	-118.2739135	Los Angeles County
190840	Fee-for-Service	1467548149	1467548149	1	1	LINGBERG, JANE C MD	12/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	53056	41	Internal Medicine	0	In state provider	None	550 ST CHARLES DR	STE 200	THOUSAND OAKS	CA	91360	3973	56	06111	34.18543014	-118.8777916	Ventura County
190843	Fee-for-Service	1407973043	1407973043	2	1	LIFELONG MEDICAL CARE	3/7/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	150 HARBOUR WAY	None	RICHMOND	CA	94801	3554	07	06013	37.933713	-122.3599835	Contra Costa County
190851	Fee-for-Service	1437226321	1437226321	1	1	LOUIE, ROBERT T MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25610	02	General Surgery	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
190852	Fee-for-Service	1265684864	1265684864	1	1	LEE, JULIE S MD	7/10/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	99012	30	Radiology	0	In state provider	None	301 NEWPORT BEACH BLVD	None	NEWPORT BEACH	CA	92663	0000	30	06059	33.6242782	-117.9284249	Orange County
190884	Fee-for-Service	1477834281	1477834281	1	1	LIM, SHU-EN A	10/17/2011	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	496 1ST ST	STE 120	LOS ALTOS	CA	94022	3677	43	06085	37.37407154	-122.1144185	Santa Clara County
190905	Fee-for-Service	1093936403	1093936403	1	1	LE,NGUYEN,TRAM,NGUYEN	6/28/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	& TRAN MEDICAL CORP	15355 BROOKHURST ST	STE 102-108	WESTMINSTER	CA	92683	7077	30	06059	33.73998831	-117.9548789	Orange County
190929	Fee-for-Service	1386960714	1386960714	1	1	LOEHFELM, THOMAS W PHD	6/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135526	None	None	0	In state provider	None	300 PASTEUR DRIVE	MC:5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
190937	Fee-for-Service	1639121486	1639121486	1	1	LIZARRAGA, MIGUEL	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	46523	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
190947	Fee-for-Service	1114266798	1114266798	1	1	LEVI HAIM, FARZIN MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141162	38	Geriatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
191005	Fee-for-Service	1417223702	1417223702	1	1	LEE, CRYSTAL R MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124136	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
191019	Fee-for-Service	1215914288	1215914288	1	1	LABORATORY CORPORATION OF AM	10/29/2019	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	ERICA HOLDINGS	1904 TW ALEXANDER DR	None	RTP	NC	27709	0153	00	None	35.9196317	-78.82847976	Durham County
191022	Fee-for-Service	1194257196	1194257196	1	1	LU, YANG MD	10/17/2019	208600000X	NA	General Surgery	026	PHYSICIANS	159347	02	General Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
191076	Fee-for-Service	1821070780	1821070780	1	1	LOW, REGINALD I MD	2/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	32163	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5301 F ST	STE 211	SACRAMENTO	CA	95819	3221	34	06067	38.571354	-121.4368695	Sacramento County
191077	Fee-for-Service	1699197400	1699197400	1	1	LUXE HOSPICE, INC	8/20/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	881 ALMA REAL DRIVE	STE T9B	PACIFIC PALISADES	CA	90272	5006	19	06037	34.04487687	-118.5250831	Los Angeles County
191080	Fee-for-Service	1316427966	1316427966	1	1	LOPES, MICHAEL PT	8/30/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2908 E WHITMORE AVE	E	CERES	CA	95307	2800	50	06099	37.59473048	-120.9412035	Stanislaus County
191109	Fee-for-Service	1326103060	1326103060	1	1	LOPEZ, NANCY S NP	4/22/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
191110	Fee-for-Service	1306914213	1306914213	1	1	LOVELACE HEALTH SYSTEMS INC	2/23/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	601 DR MARTIN LUTHER	KING JR AVE NE	ALBUQUERQUE	NM	87102	3619	00	None	35.0856531	-106.639762	Bernalillo County
191133	Fee-for-Service	1407973043	1407973043	2	1	LIFELONG MEDICAL CARE	3/7/2012	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	150 HARBOUR WAY	None	RICHMOND	CA	94801	3554	07	06013	37.933713	-122.3599835	Contra Costa County
191139	Fee-for-Service	1437226321	1437226321	1	1	LOUIE, ROBERT T MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25610	34	Urology and Urological Surgery	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
191142	Fee-for-Service	1740224575	1740224575	2	1	LONGS DRUG STORES CALIFORNIA	9/21/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1587 W EL CAMINO	None	SACRAMENTO	CA	95833	1992	34	06067	38.613465	-121.4960805	Sacramento County
191161	Fee-for-Service	1255597217	1255597217	1	1	LOMBARDI, JENNIFER L LMFT	7/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
191165	Fee-for-Service	1114312519	1114312519	1	1	LIPOF, JASON S MD	4/23/2021	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	170275	None	None	0	In state provider	None	1225 15TH ST	2100	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
191177	Fee-for-Service	1871699439	1871699439	1	1	LITTLEWOOD, STEVEN C MD	11/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	45108	84	Surgery-Head and Neck	0	In state provider	INC	7601 HOSPITAL DR	STE 203	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
191201	Fee-for-Service	1528414877	1528414877	1	1	LY, QUANGMINH D MD	8/28/2020	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
191231	Fee-for-Service	1619946753	1619946753	1	1	LIU, LI MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79806	30	Radiology	0	In state provider	None	7130 N MILLBROOK AVE	STE 112	FRESNO	CA	93720	3347	10	06019	36.83832032	-119.7632391	Fresno County
191242	Fee-for-Service	1457679201	1457679201	1	1	LE, JESSE D MD	10/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120776	34	Urology and Urological Surgery	0	In state provider	None	2222 EAST ST	250	CONCORD	CA	94520	2084	07	06013	37.98125538	-122.0329375	Contra Costa County
191252	Fee-for-Service	1942797543	1942797543	1	1	LUCERO, RENEE DO	5/24/2023	390200000X	NA	Other	026	PHYSICIANS	17953	None	None	0	In state provider	None	360 SAN MIGUEL DR	STE 309	NEWPORT BEACH	CA	92660	7836	30	06059	33.61321911	-117.8722084	Orange County
191280	Fee-for-Service	1417335134	1417335134	1	1	LA, VAN T DO	7/10/2018	207R00000X	NA	Other	026	PHYSICIANS	15659	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
191305	Fee-for-Service	1316356223	1316356223	1	1	LARSEN, INNA E MD	7/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141604	01	General Practice	0	In state provider	None	2122 W KETTLEMAN LN	None	LODI	CA	95242	4321	39	06077	38.11537452	-121.299291	San Joaquin County
191310	Fee-for-Service	1285047282	1285047282	2	1	LO, PETER S LMFT	2/1/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4344 LATHAM ST	110	RIVERSIDE	CA	92501	0400	33	06065	34.00198519	-117.3739252	Riverside County
191322	Fee-for-Service	1194048157	1194048157	1	1	LAVES, ELLEN MD	5/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114177	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
191365	Fee-for-Service	1699197400	1699197400	1	1	LUXE HOSPICE, INC	8/20/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	881 ALMA REAL DRIVE	STE T9B	PACIFIC PALISADES	CA	90272	5006	19	06037	34.04487687	-118.5250831	Los Angeles County
191395	Fee-for-Service	1306914213	1306914213	1	1	LOVELACE HEALTH SYSTEMS INC	7/8/2013	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	601 DR MARTIN LUTHER	KING JR AVE NE	ALBUQUERQUE	NM	87102	3619	00	None	35.0856531	-106.639762	Bernalillo County
191409	Fee-for-Service	1275612749	1275612749	1	2	LONGO, NICOLA MD	7/15/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	300 MEDICAL PLAZA	SUITE 3100	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
191420	Fee-for-Service	1407973043	1407973043	2	1	LIFELONG MEDICAL CARE	3/7/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	150 HARBOUR WAY	None	RICHMOND	CA	94801	3554	07	06013	37.933713	-122.3599835	Contra Costa County
191424	Fee-for-Service	1558435230	1558435230	1	1	LEE, TOMIKKA LCSW	12/17/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
191461	Fee-for-Service	1578587788	1578587788	1	1	LEE, PETER MD	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83091	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
191465	Fee-for-Service	1871699439	1871699439	1	1	LITTLEWOOD, STEVEN C MD	11/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	45108	04	Otology, Laryngology, Rhinology	0	In state provider	INC	7601 HOSPITAL DR	STE 203	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
191467	Fee-for-Service	1891896163	1891896163	1	1	LAMB, KENNETH C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	27121	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3325 CHANATE RD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
191477	Fee-for-Service	1902295991	1902295991	1	1	LEONG, KELLY LMFT	4/15/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
191529	Fee-for-Service	1073724712	1073724712	1	1	LEE, PATRICIA W MD	5/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102563	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
191543	Fee-for-Service	1467485185	1467485185	1	1	LUM, CINDY F OD	6/1/2001	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
191593	Fee-for-Service	1881697381	1881697381	1	5	LAKE COUNTY TRIBAL HEALTH	10/16/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE CLINIC #2	925 BEVINS COURT	None	LAKEPORT	CA	95453	1950	17	06033	39.03772106	-122.9223338	Lake County
191600	Fee-for-Service	1053931444	1053931444	1	1	LENTA HOSPICE INC	1/11/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3330 BARHAM BLVD	#201	LOS ANGELES	CA	90068	1400	19	06037	34.13158124	-118.3446679	Los Angeles County
191601	Fee-for-Service	1740368828	1740368828	1	1	LISS, WILLIAM A MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	74006	04	Otology, Laryngology, Rhinology	0	In state provider	None	5600 STONERIDGE MALL RD	None	PLEASANTON	CA	94588	2820	01	06001	37.6921981	-121.9276072	Alameda County
191606	Fee-for-Service	1336237247	1336237247	1	1	LEE, ANSON M MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136787	33	Thoracic Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
191621	Fee-for-Service	1093840407	1093840407	1	1	LARSEN DUNNICLIFF PHYSICAL	11/8/2018	174400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THERAPY INC	2087 GRAND CANAL BLVD	STE 17	STOCKTON	CA	95207	6651	39	06077	37.98552607	-121.3315122	San Joaquin County
191641	Fee-for-Service	1316012065	1316012065	1	1	LEGUYADER, YANNICK M MD	10/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	45341	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
191654	Fee-for-Service	1649294505	1649294505	1	1	LOPEZ, OSVALDO A MD	9/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61258	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
191676	Fee-for-Service	1164574547	1164574547	1	1	LEE, CHRISTINA H MD	5/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90105	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
191691	Fee-for-Service	1821202060	1821202060	1	1	LEBERTHON, BRIAN J MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79934	68	Hematology	0	In state provider	AMC	1135 S SUNSET AVE	STE 207	WEST COVINA	CA	91790	3908	19	06037	34.06215064	-117.9453997	Los Angeles County
191707	Fee-for-Service	1255719795	1255719795	1	1	LIANG, JENNIFER PSYD	12/11/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
191709	Fee-for-Service	1407973043	1407973043	2	1	LIFELONG MEDICAL CARE	7/28/2014	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	150 HARBOUR WAY	None	RICHMOND	CA	94801	3554	07	06013	37.933713	-122.3599835	Contra Costa County
191717	Fee-for-Service	1275577835	1275577835	1	1	LOWE, DOROTHY H MD	11/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86677	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	RM 5610	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
191718	Fee-for-Service	1487234225	1487234225	1	1	LACHMAN, MEG LMFT	2/19/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
191720	Fee-for-Service	1952729022	1952729022	1	1	LAHEL, JASMINE K MD	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14344	01	General Practice	0	In state provider	None	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
191754	Fee-for-Service	1205178696	1205178696	1	1	LANG, URSULA E MD	5/10/2017	390200000X	NA	Other	026	PHYSICIANS	136778	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
191764	Fee-for-Service	1801816921	1801816921	1	1	LEWIS, MOSHE M MD	2/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90204	25	Physical Medicine and Rehabilitation	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
191774	Fee-for-Service	1750423745	1750423745	1	1	LEE, CAROL H OD	7/10/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1321 GLENDALE GALLERIA	None	GLENDALE	CA	91210	1400	19	06037	34.144848	-118.2596735	Los Angeles County
191833	Fee-for-Service	1942761903	1942761903	1	1	LO, CARRIE C MD	12/16/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178737	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
191856	Fee-for-Service	1982088472	1982088472	1	1	LIU, DAVID X MD	5/5/2020	390200000X	NA	Other	026	PHYSICIANS	167317	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
191862	Fee-for-Service	1811356348	1811356348	1	1	LARK, CARYL S LMFT	5/20/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	305 S. CENTRAL AVE.	None	LOS ANGELES	CA	90013	1709	19	06037	34.04598286	-118.239632	Los Angeles County
191864	Fee-for-Service	1790871762	1790871762	1	1	LEE, CHIU-FU MD	4/1/1984	207RP1001X	NA	Pulmonology	026	PHYSICIANS	30366	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	10230 ARTESIA BLVD	STE 118	BELLFLOWER	CA	90706	6768	19	06037	33.8728276	-118.1160403	Los Angeles County
191881	Fee-for-Service	1881697381	1881697381	1	5	LAKE COUNTY TRIBAL HEALTH	10/16/2024	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	MOBILE CLINIC #2	925 BEVINS COURT	None	LAKEPORT	CA	95453	1950	17	06033	39.03772106	-122.9223338	Lake County
191885	Fee-for-Service	1679245377	1679245377	1	1	LUNA MEDCARE HOME HEALTH	2/26/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES	7050 OWENSMOUTH AVE	SUITE 206	CANOGA PARK	CA	91303	4206	19	06037	34.19870174	-118.6015313	Los Angeles County
191888	Fee-for-Service	1639366719	1639366719	1	1	LARIOS, FRANCISCO E CO	4/12/2002	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	7700 IMPERIAL HWY	STE E2	DOWNEY	CA	90242	3466	19	06037	33.92670648	-118.1580043	Los Angeles County
191890	Fee-for-Service	1053931444	1053931444	1	1	LENTA HOSPICE INC	1/11/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3330 BARHAM BLVD	#201	LOS ANGELES	CA	90068	1400	19	06037	34.13158124	-118.3446679	Los Angeles County
191904	Fee-for-Service	1497756290	1497756290	1	1	LEVIN, RONALD M MD	1/30/1997	207L00000X	NA	Other	026	PHYSICIANS	38788	05	Anesthesiology	0	In state provider	None	5469 KEARNY VILLA RD	None	SAN DIEGO	CA	92123	1152	37	06073	32.83298834	-117.1388725	San Diego County
191916	Fee-for-Service	1992107551	1992107551	1	1	LEE, ALICE OD	3/12/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 W VALLEY BLVD	SUITE 115	SAN GABRIEL	CA	91776	3784	19	06037	34.07958215	-118.1021957	Los Angeles County
191918	Fee-for-Service	1104921402	1104921402	1	1	LU, LESLIE I W MD	9/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	85467	41	Internal Medicine	0	In state provider	None	26800 CROWN VALLEY PKWY	STE 305	MISSION VIEJO	CA	92691	8017	30	06059	33.56286021	-117.6673449	Orange County
191940	Fee-for-Service	1952633398	1952633398	1	1	LESKIN, LORRAINE P PHD	9/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	STE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
191967	Fee-for-Service	1477849537	1477849537	1	1	LANE, JENNIFER A	12/22/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
191972	Fee-for-Service	1821202060	1821202060	1	1	LEBERTHON, BRIAN J MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79934	78	Neoplastic Diseases/Oncology	0	In state provider	AMC	1135 S SUNSET AVE	STE 207	WEST COVINA	CA	91790	3908	19	06037	34.06215064	-117.9453997	Los Angeles County
191981	Fee-for-Service	1518377217	1518377217	1	1	LECOURT, AMARATEEDHA	7/17/2023	207L00000X	NA	Other	026	PHYSICIANS	179332	None	None	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
191995	Fee-for-Service	1801327044	1801327044	1	1	LEIBRANDT, RYAN MD	7/15/2024	390200000X	NA	Other	026	PHYSICIANS	172836	41	Internal Medicine	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
192015	Fee-for-Service	1497349500	1497349500	1	1	LEVINE, ERROL G DC	1/17/2024	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	700 RIVER STREET	None	SANTA CRUZ	CA	95060	2748	44	06087	36.98383328	-122.0296395	Santa Cruz County
192027	Fee-for-Service	1083857635	1083857635	1	1	LO, YUAN-FEND C MD	7/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125666	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
192028	Fee-for-Service	1316423171	1316423171	1	1	LEE, NINA LMFT	2/11/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
192033	Fee-for-Service	1235158965	1235158965	1	1	LE, HANH M MD	8/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87539	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	225 E 2ND AVE	STE 203	ESCONDIDO	CA	92025	4244	37	06073	33.12175817	-117.0787555	San Diego County
192046	Fee-for-Service	1306962345	1306962345	1	1	LIBERMAN, DANICA B MD	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112805	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
192061	Fee-for-Service	1689771842	1689771842	1	1	LIN, DANIEL DO	11/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9140	08	Family Practice	0	In state provider	None	1025 W OLYMPIC BLVD	None	LOS ANGELES	CA	90015	1329	19	06037	34.04624254	-118.267606	Los Angeles County
192082	Fee-for-Service	1689107617	1689107617	1	1	LE, STEPHENIE MD	4/19/2021	207R00000X	NA	Other	026	PHYSICIANS	161862	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
192090	Fee-for-Service	1710979273	1710979273	1	1	LYONS, ARTHUR B MD	8/14/1995	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	43253	None	None	0	In state provider	None	5151 F ST	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
192095	Fee-for-Service	1538227897	1538227897	1	1	LI, VICTOR MD A PROFESSIONAL	1/4/2006	193200000X	NA	Other	026	PHYSICIANS	77617	None	None	0	In state provider	MEDICAL	4140 JADE STREET	STE 102	CAPITOLA	CA	95010	3956	44	06087	36.97026148	-121.9638195	Santa Cruz County
192145	Fee-for-Service	1184183337	1184183337	1	1	LEE, JUDITH CRNA	3/14/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
192155	Fee-for-Service	1790871762	1790871762	1	1	LEE, CHIU-FU MD	4/1/1984	207RP1001X	NA	Pulmonology	026	PHYSICIANS	30366	41	Internal Medicine	0	In state provider	None	10230 ARTESIA BLVD	STE 118	BELLFLOWER	CA	90706	6768	19	06037	33.8728276	-118.1160403	Los Angeles County
192167	Fee-for-Service	1194264838	1194264838	1	1	LEPPER, JESACA M LMFT	10/15/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	143 FIGUEROA STREET	STE 4	VENTURA	CA	93001	2756	56	06111	34.27894582	-119.297753	Ventura County
192172	Fee-for-Service	1174602726	1174602726	1	1	LIN, SHEENING	11/3/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
192190	Fee-for-Service	1497756290	1497756290	1	1	LEVIN, RONALD M MD	1/30/1997	207L00000X	NA	Other	026	PHYSICIANS	38788	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5469 KEARNY VILLA RD	None	SAN DIEGO	CA	92123	1152	37	06073	32.83298834	-117.1388725	San Diego County
192226	Fee-for-Service	1982250767	1982250767	1	1	LANDY, PRISCILLA A LMFT	1/27/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
192284	Fee-for-Service	1801327044	1801327044	1	1	LEIBRANDT, RYAN MD	7/15/2024	390200000X	NA	Other	026	PHYSICIANS	172836	68	Hematology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
192285	Fee-for-Service	1831372242	1831372242	1	1	LOGAN, SUSAN L	4/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81958	02	General Surgery	0	In state provider	None	1105 E SPRUCE	SUITE 201	FRESNO	CA	93720	3313	10	06019	36.839466	-119.762685	Fresno County
192289	Fee-for-Service	1255769717	1255769717	1	1	LE, CAMHA T MD	3/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127736	40	Pediatrics	0	In state provider	None	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
192295	Fee-for-Service	1730117672	1730117672	1	1	LIN, HENRY C MD	3/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	52549	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
192300	Fee-for-Service	1629654371	1629654371	1	1	LEVY-LAMBERT, DINA MD	11/4/2024	208600000X	NA	General Surgery	026	PHYSICIANS	183628	02	General Surgery	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
192307	Fee-for-Service	1891847604	1891847604	1	1	LOUIE, MICHAEL W MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	62248	41	Internal Medicine	0	In state provider	None	7601 STONERIDGE MALL RD	None	PLEASANTON	CA	94588	4501	01	06001	37.69587574	-121.9320355	Alameda County
192312	Fee-for-Service	1295816999	1295816999	1	1	LEVIN, RONALD D MD	6/5/2008	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	13590	25	Physical Medicine and Rehabilitation	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
192380	Fee-for-Service	1043468085	1043468085	1	1	LYNCH, WHITNEY L PHD	4/25/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
192395	Fee-for-Service	1649242017	1649242017	1	1	LEE, ALBERT S DO	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	7897	None	None	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
192404	Fee-for-Service	1285722744	1285722744	1	1	LEE, EDWARD C MD	1/31/2019	207L00000X	NA	Other	026	PHYSICIANS	155837	05	Anesthesiology	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
192416	Fee-for-Service	1912205204	1912205204	1	1	LAMALE, AARON M NP	4/21/2017	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
192422	Fee-for-Service	1992707442	1992707442	1	1	LOUIS JACQUES, PATRICK	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77500	41	Internal Medicine	0	In state provider	None	5375 LAKESHORE BLVD	None	LAKEPORT	CA	95453	6123	17	06033	39.10616812	-122.9035389	Lake County
192426	Fee-for-Service	1497799092	1497799092	2	1	LEON, JOSUE D MD	4/6/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	80635	None	None	0	In state provider	None	1000 VALE TERRACE DR.	None	VISTA	CA	92084	5218	37	06073	33.20904502	-117.2286439	San Diego County
192433	Fee-for-Service	1457428427	1457428427	1	3	LONIKA'S HOME, INC	6/18/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	24652 DORIA AVE	None	MISSION VIEJO	CA	92691	4636	30	06059	33.60408987	-117.6827115	Orange County
192435	Fee-for-Service	1124380688	1124380688	1	1	LOS GATOS PODIATRY GROUP INC	1/28/2013	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	14651 S BASCOM AVE	SUITE 215	LOS GATOS	CA	95032	2045	43	06085	37.25556684	-121.9504578	Santa Clara County
192504	Fee-for-Service	1194711952	1194711952	1	4	LOMPOC VALLEY MEDICAL	11/24/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1213 E OCEAN AVE	SUITE 102	LOMPOC	CA	93436	7043	42	06083	34.6388755	-120.442995	Santa Barbara County
192515	Fee-for-Service	1689699316	1689699316	1	1	LE, VIET MD INC	1/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	73490	05	Anesthesiology	0	In state provider	None	7300 MEDICAL CENTER DR	None	CANOGA PARK	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
192582	Fee-for-Service	1730117672	1730117672	1	1	LIN, HENRY C MD	3/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	52549	10	Gastroenterology (M.D. only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
192594	Fee-for-Service	1144524869	1144524869	1	1	LANGELAAR, STEPHANIE D CRNA	5/17/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.76344756	-122.4581992	San Francisco County
192654	Fee-for-Service	1740509835	1740509835	1	1	LAU, CINDY MD	11/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127869	01	General Practice	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
192660	Fee-for-Service	1215308010	1215308010	1	1	LE, HOANGNHAN H OD	12/1/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	215 CHINA GRADE LOOP	None	BAKERSFIELD	CA	93308	1707	15	06029	35.4265209	-119.0190909	Kern County
192683	Fee-for-Service	1083630180	1083630180	1	1	LEIBEL, SUSAN J CNM	12/6/2005	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
192720	Fee-for-Service	1417207036	1417207036	1	1	LUCAS, CHELSEA T PSYD	11/6/2019	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	STE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
192728	Fee-for-Service	1902301047	1902301047	1	1	LEFCOURT, TERRY S MD	1/28/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165858	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
192740	Fee-for-Service	1912166968	1912166968	1	1	LAMMERING, JEANNE C MD	8/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108884	30	Radiology	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
192742	Fee-for-Service	1194711952	1194711952	1	2	LOMPOC VALLEY MEDICAL	8/5/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	228 S D STREET	None	LOMPOC	CA	93436	7308	42	06083	34.63619744	-120.4528292	Santa Barbara County
192746	Fee-for-Service	1891827770	1891827770	1	1	LEON, ALEJANDRO LCSW	12/3/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	60688	-	NOT APPLICABLE	0	In state provider	None	828 HIGH ST	None	DELANO	CA	93215	2960	15	06029	35.76731796	-119.2465757	Kern County
192755	Fee-for-Service	1497883599	1497883599	1	1	LAW, YU HONG MD	1/18/1988	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	41936	02	General Surgery	0	In state provider	None	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
192776	Fee-for-Service	1568480374	1568480374	1	1	LEHMAN, JR. JOHN J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	660 S EUCLID AVE	CAMPUS BOX 8015	ST LOUIS	MO	63110	1010	00	None	38.63518793	-90.26307576	St. Louis city
192807	Fee-for-Service	1295817708	1295817708	1	1	LANCE CLYDE SMITH MD	7/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	PO BOX 1670	None	BEAVER	UT	84713	0000	00	None	0	0	None
192809	Fee-for-Service	1992911358	1992911358	1	1	LOYDS LIBERTY HOMES INC	9/23/1993	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5801 DAGGETT AVE	None	BAKERSFIELD	CA	93309	1518	15	06029	35.35602566	-119.0671992	Kern County
192820	Fee-for-Service	1073653325	1073653325	1	1	LISI, MARGARET ELLEN	12/21/2010	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3555 ALAMEDA DE LAS PULG	STE 100	MENLO PARK	CA	94025	6509	41	06081	37.43203515	-122.2019218	San Mateo County
192821	Fee-for-Service	1720041692	1720041692	2	1	LIN, STEVEN MD	6/11/2024	207L00000X	NA	Other	026	PHYSICIANS	75524	05	Anesthesiology	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
192825	Fee-for-Service	1417410804	1417410804	1	1	LEE, JASON J MD	4/3/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
192838	Fee-for-Service	1801871306	1801871306	2	1	LOSSASO, BARRY E MD	1/25/2011	193400000X	NA	Other	026	PHYSICIANS	41474	40	Pediatrics	0	In state provider	None	317 N EL CAMINO REAL	STE 502	ENCINITAS	CA	92024	2816	37	06073	33.05428107	-117.2615637	San Diego County
192871	Fee-for-Service	1730117672	1730117672	1	1	LIN, HENRY C MD	3/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	52549	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
192875	Fee-for-Service	1194765248	1194765248	1	1	LEE, SEAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1880 W WINCHESTER RD	STE 201	LIBERTYVILLE	IL	60048	5336	00	None	42.298227	-87.9951915	Lake County
192877	Fee-for-Service	1407806292	1407806292	1	1	LIKER, MARK A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	62368	None	None	0	In state provider	NEUROSURGICAL ASSC OF LA	25751 MCBEAN PKWY	STE 305	VALENCIA	CA	91355	3701	19	06037	34.39972502	-118.5511766	Los Angeles County
192934	Fee-for-Service	1417156498	1417156498	1	1	LEE, STEVE P MD	6/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100529	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
192981	Fee-for-Service	1821651829	1821651829	1	1	LOJEK, ANDREI DO	3/29/2024	207L00000X	NA	Other	026	PHYSICIANS	21823	05	Anesthesiology	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
192985	Fee-for-Service	1346656550	1346656550	1	1	LANCASTER, LUISA	4/24/2024	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
192999	Fee-for-Service	1851967236	1851967236	1	1	LONESTAR HOME HEALTH, INC	4/24/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4119 W BURBANK BLVD	STE 127	BURBANK	CA	91505	2122	19	06037	34.1730175	-118.3553514	Los Angeles County
193000	Fee-for-Service	1346437712	1346437712	1	1	LIAN, KUO-CHIANG MD	4/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97695	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420	LOS ANGELES	CA	90024	7002	19	06037	34.06527974	-118.4462792	Los Angeles County
193078	Fee-for-Service	1033251152	1033251152	1	1	LEVITT, JOSEPH MD	7/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87822	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
193084	Fee-for-Service	1629144191	1629144191	1	1	LIU, BEI Z OD	8/29/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1104 STONERIDGE MALL RD	None	PLEASANTON	CA	94588	3219	01	06001	37.695303	-121.9287465	Alameda County
193092	Fee-for-Service	1609353135	1609353135	1	1	LIU, HSIN-CHEN DO	5/31/2022	207R00000X	NA	Other	026	PHYSICIANS	17728	None	None	0	In state provider	None	9525 MONTE VISTA AVE	STE 105	MONTCLAIR	CA	91763	2231	36	06071	34.080777	-117.698234	San Bernardino County
193101	Fee-for-Service	1144807728	1144807728	1	1	LEUNG, KIMBERLY MD	8/13/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
193117	Fee-for-Service	1326035874	1326035874	1	1	LANDMAN, ROBERT G MD	7/12/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	35501	41	Internal Medicine	0	In state provider	None	411 N LAKEVIEW AVE	STE 2	ANAHEIM	CA	92807	3028	30	06059	33.8531521	-117.8160824	Orange County
193146	Fee-for-Service	1871629923	1871629923	1	1	LU, KEVIN Q OD	9/9/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9197 CENTRAL AVENUE	SUITE D	MONTCLAIR	CA	91763	1616	36	06071	34.08682596	-117.6894472	San Bernardino County
193152	Fee-for-Service	1255508057	1255508057	1	1	LEE, EUGENE, W MD	10/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135210	34	Urology and Urological Surgery	0	In state provider	None	27303 SLEEPY HOLLOW S	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
193163	Fee-for-Service	1811078355	1811078355	1	1	LEHMAN, DAVID W MD	12/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87600	41	Internal Medicine	0	In state provider	None	8851 CENTER DR	STE 305	LA MESA	CA	91942	3048	37	06073	32.78189749	-117.0075062	San Diego County
193172	Fee-for-Service	1932356359	1932356359	1	1	LONNIE DAVID VAUGHN M.D.	12/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MEDICAL	None	OMAHA	NE	68198	7400	00	None	0	0	None
193200	Fee-for-Service	1184705600	1184705600	1	1	LE, HONG-CHAU T OD	7/21/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	25321 RAILROAD CANYON RD	STE 503	LAKE ELSINORE	CA	92532	2702	33	06065	33.66660166	-117.2650807	Riverside County
193220	Fee-for-Service	1164669446	1164669446	2	1	LARK SPRING TERRACE INC	2/8/2012	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	22504 LARK SPRING TER	None	DIAMOND BAR	CA	91765	2956	19	06037	33.98863707	-117.8229187	Los Angeles County
193222	Fee-for-Service	1891768271	1891768271	1	1	LOTT, KIRK CRNA	2/22/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	75 NIELSON	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
193249	Fee-for-Service	1245365444	1245365444	1	1	LITTLE HIDEG, ALISA M MD	5/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141123	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
193278	Fee-for-Service	1669615183	1669615183	1	1	LEE, NICOLE N MD	6/14/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160807	30	Radiology	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
193285	Fee-for-Service	1851333918	1851333918	1	1	LAI, MICHAEL C MD	6/23/2004	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	68834	None	None	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
193286	Fee-for-Service	1326332123	1326332123	1	1	LEVIN, ETHAN C MD	10/18/2019	207ND0101X	NA	Dermatology	026	PHYSICIANS	122015	07	Dermatology	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
193342	Fee-for-Service	1922267319	1922267319	1	1	LEMKUIL, BRIAN P MD	7/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98785	05	Anesthesiology	0	In state provider	None	200 W ARBOR DRIVE	8201	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
193344	Fee-for-Service	1902641087	1902641087	1	1	LE, KRISTIE LAC	4/1/2025	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	595 DOWLING BLVD	None	SAN LEANDRO	CA	94577	1905	01	06001	37.73531024	-122.1527063	Alameda County
193363	Fee-for-Service	1366624553	1366624553	1	1	LEE, SUN JOO	12/31/2007	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	JONGRO MEDICAL SUPPLY	9938 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92844	1645	30	06059	33.7739753	-117.9592846	Orange County
193365	Fee-for-Service	1861953671	1861953671	1	1	LEVINE, DAVID J MD	1/31/2025	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	914 PINE STREET	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
193367	Fee-for-Service	1598832347	1598832347	1	1	LEE, ANN Y OD	12/16/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
193407	Fee-for-Service	1689089195	1689089195	1	1	LIM, JUNG-EUN J MD	2/28/2019	207P00000X	NA	Other	026	PHYSICIANS	138638	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13100 STUDEBAKER ROAD	None	NORWALK	CA	90650	2531	19	06037	33.912594	-118.099152	Los Angeles County
193506	Fee-for-Service	1326110073	1326110073	1	1	LAI,JERRY J MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68953	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
193515	Fee-for-Service	1497934871	1497934871	1	1	LOCKHART-PETTAWAY, STEFANIE	10/15/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	AL SERVICES	9113 FOOTHILL BLVD.	SUITE 130	RANCHO CUCAMONGA	CA	91730	6565	36	06071	34.10651347	-117.606528	San Bernardino County
193531	Fee-for-Service	1770770356	1770770356	1	1	LIN, PETER MD	10/24/2017	208200000X	NA	General Surgery	026	PHYSICIANS	99767	24	Plastic Surgery	0	In state provider	None	27200 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.8955513	-117.189743	Riverside County
193558	Fee-for-Service	1306210760	1306210760	1	1	LEE, HYERAN NP	5/14/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
193618	Fee-for-Service	1891420394	1891420394	1	1	LA MIRADA POST ACUTE LLC	8/16/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	12200 LA MIRADA BLVD	None	LA MIRADA	CA	90638	1306	19	06037	33.920109	-118.0118115	Los Angeles County
193619	Fee-for-Service	1952374936	1952374936	1	1	LEE, LISA M MD	8/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79212	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
193621	Fee-for-Service	1710902655	1710902655	1	1	LEBRUN, CHRISTOPHER T MD	4/28/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	172147	None	None	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 200	RIVERSIDE	CA	92505	8510	33	06065	33.90290859	-117.4941562	Riverside County
193643	Fee-for-Service	1063662948	1063662948	1	1	LEE, KEUM B	2/8/2015	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	2835 W PICO BLVD	None	LOS ANGELES	CA	90006	3910	19	06037	34.04726048	-118.301382	Los Angeles County
193658	Fee-for-Service	1215970579	1215970579	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	35080 NEWARK BLVD	None	NEWARK	CA	94560	1218	01	06001	37.5500662	-122.0483116	Alameda County
193663	Fee-for-Service	1356883466	1356883466	1	1	LICON, HILDA G CRNA	1/12/2023	363LF0000X	NA	Nurse Practitioner	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
193674	Fee-for-Service	1205076262	1205076262	1	1	LEE, DANIEL MD	9/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106824	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
193701	Fee-for-Service	1881157998	1881157998	1	1	LICUP, WADE K MD	4/24/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	179911	08	Family Practice	0	In state provider	None	6000 SEPULVEDA BLVD	E10	CULVER CITY	CA	90230	6421	19	06037	33.985512	-118.393524	Los Angeles County
193711	Fee-for-Service	1588820245	1588820245	1	1	LARSEN, MATTHEW W MD	9/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
193749	Fee-for-Service	1700542040	1700542040	1	1	LADZINSKI, LINDSAY A	7/29/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	197 E CAROLINE ST	None	SAN BERNARDINO	CA	92408	3731	36	06071	34.06143353	-117.2822085	San Bernardino County
193773	Fee-for-Service	1548210453	1548210453	1	1	LANE, KEVIN J OD	3/1/1995	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	28125 BRADLEY RD	STE 180	SUN CITY	CA	92586	2279	33	06065	33.71309746	-117.1898349	Riverside County
193816	Fee-for-Service	1326509886	1326509886	1	1	LUONG, THOMAS MD	2/14/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181353	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
193846	Fee-for-Service	1033360946	1033360946	1	1	LEVINE, JEFFREY J DO	10/15/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	17192	68	Hematology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
193858	Fee-for-Service	1689843294	1689843294	1	1	LING, JANICE H	6/28/2004	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1815 W 213TH ST	STE 100	TORRANCE	CA	90501	2852	19	06037	33.83547351	-118.312776	Los Angeles County
193884	Fee-for-Service	1710054606	1710054606	1	1	LEE, CHIN MD	10/31/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	39014	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
193906	Fee-for-Service	1669423919	1669423919	1	1	LA FONT, ROBERT A OD INC	12/12/2006	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7960 ORANGETHORPE AVE	None	BUENA PARK	CA	90621	3437	30	06059	33.85899466	-117.9941923	Orange County
193909	Fee-for-Service	1285644963	1285644963	1	1	LEIBOWITZ, ROBERT L MD INC	5/6/2013	207RX0202X	NA	Oncology	026	PHYSICIANS	None	None	None	0	In state provider	APC	2080 CENTURY PARK EAST	STE 1005	LOS ANGELES	CA	90067	2013	19	06037	34.05887194	-118.4122914	Los Angeles County
193913	Fee-for-Service	1477959583	1477959583	1	1	LAI, MAI NGAN N MD	10/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138564	41	Internal Medicine	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
193959	Fee-for-Service	1447888698	1447888698	1	1	LYU, JONATHAN Y DO	10/22/2024	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	21026	38	Geriatrics	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
193985	Fee-for-Service	1225368004	1225368004	1	1	LUSK, LESLIE A MD	5/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110156	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
194012	Fee-for-Service	1508919929	1508919929	1	1	LUU, JOHNNY L MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90179	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
194048	Fee-for-Service	1770603912	1770603912	1	1	LAKE ELSINORE UNIFIED SD	6/26/1996	251300000X	NA	Other	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	545 CHANEY ST	None	LAKE ELSINORE	CA	92530	2712	33	06065	33.68277396	-117.3359408	Riverside County
194062	Fee-for-Service	1346694593	1346694593	1	1	LOOK, MARISA DO	9/9/2019	207P00000X	NA	Other	026	PHYSICIANS	16569	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
194074	Fee-for-Service	1285950238	1285950238	1	1	LIN, JENNIFER W MD	10/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93194	45	Nephrology (Renal-Kidney)	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
194087	Fee-for-Service	1528297900	1528297900	1	1	LOFGRAN, ADAM J OD	4/12/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7291 BOULDER AVENUE SUIT	None	HIGHLAND	CA	92346	3389	36	06071	34.12169346	-117.1953693	San Bernardino County
194126	Fee-for-Service	1073747176	1073747176	1	2	LIN, STEPHANIE N	8/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142068	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1941 JOHNSON AVE	STE 105B	SAN LUIS OBISPO	CA	93401	4140	40	06079	35.27804785	-120.649711	San Luis Obispo County
194135	Fee-for-Service	1649420068	1649420068	1	1	LEE, MELISSA K MD	10/11/2010	390200000X	NA	Other	026	PHYSICIANS	105755	41	Internal Medicine	0	In state provider	None	700 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
194138	Fee-for-Service	1871559229	1871559229	1	1	LEBOWITZ, EDWARD A MD	1/1/1982	2085B0100X	NA	MRI Provider	026	PHYSICIANS	32909	30	Radiology	0	In state provider	None	123 DI SALVO AVE	STE A	SAN JOSE	CA	95128	1717	43	06085	37.32628785	-121.9371289	Santa Clara County
194155	Fee-for-Service	1558599514	1558599514	1	1	LEE, ADA P MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119088	67	Endocrinology	0	In state provider	None	375 LAGUNA HONDA BLVD	RM B-200	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
194174	Fee-for-Service	1487856985	1487856985	1	1	LEE, LINDA W MD	12/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123681	10	Gastroenterology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
194189	Fee-for-Service	1629728068	1629728068	1	1	LEE-COOMES, JANET MD	7/30/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	191169	36	Psychiatry	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
194197	Fee-for-Service	1033741822	1033741822	1	1	LOUIS, KESIAH D CRNA	11/15/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
194231	Fee-for-Service	1619019445	1619019445	1	1	LEE, HOSUK	3/9/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8110 MANGO AVE	STE 107	FONTANA	CA	92335	3603	36	06071	34.10549796	-117.4314604	San Bernardino County
194246	Fee-for-Service	1376975995	1376975995	1	1	LEE, VINCENT Z MD	12/5/2022	207P00000X	NA	Other	026	PHYSICIANS	166579	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
194247	Fee-for-Service	1609849074	1609849074	1	15	LA MAESTRA FAMILY CLINIC INC	7/2/2024	No Taxonomy Provided	NMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	CENTERS	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	37	06073	32.750523	-117.100927	San Diego County
194342	Fee-for-Service	1528494267	1528494267	1	1	LIU, YING MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123484	41	Internal Medicine	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4404	50	06099	37.66508443	-120.9962589	Stanislaus County
194369	Fee-for-Service	1174685770	1174685770	1	1	LI, SUZANNE G MD	7/15/1980	207W00000X	NA	Ophthalmology	026	PHYSICIANS	42546	18	Ophthalmology	0	In state provider	None	2100 WEBSTER ST	STE 209	SAN FRANCISCO	CA	94115	2375	38	06075	37.7904826	-122.4324477	San Francisco County
194396	Fee-for-Service	1114037181	1114037181	1	1	LIFSHITZ, ALIZA A MD	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	37876	41	Internal Medicine	0	In state provider	CEDARS SINAI TOWERS	8635 W THIRD ST	STE 485W	LOS ANGELES	CA	90048	6156	19	06037	34.07361928	-118.3803143	Los Angeles County
194432	Fee-for-Service	1720136807	1720136807	1	1	LIN, JOSEPH H MD	10/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69387	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
194444	Fee-for-Service	1558599514	1558599514	1	1	LEE, ADA P MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119088	41	Internal Medicine	0	In state provider	None	375 LAGUNA HONDA BLVD	RM B-200	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
194457	Fee-for-Service	1427330885	1427330885	1	1	LE, LINH N OD	11/29/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	2020	01	06001	37.87133398	-122.2545466	Alameda County
194482	Fee-for-Service	1881221901	1881221901	1	1	LEPKOWSKI, ANNA E MD	7/1/2023	390200000X	NA	Other	026	PHYSICIANS	186419	None	None	0	In state provider	None	2801 ATLANTIC AVE	3RD FL	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
194489	Fee-for-Service	1669513222	1669513222	1	1	LA SIERRA MEDICAL CORPORATIO	7/28/2005	163WG0000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	10600 MAGNOLIA AVE	I	RIVERSIDE	CA	92505	1819	33	06065	33.90819148	-117.4676613	Riverside County
194521	Fee-for-Service	1437117041	1437117041	1	1	LEON, JESUS M MD	4/30/1988	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	48712	30	Radiology	0	In state provider	None	15151 JANINE DR	None	WHITTIER	CA	90605	1803	19	06037	33.94969305	-118.0035917	Los Angeles County
194525	Fee-for-Service	1588142194	1588142194	1	1	LEON, EDGAR G RRT	2/16/2021	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
194526	Fee-for-Service	1124300207	1124300207	1	2	LIVINGSTON COMMUNITY HEALTH	3/4/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	800 DELBON AVE	None	TURLOCK	CA	95382	2022	50	06099	37.51047152	-120.839499	Stanislaus County
194539	Fee-for-Service	1528056371	1528056371	1	1	LEONARD, PAUL A MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	HOSPITALS & CLINICS	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	5500	00	None	41.659929	-91.548099	Johnson County
194574	Fee-for-Service	1366670747	1366670747	1	1	LOZANOV, NIKOLA MD INC	11/14/2012	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	93178	08	Family Practice	0	In state provider	None	108 LYNCH CREEK WY	STE 4	PETALUMA	CA	94954	2310	49	06097	38.25209087	-122.6340827	Sonoma County
194587	Fee-for-Service	1932142783	1932142783	2	1	LONGS DRUG STORES CA LLC	12/26/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3458 S SEPULVEDA BLVD	None	LOS ANGELES	CA	90034	6010	19	06037	34.02006068	-118.4228408	Los Angeles County
194597	Fee-for-Service	1457397770	1457397770	1	1	LIEBERMAN, DAVID N MD	3/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101812	13	Neurology (M.D. only)	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
194606	Fee-for-Service	1851524383	1851524383	1	1	LIN, THAN S DO	3/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	10925	41	Internal Medicine	0	In state provider	None	120 E EMERSON AVE	None	MONTEREY PARK	CA	91755	1709	19	06037	34.06610653	-118.1219085	Los Angeles County
194681	Fee-for-Service	1194133223	1194133223	1	1	LUCERO, ANTHONY D MD	3/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138707	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
194689	Fee-for-Service	1437405396	1437405396	1	1	LOCKWOOD, KRISTINA M PT	12/5/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1914 TICE VALLEY BLVD	None	WALNUT CREEK	CA	94595	2203	07	06013	37.87851556	-122.0745896	Contra Costa County
194746	Fee-for-Service	1417983834	1417983834	1	1	LESH, MARY B NP	8/30/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
194752	Fee-for-Service	1467472472	1467472472	1	1	LIN, HAROLD M MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	29948	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3791 KATELLA AVE	STE 105	LOS ALAMITOS	CA	90720	2000	30	06059	33.80318449	-118.0672965	Orange County
194778	Fee-for-Service	1669513222	1669513222	1	1	LA SIERRA MEDICAL CORPORATIO	7/28/2005	163WG0000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	10600 MAGNOLIA AVE	I	RIVERSIDE	CA	92505	1819	33	06065	33.90819148	-117.4676613	Riverside County
194805	Fee-for-Service	1467542621	1467542621	1	1	LAGLEVA, CESAR LCSW	3/27/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
194813	Fee-for-Service	1124300207	1124300207	1	2	LIVINGSTON COMMUNITY HEALTH	5/7/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	800 DELBON AVE	None	TURLOCK	CA	95382	2022	50	06099	37.51047152	-120.839499	Stanislaus County
194830	Fee-for-Service	1770592131	1770592131	1	1	LEWENSTEIN, LEONARD N MD	6/1/1976	207L00000X	NA	Other	026	PHYSICIANS	37173	05	Anesthesiology	0	In state provider	CEDARS-SINAI MEDICAL CTR	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
194844	Fee-for-Service	1740649672	1740649672	1	1	LOAN T. TRUONG, M.D., INC.	3/21/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	CIATES	709 E ANAHEIM ST	None	LONG BEACH	CA	90813	3301	19	06037	33.78263447	-118.1827035	Los Angeles County
194862	Fee-for-Service	1366670747	1366670747	1	1	LOZANOV, NIKOLA MD INC	11/14/2012	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	93178	01	General Practice	0	In state provider	None	108 LYNCH CREEK WY	STE 4	PETALUMA	CA	94954	2310	49	06097	38.25209087	-122.6340827	Sonoma County
194869	Fee-for-Service	1558874941	1558874941	1	1	LEE, SHEEN NP	10/6/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
194873	Fee-for-Service	1942847264	1942847264	1	1	LEMKE, JULIE A CRNA	2/8/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
194883	Fee-for-Service	1114062635	1114062635	2	1	LIVERMORE OPTOMETRY GROUP	3/22/2023	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1800 4TH ST	None	LIVERMORE	CA	94550	4454	01	06001	37.67808567	-121.7724653	Alameda County
194884	Fee-for-Service	1629194782	1629194782	1	1	LARSEN, STEVEN R OD	10/1/1998	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4096 PARK BLVD	None	SAN DIEGO	CA	92103	2620	37	06073	32.75225441	-117.1464876	San Diego County
194885	Fee-for-Service	1457397770	1457397770	1	1	LIEBERMAN, DAVID N MD	3/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101812	79	Neurology-Child	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
194893	Fee-for-Service	1851524383	1851524383	1	1	LIN, THAN S DO	3/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	10925	45	Nephrology (Renal-Kidney)	0	In state provider	None	120 E EMERSON AVE	None	MONTEREY PARK	CA	91755	1709	19	06037	34.06610653	-118.1219085	Los Angeles County
194894	Fee-for-Service	1982068243	1982068243	1	1	LOPEZ, JOSE MD	6/22/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172347	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
194929	Fee-for-Service	1912135104	1912135104	1	1	LINANE, AVRIEL S DO	2/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	11802	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
194982	Fee-for-Service	1801966254	1801966254	1	1	LONGO, FRANK MICHAEL MD	7/31/1987	2084N0400X	NA	Neurology	026	PHYSICIANS	55216	13	Neurology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	# 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
194983	Fee-for-Service	1467466193	1467466193	1	1	LOYOLA, ROWELL S MD	11/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	7720	None	None	0	In state provider	None	500 S MAIN ST	STE 1210	ORANGE	CA	92868	4556	30	06059	33.77991974	-117.8674745	Orange County
194990	Fee-for-Service	1922297712	1922297712	1	1	LEU, AMY N DO	7/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9744	08	Family Practice	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
194997	Fee-for-Service	1437241171	1437241171	1	1	LIMFAT, ALAN E OD	9/30/1989	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	377 E COLORADO BLVD	None	PASADENA	CA	91101	1909	19	06037	34.1459133	-118.142582	Los Angeles County
195003	Fee-for-Service	1386676468	1386676468	1	1	LEN,KYRA A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1319 PUNAHOU STREET	None	HONOLULU	HI	96826	1001	00	None	21.30030321	-157.8342762	Honolulu County
195009	Fee-for-Service	1780013342	1780013342	1	1	LASHEEN, TARA LCSW	3/11/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
195022	Fee-for-Service	1003841370	1003841370	1	1	LOWE, ROBERT N MD	2/28/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	101 MARGARET LN	STE B	GRASS VALLEY	CA	95945	4207	29	06057	39.23003572	-121.0469625	Nevada County
195029	Fee-for-Service	1194011734	1194011734	1	1	LAYAL, SUKHMANI K MD	9/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127884	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
195040	Fee-for-Service	1467472472	1467472472	1	1	LIN, HAROLD M MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	29948	41	Internal Medicine	0	In state provider	None	3791 KATELLA AVE	STE 105	LOS ALAMITOS	CA	90720	2000	30	06059	33.80318449	-118.0672965	Orange County
195060	Fee-for-Service	1114019171	1114019171	1	1	LEE, PALMER N OD	12/8/1995	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5959 GREENBACK LN	STE 130	CITRUS HEIGHTS	CA	95621	4700	34	06067	38.681397	-121.322682	Sacramento County
195064	Fee-for-Service	1669513222	1669513222	1	1	LA SIERRA MEDICAL CORPORATIO	7/28/2005	163WG0000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	10600 MAGNOLIA AVE	I	RIVERSIDE	CA	92505	1819	33	06065	33.90819148	-117.4676613	Riverside County
195070	Fee-for-Service	1114167178	1114167178	1	1	LIN, GRACE Y MD	12/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106746	41	Internal Medicine	0	In state provider	None	9808 VENICE BLVD	PENTHOUSE	CULVER CITY	CA	90232	2732	19	06037	34.0236396	-118.3980847	Los Angeles County
195102	Fee-for-Service	1124300207	1124300207	1	2	LIVINGSTON COMMUNITY HEALTH	3/4/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	800 DELBON AVE	None	TURLOCK	CA	95382	2022	50	06099	37.51047152	-120.839499	Stanislaus County
195131	Fee-for-Service	1487982252	1487982252	1	1	LEVIN, SUSAN LMFT	3/9/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16055 VENTURA BLVD	STE 1010	ENCINO	CA	91436	1002	19	06037	34.15632563	-118.4832351	Los Angeles County
195165	Fee-for-Service	1154694883	1154694883	1	1	LEE, PHILIP I MD	9/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113341	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
195173	Fee-for-Service	1407117039	1407117039	1	1	LYONS, JANE A MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126810	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
195181	Fee-for-Service	1982753364	1982753364	1	1	LANG, MICHAEL E MD	12/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86194	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
195194	Fee-for-Service	1851754188	1851754188	1	1	LI, ANDREW A MD	2/2/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	150938	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
195200	Fee-for-Service	1801423066	1801423066	1	1	LIM, MALINA MD	12/7/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185038	None	None	0	In state provider	None	2704 E WILLOW ST	None	SIGNAL HILL	CA	90755	2217	19	06037	33.80432955	-118.1594295	Los Angeles County
195208	Fee-for-Service	1558717991	1558717991	1	1	LEARY, MICHELLE	7/13/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
195215	Fee-for-Service	1427133198	1427133198	1	1	LEDERMAN, J NICOLE MD	6/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	78605	41	Internal Medicine	0	In state provider	None	1580 VALENCIA ST	STE 201	SAN FRANCISCO	CA	94110	4420	38	06075	37.74746923	-122.4202583	San Francisco County
195223	Fee-for-Service	1568501005	1568501005	1	1	LE, CHUONG M MD	8/27/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	112526	13	Neurology (M.D. only)	0	In state provider	None	200 JOSE FIGUERES AVE	SUITE 475	SAN JOSE	CA	95116	1500	43	06085	37.36122014	-121.8505998	Santa Clara County
195266	Fee-for-Service	1558135061	1558135061	1	1	LE, AUDREY CRNA	3/7/2024	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
195275	Fee-for-Service	1114975455	1114975455	1	1	LEHR, BEVERLY K PHD	5/5/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
195291	Fee-for-Service	1295287787	1295287787	1	1	LIWANAGAN, RICO C CRNA	6/2/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
195295	Fee-for-Service	1336307842	1336307842	1	1	LAI, AMY W MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128887	30	Radiology	0	In state provider	None	115 LA CASA VIA	SUITE 202	WALNUT CREEK	CA	94598	3042	07	06013	37.91251201	-122.0424904	Contra Costa County
195305	Fee-for-Service	1538723606	1538723606	1	1	LYUBASYUK, ALEKSANDR MD	7/28/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	179237	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
195337	Fee-for-Service	1477751162	1477751162	1	1	LUU, CUONG H MD	11/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100773	41	Internal Medicine	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
195349	Fee-for-Service	1619430824	1619430824	1	1	LAM, VERONICA A MD	5/12/2023	207L00000X	NA	Other	026	PHYSICIANS	180497	None	None	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
195354	Fee-for-Service	1083707087	1083707087	1	1	LYNE, ALAN W MD	1/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75644	15	Obstetrics (D.O. only)	0	In state provider	None	245 N 10TH ST	None	SANTA PAULA	CA	93060	2804	56	06111	34.35715227	-119.0613633	Ventura County
195358	Fee-for-Service	1114167178	1114167178	1	1	LIN, GRACE Y MD	12/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106746	45	Nephrology (Renal-Kidney)	0	In state provider	None	9808 VENICE BLVD	PENTHOUSE	CULVER CITY	CA	90232	2732	19	06037	34.0236396	-118.3980847	Los Angeles County
195379	Fee-for-Service	1689273625	1689273625	1	1	LA PRIME HOME HEALTH INC	8/27/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12444 VICTORY BLVD	SUITE 215	NORTH HOLLYWOOD	CA	91606	3199	19	06037	34.18663951	-118.4043555	Los Angeles County
195390	Fee-for-Service	1124300207	1124300207	1	2	LIVINGSTON COMMUNITY HEALTH	7/20/2020	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	800 DELBON AVE	None	TURLOCK	CA	95382	2022	50	06099	37.51047152	-120.839499	Stanislaus County
195396	Fee-for-Service	1205292356	1205292356	1	1	LLOYD, CHRISTOPHER J PT	8/17/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 5TH AVE.	SUITE 100	SAN DIEGO	CA	92103	3108	37	06073	32.749335	-117.160413	San Diego County
195404	Fee-for-Service	1598050205	1598050205	1	1	LY, NGOC G MD	7/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153735	01	General Practice	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
195448	Fee-for-Service	1558544635	1558544635	1	2	LOGAN, BRENDA R LMFT	3/15/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1225 WEST 190TH STREET	SUITE 310	GARDENA	CA	90248	4315	19	06037	33.85835623	-118.2987754	Los Angeles County
195470	Fee-for-Service	1164465332	1164465332	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1560 W VALLEY PKWY	None	ESCONDIDO	CA	92029	2140	37	06073	33.10844445	-117.1045795	San Diego County
195511	Fee-for-Service	1891889531	1891889531	1	1	LIU, ANTHONY D MD	12/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77892	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
195525	Fee-for-Service	1629188081	1629188081	1	1	LIU, YUNBO LAC	1/15/2021	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3925 ROSEMEAD BLVD	#102	ROSEMEAD	CA	91770	1933	19	06037	34.07930385	-118.0732531	Los Angeles County
195535	Fee-for-Service	1689133621	1689133621	1	1	LUCKY STARS ADULT DAY HEALTH	9/30/2020	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER INC	19715 E COLIMA RD	STE B	ROWLAND HEIGHTS	CA	91748	3211	19	06037	33.98620535	-117.8723624	Los Angeles County
195537	Fee-for-Service	1003013020	1003013020	1	1	LUDEMAN, NORNA A MD	6/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113399	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.76344756	-122.4581992	San Francisco County
195550	Fee-for-Service	1598055337	1598055337	1	1	LO, THERESA MD	8/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123351	05	Anesthesiology	0	In state provider	None	2500 GRANT ROAD	None	MOUNTAIN VIEW	CA	94040	4378	43	06085	37.36893518	-122.0779448	Santa Clara County
195551	Fee-for-Service	1912090853	1912090853	1	1	LINOVITZ, RAYMOND J MD	7/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	16599	02	General Surgery	0	In state provider	None	320 SANTA FE DR	STE 204	ENCINITAS	CA	92024	5179	37	06073	33.038847	-117.285579	San Diego County
195564	Fee-for-Service	1700964509	1700964509	1	1	LEAHY, RICHARD MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	59047	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
195602	Fee-for-Service	1336313139	1336313139	1	1	LIMA, KATHLEEN B DO	7/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10999	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
195605	Fee-for-Service	1518900307	1518900307	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	305 S HIGHWAY 101	None	SOLANA BEACH	CA	92075	1808	37	06073	32.98850539	-117.2709861	San Diego County
195611	Fee-for-Service	1609469139	1609469139	1	1	LAMPERT, MELISSA A LMFT	2/18/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28465 OLD TOWN FRONT ST	None	TEMECULA	CA	92590	1822	33	06065	33.49566437	-117.1516462	Riverside County
195622	Fee-for-Service	1609849074	1609849074	1	6	LA MAESTRA FAMILY CLINIC INC	5/2/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INC	4157 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1609	37	06073	32.75246035	-117.1008454	San Diego County
195642	Fee-for-Service	1083707087	1083707087	1	1	LYNE, ALAN W MD	1/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75644	01	General Practice	0	In state provider	None	245 N 10TH ST	None	SANTA PAULA	CA	93060	2804	56	06111	34.35715227	-119.0613633	Ventura County
195659	Fee-for-Service	1811018724	1811018724	1	1	LOCKETT, DUSTY M LCSW	5/3/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	384 E OLIVE	STE 1	TURLOCK	CA	95380	4051	50	06099	37.49658844	-120.8452043	Stanislaus County
195692	Fee-for-Service	1609692813	1609692813	1	1	LION RX INC.	1/7/2025	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2857 SENTER RD	SUITE A	SAN JOSE	CA	95111	1100	43	06085	37.29978318	-121.8398952	Santa Clara County
195724	Fee-for-Service	1083870174	1083870174	1	1	LUNA, ANGELA L LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
195725	Fee-for-Service	1922194349	1922194349	1	1	LEE, DAVID J MD	3/1/1999	207L00000X	NA	Other	026	PHYSICIANS	65188	05	Anesthesiology	0	In state provider	None	521 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2206	38	06075	37.7634502	-122.4579779	San Francisco County
195734	Fee-for-Service	1104152149	1104152149	1	1	LOUIE, BRANDON G MD	1/15/2019	208800000X	NA	Other	026	PHYSICIANS	109692	34	Urology and Urological Surgery	0	In state provider	None	4244 RIVERWALK PKWY	SUITE 240	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
195773	Fee-for-Service	1669811824	1669811824	1	1	LEVINE, LAUREN S MD	7/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143010	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
195800	Fee-for-Service	1891889531	1891889531	1	1	LIU, ANTHONY D MD	12/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77892	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
195803	Fee-for-Service	1003930900	1003930900	1	1	LOPEZ, LETICIA LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	734 WEST OAK AVE	None	VISALIA	CA	93291	6036	54	06107	36.332118	-119.2998195	Tulare County
195813	Fee-for-Service	1184650863	1184650863	1	1	LI, YAN MD	7/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79997	05	Anesthesiology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
195838	Fee-for-Service	1912090853	1912090853	1	1	LINOVITZ, RAYMOND J MD	7/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	16599	20	Orthopedic Surgery	0	In state provider	None	320 SANTA FE DR	STE 204	ENCINITAS	CA	92024	5179	37	06073	33.038847	-117.285579	San Diego County
195840	Fee-for-Service	1013394477	1013394477	1	1	LEMARIE, MAURICE K MD	9/19/2018	207P00000X	NA	Other	026	PHYSICIANS	34550	40	Pediatrics	0	In state provider	None	41880 KALMIA ST STE 100	None	MURRIETA	CA	92562	8835	33	06065	33.55740114	-117.2157733	Riverside County
195870	Fee-for-Service	1932355310	1932355310	1	1	LEYKINA, DIANA Y MD	7/28/2010	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	104868	08	Family Practice	0	In state provider	None	2299 POST ST	SUITE 305	SAN FRANCISCO	CA	94115	3475	38	06075	37.78434298	-122.4392033	San Francisco County
195877	Fee-for-Service	1043653181	1043653181	1	1	LA CASA ADULT HEALTH CENTER	9/4/2013	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	909 BLANCO CIRCLE	STE B	SALINAS	CA	93901	4401	27	06053	36.65354107	-121.6381985	Monterey County
195880	Fee-for-Service	1225051592	1225051592	1	1	LOS ANGELES COUNTY	7/1/2005	282N00000X	NA	Hospitals	060	COUNTY HOSPITAL INPATIENT	-	-	NOT APPLICABLE	0	In state provider	HARBOR-UCLA MEDICAL CTR	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
195900	Fee-for-Service	1164717815	1164717815	1	1	LAY, LINDA DO	10/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13401	41	Internal Medicine	0	In state provider	None	2767 OLIVE HIGHWAY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
195903	Fee-for-Service	1891052080	1891052080	1	1	LIOU, DOUGLAS Z MD	9/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119889	02	General Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
195912	Fee-for-Service	1609849074	1609849074	1	6	LA MAESTRA FAMILY CLINIC INC	5/2/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INC	4157 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1609	37	06073	32.75246035	-117.1008454	San Diego County
195914	Fee-for-Service	1154374411	1154374411	1	1	LO, MEI-VEN C MD	6/30/1993	207L00000X	NA	Other	026	PHYSICIANS	66296	05	Anesthesiology	0	In state provider	None	725 E SANTA CLARA ST	STE 101	SAN JOSE	CA	95112	1936	43	06085	37.34328626	-121.8756374	Santa Clara County
195924	Fee-for-Service	1598182347	1598182347	1	1	LUNA, ALEJANDRA LCSW	9/29/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	17822 BEACH BLVD	278	HUNTINGTON BEACH	CA	92647	7180	30	06059	33.70331388	-117.9890471	Orange County
195928	Fee-for-Service	1770750275	1770750275	1	1	LEVIN, DAVID E DO	1/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	280 MAPLE	EMERGENCY DEPT	ASHLAND	OR	97520	1552	00	None	42.20644248	-122.724936	Jackson County
195938	Fee-for-Service	1891788022	1891788022	1	1	LANDAU, JEFFREY H MD	6/4/2024	208800000X	NA	Other	026	PHYSICIANS	50587	34	Urology and Urological Surgery	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
196002	Fee-for-Service	1528066008	1528066008	1	1	LEUNG, ANTHONY MD	10/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	62494	20	Orthopedic Surgery	0	In state provider	None	9930 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166152	-117.955521	Orange County
196049	Fee-for-Service	1972516631	1972516631	1	1	LOS ANGELES COUNTY	7/1/2000	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	EL MONTE COMPREHENSIVE	10953 RAMONA BLVD	None	EL MONTE	CA	91731	2629	19	06037	34.07205148	-118.0372365	Los Angeles County
196074	Fee-for-Service	1245429422	1245429422	1	1	LUNA, MARIO E MD	8/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92302	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
196126	Fee-for-Service	1912090853	1912090853	1	1	LINOVITZ, RAYMOND J MD	7/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	16599	01	General Practice	0	In state provider	None	320 SANTA FE DR	STE 204	ENCINITAS	CA	92024	5179	37	06073	33.038847	-117.285579	San Diego County
196129	Fee-for-Service	1013394477	1013394477	1	1	LEMARIE, MAURICE K MD	9/19/2018	207P00000X	NA	Other	026	PHYSICIANS	34550	41	Internal Medicine	0	In state provider	None	41880 KALMIA ST STE 100	None	MURRIETA	CA	92562	8835	33	06065	33.55740114	-117.2157733	Riverside County
196158	Fee-for-Service	1932355310	1932355310	1	1	LEYKINA, DIANA Y MD	7/28/2010	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	104868	01	General Practice	0	In state provider	None	2299 POST ST	SUITE 305	SAN FRANCISCO	CA	94115	3475	38	06075	37.78434298	-122.4392033	San Francisco County
196166	Fee-for-Service	1790943025	1790943025	1	1	LIYANAGE, TEHANI MD	6/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96831	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
196185	Fee-for-Service	1952482416	1952482416	1	1	LAU, SHIRLEY TIN-SHOU MD	12/7/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45348	40	Pediatrics	0	In state provider	None	1234 E 14TH ST	STE 401	SAN LEANDRO	CA	94577	4512	01	06001	37.72546198	-122.1564484	Alameda County
196209	Fee-for-Service	1699227983	1699227983	1	1	LANDMARK PHARMA INC	3/1/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1004 W FOOTHILL BLVD,	SUITE 101	UPLAND	CA	91786	2804	36	06071	34.10647255	-117.665541	San Bernardino County
196218	Fee-for-Service	1790856367	1790856367	2	1	LIM, SUSIE L OD	4/3/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1615 E PLAZA BLVD	STE 101	NATIONAL CITY	CA	91950	3771	37	06073	32.67670551	-117.0885584	San Diego County
196229	Fee-for-Service	1104323740	1104323740	1	1	LIFE SAVING IMAGES INC	7/20/2018	No Taxonomy Provided	NA	None	028	PORTABLE X-RAY	-	-	NOT APPLICABLE	0	In state provider	None	5628 PIRRONE ROAD	None	SALIDA	CA	95368	8203	50	06099	37.71985741	-121.0966095	Stanislaus County
196245	Fee-for-Service	1275557191	1275557191	1	1	LERNER, JASON T MD	7/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96522	79	Neurology-Child	0	In state provider	None	10833 L CONTE AVE	None	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
196252	Fee-for-Service	1184112682	1184112682	1	1	LARA, LESLEY MD	10/22/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173435	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
196259	Fee-for-Service	1770918591	1770918591	1	1	LOFTHOUSE, REBECCA A LCSW	9/18/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
196265	Fee-for-Service	1144228446	1144228446	1	1	LAKELAND REGIONAL MEDICAL	4/28/2011	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER INC	1324 LAKELAND HILLS BLVD	None	LAKELAND	FL	33805	4543	00	None	28.06113647	-81.95328047	Polk County
196289	Fee-for-Service	1154542694	1154542694	1	1	LYNWOOD DEVELOPMENTAL CARE	1/2/1997	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	709 W RAYMOND ST	None	COMPTON	CA	90220	4411	19	06037	33.88716398	-118.2357741	Los Angeles County
196323	Fee-for-Service	1366649147	1366649147	1	1	LAI, JENNIFER I MD	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95590	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
196339	Fee-for-Service	1972516631	1972516631	1	1	LOS ANGELES COUNTY	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	EL MONTE COMPREHENSIVE	10953 RAMONA BLVD	None	EL MONTE	CA	91731	2629	19	06037	34.07205148	-118.0372365	Los Angeles County
196369	Fee-for-Service	1952323776	1952323776	1	1	LINDES, DEBORAH S MD	1/1/2000	207R00000X	NA	Other	026	PHYSICIANS	65191	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
196391	Fee-for-Service	1568658292	1568658292	1	1	LUNSFORD, DAVID L CRNA	8/14/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	450 N ROXBURY DR	STE 600	BEVERLY HILLS	CA	90210	4220	19	06037	34.06820793	-118.4070317	Los Angeles County
196418	Fee-for-Service	1922042365	1922042365	2	1	LONGS DRUG STORE CAL LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	750 BLOSSOM HILL RD	None	LOS GATOS	CA	95032	3503	43	06085	37.235353	-121.9617334	Santa Clara County
196427	Fee-for-Service	1376864652	1376864652	1	1	LIN, DARIUS E MD	1/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138300	20	Orthopedic Surgery	0	In state provider	None	11160 WARNER AVE	STE 311	FOUNTAIN VALLEY	CA	92708	4055	30	06059	33.71630854	-117.934317	Orange County
196441	Fee-for-Service	1215464318	1215464318	1	1	LUO, XIANGYING NP	12/13/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
196460	Fee-for-Service	1962109033	1962109033	1	1	LOS ANGELES COUNTY DEPARTMEN	2/7/2024	261QP0905X	NA	Other	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	R	335 E AVENUE K6	STE B	LANCASTER	CA	93535	4645	19	06037	34.6694985	-118.125468	Los Angeles County
196462	Fee-for-Service	1285803643	1285803643	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2539 N 11TH AVE	None	HANFORD	CA	93230	1426	16	06031	36.357669	-119.655072	Kings County
196467	Fee-for-Service	1033288774	1033288774	1	1	LINDSAY, ROBERT J MD	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	55110	05	Anesthesiology	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
196470	Fee-for-Service	1508196247	1508196247	1	1	LLOYD, DUSTIN J	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12693	None	None	0	In state provider	None	215 W JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
196520	Fee-for-Service	1194796664	1194796664	1	1	LAC, TRI H MD	12/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	85786	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
196528	Fee-for-Service	1497028021	1497028021	1	1	LONGEVITY HOSPICE INC	5/10/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8781 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	2401	19	06037	34.22960628	-118.4502708	Los Angeles County
196533	Fee-for-Service	1275557191	1275557191	1	1	LERNER, JASON T MD	7/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96522	40	Pediatrics	0	In state provider	None	10833 L CONTE AVE	None	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
196546	Fee-for-Service	1194143164	1194143164	1	1	LI, RON C MD	8/28/2019	207R00000X	NA	Other	026	PHYSICIANS	138510	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
196552	Fee-for-Service	1265745871	1265745871	1	1	LONG, YASHA S MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126009	66	Emergency Medicine (Urgent Care)	0	In state provider	None	825 NORTH TENTH STREET	None	SANTA PAULA	CA	93060	1309	56	06111	34.36574255	-119.0654422	Ventura County
196557	Fee-for-Service	1144228446	1144228446	1	1	LAKELAND REGIONAL MEDICAL	4/28/2011	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER INC	1324 LAKELAND HILLS BLVD	None	LAKELAND	FL	33805	4543	00	None	28.06113647	-81.95328047	Polk County
196558	Fee-for-Service	1790868156	1790868156	1	1	LEVIN, MELANIE B MD	11/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80845	7201	00	None	39.748041	-104.834673	Adams County
196578	Fee-for-Service	1225399546	1225399546	1	1	LEE, CINDY MD	3/11/2020	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	657 TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
196586	Fee-for-Service	1568928869	1568928869	1	1	LANCASTER PHARMACY INC	1/15/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16912 HIGHWAY 14	None	MOJAVE	CA	93501	1226	15	06029	35.06852418	-118.1752236	Kern County
196613	Fee-for-Service	1336777614	1336777614	1	1	LUBNER, RORY J MD	2/21/2025	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
196629	Fee-for-Service	1588372411	1588372411	1	1	LENG, KIARA P AU	1/27/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
196653	Fee-for-Service	1275821332	1275821332	1	1	LE-PUGEDA, MICHELLE M	10/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135114	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
196686	Fee-for-Service	1407259880	1407259880	1	1	LAU, CHRISTINE Y Y LCSW	2/17/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
196720	Fee-for-Service	1447783923	1447783923	1	1	LABS ASAP LLC	2/18/2019	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	3320 SW 33RD ROAD	UNIT 100	OCALA	FL	34471	7427	00	None	29.15271	-82.176732	Marion County
196749	Fee-for-Service	1568493641	1568493641	1	1	LIFEMARK HOSPITALS OF	12/25/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	FLORIDA INC	2001 WEST 68TH ST	None	HIALEAH	FL	33016	1801	00	None	25.88534261	-80.32650485	Miami-Dade County
196769	Fee-for-Service	1629006515	1629006515	1	1	LAW, ARTHUR K MD	9/22/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	77603	40	Pediatrics	0	In state provider	None	345 9TH ST	STE 204	OAKLAND	CA	94607	4206	01	06001	37.79975865	-122.2705956	Alameda County
196780	Fee-for-Service	1811932148	1811932148	1	1	LEE, JAMES S MD	10/16/2023	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	60919	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
196791	Fee-for-Service	1043676687	1043676687	1	1	LE, NGOC N MD	7/26/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	158922	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
196817	Fee-for-Service	1497028021	1497028021	1	1	LONGEVITY HOSPICE INC	5/10/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8781 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	2401	19	06037	34.22960628	-118.4502708	Los Angeles County
196846	Fee-for-Service	1790868156	1790868156	1	1	LEVIN, MELANIE B MD	11/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80845	7201	00	None	39.748041	-104.834673	Adams County
196874	Fee-for-Service	1174566400	1174566400	2	1	LONGS DRUG STORES CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	110 E LAUREL DR.	None	SALINAS	CA	93906	2860	27	06053	36.69886267	-121.6498155	Monterey County
196884	Fee-for-Service	1669072328	1669072328	1	1	LEWIS, IRMARITA NP	9/2/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
196930	Fee-for-Service	1982168803	1982168803	1	1	LENITY HOSPICE LLC	4/24/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4920 E YALE AVE	STE 101	FRESNO	CA	93727	1517	10	06019	36.7701115	-119.729943	Fresno County
196932	Fee-for-Service	1992158489	1992158489	1	1	LAPOINTE, LAURA LMFT	10/3/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	410 S. GLENDORA AVE	STE. 130	GLENDORA	CA	91741	6207	19	06037	34.13122731	-117.863713	Los Angeles County
196940	Fee-for-Service	1114087301	1114087301	1	1	LE, NHAT D MD	2/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80604	05	Anesthesiology	0	In state provider	ATTN MGA OFFICE	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
196958	Fee-for-Service	1235140336	1235140336	1	1	LOMA LINDA FOOT AND	3/24/2005	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	ANKLE CENTER	18225 OUTER HWY 18	None	APPLE VALLEY	CA	92307	0000	36	06071	34.54037022	-117.2667488	San Bernardino County
196986	Fee-for-Service	1831760362	1831760362	1	1	LING, LINSAY	11/22/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
196996	Fee-for-Service	1427677996	1427677996	1	1	LONZANIDA, JAYMES A MD	9/9/2022	390200000X	NA	Other	026	PHYSICIANS	176885	None	None	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
196999	Fee-for-Service	1114326287	1114326287	1	1	LILLY, ALICE P HAD	4/19/2018	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	30250 RANCHO VIEJO RD	STE A	SAN JUAN CAPISTRA	CA	92675	1555	30	06059	33.52319034	-117.6657717	Orange County
197035	Fee-for-Service	1568493641	1568493641	1	1	LIFEMARK HOSPITALS OF	12/25/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	FLORIDA INC	2001 WEST 68TH ST	None	HIALEAH	FL	33016	1801	00	None	25.88534261	-80.32650485	Miami-Dade County
197060	Fee-for-Service	1235661331	1235661331	1	1	LEE, PATRICIA N MD	9/9/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	None	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
197120	Fee-for-Service	1629145511	1629145511	1	1	LEE, PAUL H MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61684	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
197126	Fee-for-Service	1013196302	1013196302	1	1	LU, CHRISTINA N OD	12/10/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4418 VINELAND AVE	STE 106	NORTH HOLLYWOOD	CA	91602	3457	19	06037	34.15107052	-118.3702155	Los Angeles County
197141	Fee-for-Service	1417341967	1417341967	1	1	LANCASTER, ELIZABETH MD	9/13/2024	2086S0129X	NA	General Surgery	026	PHYSICIANS	145608	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
197151	Fee-for-Service	1538303540	1538303540	1	1	LEE, KEVIN K MD	5/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113960	30	Radiology	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
197164	Fee-for-Service	1033738224	1033738224	1	1	LIWANAG, RICHARD M CCC-SLP	5/3/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
197188	Fee-for-Service	1245618701	1245618701	1	1	LEE, ERIC J MD	3/10/2023	207L00000X	NA	Other	026	PHYSICIANS	183745	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
197213	Fee-for-Service	1891938601	1891938601	1	1	LUU, PAUL T MD	8/25/2009	207L00000X	NA	Other	026	PHYSICIANS	107050	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
197219	Fee-for-Service	1982168803	1982168803	1	1	LENITY HOSPICE LLC	4/24/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4920 E YALE AVE	STE 101	FRESNO	CA	93727	1517	10	06019	36.7701115	-119.729943	Fresno County
197235	Fee-for-Service	1992755003	1992755003	1	1	LIPP, VICTOR H MD	1/2/1979	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	30975	40	Pediatrics	0	In state provider	None	2675 SCHENLEY TER	None	SAN DIEGO	CA	92122	4045	37	06073	32.84180753	-117.2284528	San Diego County
197242	Fee-for-Service	1528284627	1528284627	1	1	LASHKARI, ASHKAN MD	8/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90916	78	Neoplastic Diseases/Oncology	0	In state provider	None	7320 WOODLAKE AVE	#330	WEST HILLS	CA	91307	1474	19	06037	34.20245266	-118.6321273	Los Angeles County
197292	Fee-for-Service	1770511081	1770511081	1	1	LIN, AMY P MD	11/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	80637	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
197344	Fee-for-Service	1609849074	1609849074	1	14	LA MAESTRA FAMILY CLINIC INC	9/27/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	3878 ORANGE AVENUE	BUILDING 100	SAN DIEGO	CA	92105	1038	37	06073	32.7532983	-117.1107914	San Diego County
197360	Fee-for-Service	1457398760	1457398760	1	1	LIN, HENRY J MD	9/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	47739	40	Pediatrics	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
197365	Fee-for-Service	1578765541	1578765541	1	2	L & A HOME HEALTH CARE INC	2/8/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3580 WILSHIRE BLVD	STE 1626	LOS ANGELES	CA	90010	2151	19	06037	34.06170677	-118.302787	Los Angeles County
197366	Fee-for-Service	1174791008	1174791008	1	1	LIBERTY DLYS SO RENO LLC	7/13/2009	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	None	601 SIERRA ROSE DR	SUITE 101	RENO	NV	89511	2358	00	None	39.47338868	-119.7957435	Washoe County
197367	Fee-for-Service	1396279683	1396279683	1	1	LEE, JONATHAN H DO	6/29/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	20398	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
197372	Fee-for-Service	1255313060	1255313060	1	1	LARSON, CATHERINE A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38416	41	Internal Medicine	0	In state provider	None	3660 ARLINGTON AVENUE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
197379	Fee-for-Service	1932766458	1932766458	1	1	LARSEN, MATTHEW CNM	3/31/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
197397	Fee-for-Service	1538375993	1538375993	1	1	LOYDS LIBERTY HOMES INC	7/1/1991	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3701 PANORAMA DR	None	BAKERSFIELD	CA	93306	1162	15	06029	35.41121472	-118.9519066	Kern County
197424	Fee-for-Service	1295062321	1295062321	1	1	LAMAR, ROBYN A MD	6/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106423	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
197436	Fee-for-Service	1205398344	1205398344	1	1	LAMBERT, GERALD J LMFT	6/8/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1510 FASHION ISLAND BLVD	110	SAN MATEO	CA	94404	5043	41	06081	37.5583415	-122.2861555	San Mateo County
197469	Fee-for-Service	1841681533	1841681533	1	1	LEE, ADRIANA W S MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128175	40	Pediatrics	0	In state provider	None	910 MARSHALL STREET	None	REDWOOD CITY	CA	94063	2034	41	06081	37.4876781	-122.2249265	San Mateo County
197499	Fee-for-Service	1710961479	1710961479	1	1	LLOYD, WILLIAM C MD	8/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87184	22	Pathology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
197528	Fee-for-Service	1528284627	1528284627	1	1	LASHKARI, ASHKAN MD	8/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90916	68	Hematology	0	In state provider	None	7320 WOODLAKE AVE	#330	WEST HILLS	CA	91307	1474	19	06037	34.20245266	-118.6321273	Los Angeles County
197531	Fee-for-Service	1033301247	1033301247	1	1	LIU, BETTY D MD	12/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102490	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
197539	Fee-for-Service	1063747624	1063747624	1	1	LAURENT, JULIE A LCSW	9/11/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
197581	Fee-for-Service	1659588457	1659588457	1	1	LIN, MIMI S	7/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	85457	10	Gastroenterology (M.D. only)	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
197634	Fee-for-Service	1609849074	1609849074	1	14	LA MAESTRA FAMILY CLINIC INC	9/27/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	3878 ORANGE AVENUE	BUILDING 100	SAN DIEGO	CA	92105	1038	37	06073	32.7532983	-117.1107914	San Diego County
197635	Fee-for-Service	1972517928	1972517928	1	1	LAMA, DANIEL J MD	7/31/1989	208800000X	NA	Other	026	PHYSICIANS	68442	01	General Practice	0	In state provider	None	1800 WESTERN AVE	STE 403	SAN BERNARDINO	CA	92411	1355	36	06071	34.1315778	-117.3182453	San Bernardino County
197646	Fee-for-Service	1730795139	1730795139	1	1	LAMM, LAURA M	10/2/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	12524 DOUGLAS ST.	None	YUCAIPA	CA	92399	4823	36	06071	34.026192	-117.0301065	San Bernardino County
197651	Fee-for-Service	1881863397	1881863397	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4414 YORK BLVD	None	LOS ANGELES	CA	90041	3328	19	06037	34.12395833	-118.2200227	Los Angeles County
197708	Fee-for-Service	1780609792	1780609792	1	1	LAMPE, GEORGE H MD	4/28/1999	207L00000X	NA	Other	026	PHYSICIANS	40506	05	Anesthesiology	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
197772	Fee-for-Service	1649413311	1649413311	1	1	LI, WAI-YEE MD	2/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	113620	24	Plastic Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
197773	Fee-for-Service	1992749725	1992749725	2	1	LONGS DRUG STORE CAL LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 1ST	None	LIVERMORE	CA	94550	4302	01	06001	37.67906154	-121.7776452	Alameda County
197785	Fee-for-Service	1710961479	1710961479	1	1	LLOYD, WILLIAM C MD	8/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87184	18	Ophthalmology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
197799	Fee-for-Service	1114547650	1114547650	1	1	L &L RX INC	9/10/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1118 S. GARFIELD AVE.	STE 101	ALHAMBRA	CA	91801	4796	19	06037	34.08203532	-118.1230362	Los Angeles County
197835	Fee-for-Service	1821454869	1821454869	1	1	LALLAVE, GLENN A PT	2/23/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	20940 BURBANK BLVD	None	WOODLAND HILLS	CA	91367	6601	19	06037	34.1719401	-118.5881418	Los Angeles County
197840	Fee-for-Service	1972146991	1972146991	1	1	LANDAU ENTERPRISES INC	2/14/2024	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1475 S BASCOM AVE	STE 203	CAMPBELL	CA	95008	0629	43	06085	37.29595562	-121.9318161	Santa Clara County
197871	Fee-for-Service	1659588457	1659588457	1	1	LIN, MIMI S	7/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	85457	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
197897	Fee-for-Service	1447543921	1447543921	1	1	LIBBY, ALLISON B PHD	11/25/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
197899	Fee-for-Service	1033561816	1033561816	1	1	LE, ALEXANDER M MD	9/29/2022	2085R0204X	NA	Other	026	PHYSICIANS	179330	None	None	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
197914	Fee-for-Service	1548465073	1548465073	1	1	LOH, ANNIE I MD	1/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94072	41	Internal Medicine	0	In state provider	None	2333 BUCHANNAN STREET	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
197915	Fee-for-Service	1558664169	1558664169	1	1	LIAO, ALICE J NP	4/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
197917	Fee-for-Service	1629509716	1629509716	1	1	LI, EDWIN MD	6/29/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157034	40	Pediatrics	0	In state provider	None	1300 CRANE STREET	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
197921	Fee-for-Service	1972517928	1972517928	1	1	LAMA, DANIEL J MD	7/31/1989	208800000X	NA	Other	026	PHYSICIANS	68442	34	Urology and Urological Surgery	0	In state provider	None	1800 WESTERN AVE	STE 403	SAN BERNARDINO	CA	92411	1355	36	06071	34.1315778	-117.3182453	San Bernardino County
197931	Fee-for-Service	1730795139	1730795139	1	1	LAMM, LAURA M	10/2/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	12524 DOUGLAS ST.	None	YUCAIPA	CA	92399	4823	36	06071	34.026192	-117.0301065	San Bernardino County
197933	Fee-for-Service	1033414230	1033414230	1	1	LIM, CHUN H LAC	7/27/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	740 S WESTERN AVE	STE 216	LOS ANGELES	CA	90005	5902	19	06037	34.058592	-118.3090605	Los Angeles County
197948	Fee-for-Service	1073034401	1073034401	1	1	LOMBARDI, SARAH PSYD	2/2/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
197963	Fee-for-Service	1851305973	1851305973	1	1	LIU, JASPER E MD	9/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
197966	Fee-for-Service	1407099732	1407099732	2	1	LAKEWOOD PATHOLOGY ASSOCIATE	11/27/2013	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	7669 HOLLOW OAK RD	None	ANAHEIM	CA	92808	1426	30	06059	33.85581843	-117.74636	Orange County
197967	Fee-for-Service	1710014980	1710014980	1	1	LEVINE, DAVID L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36134	36	Psychiatry	0	In state provider	None	2107 VAN NESS AVE	STE 305	SAN FRANCISCO	CA	94109	2571	38	06075	37.79507411	-122.4234233	San Francisco County
197972	Fee-for-Service	1174532618	1174532618	1	1	LUPERCIO, RAFAEL MD	8/12/1995	207RP1001X	NA	Pulmonology	026	PHYSICIANS	53300	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
197974	Fee-for-Service	1154615391	1154615391	1	1	LUDLOW, JOHN T MD	11/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122427	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
198067	Fee-for-Service	1568805422	1568805422	1	1	LEE, JONATHAN W MD	3/2/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	152742	None	None	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
198105	Fee-for-Service	1720376064	1720376064	1	1	LATINO COMMISSION ON ALCOHOL	1/31/2017	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	508 7TH AVENUE	None	SAN BRUNO	CA	94066	4522	41	06081	37.62545574	-122.4047451	San Mateo County
198113	Fee-for-Service	1790961639	1790961639	1	1	LA MAESTRA FAMILY	5/22/2007	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CLINIC, INC	165 S 1ST ST	None	EL CAJON	CA	92019	4795	37	06073	32.794002	-116.944563	San Diego County
198114	Fee-for-Service	1235612631	1235612631	1	1	LO, BILLY LCSW	7/26/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
198115	Fee-for-Service	1750156022	1750156022	1	1	LUBAN, ELANA LCSW	10/2/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
198133	Fee-for-Service	1417443334	1417443334	1	1	LY, AMANDA V DO	8/8/2023	208600000X	NA	General Surgery	026	PHYSICIANS	21163	None	None	0	In state provider	None	584 N. SUNRISE AVE	100	ROSEVILLE	CA	95661	2862	31	06061	38.75842021	-121.2528302	Placer County
198150	Fee-for-Service	1750323564	1750323564	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	45 N MILPITAS BLVD	None	MILPITAS	CA	95035	4402	43	06085	37.43408286	-121.9005444	Santa Clara County
198151	Fee-for-Service	1538598131	1538598131	2	1	LOS ROBLES HOSPICE INC	1/24/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1720 E GARRY AVE	STE 120	SANTA ANA	CA	92705	5832	30	06059	33.70531049	-117.853506	Orange County
198252	Fee-for-Service	1154509453	1154509453	1	1	LUNN, HILARY M LMFT	6/24/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	870 MARKET STREET	SUITE 758	SAN FRANCISCO	CA	94102	2901	38	06075	37.7848184	-122.4070488	San Francisco County
198259	Fee-for-Service	1174100168	1174100168	1	1	LA, CINDY MD	11/3/2023	207R00000X	NA	Other	026	PHYSICIANS	183583	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
198261	Fee-for-Service	1174532618	1174532618	1	1	LUPERCIO, RAFAEL MD	8/12/1995	207RP1001X	NA	Pulmonology	026	PHYSICIANS	53300	41	Internal Medicine	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
198323	Fee-for-Service	1417126764	1417126764	1	1	LIZARRAGA, JUAN F MD	4/10/2021	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	49181	None	None	0	In state provider	None	895 W. VALLEY BLVD.	None	COLTON	CA	92324	2001	36	06071	34.0687227	-117.3383592	San Bernardino County
198328	Fee-for-Service	1225533839	1225533839	1	1	LE, HONG DIEM T DO	8/12/2021	208M00000X	NA	Other	026	PHYSICIANS	17794	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
198335	Fee-for-Service	1629024914	1629024914	1	1	LINCOLN MEDICAL CENTER	8/16/2010	282NR1301X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	106 MEDICAL CENTER BLVD	None	FAYETTEVILLE	TN	37334	2684	00	None	35.14841002	-86.5560604	Lincoln County
198343	Fee-for-Service	1255893517	1255893517	1	1	LEE, KATRINA H MD	9/7/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	179444	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
198350	Fee-for-Service	1235211236	1235211236	1	1	LOPEZ, ANTOINETTE L MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54812	01	General Practice	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
198369	Fee-for-Service	1790852911	1790852911	1	1	LEE, JONATHAN W MD	9/30/1987	207R00000X	NA	Other	026	PHYSICIANS	63814	41	Internal Medicine	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
198400	Fee-for-Service	1376931295	1376931295	1	8	LIFELONG MEDICAL CARE	12/28/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	920 ALLSTON WAY	None	BERKELEY	CA	94710	2389	01	06001	37.86575915	-122.294211	Alameda County
198415	Fee-for-Service	1285496182	1285496182	1	1	LIM, KATRINA PT	3/27/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
198434	Fee-for-Service	1386677045	1386677045	1	1	LEE, SUSAN J MD	9/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67596	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
198435	Fee-for-Service	1134198922	1134198922	1	1	LEE, JUDY J MD	11/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75018	40	Pediatrics	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
198438	Fee-for-Service	1538598131	1538598131	2	1	LOS ROBLES HOSPICE INC	1/24/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1720 E GARRY AVE	STE 120	SANTA ANA	CA	92705	5832	30	06059	33.70531049	-117.853506	Orange County
198446	Fee-for-Service	1356347959	1356347959	1	1	LEMAY, DANIEL R MD	12/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	74285	14	Neurological Surgery	0	In state provider	None	8043 2ND ST	STE 105	DOWNEY	CA	90241	3621	19	06037	33.94296553	-118.1360957	Los Angeles County
198449	Fee-for-Service	1255651329	1255651329	2	1	LESTER, LAUREEN A	5/1/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7921 KINGSWOOD DR	SUITE A5B	CITRUS HEIGHTS	CA	95610	7710	34	06067	38.670192	-121.2705855	Sacramento County
198469	Fee-for-Service	1821247966	1821247966	1	1	LASIEWICKI, TONI M LMFT	6/9/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7171 ALVARADO RD	STE 100A	LA MESA	CA	91942	8996	37	06073	32.77267798	-117.0445155	San Diego County
198476	Fee-for-Service	1891178638	1891178638	1	1	LAM, JULIA MD	11/19/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	144473	40	Pediatrics	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
198486	Fee-for-Service	1962109033	1962109033	1	8	LOS ANGELES COUNTY DEPARTMEN	2/8/2024	261QP0905X	NA	Other	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	R	5300 TUJUNGA AVE	None	NORTH HOLLYWOOD	CA	91601	3121	19	06037	34.167276	-118.3789445	Los Angeles County
198489	Fee-for-Service	1881708220	1881708220	1	1	LESIN, BENJAMIN E MD INC	7/1/1982	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	14624 SHERMAN WAY	STE 303	VAN NUYS	CA	91405	2288	19	06037	34.20078354	-118.450843	Los Angeles County
198492	Fee-for-Service	1336138015	1336138015	1	1	LIEBERMAN, RONALD E DPM INC	8/1/1985	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1011 DEVONSHIRE DR	STE F	ENCINITAS	CA	92024	5136	37	06073	33.03945	-117.285914	San Diego County
198532	Fee-for-Service	1265568315	1265568315	1	1	LOVINCEVIC, IGOR MD	7/28/2017	207L00000X	NA	Other	026	PHYSICIANS	146298	05	Anesthesiology	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
198538	Fee-for-Service	1578582961	1578582961	1	1	LEONARD, JOHN A MD	6/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77839	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
198547	Fee-for-Service	1174532618	1174532618	1	1	LUPERCIO, RAFAEL MD	8/12/1995	207RP1001X	NA	Pulmonology	026	PHYSICIANS	53300	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
198562	Fee-for-Service	1437934577	1437934577	1	1	LEE, YEHJEE PT	11/30/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 W HOSPITALITY LANE	100	SAN BERNARDINO	CA	92408	3238	36	06071	34.0659135	-117.289215	San Bernardino County
198620	Fee-for-Service	1629024914	1629024914	1	1	LINCOLN MEDICAL CENTER	8/16/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	106 MEDICAL CENTER BLVD	None	FAYETTEVILLE	TN	37334	2684	00	None	35.14841002	-86.5560604	Lincoln County
198647	Fee-for-Service	1063496545	1063496545	1	1	LAURIE, JACK A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43352	02	General Surgery	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
198648	Fee-for-Service	1306135124	1306135124	1	1	LEE, JONATHAN S J MD	6/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134228	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
198676	Fee-for-Service	1407814908	1407814908	1	1	LIANG, IVAN E-H MD	9/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108898	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
198689	Fee-for-Service	1376931295	1376931295	1	8	LIFELONG MEDICAL CARE	12/28/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	920 ALLSTON WAY	None	BERKELEY	CA	94710	2389	01	06001	37.86575915	-122.294211	Alameda County
198690	Fee-for-Service	1326009572	1326009572	1	1	LEE, GORDON K MD	6/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	68322	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
198703	Fee-for-Service	1154731560	1154731560	1	1	LEE, JENNY X MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138211	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
198715	Fee-for-Service	1699922104	1699922104	1	1	LUGO, LAURA	6/25/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	105228	-	NOT APPLICABLE	0	In state provider	None	2695 S 4TH ST	2ND FL	EL CENTRO	CA	92243	6012	13	06025	32.76973509	-115.5520629	Imperial County
198718	Fee-for-Service	1891892188	1891892188	1	1	LEONIDA, EFREN B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	ONE BRADDOCK AVE, STE A	None	MT PLEASANT	PA	15666	0000	00	None	40.15459657	-79.55019868	Westmoreland County
198723	Fee-for-Service	1386677045	1386677045	1	1	LEE, SUSAN J MD	9/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67596	83	Rheumatology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
198767	Fee-for-Service	1477560423	1477560423	1	1	LESLIE,KIMBERLY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
198799	Fee-for-Service	1912955048	1912955048	1	1	LOONEY, DAVID J MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67588	41	Internal Medicine	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
198821	Fee-for-Service	1154364982	1154364982	2	1	LONGS DRUG STORES CA LLC	12/15/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1193 ADMIRAL CALLAGHAN L	None	VALLEJO	CA	94891	3701	48	06095	38.13568023	-122.2146369	Solano County
198823	Fee-for-Service	1821860735	1821860735	1	1	LEUNG, IAN A PT	1/31/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
198826	Fee-for-Service	1336144732	1336144732	1	1	LIMA MEMORIAL JOINT	11/1/2011	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	OPERATING COMPANY	1001 BELLEFONTAINE AVE	None	LIMA	OH	45804	2899	00	None	40.73497429	-84.08667156	Allen County
198854	Fee-for-Service	1730100215	1730100215	1	1	LEVINE, DANIEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	593 EDDY ST	None	PROVIDENCE	RI	02903	4923	00	None	41.81122992	-71.40713931	Providence County
198882	Fee-for-Service	1528120748	1528120748	1	1	LIU, WILSON L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72764	08	Family Practice	0	In state provider	None	2910 JEFFERSON ST	STE 103	CARLSBAD	CA	92008	2358	37	06073	33.16226261	-117.3463592	San Diego County
198918	Fee-for-Service	1689180838	1689180838	1	1	LEGG, JESSICA D	1/18/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	120 KOKANEE DRIVE	None	OROVILLE	CA	95966	3972	04	06007	39.52656239	-121.4639819	Butte County
198935	Fee-for-Service	1063496545	1063496545	1	1	LAURIE, JACK A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43352	40	Pediatrics	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
198951	Fee-for-Service	1518498856	1518498856	1	1	LEE, JAY P MD	10/18/2022	207L00000X	NA	Other	026	PHYSICIANS	157218	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
198953	Fee-for-Service	1710914569	1710914569	1	1	LUM, KEVIN K. MD	2/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	347 N KUAKINI ST	None	HONOLULU	HI	96817	2336	00	None	21.32247447	-157.8564644	Honolulu County
198978	Fee-for-Service	1972546760	1972546760	2	1	LONGS DRUG STORE CAL LLC	11/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	670 EL CERRITO PLAZA	None	EL CERRITO	CA	94530	4010	07	06013	37.89958525	-122.300105	Contra Costa County
198980	Fee-for-Service	1730113820	1730113820	1	1	LY, NGOC P MD	10/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100697	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
198982	Fee-for-Service	1710930235	1710930235	1	1	LIM, JERRIE G MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	49299	40	Pediatrics	0	In state provider	None	260 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.65808446	-121.6456618	Monterey County
198987	Fee-for-Service	1871752816	1871752816	1	1	LIMBERG, RYAN M MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120614	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
198995	Fee-for-Service	1124106752	1124106752	1	1	LINDAN, CAMILLA E MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	63257	30	Radiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
199001	Fee-for-Service	1467758201	1467758201	1	1	LAU, STEPHEN F T MD	8/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128257	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
199003	Fee-for-Service	1013516350	1013516350	1	1	LANCE J JOHNS MARRIAGE AND F	5/3/2021	261QM0801X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1255 W COLTON AVE	None	REDLANDS	CA	92374	2861	36	06071	34.06285254	-117.20178	San Bernardino County
199008	Fee-for-Service	1962509869	1962509869	1	1	LA MOTHE, PIERRE D MD	8/31/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	56770	40	Pediatrics	0	In state provider	None	23845 HOLMAN HWY	STE 203	MONTEREY	CA	93940	5901	27	06053	36.57594044	-121.9132944	Monterey County
199018	Fee-for-Service	1396717385	1396717385	1	1	LIGMAN, CATHLEEN M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	76320	02	General Surgery	0	In state provider	None	2407 W VINE ST	STE B	LODI	CA	95242	3730	39	06077	38.12285348	-121.3044345	San Joaquin County
199037	Fee-for-Service	1235459678	1235459678	1	1	LINDA J HODES-VILLAMAR MD	8/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
199046	Fee-for-Service	1881863090	1881863090	1	1	LE, STEVEN Q MD	11/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104419	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
199066	Fee-for-Service	1316568371	1316568371	1	1	LIANG, ELLEN DO	7/11/2024	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	21108	08	Family Practice	0	In state provider	None	26520 CACTUS AVE	# B2018	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
199080	Fee-for-Service	1538707013	1538707013	1	1	LIM, ANGELA CNM	12/31/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	23141 MOULTON PKWY	108	LAGUNA HILLS	CA	92653	1241	30	06059	33.62613379	-117.7305831	Orange County
199086	Fee-for-Service	1912955048	1912955048	1	1	LOONEY, DAVID J MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67588	77	Infectious Disease	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
199096	Fee-for-Service	1235397142	1235397142	1	1	LEE, TENG C MD	10/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150297	33	Thoracic Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
199103	Fee-for-Service	1972693836	1972693836	1	1	LEDWIN, REBECCA K NP	1/8/2025	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
199112	Fee-for-Service	1336144732	1336144732	1	1	LIMA MEMORIAL JOINT	11/1/2011	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	OPERATING COMPANY	1001 BELLEFONTAINE AVE	None	LIMA	OH	45804	2899	00	None	40.73497429	-84.08667156	Allen County
199113	Fee-for-Service	1174621320	1174621320	1	2	LOUWRENS, NEIL A MD	4/10/2019	207R00000X	NA	Other	086	MEDICAL DIRECTORS	52662	-	NOT APPLICABLE	0	In state provider	None	3590 EL PORTAL DR.	7, 8, 9, 10, 15, 16, & 1	REDDING	CA	96002	3154	45	06089	40.55435123	-122.3565549	Shasta County
199147	Fee-for-Service	1013042886	1013042886	1	1	LUU, PHILIP P MD	9/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76772	30	Radiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
199157	Fee-for-Service	1184981029	1184981029	1	1	LE-TRAN, VIVIAN V DO	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13153	02	General Surgery	0	In state provider	None	6380 CLARK AVE	None	DUBLIN	CA	94567	3036	01	06001	37.70451998	-121.9205494	Alameda County
199158	Fee-for-Service	1841488525	1841488525	1	1	LEE, JENNIFER MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91542	04	Otology, Laryngology, Rhinology	0	In state provider	None	1011 BALDWIN PARK	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
199159	Fee-for-Service	1891898862	1891898862	2	1	LONG BEACH NEUROLOGICAL	11/5/2015	2084N0402X	NA	Neurology	026	PHYSICIANS	32989	79	Neurology-Child	0	In state provider	MEDICAL GROUP INC	2880 ATLANTIC AVE	STE 260	LONG BEACH	CA	90806	1716	19	06037	33.809382	-118.185001	Los Angeles County
199171	Fee-for-Service	1316017478	1316017478	1	1	LEE, JOHN M MD	5/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	23616	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
199185	Fee-for-Service	1366440018	1366440018	1	1	LEE, ANNE C MD	3/2/2010	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 W VALLEY BLVD	#115	SAN GABRIEL	CA	91776	3784	19	06037	34.07958215	-118.1021957	Los Angeles County
199196	Fee-for-Service	1497041883	1497041883	1	1	LEE, SUNG W MD	10/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123119	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
199206	Fee-for-Service	1689180838	1689180838	1	1	LEGG, JESSICA D	1/18/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	120 KOKANEE DRIVE	None	OROVILLE	CA	95966	3972	04	06007	39.52656239	-121.4639819	Butte County
199227	Fee-for-Service	1588971741	1588971741	1	1	LEHMAN, ERICA E PHD	6/27/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7700 IRVINE CENTER DR	SUITE 800	ORANGE	CA	92618	3047	30	06059	33.65876225	-117.7500004	Orange
199296	Fee-for-Service	1962509869	1962509869	1	1	LA MOTHE, PIERRE D MD	8/31/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	56770	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23845 HOLMAN HWY	STE 203	MONTEREY	CA	93940	5901	27	06053	36.57594044	-121.9132944	Monterey County
199313	Fee-for-Service	1538247143	1538247143	1	1	LIU, EVA S MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63051	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
199316	Fee-for-Service	1972827871	1972827871	1	1	LAI, CHRISTOPHER MD	2/9/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	328 S 1ST STREET	SUITES F AND G	ALHAMBRA	CA	91801	3789	19	06037	34.09104553	-118.1252904	Los Angeles County
199342	Fee-for-Service	1366671836	1366671836	1	1	LEE, HO JE MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112040	08	Family Practice	0	In state provider	None	1577 E CHEVY CHASE DR	STE 110	GLENDALE	CA	91206	4107	19	06037	34.15313959	-118.2299467	Los Angeles County
199350	Fee-for-Service	1346583572	1346583572	1	1	LAWRENCE, MATTHEW W MD	3/15/2019	207L00000X	NA	Other	026	PHYSICIANS	159996	05	Anesthesiology	0	In state provider	None	CLAY AND BUCHANNAN ST	None	SAN FRANCISCO	CA	94115	0000	38	06075	37.791126	-122.4309105	San Francisco County
199355	Fee-for-Service	1316568371	1316568371	1	1	LIANG, ELLEN DO	7/11/2024	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	21108	38	Geriatrics	0	In state provider	None	26520 CACTUS AVE	# B2018	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
199367	Fee-for-Service	1619328499	1619328499	1	1	LEE, JAKE J MD	8/16/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
199371	Fee-for-Service	1639667447	1639667447	1	3	LANDAU WEED, BONNIE LPCC	12/17/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	143 FIGUEROA STREET	SUITE 11	VENTURA	CA	93001	2756	56	06111	34.27894582	-119.297753	Ventura County
199398	Fee-for-Service	1205880259	1205880259	1	1	LIN, STEPHEN P MD	8/1/1998	2085R0204X	NA	Other	026	PHYSICIANS	77159	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
199412	Fee-for-Service	1477996833	1477996833	1	1	LOHDOYLE, JEFFREY C H MD	4/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125179	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
199415	Fee-for-Service	1386002970	1386002970	1	1	LIGHT HOME CARE INC	12/31/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	511 E HARVARD ST	STE 1	GLENDALE	CA	91205	1184	19	06037	34.14449793	-118.2495946	Los Angeles County
199432	Fee-for-Service	1558361204	1558361204	1	1	LEVINE, LORI E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1601 W SAINT MARYS RD	None	TUCSON	AZ	85745	2623	00	None	32.228199	-111.0000825	Pima County
199435	Fee-for-Service	1710357884	1710357884	1	1	LOWMAN, MONICA Y	1/25/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
199475	Fee-for-Service	1972576221	1972576221	1	1	LEVINE, JOSIE A LMFT	7/31/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2220 MOUNTAIN BLVD	STE 240	OAKLAND	CA	94611	2905	01	06001	37.82318115	-122.2080468	Alameda County
199558	Fee-for-Service	1134702707	1134702707	1	1	LIN, JOHN L MD	5/28/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	309 WEST BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
199610	Fee-for-Service	1306138722	1306138722	1	1	LEAVER, NICHOLAS MD	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	8280 W WARM SPRINGS RD	None	LAS VEGAS	NV	89113	3612	00	None	36.057384	-115.2721395	Clark County
199620	Fee-for-Service	1609475904	1609475904	1	1	LEMOINE, JUSTIN J PT	2/2/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5337 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	2807	15	06029	35.36721148	-119.0622416	Kern County
199669	Fee-for-Service	1225660939	1225660939	1	1	LUU, JULIE L NP	3/22/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	501 S VINCENT AVE	SUITE 205	WEST COVINA	CA	91790	6712	19	06037	34.0662144	-117.9274205	Los Angeles County
199683	Fee-for-Service	1578589396	1578589396	1	1	LEHMAN, DAVID H MD	7/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77927	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
199688	Fee-for-Service	1669683520	1669683520	1	1	LOGAN, TINA LMFT	4/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18837 BROOKHURST ST	SUITE 102	FOUNTAIN VALLEY	CA	92708	7301	30	06059	33.68919119	-117.9542204	Orange County
199722	Fee-for-Service	1780748111	1780748111	1	1	LEFKOWITZ, ROBERT B MD	12/26/1996	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	27920	None	None	0	In state provider	VENTURA COUNTY MED CTR	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
199724	Fee-for-Service	1356684997	1356684997	1	1	LWIN, THINZAR M MD	7/12/2022	2086X0206X	NA	General Surgery	026	PHYSICIANS	144570	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
199768	Fee-for-Service	1427242403	1427242403	1	1	LE, MARY D MD	8/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	97806	22	Pathology (M.D. only)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
199781	Fee-for-Service	1255694238	1255694238	1	1	LIU, JEHNAN MD	8/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142010	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
199785	Fee-for-Service	1922078807	1922078807	1	1	LIM, THOMAS W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	333 W HAMPDEN AVE	STE 600	ENGLEWOOD	CO	80110	2336	00	None	39.65335027	-104.9924183	Arapahoe County
199796	Fee-for-Service	1609108836	1609108836	1	1	LIN-DUFFY, MENG-FEY F DO	8/1/2024	2086X0206X	NA	General Surgery	026	PHYSICIANS	21268	02	General Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
199814	Fee-for-Service	1710454293	1710454293	1	1	LUI, SHELLY OT	4/5/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
199834	Fee-for-Service	1881697381	1881697381	1	3	LAKE COUNTY TRIBAL HEALTH	11/21/2023	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	14678 LAKESHORE DRIVE	None	CLEARLAKE	CA	95422	9290	17	06033	38.95000853	-122.636988	Lake County
199835	Fee-for-Service	1710901616	1710901616	2	1	LAWRENCE, BRUCE P MD	12/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	445 30TH STREET	FL 2	OAKLAND	CA	94609	3301	01	06001	37.8191601	-122.2656731	Alameda County
199838	Fee-for-Service	1750879177	1750879177	1	1	LEE, CHARLES MD	11/3/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174164	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
199861	Fee-for-Service	1952489791	1952489791	1	1	LORITZ, JOANNE M MD	10/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	66508	36	Psychiatry	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
199875	Fee-for-Service	1356693246	1356693246	1	1	LY, ALLISON LCSW	4/9/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1015 FREMONT AVE	2ND FLOOR	SOUTH PASADENA	CA	91030	3224	19	06037	34.114176	-118.1531575	Los Angeles County
199876	Fee-for-Service	1043501851	1043501851	1	1	LAFONTANT, JEAN E MD	6/16/2020	2083P0901X	NA	Adult Primary Care	026	PHYSICIANS	131224	39	Preventive (M.D. only)	0	In state provider	None	524 W 4TH ST	B	PERRIS	CA	92570	2016	33	06065	33.78236446	-117.237456	Riverside County
199899	Fee-for-Service	1477995249	1477995249	1	1	LOFTIS, KELLY D LCSW	3/4/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
199911	Fee-for-Service	1285619924	1285619924	1	1	LAAKANIEMI, BRIAN E MD	6/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102322	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
199936	Fee-for-Service	1225068836	1225068836	1	1	LAI, JOSEPHINE L OD	7/8/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 W VALLEY BLVD	STE 115	SAN GABRIEL	CA	91776	3784	19	06037	34.07958215	-118.1021957	Los Angeles County
199959	Fee-for-Service	1619234515	1619234515	1	1	LU, LOAN T MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128110	40	Pediatrics	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
199972	Fee-for-Service	1164500898	1164500898	1	1	LEE, EDWARD R MD	8/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80709	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
199973	Fee-for-Service	1477009330	1477009330	1	1	LAVELLE, BIANCA J MD	4/12/2023	208M00000X	NA	Other	026	PHYSICIANS	184712	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
199981	Fee-for-Service	1326507344	1326507344	1	1	LOWDER, HARRISON B MD	4/27/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	179846	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
199984	Fee-for-Service	1336183789	1336183789	2	1	LONGS DRUG STORE CAL LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8585 ELK GROVE BLVD	None	ELK GROVE	CA	95624	1774	34	06067	38.410146	-121.3851645	Sacramento County
199987	Fee-for-Service	1285618710	1285618710	1	1	LUCE, MARK E MD	5/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2735 SILVER CREEK RD	None	BULLHEAD CITY	AZ	86442	7924	00	None	35.110926	-114.5552445	Mohave County
200010	Fee-for-Service	1710052113	1710052113	1	1	LITTEN, JOHN	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
200012	Fee-for-Service	1528260825	1528260825	1	1	LI, MARILYN MD	5/24/2019	2080P0201X	NA	Neurology	026	PHYSICIANS	64596	03	Allergy	0	In state provider	None	1850 S AZUSA AVE STE 206	None	HACIENDA HEIGHTS	CA	91745	6853	19	06037	33.98895597	-117.9322797	Los Angeles County
200052	Fee-for-Service	1417093691	1417093691	1	1	LIN, CHENYI MD	1/29/2021	207R00000X	NA	Other	026	PHYSICIANS	170149	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
200109	Fee-for-Service	1427136134	1427136134	1	1	LUNDBERG, ALAN R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25483	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
200111	Fee-for-Service	1720152416	1720152416	1	1	LUCIER, PETER A	12/24/2012	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	735 PINE ST	None	PASO ROBLES	CA	93446	2857	40	06079	35.62232732	-120.6885158	San Luis Obispo County
200164	Fee-for-Service	1427110329	1427110329	1	5	LIVINGSTON COMMUNITY HEALTH	4/22/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2116 E ORANGEBURG AVENUE	None	MODESTO	CA	95355	3370	50	06099	37.66354152	-120.958056	Stanislaus County
200216	Fee-for-Service	1184957979	1184957979	1	1	LAUREN RENNER	1/25/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
200229	Fee-for-Service	1952344129	1952344129	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	291 N MCDOWELL BLVD	None	PETALUMA	CA	94954	2306	49	06097	38.25181594	-122.6306259	Sonoma County
200244	Fee-for-Service	1245752575	1245752575	1	1	LASCANO, ANDROMEDA LMFT	3/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
200271	Fee-for-Service	1114150562	1114150562	1	1	LUKAS, LAUREN A MD	9/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109093	78	Neoplastic Diseases/Oncology	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	7049	19	06037	34.15729818	-118.3277073	Los Angeles County
200282	Fee-for-Service	1376784447	1376784447	1	1	LEE, EDWARD S J MD	4/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107027	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
200292	Fee-for-Service	1003216896	1003216896	1	1	LUXOR CARE INC	12/11/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	301 GEORGIA STREET	SUITE 316	VALLEJO	CA	94590	5997	48	06095	38.10109387	-122.2578133	Solano County
200304	Fee-for-Service	1881289619	1881289619	1	1	LAB DISTRICT INC.	9/20/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	3911 HOLLYWOOD BLVD	STE 202	HOLLYWOOD	FL	33021	6795	00	None	26.01170454	-80.18329494	Broward County
200305	Fee-for-Service	1619055472	1619055472	1	1	LISKER, WESLEY H MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42699	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
200332	Fee-for-Service	1962858209	1962858209	1	1	LEVINSON, JENNA N LCSW	8/8/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
200347	Fee-for-Service	1568966216	1568966216	1	1	LIN, EDWARD MD	7/22/2021	207R00000X	NA	Other	026	PHYSICIANS	164355	None	None	0	In state provider	None	4700 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6082	19	06037	34.09812055	-118.2921165	Los Angeles County
200348	Fee-for-Service	1154728533	1154728533	1	1	LEPREAU, RENEE DOULA	3/10/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	01	06001	0	0	None
200396	Fee-for-Service	1699922104	1699922104	1	2	LUGO, LAURA	8/23/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	945 WESTWIND DR	None	EL CENTRO	CA	92243	4365	13	06025	32.77755399	-115.5629306	Imperial County
200428	Fee-for-Service	1467507046	1467507046	1	1	LOS ANGELES COUNTY CCS	9/29/1993	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	HUNTINGTON PARK MTU	6222 STATE ST	None	HUNTINGTON PARK	CA	90255	4403	19	06037	33.98247632	-118.2125545	Los Angeles County
200432	Fee-for-Service	1184878258	1184878258	1	1	LAKSANA, GIZELLA S MD	9/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103703	40	Pediatrics	0	In state provider	None	795 WILLOW ROAD	BLG 334	MENLO PARK	CA	94025	2539	41	06081	37.466676	-122.160384	San Mateo County
200452	Fee-for-Service	1427110329	1427110329	1	5	LIVINGSTON COMMUNITY HEALTH	4/22/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2116 E ORANGEBURG AVENUE	None	MODESTO	CA	95355	3370	50	06099	37.66354152	-120.958056	Stanislaus County
200463	Fee-for-Service	1285672550	1285672550	1	1	LAMBERT, THOMAS J MD	8/31/1989	207P00000X	NA	Other	026	PHYSICIANS	30066	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1633 S COURT ST	None	VISALIA	CA	93277	4945	54	06107	36.315972	-119.292237	Tulare County
200472	Fee-for-Service	1114944923	1114944923	1	1	LAS COLINAS MED GRP	5/11/1993	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2820 ALUM ROCK AVE	None	SAN JOSE	CA	95127	5608	43	06085	37.3631929	-121.8334108	Santa Clara County
200534	Fee-for-Service	1083196166	1083196166	1	1	LOBBAN MARRIAGE AND FAMILY T	10/4/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ICES	473 E. CARNEGIE DRIVE	SUITE 200	SAN BERNARDINO	CA	92408	4201	36	06071	34.0683677	-117.2746246	San Bernardino County
200560	Fee-for-Service	1487231247	1487231247	1	1	LE, WILLIAMSON	7/12/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
200572	Fee-for-Service	1962109033	1962109033	1	10	LOS ANGELES COUNTY DEPARTMEN	2/8/2024	261QP0905X	NA	Other	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	750 S PARK AVE	None	POMONA	CA	91766	3129	19	06037	34.05272034	-117.7543163	Los Angeles County
200599	Fee-for-Service	1942303904	1942303904	1	1	LAMBERT, GARRY W. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1050 WELLINGTON AVE	None	GRAND JCT	CO	81501	8121	00	None	39.09000173	-108.5550488	Mesa County
200602	Fee-for-Service	1639190341	1639190341	1	1	LU, SHI P	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1800 BROADWAY ST	STE 2	REDWOOD CITY	CA	94063	2044	41	06081	37.48674011	-122.2238575	San Mateo County
200643	Fee-for-Service	1811290083	1811290083	1	1	LEE, VIVIAN MD	1/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112771	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
200646	Fee-for-Service	1902386121	1902386121	1	1	LOVELL, BENJAMIN R PT	5/16/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
200648	Fee-for-Service	1659459642	1659459642	2	1	LIM, MARY E MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	75107	40	Pediatrics	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
200658	Fee-for-Service	1740533660	1740533660	1	1	LEE, MYONG H CRNA	3/21/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
200705	Fee-for-Service	1962580530	1962580530	1	1	LOPEZ, KENNETH T DPM	10/11/2010	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3925 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
200728	Fee-for-Service	1235593104	1235593104	1	1	LIN, WILLIAM I MD	4/14/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158034	None	None	0	In state provider	None	660 BAKER STREET	STE A-102	COSTA MESA	CA	92626	4407	30	06059	33.68014263	-117.8842009	Orange County
200737	Fee-for-Service	1033384649	1033384649	1	1	LEE, RENEE M LMFT	12/2/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 COLORADO BLVD	5TH FLOOR	PASADENA	CA	91106	2327	19	06037	34.14595648	-118.1287575	Los Angeles County
200775	Fee-for-Service	1942801162	1942801162	1	1	LONGENECKER, ERIC CRNA	4/1/2022	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
200816	Fee-for-Service	1326144148	1326144148	1	1	LESSANI, FAHIMEH MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	46047	41	Internal Medicine	0	In state provider	None	8540 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4628	19	06037	34.22579296	-118.5360435	Los Angeles County
200851	Fee-for-Service	1821494576	1821494576	1	1	LA DRUGS INC	5/11/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4233 ATLANTIC AVE	None	LONG BEACH	CA	90807	2801	19	06037	33.83361	-118.1850965	Los Angeles County
200853	Fee-for-Service	1881172351	1881172351	1	1	LADD, LUISA M PHD	1/28/2019	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
200898	Fee-for-Service	1255399523	1255399523	1	1	LEVINSON, GARY D MD	6/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	49820	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4282 GENESEE AVE	STE 102	SAN DIEGO	CA	92117	4986	37	06073	32.82092667	-117.1828683	San Diego County
200900	Fee-for-Service	1508875873	1508875873	1	1	LEVINE, DENNIS CNP	8/23/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
200907	Fee-for-Service	1871638742	1871638742	1	1	LEONG, HYMAN R LMFT	10/15/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18837 BROOKHURST ST	None	FOUNTAIN VALLEY	CA	92708	7308	30	06059	33.68919119	-117.9542204	Orange County
200928	Fee-for-Service	1457394777	1457394777	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2601 OAKDALE RD	#E	MODESTO	CA	95355	2257	50	06099	37.67844965	-120.9577951	Stanislaus County
200932	Fee-for-Service	1811290083	1811290083	1	1	LEE, VIVIAN MD	1/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112771	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
200949	Fee-for-Service	1144432873	1144432873	1	1	LIN, YU-CHEN	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	312 E 1ST ST	STE 220	LOS ANGELES	CA	90012	3918	19	06037	34.0502134	-118.240711	Los Angeles County
200971	Fee-for-Service	1942303003	1942303003	1	1	LIN, ANNA PEI-FEN MD	3/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94202	None	None	0	In state provider	None	220 E 13TH ST	None	MERCED	CA	95340	6242	24	06047	37.29309532	-120.4748791	Merced County
200999	Fee-for-Service	1487827929	1487827929	1	1	LEE, JOHN C MD INC	4/21/2008	261Q00000X	NA	Other	026	PHYSICIANS	37292	41	Internal Medicine	0	In state provider	None	207 S SANTA ANITA ST	#G-18	SAN GABRIEL	CA	91776	1147	19	06037	34.10072807	-118.1066296	Los Angeles County
201009	Fee-for-Service	1013247899	1013247899	1	1	LI, SUYU MD	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128898	30	Radiology	0	In state provider	None	5000 SAN BERNADINE ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
201018	Fee-for-Service	1982664041	1982664041	1	1	LIN, DAVID H Y MD	6/30/1981	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	41718	10	Gastroenterology (M.D. only)	0	In state provider	None	905 SAN RAMON VALLEY BLV	STE 206	DANVILLE	CA	94526	4035	07	06013	37.80823414	-121.9922059	Contra Costa County
201081	Fee-for-Service	1811254329	1811254329	1	1	LOIDOLT, TRAVIS DO	10/11/2019	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	16495	20	Orthopedic Surgery	0	In state provider	None	584 N. SUNRISE AVE.	SUITE 100	ROSEVILLE	CA	95661	2862	31	06061	38.75842021	-121.2528302	Placer County
201089	Fee-for-Service	1558512848	1558512848	2	1	LIFETIME PHARMACY CORP	10/17/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	23080 ALESSANDRO BLVD.	STE. 212	MORENO VALLEY	CA	92553	9673	33	06065	33.91731429	-117.2599095	Riverside County
201098	Fee-for-Service	1932179595	1932179595	2	1	LAURON, MARK P MD	9/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	61892	41	Internal Medicine	0	In state provider	None	16024 KAMANA RD	None	APPLE VALLEY	CA	92307	1308	36	06071	34.54228943	-117.2719742	San Bernardino County
201127	Fee-for-Service	1528252558	1528252558	1	1	LALANI, FAISAL MD	7/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100812	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
201129	Fee-for-Service	1093718678	1093718678	1	1	LIU, HSIN-PEI MD	2/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88658	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	102 SAN MIGUEL AVE	None	SALINAS	CA	93901	3057	27	06053	36.65895947	-121.6556795	Monterey County
201154	Fee-for-Service	1952572265	1952572265	1	1	LEE, IDA C	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
201181	Fee-for-Service	1043873979	1043873979	1	1	LOPEZ, KRISTOFER-MYLES M	2/3/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	181408	None	None	0	In state provider	None	2105 BEVERLY BLVD	129	LOS ANGELES	CA	90057	2216	19	06037	34.06682861	-118.2706286	Los Angeles County
201185	Fee-for-Service	1255399523	1255399523	1	1	LEVINSON, GARY D MD	6/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	49820	41	Internal Medicine	0	In state provider	None	4282 GENESEE AVE	STE 102	SAN DIEGO	CA	92117	4986	37	06073	32.82092667	-117.1828683	San Diego County
201190	Fee-for-Service	1225780562	1225780562	1	1	LEE, YOUNG TAE NP	10/18/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15260 VENTURA BLVD	1200	SHERMAN OAKS	CA	91403	5307	19	06037	34.15370926	-118.4656644	Los Angeles County
201201	Fee-for-Service	1871685255	1871685255	1	1	LAWRENCE, BRUCE P MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	445 30TH STREET	FL 2	OAKLAND	CA	94609	3301	01	06001	37.8191601	-122.2656731	Alameda County
201222	Fee-for-Service	1104189414	1104189414	1	1	LU, CHARLES C DO	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15281	66	Emergency Medicine (Urgent Care)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
201256	Fee-for-Service	1992214449	1992214449	1	1	LI, TAMMY OD	9/7/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1211 NORTH MAIN STREET	None	SALINAS	CA	93906	2826	27	06053	36.69964289	-121.6521198	Monterey County
201270	Fee-for-Service	1295178002	1295178002	1	1	LAU, DEON W MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149957	05	Anesthesiology	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
201275	Fee-for-Service	1033268081	1033268081	1	1	LEVIN, MICHAEL I OD	4/25/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10724 WASHINGTON BLVD	None	CULVER CITY	CA	90232	3314	19	06037	34.0162352	-118.4061254	Los Angeles County
201288	Fee-for-Service	1043252943	1043252943	1	1	LE, ANNIE V MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74521	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
201307	Fee-for-Service	1982664041	1982664041	1	1	LIN, DAVID H Y MD	6/30/1981	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	41718	41	Internal Medicine	0	In state provider	None	905 SAN RAMON VALLEY BLV	STE 206	DANVILLE	CA	94526	4035	07	06013	37.80823414	-121.9922059	Contra Costa County
201336	Fee-for-Service	1992859300	1992859300	1	1	LATIF, OMAR A MD	5/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97570	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
201347	Fee-for-Service	1124098736	1124098736	1	1	LUCENT PATHOLOGY PARTNERS IN	11/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	C	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
201361	Fee-for-Service	1134613987	1134613987	1	1	LEON, MIGUEL MD	7/1/2024	390200000X	NA	Other	026	PHYSICIANS	185138	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 MARSHALL WAY	None	PLACERVILLE	CA	95667	6533	09	06017	38.72453536	-120.7921649	El Dorado County
201375	Fee-for-Service	1093995516	1093995516	1	1	LEE, MAY M MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143720	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
201379	Fee-for-Service	1386148864	1386148864	1	1	LYNCH, KATHERINE L PSYD	11/8/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
201406	Fee-for-Service	1376539130	1376539130	1	1	LOMPOC VALLEY MEDICAL CENTER	9/1/1975	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	216 N 3RD ST	None	LOMPOC	CA	93436	6104	42	06083	34.641279	-120.445174	Santa Barbara County
201438	Fee-for-Service	1528104858	1528104858	2	1	LAUNER, DANA P MD AND WORSEY	11/10/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	M JONATHAN MD APC	9834 GENESEE AVE	SUITE 201	SAN DIEGO	CA	92037	1205	37	06073	32.884074	-117.225855	San Diego County
201475	Fee-for-Service	1255399523	1255399523	1	1	LEVINSON, GARY D MD	6/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	49820	08	Family Practice	0	In state provider	None	4282 GENESEE AVE	STE 102	SAN DIEGO	CA	92117	4986	37	06073	32.82092667	-117.1828683	San Diego County
201485	Fee-for-Service	1225494636	1225494636	1	1	LOMA VISTA ENDOCRINOLOGY INC	3/25/2016	207RE0101X	NA	Endocrinology	026	PHYSICIANS	66887	None	None	0	In state provider	None	2629 LOMA VISTA RD	None	VENTURA	CA	93003	1548	56	06111	34.27488905	-119.2610224	Ventura County
201507	Fee-for-Service	1841831955	1841831955	1	1	LEWIS, KEVIN P CRNA	9/23/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
201532	Fee-for-Service	1811339716	1811339716	1	1	LY, SON V OD	12/23/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1843 1/2 S LA CIENEGA BL	None	LOS ANGELES	CA	90035	4603	19	06037	34.04410366	-118.3768223	Los Angeles County
201545	Fee-for-Service	1992333843	1992333843	1	1	LIANG, JUSTINE J MD	2/29/2024	207L00000X	NA	Other	026	PHYSICIANS	188715	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
201556	Fee-for-Service	1295178002	1295178002	1	1	LAU, DEON W MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149957	01	General Practice	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
201557	Fee-for-Service	1003970104	1003970104	1	1	LEGACY HEALTHCARE PROVIDERS	3/17/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	1272 CENTER COURT DRIVE	STE 203	COVINA	CA	91724	3667	19	06037	34.07289566	-117.864007	Los Angeles County
201559	Fee-for-Service	1033153713	1033153713	1	1	LAMM, TARYN P MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60556	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
201576	Fee-for-Service	1033225271	1033225271	1	1	LOPANSRI, CHERAPHAT MD	1/1/1981	207W00000X	NA	Ophthalmology	026	PHYSICIANS	33669	18	Ophthalmology	0	In state provider	None	1127 WILSHIRE BLVD	STE 1604	LOS ANGELES	CA	90017	4007	19	06037	34.05270508	-118.2641005	Los Angeles County
201588	Fee-for-Service	1881757078	1881757078	1	1	LEE, ROBERT K DPM	12/7/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
201607	Fee-for-Service	1043849730	1043849730	1	1	LEE, SARAH K MD	4/16/2024	208600000X	NA	General Surgery	026	PHYSICIANS	178539	02	General Surgery	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
201621	Fee-for-Service	1639799109	1639799109	1	1	LARA-PACHECO, ABRAHAN N MD	10/31/2024	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	176759	08	Family Practice	0	In state provider	None	3700 MALL VIEW RD	None	BAKERSFIELD	CA	93306	3050	15	06029	35.39462173	-118.9518506	Kern County
201624	Fee-for-Service	1861642506	1861642506	1	1	LOPEZ, EVELYN E NP	10/11/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
201697	Fee-for-Service	1780696039	1780696039	1	1	LIAO, YUNGTING MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63537	40	Pediatrics	0	In state provider	None	2501 FOREST AVE	None	SAN JOSE	CA	95117	1118	43	06085	37.32737951	-121.950486	Santa Clara County
201703	Fee-for-Service	1518026236	1518026236	1	1	LEE FLORES, SOYONG T LCSW	10/3/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
201727	Fee-for-Service	1598999054	1598999054	1	1	LAL, DEEPALI MD	5/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106959	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
201768	Fee-for-Service	1811038912	1811038912	1	1	LUONG, LIEN T MD	9/8/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	71529	08	Family Practice	0	In state provider	None	2435 WEBSTER ST	STE E	BERKELEY	CA	94705	2050	01	06001	37.85537621	-122.2585128	Alameda County
201825	Fee-for-Service	1245810365	1245810365	1	1	LIU, TZU CHIA OT	1/16/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
201876	Fee-for-Service	1598777401	1598777401	1	1	LEFF, EMILY MD	11/30/1983	207ZP0101X	NA	Other	026	PHYSICIANS	43242	22	Pathology (M.D. only)	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
201890	Fee-for-Service	1972552248	1972552248	1	1	LEE, JUNGJIN H MD	10/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82988	41	Internal Medicine	0	In state provider	None	1411 COFFEE RD	None	MODESTO	CA	95355	3104	50	06099	37.66406061	-120.9757639	Stanislaus County
201891	Fee-for-Service	1659603942	1659603942	1	1	LEE, REBECCA E MD	11/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110119	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
201899	Fee-for-Service	1467226019	1467226019	1	1	LUXE LAIRS LLC	12/4/2023	347C00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3625 N PARKWAY DR	None	FRESNO	CA	93722	4705	10	06019	36.79077339	-119.861669	Fresno County
201973	Fee-for-Service	1457033623	1457033623	1	1	LOTIA CORP	6/24/2024	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	537 FULTON ST	None	STOCKTON	CA	95204	2227	39	06077	37.98493477	-121.2934666	San Joaquin County
202001	Fee-for-Service	1043897259	1043897259	1	1	LARSEN, MARTIN G DO	2/15/2025	207P00000X	NA	Other	026	PHYSICIANS	-	70	Clinic (mixed specialty)	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
202006	Fee-for-Service	1124106836	1124106836	1	1	LEWIS, REENA A MD	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	71226	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1907 DOUGLAS BLVD	STE 70	ROSEVILLE	CA	95661	3808	31	06061	38.74437759	-121.2577195	Placer County
202039	Fee-for-Service	1225661747	1225661747	1	1	LOPEZ, MARISOL M	2/19/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1448 W BERKELEY CT	None	WEST COVINA	CA	91792	2010	19	06037	0	0	None
202079	Fee-for-Service	1194732347	1194732347	1	1	LEE, NICHOLAS S C MD	2/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	32378	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	12362 BEACH BLVD	STE 10	STANTON	CA	90680	3944	30	06059	33.78298855	-117.9927453	Orange County
202095	Fee-for-Service	1548361926	1548361926	1	1	LELAND-ARIZMED, ODILE MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61396	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2151 APPIAN WAY	None	PINOLE	CA	94564	2514	07	06013	37.99738125	-122.3013414	Contra Costa County
202119	Fee-for-Service	1962473439	1962473439	1	1	LENG, CHERI W MD	8/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93688	18	Ophthalmology	0	In state provider	None	1001 RIVERSIDE AVENUE	None	ROSEVILLE	CA	95678	6134	31	06061	38.72845186	-121.2904134	Placer County
202125	Fee-for-Service	1306461363	1306461363	1	1	LIGHT BEAM HOSPICE INC	10/13/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11350 VENTURA BLVD	SUITE 103	STUDIO CITY	CA	91604	3140	19	06037	34.14014506	-118.3774984	Los Angeles County
202137	Fee-for-Service	1902990518	1902990518	1	1	LONGO, THERESA A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	59848	40	Pediatrics	0	In state provider	None	1401 GARCES HWY	None	DELANO	CA	93215	3690	15	06029	35.76144847	-119.238912	Kern County
202139	Fee-for-Service	1114981255	1114981255	1	1	LADELLA, SUBHASHINI J MD	3/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68832	None	None	0	In state provider	None	2210 E ILLINOIS AVE	STE 301	FRESNO	CA	93701	2168	10	06019	36.74500687	-119.7846885	Fresno County
202163	Fee-for-Service	1972587137	1972587137	1	1	LIN, ROBIN F MD	5/6/2009	2084P0800X	NA	Psychiatry	026	PHYSICIANS	75024	36	Psychiatry	0	In state provider	None	4250 AUBURN BLVD	None	SACRAMENTO	CA	95841	4100	34	06067	38.642832	-121.3649325	Sacramento County
202192	Fee-for-Service	1578096905	1578096905	1	1	LOVEPREET SINGH	3/1/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
202222	Fee-for-Service	1487913059	1487913059	1	1	LEWIS, SARAH MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120507	20	Orthopedic Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
202247	Fee-for-Service	1215427992	1215427992	1	1	LIVINGSTONE, JOHN P MD	7/17/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
202267	Fee-for-Service	1104814722	1104814722	1	1	LARY, DARREL L MD	3/1/1966	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	28584	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	CLAY AND WEBSTER STREETS	None	SAN FRANCISCO	CA	94103	0000	38	06075	37.790928	-122.432571	San Francisco County
202289	Fee-for-Service	1649483033	1649483033	1	1	LIN, HENRY C MD	7/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107466	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
202290	Fee-for-Service	1043897259	1043897259	1	1	LARSEN, MARTIN G DO	2/15/2025	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
202313	Fee-for-Service	1396812277	1396812277	1	1	LIU, RICHARD K MD	10/1/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	78280	01	General Practice	0	In state provider	None	6301 BEACH BLVD	STE 101	BUENA PARK	CA	90621	4030	30	06059	33.86880928	-117.9983013	Orange County
202326	Fee-for-Service	1225661747	1225661747	1	1	LOPEZ, MARISOL M	2/19/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1448 W BERKELEY CT	None	WEST COVINA	CA	91792	2010	19	06037	0	0	None
202388	Fee-for-Service	1942229695	1942229695	1	1	LESLIE C PARKER, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
202411	Fee-for-Service	1306461363	1306461363	1	1	LIGHT BEAM HOSPICE INC	10/13/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11350 VENTURA BLVD	SUITE 103	STUDIO CITY	CA	91604	3140	19	06037	34.14014506	-118.3774984	Los Angeles County
202423	Fee-for-Service	1366578031	1366578031	1	1	LAHEY, SUSAN MD	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137247	34	Urology and Urological Surgery	0	In state provider	None	8851 CENTER DRIVE	STE 501	LA MESA	CA	91942	3017	37	06073	32.78189749	-117.0075062	San Diego County
202466	Fee-for-Service	1639667447	1639667447	1	2	LANDAU WEED, BONNIE LPCC	1/31/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	196 MAHONEY AVENUE	None	OAK VIEW	CA	93022	0000	56	06111	34.39858317	-119.3012014	Ventura County
202480	Fee-for-Service	1154446656	1154446656	1	1	LEWIS, DIANE G NP	11/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3875 AVOCADO BLVD	None	LA MESA	CA	91941	7303	37	06073	32.750325	-116.9607955	San Diego County
202519	Fee-for-Service	1538374368	1538374368	1	1	LIN, STAN T MD	11/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	38562	41	Internal Medicine	0	In state provider	None	2324 SANTA RITA RD	STE 5	PLEASANTON	CA	94566	4150	01	06001	37.68217511	-121.8757097	Alameda County
202557	Fee-for-Service	1144308727	1144308727	1	1	LOWRY, TERRY B MD	11/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83193	20	Orthopedic Surgery	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
202620	Fee-for-Service	1699087213	1699087213	1	1	LIU, ANNIE S MD	10/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118416	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
202639	Fee-for-Service	1326070657	1326070657	1	1	LO, ROGER SHENG-CHIEH MD	7/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84131	07	Dermatology	0	In state provider	None	200 MED PLAZA	STE 465	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
202694	Fee-for-Service	1992100671	1992100671	1	1	LOCKETT, HEIDI J	9/15/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
202731	Fee-for-Service	1184260879	1184260879	1	1	LEE, ABDURRAHHIM M PT	1/17/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
202810	Fee-for-Service	1538374368	1538374368	1	1	LIN, STAN T MD	11/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	38562	13	Neurology (M.D. only)	0	In state provider	None	2324 SANTA RITA RD	STE 5	PLEASANTON	CA	94566	4150	01	06001	37.68217511	-121.8757097	Alameda County
202815	Fee-for-Service	1578506960	1578506960	1	1	LONGAR, SUSAN M MD	5/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	75139	18	Ophthalmology	0	In state provider	None	1850 SULLIVAN AVE	STE 101	DALY CITY	CA	94015	2215	41	06081	37.68085904	-122.4728842	San Mateo County
202823	Fee-for-Service	1013124726	1013124726	1	1	LAUREN MORRIS	5/17/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 1ST AVE	None	NEW YORK	NY	10029	7494	00	None	40.784778	-73.9439055	New York County
202840	Fee-for-Service	1639346687	1639346687	1	1	LEO N LEVI MEMORIAL HOSPITAL	5/3/2021	273R00000X	NA	Other	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	300 PROSPECT AVE	None	HOT SPRINGS NATIO	AR	71901	4003	00	None	34.510203	-93.0574125	Garland County
202843	Fee-for-Service	1720280787	1720280787	1	1	LEE, SUNG MD	4/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139416	18	Ophthalmology	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
202862	Fee-for-Service	1003129883	1003129883	1	1	LEWIS, JENNIFER A	7/19/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2262 N. 1ST ST	None	SAN JOSE	CA	95131	2022	43	06085	37.37772646	-121.921374	Santa Clara County
202923	Fee-for-Service	1467764654	1467764654	1	1	LEONG, SHELDON MD	9/16/2018	207R00000X	NA	Other	026	PHYSICIANS	129154	45	Nephrology (Renal-Kidney)	0	In state provider	None	777 CAMPUS COMMONS RD	SUITE 120	SACRAMENTO	CA	95825	8343	34	06067	38.571021	-121.416786	Sacramento County
202951	Fee-for-Service	1124694625	1124694625	1	1	LEBADA, SALEM DPM	10/9/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	505 S VIRGIL AVE	205	LOS ANGELES	CA	90020	1406	19	06037	34.064883	-118.287086	Los Angeles County
202956	Fee-for-Service	1588844021	1588844021	1	1	LAFRANCONI, SCOTT D LMFT	3/25/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
202964	Fee-for-Service	1437559168	1437559168	1	1	LUI, JANET W OT	1/7/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1902 ROYALTY DRIVE	SUITE 170	POMONA	CA	91767	3030	19	06037	34.07791925	-117.746146	Los Angeles County
202976	Fee-for-Service	1033312004	1033312004	1	1	LASER ENDOSCOPY MED GRP	1/1/1983	174400000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	INC	201 S ALVARADO ST	STE 407	LOS ANGELES	CA	90057	2353	19	06037	34.06417777	-118.2719543	Los Angeles County
203022	Fee-for-Service	1619049418	1619049418	1	1	LITVACK, FRANK MD	10/25/1991	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	47270	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
203032	Fee-for-Service	1487141354	1487141354	1	1	LAI, STEPHANIE DO	5/7/2020	390200000X	NA	Other	026	PHYSICIANS	17761	08	Family Practice	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
203047	Fee-for-Service	1790045540	1790045540	1	1	LEWIS, JUANITA MD	1/21/2019	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	136917	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
203053	Fee-for-Service	1124084082	1124084082	1	1	LINGAMNENI, SANTHI S MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	78794	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
203059	Fee-for-Service	1255490991	1255490991	1	1	LIEN, WINSTON W MD	1/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95489	01	General Practice	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
203079	Fee-for-Service	1699297382	1699297382	1	1	LEE, ANNE V MD	11/13/2024	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	68321	39	Preventive (M.D. only)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
203090	Fee-for-Service	1548873110	1548873110	1	1	LONG, GARRETT B DO	10/13/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22103	None	None	0	In state provider	None	6000 SEPULVEDA BLVD	E10	CULVER CITY	CA	90230	6421	19	06037	33.985512	-118.393524	Los Angeles County
203130	Fee-for-Service	1639346687	1639346687	1	1	LEO N LEVI MEMORIAL HOSPITAL	5/3/2021	273R00000X	NA	Other	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	300 PROSPECT AVE	None	HOT SPRINGS NATIO	AR	71901	4003	00	None	34.510203	-93.0574125	Garland County
203180	Fee-for-Service	1619096732	1619096732	1	1	LINARES, BARBARA L LCSW	4/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	27868	-	NOT APPLICABLE	0	In state provider	None	710 E 111TH PLACE	None	LOS ANGELES	CA	90059	1518	19	06037	33.93454026	-118.2626368	Los Angeles County
203182	Fee-for-Service	1134366040	1134366040	1	2	LORENZ, MICHELE LCSW	8/14/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5200 WARNER AVE	STE 208	HUNTINGTON BEACH	CA	92649	4033	30	06059	33.71527028	-118.0375369	Orange County
203185	Fee-for-Service	1912243890	1912243890	1	1	LAMARR, STEPHANIE A LPCC	7/8/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	C	3400 MATANZAS CREEK LN	None	SANTA ROSA	CA	95404	8221	49	06097	38.37951359	-122.5971749	Sonoma County
203193	Fee-for-Service	1205302676	1205302676	1	1	LAWLER, RAINA A	12/22/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2615 ASHBY AVE	None	BERKELEY	CA	94705	2200	01	06001	37.85685511	-122.2547897	Alameda County
203214	Fee-for-Service	1689857971	1689857971	1	1	LE, SCHEHERAZADE T MD	11/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101971	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
203241	Fee-for-Service	1437123734	1437123734	1	1	LAMBERTY,PHILLIP MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3601 FIFTH AVE	4TH FLOOR FALK	PITTSBURGH	PA	15213	0000	00	None	40.44135069	-79.95912416	Allegheny County
203247	Fee-for-Service	1528235868	1528235868	1	1	LEE, JOHN C MD INC	7/31/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	37292	41	Internal Medicine	0	In state provider	None	7136 PACIFIC BLVD	#225	HUNTINGTON PARK	CA	90255	4767	19	06037	33.97474083	-118.2251149	Los Angeles County
203259	Fee-for-Service	1154886166	1154886166	1	1	LIFEWEST NORTHERN CALIFORNIA	5/2/2019	341600000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	5460 SKYLANE BLVD	STE C	SANTA ROSA	CA	95403	1084	49	06097	38.51391542	-122.798759	Sonoma County
203278	Fee-for-Service	1104400951	1104400951	1	2	LITTLE, LORRAINE LCSW	2/14/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	101071	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	214	TRUCKEE	CA	96161	0232	29	06057	39.33573744	-120.180872	Nevada County
203294	Fee-for-Service	1285708883	1285708883	1	1	LAI, GEORGE C DO	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	6566	30	Radiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
203318	Fee-for-Service	1083732341	1083732341	1	1	LOTICH, PATRICIA	5/16/2011	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
203366	Fee-for-Service	1962109033	1962109033	1	6	LOS ANGELES COUNTY DEPARTMEN	2/8/2024	261QP0905X	NA	Other	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	) HEALTH CENTER	11833 WILMINGTON AVE	None	LOS ANGELES	CA	90059	3015	19	06037	33.925077	-118.2391655	Los Angeles County
203369	Fee-for-Service	1184707853	1184707853	1	1	LEVIN, SARA K MD	12/16/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77340	41	Internal Medicine	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
203389	Fee-for-Service	1861717811	1861717811	1	1	LORENSON, MELINDA J MD	11/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121337	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2200 OFARRELL	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
203398	Fee-for-Service	1083934525	1083934525	1	1	LANDE, JESSICA R PHD	10/23/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
203399	Fee-for-Service	1699940692	1699940692	1	1	LEE, EDWARD J MD	4/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103088	84	Surgery-Head and Neck	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
203411	Fee-for-Service	1689053837	1689053837	1	1	LEJANO, KRYSTLE P LMFT	7/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
203417	Fee-for-Service	1467762294	1467762294	1	1	L.T. DUONG, M.D., INC.	2/23/2011	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	74045	None	None	0	In state provider	None	2708 WESTMINSTER AVE	STE 110	SANTA ANA	CA	92706	2192	30	06059	33.75978099	-117.9059769	Orange County
203446	Fee-for-Service	1275518102	1275518102	1	1	LAIRD, DENNIS A MD	6/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	5330 S HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
203461	Fee-for-Service	1538130380	1538130380	2	1	LEMOR, MARCOS MD	5/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	45400	18	Ophthalmology	0	In state provider	None	4036 WHITTIER BLVD	SUITE 20	LOS ANGELES	CA	90023	2561	19	06037	34.02390455	-118.1847825	Los Angeles County
203464	Fee-for-Service	1386091270	1386091270	1	1	LINDGREN, AMELIA M MD	9/6/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	151051	None	None	0	In state provider	None	1925 BUDLONG AVE	None	LOS ANGELES	CA	90007	1109	19	06037	34.03903111	-118.2962577	Los Angeles County
203468	Fee-for-Service	1326238643	1326238643	1	1	LE, KIM V MD	6/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93808	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1749	19	06037	34.069509	-118.383743	Los Angeles County
203470	Fee-for-Service	1952047367	1952047367	1	1	LIM, KAH WHYE MD	2/20/2025	111NR0200X	NA	Other	026	PHYSICIANS	188217	30	Radiology	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
203482	Fee-for-Service	1215004239	1215004239	1	1	LIM, DANIEL MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32348	41	Internal Medicine	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
203492	Fee-for-Service	1093169393	1093169393	1	1	LJUBIMOV, VLADIMIR A MD	6/12/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	162804	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
203508	Fee-for-Service	1073830675	1073830675	1	1	LABARTE, THERESA L DO	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11876	13	Neurology (M.D. only)	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
203560	Fee-for-Service	1104992213	1104992213	1	1	LING, YU-FU	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	LINGS ACUPUNCTURE & HERB	2615 MARINE AVE	None	GARDENA	CA	90249	3730	19	06037	33.89468949	-118.322784	Los Angeles County
203643	Fee-for-Service	1891351961	1891351961	1	1	LA, SUSANNA W PHD	6/18/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
203667	Fee-for-Service	1447260583	1447260583	1	1	LEE, SAN T MD	12/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89554	41	Internal Medicine	0	In state provider	None	1310 W STEWART DR	STE 410	ORANGE	CA	92868	3855	30	06059	33.78236048	-117.8664975	Orange County
203705	Fee-for-Service	1275611774	1275611774	1	1	LOH, ANGELA C MD	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73832	66	Emergency Medicine (Urgent Care)	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
203711	Fee-for-Service	1679098834	1679098834	1	1	LINDA Y. SHEN, MD	12/15/2017	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2707 E VALLEY BLVD STE 2	None	WEST COVINA	CA	91792	3197	19	06037	34.00300402	-117.8871067	Los Angeles County
203730	Fee-for-Service	1265061626	1265061626	1	1	LE, PHUONGANH M MD	9/1/2023	207R00000X	NA	Other	026	PHYSICIANS	183664	None	None	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	3663	30	06059	33.62421676	-117.9309656	Orange County
203749	Fee-for-Service	1386091270	1386091270	1	1	LINDGREN, AMELIA M MD	10/1/2024	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	1925 BUDLONG AVE	None	LOS ANGELES	CA	90007	1109	19	06037	34.03903111	-118.2962577	Los Angeles County
203757	Fee-for-Service	1346961356	1346961356	1	1	LUONG, MONICA OD	9/22/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2001 E VENTURA BLVD.	None	OXNARD	CA	93036	1813	56	06111	34.22378048	-119.1501106	Ventura County
203758	Fee-for-Service	1124494851	1124494851	1	1	LEMUS-REYES, CELENE LCSW	5/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
203780	Fee-for-Service	1750918587	1750918587	1	1	LIU, BENJAMIN MD	8/2/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
203852	Fee-for-Service	1770516536	1770516536	1	1	LIN-CHANG, LYNNE MD	11/29/2007	207ZC0500X	NA	Other	026	PHYSICIANS	75959	22	Pathology (M.D. only)	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
203909	Fee-for-Service	1982198123	1982198123	1	1	LUONG, KATRINA AU	4/2/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1640 MARENGO STREET	600	LOS ANGELES	CA	90033	1036	19	06037	34.05946374	-118.213356	Los Angeles County
203916	Fee-for-Service	1225039183	1225039183	1	1	LABABIDI, ZAKI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	475 S DOBSON RD	None	CHANDLER	AZ	85224	5605	00	None	33.29768043	-111.8761089	Maricopa County
203946	Fee-for-Service	1346378940	1346378940	1	1	LUETKEMEYER, ANNE F	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74234	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
203952	Fee-for-Service	1568412567	1568412567	1	1	LEE, HIN W MD	5/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	76523	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	STE 3150	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
203975	Fee-for-Service	1932466778	1932466778	1	1	LAPALME, SULEIMAN N MD	8/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143434	25	Physical Medicine and Rehabilitation	0	In state provider	None	1450 TREAT BLVD	STE 200	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
203980	Fee-for-Service	1619119187	1619119187	1	1	LEE, JAMES H MD	5/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115680	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12-411 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
203982	Fee-for-Service	1073599627	1073599627	1	1	LI, HONG Y MD	7/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75719	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
203992	Fee-for-Service	1427169531	1427169531	1	1	LANGEVIN, KATHY K MD	3/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85857	07	Dermatology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
204012	Fee-for-Service	1083949267	1083949267	1	1	LONG, JAMES A MD	9/29/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	137094	None	None	0	In state provider	None	74785 US HIGHWAY 111	STE 101	INDIAN WELLS	CA	92210	7129	33	06065	33.72131925	-116.360116	Riverside County
204037	Fee-for-Service	1881136984	1881136984	1	1	LEHR, COLLEEN T NP	1/29/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
204042	Fee-for-Service	1902227499	1902227499	1	1	LIN, STEPHANIE	8/27/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	132969	30	Radiology	0	In state provider	None	4640 ADMIRALTY WAY	STE 102	MARINA DEL REY	CA	90292	6629	19	06037	33.98120707	-118.4409729	Los Angeles County
204045	Fee-for-Service	1649674797	1649674797	1	1	LOPEZ, MARK ERWIN S NP	10/12/2020	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
204046	Fee-for-Service	1083773618	1083773618	1	1	LIM, ALICE MD	10/1/1998	2080P0006X	NA	Psychiatry	026	PHYSICIANS	61725	40	Pediatrics	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
204070	Fee-for-Service	1699780437	1699780437	1	1	LEVIN, NORMAN MD INC	11/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	9672	05	Anesthesiology	0	In state provider	None	2070 CENTURY PARK E	None	LOS ANGELES	CA	90067	1907	19	06037	34.05887194	-118.4122914	Los Angeles County
204089	Fee-for-Service	1750339446	1750339446	1	1	LUKACZ, EMILY S MD	9/1/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	63540	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
204159	Fee-for-Service	1386117711	1386117711	1	1	LIFEWEST SOUTHERN CALIFORNIA	3/22/2019	3416L0300X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	4223 PONDEROSA AVE	STE A	SAN DIEGO	CA	92123	1529	37	06073	32.81652	-117.131301	San Diego County
204173	Fee-for-Service	1457343568	1457343568	1	1	LIN, STEVEN G MD	1/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	84610	18	Ophthalmology	0	In state provider	None	340 S FARRELL DR	STE A105	PALM SPRINGS	CA	92262	7921	33	06065	33.81788398	-116.5180079	Riverside County
204206	Fee-for-Service	1215900196	1215900196	1	1	LUETKEHANS, KIRK J MD	10/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	68177	40	Pediatrics	0	In state provider	MGA OFFICE	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
204226	Fee-for-Service	1619141223	1619141223	1	1	LUE, JASON MD	6/25/2008	390200000X	NA	Other	026	PHYSICIANS	104300	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
204234	Fee-for-Service	1346378940	1346378940	1	1	LUETKEMEYER, ANNE F	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74234	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
204242	Fee-for-Service	1518980663	1518980663	1	1	LIU, ANTONIO K MD	2/1/1999	207T00000X	NA	General Surgery	026	PHYSICIANS	62246	13	Neurology (M.D. only)	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 510	LOS ANGELES	CA	90033	2488	19	06037	34.05112725	-118.2173921	Los Angeles County
204258	Fee-for-Service	1982622064	1982622064	1	1	LANESSA D BASS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	None	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
204312	Fee-for-Service	1184890063	1184890063	1	2	LUND, GREGG C DO	7/10/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	11500	-	NOT APPLICABLE	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
204314	Fee-for-Service	1134278476	1134278476	1	1	LAOS, CARLA M MD FAAP	10/18/2019	207PP0204X	NA	Other	026	PHYSICIANS	161764	40	Pediatrics	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
204329	Fee-for-Service	1346686664	1346686664	1	1	LAPP, KIRSTEN R LMFT	5/17/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	748 N MARKET ST	None	REDDING	CA	96003	3606	45	06089	40.5960907	-122.38781	Shasta County
204359	Fee-for-Service	1942372420	1942372420	1	1	LEE, YOUNG H MD	4/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61424	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
204390	Fee-for-Service	1780664250	1780664250	1	1	LONGOBARDI, JAMES J	2/21/2008	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	450 4TH AVE	STE 401	CHULA VISTA	CA	91910	4430	37	06073	32.63513513	-117.0820663	San Diego County
204391	Fee-for-Service	1396981445	1396981445	1	1	LI, JIALI MD	11/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105831	68	Hematology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
204429	Fee-for-Service	1205179793	1205179793	1	1	LISS, JILL H MD	6/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
204436	Fee-for-Service	1104868660	1104868660	1	1	LEBOW, MAX F MD	10/31/1986	207P00000X	NA	Other	026	PHYSICIANS	49950	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3700 SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
204442	Fee-for-Service	1275625204	1275625204	1	1	LONGTON, WILLIAM C MD	7/31/1991	207L00000X	NA	Other	026	PHYSICIANS	71946	05	Anesthesiology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
204472	Fee-for-Service	1013940907	1013940907	1	1	LEE. STEPHEN J MD	5/31/1995	207P00000X	NA	Other	026	PHYSICIANS	77712	41	Internal Medicine	0	In state provider	None	14500 SHERMAN CIR	None	VAN NUYS	CA	91405	3052	19	06037	34.20025916	-118.4500763	Los Angeles County
204477	Fee-for-Service	1740226828	1740226828	1	1	LUGO, CARLOS MD	9/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	49116	20	Orthopedic Surgery	0	In state provider	None	1135 S SUNSET AVE	STE 200	WEST COVINA	CA	91790	3937	19	06037	34.06215064	-117.9453997	Los Angeles County
204509	Fee-for-Service	1134612674	1134612674	1	1	LUC, KENNY PT	12/18/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	599 S BARRANCA AVE	STE 100	COVINA	CA	91723	2791	19	06037	34.079373	-117.881338	Los Angeles County
204542	Fee-for-Service	1679137780	1679137780	1	1	LACH, REBECCA L MD	8/9/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177922	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
204548	Fee-for-Service	1326627860	1326627860	1	1	LEWIS, SCOTT J	5/6/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	180166	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
204643	Fee-for-Service	1306284765	1306284765	1	1	LAROIA COON, SWATI DO	8/30/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	21552	None	None	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
204672	Fee-for-Service	1467890913	1467890913	1	1	LOUIE, CHRISTINA ANNE L NP	11/27/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
204680	Fee-for-Service	1396981445	1396981445	1	1	LI, JIALI MD	11/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105831	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
204681	Fee-for-Service	1639667447	1639667447	1	1	LANDAU WEED, BONNIE LPCC	5/5/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
204702	Fee-for-Service	1407422769	1407422769	1	1	LAMA, SUDHA NP	1/31/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
204706	Fee-for-Service	1720003759	1720003759	1	1	LIN, ANTHONY M MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	64438	05	Anesthesiology	0	In state provider	None	815 POLLARD RD	None	LOS GATOS	CA	95032	1438	43	06085	37.26214754	-121.9701986	Santa Clara County
204717	Fee-for-Service	1518208123	1518208123	1	1	LEE, JASON H MD	4/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123874	30	Radiology	0	In state provider	None	11370 ANDERSON STREET	SUITE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
204734	Fee-for-Service	1063705143	1063705143	1	1	LUCES, LATOYA A MD	4/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135885	None	None	0	In state provider	None	1500 FLORIDA AVE	None	MODESTO	CA	95350	1365	50	06099	37.665738	-120.9962205	Stanislaus County
204754	Fee-for-Service	1518379486	1518379486	1	1	LOPEZ, LIZBEETH MD	1/27/2023	390200000X	NA	Other	026	PHYSICIANS	172519	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
204760	Fee-for-Service	1013940907	1013940907	1	1	LEE. STEPHEN J MD	5/31/1995	207P00000X	NA	Other	026	PHYSICIANS	77712	66	Emergency Medicine (Urgent Care)	0	In state provider	None	14500 SHERMAN CIR	None	VAN NUYS	CA	91405	3052	19	06037	34.20025916	-118.4500763	Los Angeles County
204784	Fee-for-Service	1598020786	1598020786	1	1	LEE, ELLEN LCSW	12/1/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
204788	Fee-for-Service	1962513465	1962513465	1	1	LEAN, JOHN STEWART MD	3/30/2011	207W00000X	NA	Ophthalmology	026	PHYSICIANS	41624	18	Ophthalmology	0	In state provider	None	23521 PASEO DE VALENCIA	STE 305	LAGUNA HILLS	CA	92653	3140	30	06059	33.61113028	-117.7126684	Orange County
204811	Fee-for-Service	1174152490	1174152490	1	1	LUO, VINCENT MD	7/29/2024	207L00000X	NA	Other	026	PHYSICIANS	190768	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
204860	Fee-for-Service	1730248329	1730248329	1	1	LIM, JAMES WING YAN MD	12/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54735	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
204864	Fee-for-Service	1972966828	1972966828	1	1	LECLERE, FLAVIEN E MD	10/21/2019	390200000X	NA	Other	026	PHYSICIANS	151159	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1350 W COVINA BLVD	None	SAN DIMAS	CA	91773	3219	19	06037	34.09906108	-117.8343639	Los Angeles County
204867	Fee-for-Service	1912261736	1912261736	1	1	LIBERATOR, COLE MD	9/24/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	164583	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
204873	Fee-for-Service	1548379456	1548379456	2	1	LONGS DRUG STORE CA, INC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	869 NEWVILLE RD	None	ORLAND	CA	95963	1108	11	06021	39.74892107	-122.2013266	Glenn County
204880	Fee-for-Service	1023436391	1023436391	1	1	LING, JOHN F MD	6/12/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	155679	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
204892	Fee-for-Service	1679383699	1679383699	1	1	LAKEY, NICOLE BIRTH DOULA	1/24/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	44	06087	0	0	None
204978	Fee-for-Service	1609220284	1609220284	1	1	LE, MICHAEL DO	10/12/2021	208M00000X	NA	Other	026	PHYSICIANS	17510	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
204986	Fee-for-Service	1184742025	1184742025	1	1	LIN, JAMES T Y MD	4/30/1985	2084N0400X	NA	Neurology	026	PHYSICIANS	40982	13	Neurology (M.D. only)	0	In state provider	None	600 N GARFIELD AVE	STE 303	MONTEREY PARK	CA	91754	1171	19	06037	34.06820797	-118.1228835	Los Angeles County
204999	Fee-for-Service	1134804891	1134804891	1	1	LINDOW, MELISSA OD PC	8/3/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	36330 HIDDEN SPRINGS RD	STE A	WILDOMAR	CA	92595	5804	33	06065	33.59339735	-117.2454691	Riverside County
205023	Fee-for-Service	1861483182	1861483182	1	1	LENGLE, STEVEN J MD	11/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	61434	30	Radiology	0	In state provider	None	5020 COMMERCE DRIVE	None	BAKERSFIELD	CA	93309	0631	15	06029	35.36787086	-119.0579597	Kern County
205038	Fee-for-Service	1679862684	1679862684	1	1	LUPSA, DELIA MD	8/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121929	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
205070	Fee-for-Service	1639230550	1639230550	1	1	LANG, RONALD P MD	8/31/1983	207R00000X	NA	Other	026	PHYSICIANS	42331	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
205092	Fee-for-Service	1184260697	1184260697	1	1	LANDMARK ANESTHESIA MEDICAL	1/16/2020	207LC0200X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	GROUP LLUMC	28062 BAXTER RD	None	MURRIETA	CA	92563	1401	33	06065	33.61350847	-117.1691225	Riverside County
205150	Fee-for-Service	1730248329	1730248329	1	1	LIM, JAMES WING YAN MD	12/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54735	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
205156	Fee-for-Service	1306913314	1306913314	1	1	LODIN, KENNETH MD	4/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69008	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
205158	Fee-for-Service	1912261736	1912261736	1	1	LIBERATOR, COLE MD	9/24/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	164583	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
205210	Fee-for-Service	1578628731	1578628731	1	1	LEE, PHILLIP H MD	2/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	64665	07	Dermatology	0	In state provider	None	401 S FAIR OAKS AVE	None	PASADENA	CA	91105	2603	19	06037	34.13887038	-118.1504485	Los Angeles County
205219	Fee-for-Service	1861854804	1861854804	1	1	LAM, GRACE MD	1/8/2019	207P00000X	NA	Other	026	PHYSICIANS	154888	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
205253	Fee-for-Service	1407814155	1407814155	1	1	LAM, HENRY M MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	41629	01	General Practice	0	In state provider	None	450 E YOSEMITE AVE	STE D	MERCED	CA	95340	8489	24	06047	37.33211352	-120.4620165	Merced County
205267	Fee-for-Service	1194254896	1194254896	1	1	LICON, ERNESTO MD	5/3/2021	390200000X	NA	Other	026	PHYSICIANS	160205	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
205317	Fee-for-Service	1295188407	1295188407	1	1	LE, TRANG MD	4/11/2022	207L00000X	NA	Other	026	PHYSICIANS	157431	None	None	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
205339	Fee-for-Service	1659597037	1659597037	1	1	L'CHAIM ADULT DAY HEALTH	5/21/2002	385HR2065X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	7636 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90046	6409	19	06037	34.09073972	-118.3558967	Los Angeles County
205368	Fee-for-Service	1407540628	1407540628	1	1	LA BELLE, LINDSAY LMFT	6/1/2024	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5743 CORSA AVE	STE 112	WESTLAKE VILLAGE	CA	91362	6441	19	06037	34.156863	-118.7994295	Los Angeles County
205378	Fee-for-Service	1083825657	1083825657	1	1	L&N INC	6/2/2003	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	PERLITA HOUSE	2627 PERLITA CT	None	HAYWARD	CA	94541	3334	01	06001	37.68837333	-122.0588387	Alameda County
205379	Fee-for-Service	1114593324	1114593324	1	1	LANDON, MEGAN L MD	7/24/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
205384	Fee-for-Service	1184260697	1184260697	1	1	LANDMARK ANESTHESIA MEDICAL	5/18/2020	207LC0200X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP LLUMC	28062 BAXTER RD	None	MURRIETA	CA	92563	1401	33	06065	33.61350847	-117.1691225	Riverside County
205405	Fee-for-Service	1801430467	1801430467	1	5	LANDMARK ANESTHESIA MEDICAL	1/17/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP PRIME	4929 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
205407	Fee-for-Service	1164582359	1164582359	1	2	LISSKA, MEGAN C MD	1/12/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	76321	-	NOT APPLICABLE	0	In state provider	None	100 MASONIC AVE	None	SAN FRANCISCO	CA	94118	4415	38	06075	37.78055387	-122.4474128	San Francisco County
205424	Fee-for-Service	1386170561	1386170561	1	1	LOPEZ, HENDERSON V MD	5/17/2021	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
205435	Fee-for-Service	1871574400	1871574400	1	1	LEE, CHYH WOEI MD	7/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89369	03	Allergy	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
205453	Fee-for-Service	1326315284	1326315284	1	1	LUNG, DAVID Y DO	12/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	11545	01	General Practice	0	In state provider	None	1101 S MILLIKEN AVE	STE C	ONTARIO	CA	91761	8112	36	06071	34.053012	-117.557685	San Bernardino County
205454	Fee-for-Service	1962109033	1962109033	1	16	LOS ANGELES COUNTY DEPARTMEN	2/8/2024	261QP0905X	NA	Other	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	123 W MANCHESTER BLVD	None	INGLEWOOD	CA	90301	1753	19	06037	33.96180447	-118.3565745	Los Angeles County
205462	Fee-for-Service	1437160025	1437160025	1	1	LEVINSON, RALPH D MD	10/31/1992	207W00000X	NA	Ophthalmology	026	PHYSICIANS	69916	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	10614 RIVERSIDE DR	None	NORTH HOLLYWOOD	CA	91602	2373	19	06037	34.15217655	-118.362069	Los Angeles County
205489	Fee-for-Service	1225164148	1225164148	1	1	LANDON, HELEN Z	10/1/2001	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1421 SANTA MONICA BLVD	STE 106	SANTA MONICA	CA	90404	1750	19	06037	34.02456299	-118.4851618	Los Angeles County
205538	Fee-for-Service	1396123717	1396123717	1	1	LY, JOHNATHAN MD	8/21/2019	207P00000X	NA	Other	026	PHYSICIANS	163623	None	None	0	In state provider	None	2105 FOREST AVE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
205541	Fee-for-Service	1972007383	1972007383	1	1	LIN, JONATHAN K MD	9/27/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	164686	10	Gastroenterology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
205563	Fee-for-Service	1609827443	1609827443	1	1	LIU, SHWUJING J LCSW	11/19/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
205626	Fee-for-Service	1538656202	1538656202	1	1	LOGAN, STEWART R MD	3/23/2021	208600000X	NA	General Surgery	026	PHYSICIANS	167320	None	None	0	In state provider	None	22419 KENT AVE	None	TORRANCE	CA	90505	2303	19	06037	33.824448	-118.3564765	Los Angeles County
205657	Fee-for-Service	1417055344	1417055344	1	1	LEE, JUNG H OD	1/27/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 TRAVELODGE DR	None	EL CAJON	CA	92020	4126	37	06073	32.79312432	-116.980275	San Diego County
205667	Fee-for-Service	1801236922	1801236922	1	1	LEE, SONG-YI MD	3/15/2019	207P00000X	NA	Other	026	PHYSICIANS	155440	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
205687	Fee-for-Service	1639658545	1639658545	1	1	LAMBERT, ALEXUS LCSW	11/4/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
205693	Fee-for-Service	1801430467	1801430467	1	5	LANDMARK ANESTHESIA MEDICAL	11/7/2022	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP PRIME	4929 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
205719	Fee-for-Service	1699745471	1699745471	1	1	LEE, FAITH MD	12/1/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63452	08	Family Practice	0	In state provider	None	1700 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5115	36	06071	34.130214	-117.2788065	San Bernardino County
205728	Fee-for-Service	1366679516	1366679516	1	1	LEVIN, DAVID J MD	8/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108261	04	Otology, Laryngology, Rhinology	0	In state provider	None	1220 LAS TABLAS RD	STE 1418	TEMPLETON	CA	93465	9756	40	06079	35.55442452	-120.7211175	San Luis Obispo County
205733	Fee-for-Service	1316982713	1316982713	1	1	LARA, MARIA E MD	5/31/1994	207R00000X	NA	Other	026	PHYSICIANS	72582	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
205744	Fee-for-Service	1912017286	1912017286	1	1	LIU, MING MD	10/2/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	56341	02	General Surgery	0	In state provider	None	2485 HOSPITAL DRIVE	#240	MOUNTAIN VIEW	CA	94040	4101	43	06085	37.368918	-122.081761	Santa Clara County
205751	Fee-for-Service	1295858959	1295858959	1	1	LEMUS, NANCY LCSW	3/15/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
205813	Fee-for-Service	1902490683	1902490683	1	1	LIFELONG HOSPICE CARE, INC.	8/11/2023	163WH1000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	8399 TOPANGA CANYON BLVD	SUITE 308	WEST HILLS	CA	91304	2359	19	06037	34.221807	-118.606026	Los Angeles County
205828	Fee-for-Service	1972007383	1972007383	1	1	LIN, JONATHAN K MD	9/27/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	164686	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
205860	Fee-for-Service	1649309022	1649309022	1	1	LUU, THANH C DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	SUNSET FAMILY CHIROPRACT	2300 JUDAH ST	None	SAN FRANCISCO	CA	94122	1539	38	06075	37.76130465	-122.4869134	San Francisco County
205915	Fee-for-Service	1134273543	1134273543	1	1	LEUNG, CLARENCE M PHD	2/6/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	415 W ROUTE 66	STE 202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
205971	Fee-for-Service	1477873222	1477873222	1	1	LEE, LA CRESHEIA V LMFT	9/15/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
205997	Fee-for-Service	1205879053	1205879053	2	1	LONGS DRUG STORES CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3964 MISSOURI FLAT RD.	STE A	PLACERVILLE	CA	95667	5238	09	06017	38.71249081	-120.8413637	El Dorado County
206007	Fee-for-Service	1417548868	1417548868	1	1	LEE, TAMLYN D LMFT	12/18/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
206083	Fee-for-Service	1578926317	1578926317	1	1	LI, QIUYUE NP	11/20/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1207 E FLORIDA AVE	None	HEMET	CA	92543	4513	33	06065	33.74753552	-116.9593245	Riverside County
206090	Fee-for-Service	1538318704	1538318704	1	1	LEE, ROGER CHI-CHE MD	1/21/2009	207N00000X	NA	Dermatology	026	PHYSICIANS	93734	07	Dermatology	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
206100	Fee-for-Service	1417016544	1417016544	1	1	LIEN, MARY H MD	4/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55676	07	Dermatology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
206110	Fee-for-Service	1710373774	1710373774	1	1	LE, ANH Q MD	8/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150693	01	General Practice	0	In state provider	None	200 MEDICAL PLAZA	SUITE 530	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
206120	Fee-for-Service	1255617304	1255617304	1	1	LONG, KAN T PHD	1/18/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
206147	Fee-for-Service	1811103278	1811103278	1	1	LOYD'S LIBERTY HOMES INC	6/23/1993	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5493 N FELAND AVE	None	FRESNO	CA	93711	2128	10	06019	36.817164	-119.848446	Fresno County
206171	Fee-for-Service	1154595346	1154595346	1	1	LLURI, GENTIAN MD	6/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114499	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365,420,120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
206234	Fee-for-Service	1700993003	1700993003	1	1	LARA, XAVIER D MD	10/5/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	76215	-	NOT APPLICABLE	0	In state provider	None	4946 E YALE AVE	STE 103	FRESNO	CA	93727	1571	10	06019	36.7701095	-119.7296595	Fresno County
206273	Fee-for-Service	1760415277	1760415277	1	1	LESTER, PATRICIA E MD	9/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80402	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
206277	Fee-for-Service	1326031030	1326031030	2	1	LAU, ANNIE Y MD	3/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	38392	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
206289	Fee-for-Service	1194711952	1194711952	1	1	LOMPOC VALLEY MEDICAL	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	1515 E OCEAN AVENUE	None	LOMPOC	CA	93436	6104	42	06083	34.63941491	-120.4393023	Santa Barbara County
206337	Fee-for-Service	1265443345	1265443345	1	1	LUEHRS, PATRICIA M PSYD	9/1/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	595 E COLORADO BLVD	STE. 332	PASADENA	CA	91101	2015	19	06037	34.14588202	-118.1380722	Los Angeles County
206377	Fee-for-Service	1477602886	1477602886	1	1	LEE, DAVID MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37543	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
206445	Fee-for-Service	1629128426	1629128426	1	1	LEE, SANDRA J MD	12/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75105	25	Physical Medicine and Rehabilitation	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
206459	Fee-for-Service	1154595346	1154595346	1	1	LLURI, GENTIAN MD	6/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114499	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	STE 365,420,120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
206465	Fee-for-Service	1902839467	1902839467	1	1	LE DUC, CLIFFORD J PT	4/8/2020	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	420 B ST	None	YUBA CITY	CA	95991	5070	51	06101	39.13415904	-121.6121453	Sutter County
206498	Fee-for-Service	1073606216	1073606216	1	1	LEVIN, TERRY L MD	11/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154413	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
206508	Fee-for-Service	1285676916	1285676916	1	1	LIPSON, SCOTT R MD	3/1/1999	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	83068	20	Orthopedic Surgery	0	In state provider	None	1201 ALHAMBRA BLVD	STE 410	SACRAMENTO	CA	95816	5243	34	06067	38.570076	-121.4657145	Sacramento County
206518	Fee-for-Service	1801004791	1801004791	1	1	LIM, CONYEE T MD	4/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76277	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
206561	Fee-for-Service	1760415277	1760415277	1	1	LESTER, PATRICIA E MD	9/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80402	26	Psychiatry (child)	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
206566	Fee-for-Service	1184926693	1184926693	1	1	LEE, JA-TEE I NP	9/27/2017	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
206577	Fee-for-Service	1194711952	1194711952	1	1	LOMPOC VALLEY MEDICAL	12/1/1977	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	1515 E OCEAN AVENUE	None	LOMPOC	CA	93436	6104	42	06083	34.63941491	-120.4393023	Santa Barbara County
206600	Fee-for-Service	1053495234	1053495234	1	1	LRGHEALTHCARE	5/14/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	80 HIGHLAND ST	None	LACONIA	NH	03246	3235	00	None	43.52783815	-71.46086884	Belknap County
206613	Fee-for-Service	1821616434	1821616434	1	1	LIU, MEIQI LCSW	7/18/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
206638	Fee-for-Service	1255616041	1255616041	1	1	LIBERTY UNION HIGH SCHOOL	3/22/2012	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	20 OAK STREET	None	BRENTWOOD	CA	94513	1379	07	06013	37.9348431	-121.6908398	Contra Costa County
206648	Fee-for-Service	1760424592	1760424592	2	1	LONGS DRUG STORE CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1612 HOWARD RD	None	MADERA	CA	93637	5129	20	06039	36.95269115	-120.0763386	Madera County
206667	Fee-for-Service	1477602886	1477602886	1	1	LEE, DAVID MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37543	83	Rheumatology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
206719	Fee-for-Service	1164653093	1164653093	1	1	LEVIN, JACQUELINE M DO	4/24/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	12190	07	Dermatology	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
206738	Fee-for-Service	1376615807	1376615807	1	1	LIFE CHIROPRACTIC COLLEGE	3/28/2014	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	WEST	25001 INDUSTRIAL BLVD	None	HAYWARD	CA	94545	2801	01	06001	37.63841873	-122.1169742	Alameda County
206778	Fee-for-Service	1265169262	1265169262	1	1	LIBERTY RX PHARMACY LLC	9/26/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2458 ERRINGER RD	None	SIMI VALLEY	CA	93065	2351	56	06111	34.2801	-118.7613245	Ventura County
206781	Fee-for-Service	1235337700	1235337700	1	1	LEAMING-VAN ZANDT, KATHERINE	11/1/2020	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	MD	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
206827	Fee-for-Service	1841324456	1841324456	1	1	LEE, SANDY O MD	10/14/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	71522	40	Pediatrics	0	In state provider	None	4968 BOOTH	106	IRVINE	CA	92604	3360	30	06059	33.68590715	-117.7855253	Orange County
206839	Fee-for-Service	1588789655	1588789655	1	1	LEY, ERIC J MD	1/11/2008	208600000X	NA	General Surgery	026	PHYSICIANS	77295	02	General Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
206850	Fee-for-Service	1134352727	1134352727	1	1	LOZA, LUCIO MD	12/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103472	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
206855	Fee-for-Service	1548332398	1548332398	1	1	LEUNG, STANLEY S MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	65110	41	Internal Medicine	0	In state provider	PERMANENTE MEDICAL GROUP	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
206875	Fee-for-Service	1366646838	1366646838	1	1	LOH, CECILIA M MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143602	02	General Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
206884	Fee-for-Service	1053495234	1053495234	1	1	LRGHEALTHCARE	5/14/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	80 HIGHLAND ST	None	LACONIA	NH	03246	3235	00	None	43.52783815	-71.46086884	Belknap County
206938	Fee-for-Service	1124782115	1124782115	1	1	LIGALI, ADIJAT O NP	7/3/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
206953	Fee-for-Service	1578648556	1578648556	1	1	LINCARE, INC	9/13/2000	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	41951 CORPORATE WAY	STE B & C	PALM DESERT	CA	92260	1917	33	06065	33.743736	-116.3623675	Riverside County
206988	Fee-for-Service	1497780084	1497780084	1	1	LOS ALAMITOS MEDICAL CENTER	5/31/2002	273R00000X	NA	Other	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3101	30	06059	33.80318353	-118.0666665	Orange County
207051	Fee-for-Service	1114190907	1114190907	1	1	LITTLE TOKYO MEDICAL GRP	1/1/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	420 E 3RD ST	STE 705	LOS ANGELES	CA	90013	1646	19	06037	34.04702011	-118.241912	Los Angeles County
207053	Fee-for-Service	1386765352	1386765352	1	1	LAURA JEAN HOBART-PORTER	7/29/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	# 653	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
207092	Fee-for-Service	1225242761	1225242761	1	1	LE, JACQUELINE K MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98827	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
207098	Fee-for-Service	1760035208	1760035208	1	1	LIEW, JAZMINE MD	11/30/2023	207L00000X	NA	Other	026	PHYSICIANS	181204	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
207144	Fee-for-Service	1710959523	1710959523	1	1	LI, LI MD	2/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	73749	01	General Practice	0	In state provider	None	2930 EASTERN AVE	None	SACRAMENTO	CA	95821	4210	34	06067	38.618712	-121.3641045	Sacramento County
207146	Fee-for-Service	1548332398	1548332398	1	1	LEUNG, STANLEY S MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	65110	01	General Practice	0	In state provider	PERMANENTE MEDICAL GROUP	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
207154	Fee-for-Service	1073762274	1073762274	1	1	LE, QUY V MD	3/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100948	02	General Surgery	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
207196	Fee-for-Service	1023781655	1023781655	1	1	LEDFORD, LORI D	3/30/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
207211	Fee-for-Service	1801011580	1801011580	1	1	LARSON, DOUGLAS W PHD	6/9/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	789 E COOLEY AVE	None	COLTON	CA	92324	4007	36	06071	34.05795035	-117.3040272	San Bernardino County
207229	Fee-for-Service	1679024467	1679024467	1	1	LA CLINIQUITA, INC	12/19/2016	261QP2300X	NA	Other	026	PHYSICIANS	123276	01	General Practice	0	In state provider	None	6505 ROSEMEAD BLVD	STE 106	PICO RIVERA	CA	90660	3542	19	06037	33.98670353	-118.0945466	Los Angeles County
207247	Fee-for-Service	1346687902	1346687902	1	1	LOUIS Y. CHUN, MD, LLC	5/18/2021	207L00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
207249	Fee-for-Service	1376569277	1376569277	2	1	LALLA-REDDY MEDICAL COPORATI	12/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	ON	11180 WARNER AVE	353	FOUNTAIN VALLEY	CA	92708	7501	30	06059	33.71632048	-117.9334575	Orange County
207254	Fee-for-Service	1407387111	1407387111	1	1	LE BEAU, RICHARD T PHD	7/18/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.07067	-118.4432445	Los Angeles County
207276	Fee-for-Service	1356698278	1356698278	1	1	LIU, BELLA MD	10/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129239	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2425 SAMARITAN DRIVE	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
207281	Fee-for-Service	1972788479	1972788479	1	1	LAWSON, JOSHUA D MD	8/1/2008	2085R0001X	NA	Other	026	PHYSICIANS	104480	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
207282	Fee-for-Service	1861570434	1861570434	1	1	LEUNG, CYNTHIA W MD	10/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84052	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
207308	Fee-for-Service	1154321867	1154321867	1	1	LOGAN, SCOTT MD	8/1/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	165405	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
207319	Fee-for-Service	1053653881	1053653881	1	1	LO, TONY C T DO	8/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13743	01	General Practice	0	In state provider	None	23803 MCBEAN PKWY	SUITE 101	VALENCIA	CA	91355	2001	19	06037	34.39750589	-118.552072	Los Angeles County
207364	Fee-for-Service	1457503153	1457503153	1	2	LAWRENCE, SALLY M LMFT	6/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1588 HOMESTEAD RD	M/B 10, SUITE B	SANTA CLARA	CA	95050	4721	43	06085	37.34637328	-121.9509049	Santa Clara County
207427	Fee-for-Service	1619960556	1619960556	1	1	LEE, ANN M MD	10/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	60483	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	301 WEST PUEBLO STREET	None	SANTA BARBARA	CA	93105	4310	42	06083	34.43044504	-119.7219558	Santa Barbara County
207431	Fee-for-Service	1548332398	1548332398	1	1	LEUNG, STANLEY S MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	65110	77	Infectious Disease	0	In state provider	PERMANENTE MEDICAL GROUP	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
207432	Fee-for-Service	1457701484	1457701484	1	1	LIM, JOHN C MD INC	6/28/2016	193400000X	NA	Other	026	PHYSICIANS	52785	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4201 TORRANCE BLVD	STE 530	TORRANCE	CA	90503	4509	19	06037	33.8375955	-118.358748	Los Angeles County
207448	Fee-for-Service	1699120220	1699120220	1	1	LEE, JESSICA MD	8/17/2020	207L00000X	NA	Other	026	PHYSICIANS	147339	05	Anesthesiology	0	In state provider	None	603 E LATHAM AVE	None	HEMET	CA	92543	4342	33	06065	33.74933852	-116.96598	Riverside County
207496	Fee-for-Service	1417987033	1417987033	1	1	LEE, BRIAN P MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63043	40	Pediatrics	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
207527	Fee-for-Service	1942271044	1942271044	1	1	LUSKIN, STEPHEN A OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1018 GRAND AVE	None	SAN DIEGO	CA	92109	4117	37	06073	32.79568934	-117.2507944	San Diego County
207536	Fee-for-Service	1659875680	1659875680	1	1	LE, PHUONG M MD	8/2/2021	208M00000X	NA	Other	026	PHYSICIANS	165387	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
207537	Fee-for-Service	1376569277	1376569277	2	1	LALLA-REDDY MEDICAL COPORATI	12/11/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ON	11180 WARNER AVE	353	FOUNTAIN VALLEY	CA	92708	7501	30	06059	33.71632048	-117.9334575	Orange County
207558	Fee-for-Service	1932158854	1932158854	1	1	LUOTO, MARK H MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	42040	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
207569	Fee-for-Service	1972788479	1972788479	1	1	LAWSON, JOSHUA D MD	8/1/2008	2085R0001X	NA	Other	026	PHYSICIANS	104480	32	Radiation Therapy (D.O. only)	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
207590	Fee-for-Service	1093009896	1093009896	1	1	LAU, CHRISTOPHER S MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128519	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
207602	Fee-for-Service	1164083440	1164083440	1	1	LEVIN, GISELLE PSYD	12/17/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
207603	Fee-for-Service	1376206748	1376206748	1	1	LINGELBACH, BRETT PT	10/26/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	201 S. EL CAMINO REAL	SUITE A	ENCINITAS	CA	92024	4150	37	06073	33.043923	-117.256239	San Diego County
207698	Fee-for-Service	1609455260	1609455260	1	1	LA SKILLED HOSPICE INC	11/11/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	SUITE 313A	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
207714	Fee-for-Service	1144263591	1144263591	1	1	LYNN, MATTHEW D	5/9/1988	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	62819	30	Radiology	0	In state provider	None	709 18TH ST	None	MODESTO	CA	95354	1210	50	06099	37.64364413	-120.9896383	Stanislaus County
207726	Fee-for-Service	1962445130	1962445130	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11941 SAN VICENTE BLVD	None	LOS ANGELES	CA	90049	5003	19	06037	34.05270865	-118.4708656	Los Angeles County
207736	Fee-for-Service	1477746329	1477746329	1	1	LOZANO, MICHAEL R	3/27/2008	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2773 HARRIS ST	#C	EUREKA	CA	95503	4866	12	06023	40.78052829	-124.1363953	Humboldt County
207749	Fee-for-Service	1629034087	1629034087	1	1	LOPEZ, OSCAR D MD	5/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84436	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
207793	Fee-for-Service	1942246772	1942246772	1	1	LANE, WILLIAM H MD	2/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136437	01	General Practice	0	In state provider	None	4875 N FIRST ST	None	FRESNO	CA	93726	0513	10	06019	36.80635337	-119.7725036	Fresno County
207806	Fee-for-Service	1568487536	1568487536	1	1	LEFF, RICHARD G MD	10/18/1979	208800000X	NA	Other	026	PHYSICIANS	29796	34	Urology and Urological Surgery	0	In state provider	None	18370 BURBANK BLVD	STE 407	TARZANA	CA	91356	2846	19	06037	34.17173059	-118.5331881	Los Angeles County
207814	Fee-for-Service	1740385426	1740385426	1	1	LUTZ, JON E MD	2/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	53950	41	Internal Medicine	0	In state provider	THE TRAVEL MEDICAL CLIN	6700 N 1ST ST	STE 125	FRESNO	CA	93710	3947	10	06019	36.83586697	-119.7721176	Fresno County
207817	Fee-for-Service	1275160491	1275160491	1	1	LEE, SUNHA MD	4/4/2023	390200000X	NA	Other	026	PHYSICIANS	179378	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
207877	Fee-for-Service	1982795472	1982795472	1	1	LEE, MARTIN H MD INC	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	53608	10	Gastroenterology (M.D. only)	0	In state provider	None	1245 WILSHIRE BLVD	SUITE 780	LOS ANGELES	CA	90017	4881	19	06037	34.05362775	-118.2661889	Los Angeles County
207918	Fee-for-Service	1962825885	1962825885	1	1	LEONARD, RACHELLE LMFT	5/8/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
207925	Fee-for-Service	1851381115	1851381115	1	1	LANGLEY, ROSS M II MD	8/10/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	45107	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2067 W VISTA WAY	STE 225	VISTA	CA	92083	6001	37	06073	33.18505594	-117.285958	San Diego County
207928	Fee-for-Service	1710023692	1710023692	1	1	LENAHAN, JOHN A MD INC	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	15296	07	Dermatology	0	In state provider	None	595 BUCKINGHAM WAY	None	SAN FRANCISCO	CA	94132	1909	38	06075	37.73012679	-122.4767395	San Francisco County
207933	Fee-for-Service	1407306772	1407306772	1	1	LALLY MEDICAL GROUP APC	8/1/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	5050 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.0776775	-117.694521	San Bernardino County
207940	Fee-for-Service	1811255276	1811255276	1	1	LAVENDER, JAMIE D MD	7/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119417	41	Internal Medicine	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
207963	Fee-for-Service	1124084561	1124084561	1	1	LIM, DWIGHT D MD	12/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77341	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
207986	Fee-for-Service	1609455260	1609455260	1	1	LA SKILLED HOSPICE INC	11/11/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	SUITE 313A	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
207995	Fee-for-Service	1659572576	1659572576	1	1	LOTT, DE-ANN LCSW	7/25/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3330 CLAYTON RD	E	CONCORD	CA	94519	2838	07	06013	37.97200848	-122.0167188	Contra Costa County
208026	Fee-for-Service	1265819841	1265819841	1	1	LIPTAK, RACHEL R	5/6/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
208060	Fee-for-Service	1043208994	1043208994	1	1	LAWRY, GEORGE V MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35549	41	Internal Medicine	0	In state provider	None	1300 CRANE ST	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
208107	Fee-for-Service	1699099192	1699099192	1	1	LING, ANDREA W MD	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110694	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	700 FREDERICK ST	STE 203	SANTA CRUZ	CA	95062	2239	44	06087	36.98031434	-122.004438	Santa Cruz County
208112	Fee-for-Service	1235189879	1235189879	1	1	LINA PATEL M.D.	3/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2401 GILLHAM RD	None	KANSAS CITY	MO	64108	4619	00	None	39.08346695	-94.57884975	Jackson County
208117	Fee-for-Service	1609305259	1609305259	1	1	LEE, JI EUN MD	11/14/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174189	08	Family Practice	0	In state provider	None	4447 CANDLEWOOD ST	None	LAKEWOOD	CA	90712	1736	19	06037	33.85383446	-118.139931	Los Angeles County
208118	Fee-for-Service	1821688003	1821688003	1	1	LEGASPI, ALYSSA GRACE CNP	3/11/2024	163W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
208119	Fee-for-Service	1447874987	1447874987	1	1	L & H HOSPICE CARE INC	6/2/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	15335 MORRISON ST	STE 140	SHERMAN OAKS	CA	91403	6708	19	06037	34.16081721	-118.4680458	Los Angeles County
208155	Fee-for-Service	1871194092	1871194092	1	1	LAZAROW, SHELBY S PHD	12/22/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
208163	Fee-for-Service	1982795472	1982795472	1	1	LEE, MARTIN H MD INC	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	53608	41	Internal Medicine	0	In state provider	None	1245 WILSHIRE BLVD	SUITE 780	LOS ANGELES	CA	90017	4881	19	06037	34.05362775	-118.2661889	Los Angeles County
208220	Fee-for-Service	1689949760	1689949760	1	1	LEONG, KRYSTAL Y MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127738	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
208222	Fee-for-Service	1639478803	1639478803	1	1	LEE, CHRISTINA H MD	7/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134202	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
208237	Fee-for-Service	1073744504	1073744504	1	1	LUNA, LISA G CPO	10/1/2008	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	2151 N HARBOR BLVD	SUITE 1200	FULLERTON	CA	92835	3821	30	06059	33.89443025	-117.9288328	Orange County
208245	Fee-for-Service	1487696217	1487696217	2	1	LONGS DRUG STORES CA LLCA	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4852 S BRADLEY RD	None	SANTA MARIA	CA	93455	5048	42	06083	34.86650326	-120.4187021	Santa Barbara County
208252	Fee-for-Service	1235650904	1235650904	1	1	LETTS, NICHOLAS D MD	5/4/2020	390200000X	NA	Other	026	PHYSICIANS	165700	41	Internal Medicine	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
208284	Fee-for-Service	1457503153	1457503153	1	1	LAWRENCE, SALLY M LMFT	12/2/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	38458	-	NOT APPLICABLE	0	In state provider	None	2101 ALEXIAN DRIVE	SUITE 110	SAN JOSE	CA	95116	4209	43	06085	37.35943657	-121.848055	Santa Clara County
208301	Fee-for-Service	1295209740	1295209740	1	1	LAWTON, DIANA LMFT	4/25/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
208305	Fee-for-Service	1649288945	1649288945	1	1	LEVENSON, TOBY MD	1/1/1999	207K00000X	NA	Other	026	PHYSICIANS	74286	03	Allergy	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
208394	Fee-for-Service	1699099192	1699099192	1	1	LING, ANDREA W MD	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110694	41	Internal Medicine	0	In state provider	None	700 FREDERICK ST	STE 203	SANTA CRUZ	CA	95062	2239	44	06087	36.98031434	-122.004438	Santa Cruz County
208401	Fee-for-Service	1861504730	1861504730	1	1	LOW, ALEXANDER H MD	11/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78082	10	Gastroenterology (M.D. only)	0	In state provider	None	1006 MARSHALL WAY	None	PLACERVILLE	CA	95667	5706	09	06017	38.7261417	-120.7925328	El Dorado County
208407	Fee-for-Service	1447874987	1447874987	1	1	L & H HOSPICE CARE INC	6/2/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	15335 MORRISON ST	STE 140	SHERMAN OAKS	CA	91403	6708	19	06037	34.16081721	-118.4680458	Los Angeles County
208438	Fee-for-Service	1598725327	1598725327	1	1	LEE, PANDORA MD	7/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94463	41	Internal Medicine	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
208448	Fee-for-Service	1982796439	1982796439	1	1	LUSTER, JOHN B MD	10/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	46508	01	General Practice	0	In state provider	None	2617 E CHAPMAN AVE	STE 306	ORANGE	CA	92869	3243	30	06059	33.7878445	-117.8254845	Orange County
208461	Fee-for-Service	1801430467	1801430467	1	2	LANDMARK ANESTHESIA MEDICAL	11/7/2022	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP PRIME	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
208479	Fee-for-Service	1841739703	1841739703	1	1	LAST FRONTIER HEALTHCARE DIS	5/4/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1111 NORTH NAGLE ST	RP 101	ALTURAS	CA	96101	3840	25	06049	41.48746641	-120.5528507	Modoc County
208480	Fee-for-Service	1326353889	1326353889	1	1	LABIO, HUBERT L MD	12/3/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	161111	36	Psychiatry	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
208494	Fee-for-Service	1003970260	1003970260	1	1	LINCARE PHARMACY SERVICES	4/1/2003	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2335 CAMINO VIDA ROBLE U	None	CARLSBAD	CA	92011	1559	37	06073	33.11929589	-117.2699002	San Diego County
208515	Fee-for-Service	1023417797	1023417797	1	1	LWIN, MAY H MD	7/31/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	147865	45	Nephrology (Renal-Kidney)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
208534	Fee-for-Service	1689657751	1689657751	1	1	LUCIEN, MICHAEL C MD	3/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77742	40	Pediatrics	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
208593	Fee-for-Service	1730447459	1730447459	1	1	LEWIS, MELISSA A NP	4/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
208645	Fee-for-Service	1255466983	1255466983	1	1	LEWIS, DAVID B MD	6/1/1999	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	48589	77	Infectious Disease	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
208665	Fee-for-Service	1427034560	1427034560	1	1	LEDERHAUS, SCOTT C MD	2/1/1997	174400000X	NA	Other	026	PHYSICIANS	44897	01	General Practice	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
208668	Fee-for-Service	1043482565	1043482565	1	1	LEE, CHUN W AC	1/21/2009	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1224 JEFFERSON STREET	STE 3	DELANO	CA	93215	2551	15	06029	35.77269188	-119.2450887	Kern County
208686	Fee-for-Service	1326153768	1326153768	1	1	LIU, ALBERT Y MD	4/26/2022	207R00000X	NA	Other	026	PHYSICIANS	75174	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
208688	Fee-for-Service	1861504730	1861504730	1	1	LOW, ALEXANDER H MD	11/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78082	70	Clinic (mixed specialty)	0	In state provider	None	1006 MARSHALL WAY	None	PLACERVILLE	CA	95667	5706	09	06017	38.7261417	-120.7925328	El Dorado County
208693	Fee-for-Service	1013379882	1013379882	1	1	LIU, GRACE S MD	8/30/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	161216	None	None	0	In state provider	None	4053 LONE TREE WAY	200	ANTIOCH	CA	94531	6210	07	06013	37.97569499	-121.800733	Contra Costa County
208718	Fee-for-Service	1841256278	1841256278	1	1	LAWTON, MALCOLM MD	12/1/1995	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	45350	25	Physical Medicine and Rehabilitation	0	In state provider	BLDG H-12	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
208751	Fee-for-Service	1801430467	1801430467	1	2	LANDMARK ANESTHESIA MEDICAL	1/17/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP PRIME	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
208771	Fee-for-Service	1134165350	1134165350	1	1	LE, THANH T MD	7/31/1995	2084N0400X	NA	Neurology	026	PHYSICIANS	77927	13	Neurology (M.D. only)	0	In state provider	None	2650 ELM AVE	STE 210	LONG BEACH	CA	90806	1600	19	06037	33.805521	-118.1882945	Los Angeles County
208780	Fee-for-Service	1982817128	1982817128	1	1	LASTRA, HECTOR M MD	7/5/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	91293	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
208835	Fee-for-Service	1316073109	1316073109	1	1	LEONG, MICHAEL S MD	5/1/1998	207L00000X	NA	Other	026	PHYSICIANS	53960	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
208882	Fee-for-Service	1730190331	1730190331	1	1	LA PUENTE DIALYSIS	4/8/1991	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	14557 TEMPLE AVE	None	LA PUENTE	CA	91744	3492	19	06037	34.04092396	-117.9683556	Los Angeles County
208885	Fee-for-Service	1538456165	1538456165	1	1	LONDON, HOLLIS R DO	4/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14426	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
208900	Fee-for-Service	1982602710	1982602710	2	1	LE, TUAN MD	1/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	49909	41	Internal Medicine	0	In state provider	None	1569 LEXANN AVENUE	STE 122	SAN JOSE	CA	95121	1794	43	06085	37.30790568	-121.8141983	Santa Clara County
208905	Fee-for-Service	1336376888	1336376888	1	1	LAU, JENNIFER C MD	8/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123870	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
208908	Fee-for-Service	1073776308	1073776308	1	1	LEE, CAROL K MD	11/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109361	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
208934	Fee-for-Service	1255466983	1255466983	1	1	LEWIS, DAVID B MD	6/1/1999	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	48589	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
208937	Fee-for-Service	1407268501	1407268501	1	1	LAPARAN, CHRISTOPHER B MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14625	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
208949	Fee-for-Service	1427034560	1427034560	1	1	LEDERHAUS, SCOTT C MD	2/1/1997	174400000X	NA	Other	026	PHYSICIANS	44897	14	Neurological Surgery	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
208953	Fee-for-Service	1386295657	1386295657	1	1	LIU, JOYCE H CNP	12/17/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	576 E EL CAMINO REAL	None	SUNNYVALE	CA	94087	1940	43	06085	37.36249974	-122.0260401	Santa Clara County
208971	Fee-for-Service	1841499365	1841499365	1	1	LEE, JASON D MD	4/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102364	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
208987	Fee-for-Service	1568878080	1568878080	1	1	LOPEZ, CARINA MD	4/4/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	140208	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
209031	Fee-for-Service	1598050759	1598050759	1	1	LI, CANDICE Y MD	10/10/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	156048	40	Pediatrics	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
209056	Fee-for-Service	1811903552	1811903552	1	1	LEBOWITZ, KIRA L MD	1/31/1993	207L00000X	NA	Other	026	PHYSICIANS	73557	01	General Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
209057	Fee-for-Service	1134165350	1134165350	1	1	LE, THANH T MD	7/31/1995	2084N0400X	NA	Neurology	026	PHYSICIANS	77927	79	Neurology-Child	0	In state provider	None	2650 ELM AVE	STE 210	LONG BEACH	CA	90806	1600	19	06037	33.805521	-118.1882945	Los Angeles County
209074	Fee-for-Service	1629156237	1629156237	1	1	LAU, ALEX C MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	84504	20	Orthopedic Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
209080	Fee-for-Service	1912197393	1912197393	1	1	LU, ANDREW I MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	82430	10	Gastroenterology (M.D. only)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
209089	Fee-for-Service	1902902042	1902902042	1	1	LEE, SCOTT MD	3/1/1997	207RE0101X	NA	Endocrinology	026	PHYSICIANS	83086	67	Endocrinology	0	In state provider	None	11370 ANDERSON ST	STE 3150	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
209097	Fee-for-Service	1285900787	1285900787	1	1	LONG, SIMON K	10/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150610	None	None	0	In state provider	None	2 WEST FERN	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
209098	Fee-for-Service	1205901543	1205901543	1	1	LUM, MARC F	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
209106	Fee-for-Service	1699986331	1699986331	1	1	LOS ANGELES COUNTY	5/23/2007	No Taxonomy Provided	NA	None	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	2051 MARENGO ST	C2K100	LOS ANGELES	CA	90033	1352	19	06037	34.05627579	-118.2064774	Los Angeles County
209147	Fee-for-Service	1689752388	1689752388	1	1	LEE, CAROL A MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	62769	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
209153	Fee-for-Service	1346738218	1346738218	1	1	LEVIT, KELVY DO	11/15/2021	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
209156	Fee-for-Service	1902288186	1902288186	1	1	LIEBERT, JEFFREY	7/1/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	93108	-	NOT APPLICABLE	0	In state provider	None	2227 CAPRICORN WAY	206 & 213	SANTA ROSA	CA	95407	5478	49	06097	38.425266	-122.749875	Sonoma County
209168	Fee-for-Service	1225206857	1225206857	1	1	LAUFIK, MARTIN MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108357	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
209247	Fee-for-Service	1588691885	1588691885	1	1	LEFEVRE, CECILY	2/8/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2173 TALBERT DR	None	CHICO	CA	95928	7635	04	06007	39.72117943	-121.7984926	Butte County
209265	Fee-for-Service	1811753676	1811753676	1	1	LEWIS, AUDREY C NP	3/14/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11103 VENICE BLVD	None	LOS ANGELES	CA	90034	6914	19	06037	34.01379685	-118.4159354	Los Angeles County
209276	Fee-for-Service	1174029391	1174029391	1	1	LOMBO LUQUE, SANTIAGO MD	3/25/2024	207R00000X	NA	Other	026	PHYSICIANS	179239	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
209289	Fee-for-Service	1700221421	1700221421	1	1	LO, PACHIDA C MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134086	36	Psychiatry	0	In state provider	None	7300 WYNDHAM DR	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
209312	Fee-for-Service	1669565099	1669565099	1	1	LUU, JENNY M MD	7/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76696	26	Psychiatry (child)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
209322	Fee-for-Service	1346257706	1346257706	1	1	LANDREY, WILLIAM C DPM	12/1/1993	213ES0103X	NA	Other	027	PODIATRISTS	-	43	Pediatric Allergy	0	In state provider	None	9474 BASELINE RD	None	ALTA LOMA	CA	91701	5822	36	06071	34.1215715	-117.598653	San Bernardino County
209359	Fee-for-Service	1265648166	1265648166	1	1	LUCHETTI, VIRGINIA I PSYD	4/22/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
209400	Fee-for-Service	1962555904	1962555904	1	1	LAI, KASEY KC MD	3/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101048	41	Internal Medicine	0	In state provider	None	520 N PROSPECT AVENUE	SUITE 103	REDONDO BEACH	CA	90277	3033	19	06037	33.8529819	-118.3802954	Los Angeles County
209401	Fee-for-Service	1255719118	1255719118	1	1	LEON-MARTINEZ, DAISY MD	8/2/2022	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	179732	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
209420	Fee-for-Service	1427555143	1427555143	1	1	LUO, JESSICA L DO	8/4/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	20921	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
209429	Fee-for-Service	1528655925	1528655925	1	1	LE, JESSIE	9/13/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5120 MANZANITA AVE	SUITE 110	CARMICHAEL	CA	95608	0590	34	06067	38.659392	-121.327155	Sacramento County
209491	Fee-for-Service	1447576467	1447576467	1	1	LEE, JASON J MD	4/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119291	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVENUE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
209540	Fee-for-Service	1740433861	1740433861	1	1	LEE, NONG	11/5/2008	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	9361 W DAKOTA AVE	None	FRESNO	CA	93723	9628	10	06019	36.78591569	-119.9583375	Fresno County
209668	Fee-for-Service	1780748939	1780748939	1	1	LINCARE PHARMACY SERVICES IN	10/31/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	3985 GATEWAY CENTRE BLVD	STE 200	PINELLAS PARK	FL	33782	6127	00	None	27.85170487	-82.68607404	Pinellas County
209672	Fee-for-Service	1467835025	1467835025	1	1	LOYALTY HOME HEALTH, INC	2/10/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	905 S LAKE ST	SUITE 201	BURBANK	CA	91502	2436	19	06037	34.1695314	-118.3061352	Los Angeles County
209769	Fee-for-Service	1437573615	1437573615	1	2	LOPEZ, CIARA	10/25/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	54	06107	0	0	None
209781	Fee-for-Service	1497274302	1497274302	1	1	LEI, SHUANG MD	3/16/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	159635	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
209783	Fee-for-Service	1801007562	1801007562	1	1	LANG, CHRISTOPHER J MD	12/1/2009	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	1200 N BEAVER ST	None	FLAGSTAFF	AZ	86001	2912	00	None	35.208594	-111.645099	Coconino County
209829	Fee-for-Service	1740433861	1740433861	1	1	LEE, NONG	11/5/2008	164X00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	9361 W DAKOTA AVE	None	FRESNO	CA	93723	9628	10	06019	36.78591569	-119.9583375	Fresno County
209837	Fee-for-Service	1134590086	1134590086	1	1	LA MAESTRA FAMILY CLINIC INC	6/15/2016	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1032 BROADWAY	None	EL CAJON	CA	92021	4911	37	06073	32.80772446	-116.946612	San Diego County
209858	Fee-for-Service	1336439173	1336439173	1	1	LANE GARNER	2/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	525 BRANSON LANDING BLVD	None	BRANSON	MO	65616	2052	00	None	36.65109796	-93.2204608	Taney County
209916	Fee-for-Service	1801045778	1801045778	1	1	LEV MEDICAL GROUP APMC	8/11/2009	193400000X	NA	Other	026	PHYSICIANS	92996	None	None	0	In state provider	None	7855 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90046	5344	19	06037	34.0908873	-118.36044	Los Angeles County
209951	Fee-for-Service	1306804331	1306804331	1	1	LOS GATOS PEDIATRICS	12/29/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	320 DARDANELLI LN	STE 16	LOS GATOS	CA	95032	1419	43	06085	37.262079	-121.9673345	Santa Clara County
209959	Fee-for-Service	1003024647	1003024647	1	1	LONG BEACH DIALYSIS CTR	9/29/2008	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	3744 LONG BEACH BLVD	None	LONG BEACH	CA	90807	3310	19	06037	33.825744	-118.1893125	Los Angeles County
209965	Fee-for-Service	1639355670	1639355670	1	1	LEVY, SARA J MD	4/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103039	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
209985	Fee-for-Service	1255980280	1255980280	1	1	LARSON, REMI LCSW	10/17/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
210002	Fee-for-Service	1811420508	1811420508	1	1	LUONG, DANIEL M MD	10/10/2020	207R00000X	NA	Other	026	PHYSICIANS	166770	41	Internal Medicine	0	In state provider	None	9191 WESTMINSTER AVE	SUITE 205	GARDEN GROVE	CA	92844	2751	30	06059	33.75946879	-117.9688437	Orange County
210032	Fee-for-Service	1356429856	1356429856	1	1	LIN, CAROL K MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62694	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
210034	Fee-for-Service	1144424615	1144424615	1	1	LIN-LIU, YVONNE G MD	2/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109636	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1441 EASTLAKE AVENUE	None	LOS ANGELES	CA	90033	9179	19	06037	34.060806	-118.20636	Los Angeles County
210048	Fee-for-Service	1699069385	1699069385	1	1	LY MA	9/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1900 N HIGLEY RD	None	GILBERT	AZ	85234	1604	00	None	33.384528	-111.7222875	Maricopa County
210051	Fee-for-Service	1013238484	1013238484	1	1	LAGUNAS, KARLA F LCSW	11/12/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
210054	Fee-for-Service	1689817819	1689817819	1	1	LUGINBUHL, RYAN D MD	9/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117281	02	General Surgery	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3844	36	06071	34.12632952	-117.1956652	San Bernardino County
210078	Fee-for-Service	1528077856	1528077856	1	1	LEWIS, DAVID M	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	65631	05	Anesthesiology	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
210115	Fee-for-Service	1558710160	1558710160	1	1	LAOR, LEANNA MD	12/27/2024	2080P0203X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
210137	Fee-for-Service	1316907082	1316907082	1	1	LEONI, PETER V MD	4/1/1996	208600000X	NA	General Surgery	026	PHYSICIANS	64218	02	General Surgery	0	In state provider	None	1040 COLUSA ST	None	VALLEJO	CA	94590	4565	48	06095	38.10864086	-122.2447174	Solano County
210150	Fee-for-Service	1194781054	1194781054	1	1	LOYA, ALMA G MD	3/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71716	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
210173	Fee-for-Service	1033312004	1033312004	1	2	LASER ENDOSCOPY MED GRP	6/1/1982	174400000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	INC	1300 N VERMONT AVE	# 703	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
210181	Fee-for-Service	1891342044	1891342044	1	1	LIEU, KEVIN L MD	6/24/2024	207P00000X	NA	Other	026	PHYSICIANS	187744	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
210198	Fee-for-Service	1962438622	1962438622	1	1	LIEBLER, JANICE M MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85465	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1355 SAN PABLO ST	None	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
210206	Fee-for-Service	1194832642	1194832642	1	1	LESHAN, LOREN A MD	6/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	86992	01	General Practice	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
210207	Fee-for-Service	1700814209	1700814209	1	1	LENZ, HEINZ JOSEF MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63854	78	Neoplastic Diseases/Oncology	0	In state provider	None	1355 SAN PABLO ST	None	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
210212	Fee-for-Service	1821144429	1821144429	1	1	LEEM, TED MD	5/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107632	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	92024	2812	19	06037	33.918975	-118.1291985	Los Angeles County
210219	Fee-for-Service	1356617658	1356617658	1	1	LOCHHEAD, JEANNIE D MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128451	36	Psychiatry	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
210257	Fee-for-Service	1053430660	1053430660	1	1	LIANG, BILLY C MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104948	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
210277	Fee-for-Service	1720219280	1720219280	1	1	LINDGREN, MATTHEW D LMFT	1/28/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
210287	Fee-for-Service	1043299399	1043299399	1	1	LASKER, BRUCE R MD	1/19/2012	2084N0400X	NA	Neurology	026	PHYSICIANS	54791	13	Neurology (M.D. only)	0	In state provider	None	3737 MORAGA AVE	STE A1	SAN DIEGO	CA	92117	5485	37	06073	32.8086683	-117.2109991	San Diego County
210295	Fee-for-Service	1942661863	1942661863	1	1	LIU, JONATHAN A MD	6/10/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171673	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
210312	Fee-for-Service	1457093445	1457093445	1	1	LEE, KARIN H NP	4/16/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
210321	Fee-for-Service	1356429856	1356429856	1	1	LIN, CAROL K MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62694	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
210326	Fee-for-Service	1639349111	1639349111	1	1	LEE, JIN MD	8/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109932	07	Dermatology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
210343	Fee-for-Service	1083822217	1083822217	1	1	LIN, AARON C MD	1/11/2008	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	99429	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
210361	Fee-for-Service	1801413471	1801413471	1	1	LIM, DEXHELYN NP	9/29/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43360 MISSION BLVD	SUITE 100	FREMONT	CA	94539	5829	01	06001	37.53249631	-121.9198141	Alameda County
210373	Fee-for-Service	1588852081	1588852081	1	1	LOCHBAUM, GREGORY M MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101223	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
210410	Fee-for-Service	1932529609	1932529609	1	1	LIFFERTH, ROBERT A DO	6/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
210426	Fee-for-Service	1316907082	1316907082	1	1	LEONI, PETER V MD	4/1/1996	208600000X	NA	General Surgery	026	PHYSICIANS	64218	01	General Practice	0	In state provider	None	1040 COLUSA ST	None	VALLEJO	CA	94590	4565	48	06095	38.10864086	-122.2447174	Solano County
210464	Fee-for-Service	1164528311	1164528311	1	1	LENIHAN, ELIZABETH A CRNA	10/24/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1315 MILLER ST	STE 101	SANTA MARIA	CA	93454	6910	42	06083	34.93799144	-120.4316337	Santa Barbara County
210465	Fee-for-Service	1366040792	1366040792	1	1	LOPASSO, ANDREA C PT	12/16/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2230 LYNN RD	STE 250	THOUSAND OAKS	CA	91360	1985	56	06111	34.20894685	-118.885185	Ventura County
210484	Fee-for-Service	1194793802	1194793802	1	1	LAMBOURNE, BLAKE R MD	4/4/1997	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	83649	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2120 PROFESSIONAL DR	STE 135	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
210487	Fee-for-Service	1962438622	1962438622	1	1	LIEBLER, JANICE M MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85465	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1355 SAN PABLO ST	None	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
210492	Fee-for-Service	1659071553	1659071553	1	1	LE, TIFFANY	6/12/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
210500	Fee-for-Service	1346668142	1346668142	1	1	LA POINTE, MICHAEL MD	5/28/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	139723	30	Radiology	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
210509	Fee-for-Service	1497192470	1497192470	1	1	LITTLE, JENNIFER LPCC	11/2/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	317 N EL CAMINO REAL	STE 306	ENCINITAS	CA	92024	2814	37	06073	33.05428107	-117.2615637	San Diego County
210537	Fee-for-Service	1235298969	1235298969	1	1	LEWIS, LONELYSS C NP	10/18/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13460 ROSCOE BLVD	None	PANORAMA CITY	CA	91402	3904	19	06037	34.2216237	-118.4261864	Los Angeles County
210543	Fee-for-Service	1730306499	1730306499	1	1	LOS ANGELES COUNTY	9/3/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	DEPARTMENT OF PUBLIC HEA	44900 NORTH 60TH ST WEST	None	LANCASTER	CA	93536	7618	19	06037	34.6976943	-118.2365888	Los Angeles County
210547	Fee-for-Service	1902292261	1902292261	1	1	LORIN D STEIN NP	3/7/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	955 RIBAUT RD	None	BEAUFORT	SC	29902	5441	00	None	32.416929	-80.68852154	Beaufort County
210548	Fee-for-Service	1629088109	1629088109	1	1	LITTLER, CURT M MD	3/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	48096	07	Dermatology	0	In state provider	None	317 N EL CAMINO REAL	STE 305	ENCINITAS	CA	92024	2814	37	06073	33.05428107	-117.2615637	San Diego County
210572	Fee-for-Service	1134421266	1134421266	1	1	LITTLE, SUNSHINE K LMFT	5/22/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
210603	Fee-for-Service	1225115868	1225115868	1	1	LUCERO-PERKINS, COREEN L LCS	12/8/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
210613	Fee-for-Service	1952516825	1952516825	1	1	LOY, DAVID MD	7/26/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	179038	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
210640	Fee-for-Service	1780896209	1780896209	1	1	LENNON, KRISTEN T LMFT	8/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
210644	Fee-for-Service	1609988526	1609988526	1	1	LAC PHARMACIES INC	10/3/2006	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	WATERMAN PHARMACY	2150 N WATERMAN AVE	STE 104	SAN BERNARDINO	CA	92404	4811	36	06071	34.134705	-117.2787865	San Bernardino County
210645	Fee-for-Service	1619996980	1619996980	1	1	LIKER, HARLEY R MD	12/31/1993	207R00000X	NA	Other	026	PHYSICIANS	79084	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
210664	Fee-for-Service	1619026028	1619026028	1	1	LEE, CHANG BOUM MD	3/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	34627	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
210665	Fee-for-Service	1427561745	1427561745	1	1	LUM, SARAH C	1/22/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPRESSWAY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
210693	Fee-for-Service	1376521575	1376521575	1	2	LOYOLA UNIVERSITY MEDICAL CE	7/2/2024	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NTER	2160 S 1ST AVE	None	MAYWOOD	IL	60153	3328	00	None	41.86025379	-87.83381752	Cook County
210724	Fee-for-Service	1538778238	1538778238	1	2	LUNDGREN-WALLS, DEBORA CNM	9/1/2021	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3630 ENTERPRISE STREET	None	SAN DIEGO	CA	92110	3212	37	06073	32.74601586	-117.1985439	San Diego County
210731	Fee-for-Service	1669898631	1669898631	1	1	LOLE, HELEN N MSW LCSW	4/28/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	64855	-	NOT APPLICABLE	0	In state provider	None	1260 E ARROW HIGHWAY	BLDGS B AND C	UPLAND	CA	91786	4982	36	06071	34.09953339	-117.6333297	San Bernardino County
210804	Fee-for-Service	1295922730	1295922730	1	1	LIM, ANGELINE F MD	6/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83918	24	Plastic Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
210820	Fee-for-Service	1821438631	1821438631	1	1	LAUBACHER, BETHANY R MD	1/5/2018	390200000X	NA	Other	026	PHYSICIANS	147987	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
210828	Fee-for-Service	1992853873	1992853873	1	1	LEVASSEUR, REBECCA F MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67504	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
210853	Fee-for-Service	1306880745	1306880745	2	1	LONGS DRUG STORES CA, LLC	11/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2314 SANTA CLARA AVE	None	ALAMEDA	CA	94501	4522	01	06001	37.76570077	-122.2427985	Alameda County
210870	Fee-for-Service	1538169172	1538169172	1	1	LANE,DAVID J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 N WILMOT RD	None	TUCSON	AZ	85711	0000	00	None	32.227209	-110.8556595	Pima County
210938	Fee-for-Service	1306238795	1306238795	1	1	LEE, ANDY HUNG-YI MD	5/31/2023	207P00000X	NA	Other	026	PHYSICIANS	184125	None	None	0	In state provider	None	757 WESTWOOD PLAZA	STE 1517	LOS ANGELES	CA	90095	7402	19	06037	34.06633051	-118.4452686	Los Angeles County
210952	Fee-for-Service	1659791945	1659791945	1	1	LIN, SHAWN MD	5/7/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	140173	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
210976	Fee-for-Service	1376521575	1376521575	1	2	LOYOLA UNIVERSITY MEDICAL CE	7/2/2024	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NTER	2160 S 1ST AVE	None	MAYWOOD	IL	60153	3328	00	None	41.86025379	-87.83381752	Cook County
211075	Fee-for-Service	1730163510	1730163510	1	1	LEE, JAMES H MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67507	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
211088	Fee-for-Service	1447861646	1447861646	1	1	LIFE LINE HEALTH CARE SERVIC	7/28/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	121 W. LEXINGTON DRIVE	STE 218B	GLENDALE	CA	91203	2203	19	06037	34.1517575	-118.2560706	Los Angeles County
211115	Fee-for-Service	1992853873	1992853873	1	1	LEVASSEUR, REBECCA F MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67504	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
211139	Fee-for-Service	1811982291	1811982291	1	1	LIN, CHRISTOPHER MD	6/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	72980	18	Ophthalmology	0	In state provider	None	3190 CHURN CREEK RD	None	REDDING	CA	96002	2122	45	06089	40.56104546	-122.3531114	Shasta County
211147	Fee-for-Service	1962405753	1962405753	1	1	LANINGHAM III, FRED H MD	7/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	75723	30	Radiology	0	In state provider	None	1504 N WISHON	None	FRESNO	CA	93728	1827	10	06019	36.763497	-119.8010405	Fresno County
211161	Fee-for-Service	1619947397	1619947397	1	1	LIN, MERCURY Y MD	1/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	88435	22	Pathology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1864	19	06037	34.07671715	-118.3799413	Los Angeles County
211174	Fee-for-Service	1164684973	1164684973	1	1	LEE, MIMI S	5/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130577	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
211182	Fee-for-Service	1205319068	1205319068	1	1	LINARES, LINDA LMFT	10/7/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
211203	Fee-for-Service	1295779635	1295779635	2	1	LONGS DRUG STORES CA LLC	11/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	600 FRONT ST	None	SANTA CRUZ	CA	95060	4507	44	06087	36.97385265	-122.0247909	Santa Cruz County
211240	Fee-for-Service	1457694887	1457694887	1	1	LEE, CHAD MD	10/30/2023	208VP0014X	NA	Other	026	PHYSICIANS	185701	None	None	0	In state provider	None	10441 LAKEWOOD BLVD	E	DOWNEY	CA	90241	2744	19	06037	33.94358034	-118.1193714	Los Angeles County
211255	Fee-for-Service	1366563835	1366563835	1	1	LEMASTER, CHRISTOPHER H MD	7/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111737	18	Ophthalmology	0	In state provider	None	757 WESTWOOD PLAZA	RM 14-19	LOS ANGELES	CA	90095	3075	19	06037	34.06633051	-118.4452686	Los Angeles County
211272	Fee-for-Service	1710082284	1710082284	1	1	LOCKSON, SPENCER S DPM	4/1/1999	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	STE 335	SACRAMENTO	CA	95816	5242	34	06067	38.570076	-121.4657145	Sacramento County
211296	Fee-for-Service	1265648638	1265648638	1	1	LOYD'S LIBERTY HOMES INC	5/6/1997	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6800 COLUMBIA LN	None	BAKERSFIELD	CA	93309	0509	15	06029	35.33731539	-119.0778847	Kern County
211329	Fee-for-Service	1083807580	1083807580	1	1	LEE, NANDINI M MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111042	36	Psychiatry	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
211336	Fee-for-Service	1043244536	1043244536	1	1	LEIBOWITZ, ROBERT MD	9/30/1992	207N00000X	NA	Dermatology	026	PHYSICIANS	38159	07	Dermatology	0	In state provider	None	8635 W 3RD ST	STE 655W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
211357	Fee-for-Service	1649282856	1649282856	2	2	LOMPOC VALLEY MEDICAL CENTER	9/16/2022	207Q00000X	NA	Adult Primary Care	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1225 NORTH H STREET	None	LOMPOC	CA	93436	3301	42	06083	34.65803329	-120.4576446	Santa Barbara County
211392	Fee-for-Service	1710276456	1710276456	1	1	LEE, MAI L MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123755	41	Internal Medicine	0	In state provider	None	3000 Q ST	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
211423	Fee-for-Service	1083907232	1083907232	1	1	LIEU, CHARMAINE S MD	10/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135661	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
211447	Fee-for-Service	1760683643	1760683643	1	1	LY, NHIEU T CRNA	6/11/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
211451	Fee-for-Service	1780751784	1780751784	1	1	LI, JAN J MD	1/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72731	25	Physical Medicine and Rehabilitation	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
211455	Fee-for-Service	1780751701	1780751701	1	1	LE, GIGI M MD	10/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87021	13	Neurology (M.D. only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
211464	Fee-for-Service	1679045892	1679045892	1	1	LA HOSPICE SERVICES INC	2/25/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6464 W SUNSET BLVD	STE 945	LOS ANGELES	CA	90028	8018	19	06037	34.09796251	-118.3313115	Los Angeles County
211469	Fee-for-Service	1407906217	1407906217	1	1	LEE, CHONG A MD	9/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84663	02	General Surgery	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
211479	Fee-for-Service	1780887810	1780887810	1	1	LEE, JULIETTE L MD	12/19/2007	207N00000X	NA	Dermatology	026	PHYSICIANS	92615	07	Dermatology	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
211481	Fee-for-Service	1043244197	1043244197	1	1	LEE, ERIC H	9/18/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
211482	Fee-for-Service	1740464007	1740464007	1	1	LEWIS, JANE E MD	10/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82426	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
211496	Fee-for-Service	1346218179	1346218179	1	1	LOWY, ANDREW M MD	7/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87988	02	General Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
211532	Fee-for-Service	1639510514	1639510514	1	1	LE, HAN PSYD	10/18/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4300 LONG BEACH BLVD	STE 340	LONG BEACH	CA	90807	2011	19	06037	33.83662572	-118.1900605	Los Angeles County
211587	Fee-for-Service	1679971071	1679971071	1	1	LIMONGAN, NATALIE H NP	2/19/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
211645	Fee-for-Service	1649282856	1649282856	2	2	LOMPOC VALLEY MEDICAL CENTER	8/13/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1225 NORTH H STREET	None	LOMPOC	CA	93436	3301	42	06083	34.65803329	-120.4576446	Santa Barbara County
211669	Fee-for-Service	1750446761	1750446761	1	1	LODHIA, ANANT K MD, INC	6/30/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	5250 ELVAS AVE	None	SACRAMENTO	CA	95819	2332	34	06067	38.57614224	-121.4350326	Sacramento County
211674	Fee-for-Service	1457538522	1457538522	1	1	LAPASIA, JESSICA B MD	11/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100743	45	Nephrology (Renal-Kidney)	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
211710	Fee-for-Service	1679657662	1679657662	1	1	LEVINSON, BARI E MD	6/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75023	41	Internal Medicine	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
211711	Fee-for-Service	1366611972	1366611972	1	1	LIEPERT, AMY E MD	10/3/2019	2086S0127X	NA	General Surgery	026	PHYSICIANS	163794	02	General Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
211750	Fee-for-Service	1568449650	1568449650	1	1	LIMSUI, DAVID MD	5/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110121	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
211752	Fee-for-Service	1679045892	1679045892	1	1	LA HOSPICE SERVICES INC	2/25/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6464 W SUNSET BLVD	STE 945	LOS ANGELES	CA	90028	8018	19	06037	34.09796251	-118.3313115	Los Angeles County
211782	Fee-for-Service	1346218179	1346218179	1	1	LOWY, ANDREW M MD	7/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87988	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
211797	Fee-for-Service	1205883204	1205883204	1	1	LEWIS,GWENDOLYN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 LOTHROP STREET	None	PITTSBURG	PA	15213	0000	00	None	40.44188737	-79.96079711	Allegheny County
211807	Fee-for-Service	1467463125	1467463125	1	1	LUKASZCZYK, THOMAS JR MD	9/19/1988	207P00000X	NA	Other	026	PHYSICIANS	64119	66	Emergency Medicine (Urgent Care)	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
211830	Fee-for-Service	1639632995	1639632995	1	1	LOGONO, ALEX	9/27/2023	208M00000X	NA	Other	026	PHYSICIANS	180458	None	None	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
211848	Fee-for-Service	1487721403	1487721403	1	1	LARIVIERE, MARC J MD	12/16/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	56548	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
211882	Fee-for-Service	1184980377	1184980377	1	1	LEVIN, DANA MD	5/24/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 WESTWOOD PLAZA	STE 1517	LOS ANGELES	CA	90095	7402	19	06037	34.06633051	-118.4452686	Los Angeles County
211883	Fee-for-Service	1730282096	1730282096	1	1	LU, SHAO RU CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	ACUPUNC AND HERBS OF LU	20628 E ARROW HWY	STE 4	COVINA	CA	91724	1309	19	06037	34.10658548	-117.851904	Los Angeles County
211905	Fee-for-Service	1396858783	1396858783	1	1	LOTSTEIN, DEBRA S MD	7/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72306	41	Internal Medicine	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
211918	Fee-for-Service	1871549477	1871549477	1	1	LOMA LINDA UNIVERSITY	3/1/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	UROLOGY MEDICAL GRP INC	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
211921	Fee-for-Service	1639166945	1639166945	1	1	LONE PINE FIRE	9/30/1994	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	PROTECTION DISTRICT	130 N JACKSON ST	None	LONE PINE	CA	93545	0000	14	06027	36.60615564	-118.0624704	Inyo County
211934	Fee-for-Service	1649282856	1649282856	2	2	LOMPOC VALLEY MEDICAL CENTER	10/26/2022	207Q00000X	NA	Adult Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1225 NORTH H STREET	None	LOMPOC	CA	93436	3301	42	06083	34.65803329	-120.4576446	Santa Barbara County
211982	Fee-for-Service	1407024995	1407024995	1	1	LEIBEL, SANDRA L MD	12/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121976	41	Internal Medicine	0	In state provider	None	3020 CHILDREN'S WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
211988	Fee-for-Service	1730128232	1730128232	1	1	LEE, DAVID I MD	4/18/2021	208800000X	NA	Other	026	PHYSICIANS	79592	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
212004	Fee-for-Service	1750762340	1750762340	1	1	LEE, STEVE G MD	6/21/2018	171000000X	NA	Other	026	PHYSICIANS	149439	02	General Surgery	0	In state provider	None	525 3RD AVE	None	CHULA VISTA	CA	91910	5696	37	06073	32.63367609	-117.0769202	San Diego County
212026	Fee-for-Service	1689834020	1689834020	1	1	LOPEZ-PATEL, MARIA MD	10/1/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	99570	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
212033	Fee-for-Service	1750490645	1750490645	1	1	LANOUETTE, NICOLE M MD	4/19/2010	2084P0800X	NA	Psychiatry	026	PHYSICIANS	89709	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
212040	Fee-for-Service	1568449650	1568449650	1	1	LIMSUI, DAVID MD	5/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110121	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
212056	Fee-for-Service	1316973217	1316973217	1	1	LISSE, JEFFREY R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
212064	Fee-for-Service	1063606200	1063606200	1	1	LEBRON, CARMEN M MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74011	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
212066	Fee-for-Service	1538165576	1538165576	1	1	LAI, KHIEM DINH, INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	86360	08	Family Practice	0	In state provider	None	12502 BROOKHURST ST	None	GARDEN GROVE	CA	92840	4807	30	06059	33.78113522	-117.9584476	Orange County
212068	Fee-for-Service	1962665810	1962665810	1	1	LISS, SARAH MD	1/27/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	103090	40	Pediatrics	0	In state provider	None	4153 24TH STREET	4	SAN FRANCISCO	CA	94114	3614	38	06075	37.75120501	-122.4352246	San Francisco County
212072	Fee-for-Service	1740694736	1740694736	1	1	LIANG, BUQING MD	7/1/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	177701	14	Neurological Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
212082	Fee-for-Service	1962109033	1962109033	1	14	LOS ANGELES COUNTY DEPARTMEN	2/8/2024	261QP0905X	NA	Other	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	7643 PAINTER AVE	None	WHITTIER	CA	90602	2358	19	06037	33.9722067	-118.0327471	Los Angeles County
212123	Fee-for-Service	1609219088	1609219088	1	1	LEE, STELLA J MD	9/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139393	01	General Practice	0	In state provider	None	700 N BRAND	STE 1400	GLENDALE	CA	91203	4263	19	06037	34.15710327	-118.2549428	Los Angeles County
212135	Fee-for-Service	1487721403	1487721403	1	1	LARIVIERE, MARC J MD	12/16/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	56548	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
212136	Fee-for-Service	1568993004	1568993004	1	1	LEE, DIANA K MD	5/26/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	176570	None	None	0	In state provider	None	1225 15TH ST	2100	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
212188	Fee-for-Service	1336536861	1336536861	1	1	LEE, ANDREW MD	5/7/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	160781	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
212191	Fee-for-Service	1396858783	1396858783	1	1	LOTSTEIN, DEBRA S MD	7/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72306	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
212214	Fee-for-Service	1720717218	1720717218	1	1	LANDECKER, BRIANA S NP	7/11/2022	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
212244	Fee-for-Service	1700802451	1700802451	1	1	LIU, MICHELLE W MD INC	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73072	18	Ophthalmology	0	In state provider	None	1844 SAN MIGUEL DR	STE 303	WALNUT CREEK	CA	94596	4963	07	06013	37.89504879	-122.0529911	Contra Costa County
212255	Fee-for-Service	1134963309	1134963309	1	1	LIFELINE WALK IN MEDICAL & M	2/10/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	ENTAL HEALTH NURSING C	3535 TORRANCE BLVD	STE 13	TORRANCE	CA	90503	4815	19	06037	33.83761551	-118.348227	Los Angeles County
212296	Fee-for-Service	1629495692	1629495692	1	1	LEVINSON, ANYA L MD	6/12/2020	2080P0207X	NA	Hematology	026	PHYSICIANS	148242	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
212299	Fee-for-Service	1326052069	1326052069	1	1	LUMSDAINE, CHRIS G MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60875	08	Family Practice	0	In state provider	None	136 N 3RD ST	None	LOMPOC	CA	93436	7002	42	06083	34.64013944	-120.4451768	Santa Barbara County
212312	Fee-for-Service	1629085162	1629085162	1	1	LEE, JAMES K	11/17/2008	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4482 BARRANCA PKWY	STE 195	IRVINE	CA	92604	4706	30	06059	33.68008811	-117.8015383	Orange County
212321	Fee-for-Service	1346482007	1346482007	1	1	LEE, JAMES C MD	11/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126831	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
212325	Fee-for-Service	1801430467	1801430467	1	1	LANDMARK ANESTHESIA MEDICAL	1/17/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP PRIME	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
212328	Fee-for-Service	1205871688	1205871688	2	1	LINCARE INC	9/30/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2015 W. PARK AVE	SUITE 7 & 8	REDLANDS	CA	92373	6271	36	06071	34.05930854	-117.2232675	San Bernardino County
212343	Fee-for-Service	1649350307	1649350307	1	1	LE, CHINH MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71715	08	Family Practice	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
212353	Fee-for-Service	1588982904	1588982904	1	1	LOGAN, JENNIFER F MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120356	None	None	0	In state provider	None	200 MED PLAZA	# 365	LOS ANGELES	CA	90095	8344	19	06037	34.06527974	-118.4462792	Los Angeles County
212387	Fee-for-Service	1598957193	1598957193	1	1	LEUNG, LAURIE Y L PHD	6/10/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
212417	Fee-for-Service	1487611026	1487611026	2	1	LAGHAEE, SHAHIN MD	1/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	82720	10	Gastroenterology (M.D. only)	0	In state provider	None	250 S OAK AVE	BLDG A	OAKDALE	CA	95361	3572	50	06099	37.75888818	-120.8609099	Stanislaus County
212436	Fee-for-Service	1912141334	1912141334	1	1	LIANG, CONRAD W MD	3/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125044	13	Neurology (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	19	06037	34.072245	-117.4319685	San Bernardino County
212445	Fee-for-Service	1073619607	1073619607	1	1	LEE, PERRY L MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71117	05	Anesthesiology	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
212454	Fee-for-Service	1720166556	1720166556	1	1	LEE, KAI C MD	8/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87023	13	Neurology (M.D. only)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
212462	Fee-for-Service	1649334079	1649334079	1	1	LEVY, MATTHEW T MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61490	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1174 CASTRO ST	STE 201	MOUNTAIN VIEW	CA	94040	2569	43	06085	37.3822628	-122.0861276	Santa Clara County
212474	Fee-for-Service	1760406649	1760406649	1	1	LEE, MICHAEL W MD	9/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71671	67	Endocrinology	0	In state provider	None	12395 EL CAMINO REAL	STE 120	SAN DIEGO	CA	92130	3083	37	06073	32.94324259	-117.2396525	San Diego County
212485	Fee-for-Service	1922369651	1922369651	1	1	LIM, CAROLYN K DO	1/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12587	30	Radiology	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
212525	Fee-for-Service	1669687638	1669687638	1	1	LAWLER, JILL P LMFT	7/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
212543	Fee-for-Service	1134963309	1134963309	1	1	LIFELINE WALK IN MEDICAL & M	2/10/2025	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ENTAL HEALTH NURSING C	3535 TORRANCE BLVD	STE 13	TORRANCE	CA	90503	4815	19	06037	33.83761551	-118.348227	Los Angeles County
212576	Fee-for-Service	1447557590	1447557590	1	1	LIFSCHITZ, CASANDRA J LMFT	8/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
212579	Fee-for-Service	1801946249	1801946249	1	1	LICATA, VINCENT D MD	7/16/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	49090	08	Family Practice	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
212605	Fee-for-Service	1710916796	1710916796	1	1	LAUCHLE, JENNIFER O MD	9/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	71766	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
212613	Fee-for-Service	1801430467	1801430467	1	1	LANDMARK ANESTHESIA MEDICAL	11/7/2022	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP PRIME	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
212640	Fee-for-Service	1215052428	1215052428	1	1	LEE, EUGENE Y MD	7/31/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	60178	36	Psychiatry	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
212642	Fee-for-Service	1396145611	1396145611	1	1	LOMELI, EVA LCSW	5/13/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9235 E BROADWAY ST	None	PLANADA	CA	95365	8088	24	06047	37.29049953	-120.3207705	Merced County
212695	Fee-for-Service	1487898334	1487898334	1	1	LES, JESSICA T MD	6/30/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	114063	None	None	0	In state provider	None	121 SOTOYOME ST	STE 203	SANTA ROSA	CA	95405	4822	49	06097	38.44224	-122.70195	Sonoma County
212709	Fee-for-Service	1467664169	1467664169	1	1	LOGAN, CATHY L MD	12/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108361	77	Infectious Disease	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
212723	Fee-for-Service	1912141334	1912141334	1	1	LIANG, CONRAD W MD	3/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125044	30	Radiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	19	06037	34.072245	-117.4319685	San Bernardino County
212753	Fee-for-Service	1649334079	1649334079	1	1	LEVY, MATTHEW T MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61490	01	General Practice	0	In state provider	None	1174 CASTRO ST	STE 201	MOUNTAIN VIEW	CA	94040	2569	43	06085	37.3822628	-122.0861276	Santa Clara County
212805	Fee-for-Service	1073513263	1073513263	1	1	LESSMAN, RICHARD K MD	11/1/1981	207RN0300X	NA	Nephrology	026	PHYSICIANS	23840	41	Internal Medicine	0	In state provider	None	32144 AGOURA RD	STE 102	WESTLAKE VILLAGE	CA	91361	4038	19	06037	34.14848408	-118.8208595	Los Angeles County
212810	Fee-for-Service	1518490804	1518490804	2	1	LAN, ERIKA K MD DO	10/20/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	16842	13	Neurology (M.D. only)	0	In state provider	None	117 BUNNY AVE	None	SANTA MARIA	CA	93458	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
212830	Fee-for-Service	1134963309	1134963309	1	1	LIFELINE WALK IN MEDICAL & M	2/10/2025	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ENTAL HEALTH NURSING C	3535 TORRANCE BLVD	STE 13	TORRANCE	CA	90503	4815	19	06037	33.83761551	-118.348227	Los Angeles County
212833	Fee-for-Service	1679576706	1679576706	1	1	LAWHEAD, JEFFREY D MD	11/5/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	146704	01	General Practice	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
212883	Fee-for-Service	1114251279	1114251279	1	1	LIU, DEBORAH D C DO	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10926	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
212977	Fee-for-Service	1487813622	1487813622	1	1	LIU, YAO MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121576	18	Ophthalmology	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
212982	Fee-for-Service	1326270737	1326270737	1	1	LU, DARELLE NP	12/12/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	89 W MARCH LN	STE 1	STOCKTON	CA	95207	5723	39	06077	37.9950695	-121.307499	San Joaquin County
213001	Fee-for-Service	1265531776	1265531776	1	1	LEE,KENDRICK W. K. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	407 ULUNIU STREET	4TH FLOOR	KAILUA	HI	96734	0000	00	None	21.39646318	-157.7434882	Honolulu County
213003	Fee-for-Service	1548720733	1548720733	1	1	LYDON, EMILY C MD	6/5/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	178381	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
213024	Fee-for-Service	1295883015	1295883015	1	1	LUETZOW, WILLIAM F MD	8/31/1992	204D00000X	NA	Other	026	PHYSICIANS	66161	20	Orthopedic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
213028	Fee-for-Service	1790281244	1790281244	1	1	LIN, PAMELA MD	5/23/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	183897	None	None	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
213029	Fee-for-Service	1679558969	1679558969	1	1	LAU, OLIVER Y MD	10/3/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76690	08	Family Practice	0	In state provider	None	2000 O ST	STE 210	SACRAMENTO	CA	95814	5286	34	06067	38.57106572	-121.4822412	Sacramento County
213042	Fee-for-Service	1649334079	1649334079	1	1	LEVY, MATTHEW T MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61490	41	Internal Medicine	0	In state provider	None	1174 CASTRO ST	STE 201	MOUNTAIN VIEW	CA	94040	2569	43	06085	37.3822628	-122.0861276	Santa Clara County
213044	Fee-for-Service	1366516569	1366516569	1	1	LOPEZ, KATHLEEN L	4/10/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9 WILLIAMSBURG LANE	None	CHICO	CA	95926	2225	04	06007	39.75249362	-121.8554242	Butte County
213045	Fee-for-Service	1609817303	1609817303	1	1	LARGOZA, NONATO A MD	11/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70645	08	Family Practice	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
213052	Fee-for-Service	1043444615	1043444615	1	1	LIU, KIRSTEN Y MD	6/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123757	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4101 TORRANCE BOULEVARD	EMERGENCY DEPARTMENT	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
213136	Fee-for-Service	1063583961	1063583961	1	1	LE, TO TAM N MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67139	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
213163	Fee-for-Service	1669900536	1669900536	1	1	LAKDAWALA, MALCOLM MD	8/19/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164200	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
213189	Fee-for-Service	1588097158	1588097158	1	1	LUSSON, ROBERT A PSYD	5/10/2024	101YP2500X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
213218	Fee-for-Service	1457412140	1457412140	1	1	LAU, ANGIE K OD	7/6/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
213265	Fee-for-Service	1699903583	1699903583	1	1	LOUIE-TANAKA, JENNIFER Y PHD	6/15/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD ROAD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
213272	Fee-for-Service	1710140025	1710140025	1	1	LOPEZ, PEDRO N MD	9/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103617	41	Internal Medicine	0	In state provider	None	1700 E CESAR E CHAVEZ AV	STE 3300	LOS ANGELES	CA	90033	2469	19	06037	34.05101259	-118.217259	Los Angeles County
213312	Fee-for-Service	1932593993	1932593993	1	2	LOPEZ PEREZ, KARLA E LMFT	11/9/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10445 LAKEWOOD BVLD	SUITE 106	DOWNEY	CA	90241	2792	19	06037	33.94365444	-118.1193843	Los Angeles County
213316	Fee-for-Service	1801430467	1801430467	1	6	LANDMARK ANESTHESIA MEDICAL	11/7/2022	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP PRIME	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
213334	Fee-for-Service	1790881381	1790881381	1	1	LAI, CHUN C MD	3/14/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	72495	-	NOT APPLICABLE	0	In state provider	None	83385 ROSA AVENUE	None	THERMAL	CA	92274	9506	33	06065	33.64846105	-116.2093774	Riverside County
213379	Fee-for-Service	1447552328	1447552328	1	1	LI, CHUNXIA MD	10/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115430	08	Family Practice	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
213402	Fee-for-Service	1386757011	1386757011	1	1	LEE, JOSEPH J U MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	31929	05	Anesthesiology	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
213421	Fee-for-Service	1659425445	1659425445	1	1	LEE, VINCENT OD	11/26/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
213435	Fee-for-Service	1477662351	1477662351	1	1	LERNER, MARC A MD	10/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	47734	40	Pediatrics	0	In state provider	None	101 CITY DR S	BLDG 27	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
213446	Fee-for-Service	1083938583	1083938583	1	1	LI, LIN MD	9/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155001	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
213452	Fee-for-Service	1922254077	1922254077	1	1	LI, ALICE J MD	8/14/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	97107	40	Pediatrics	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
213454	Fee-for-Service	1245524479	1245524479	1	1	LUNDEBERG, MEGAN R MD	8/2/2017	390200000X	NA	Other	026	PHYSICIANS	142503	89	Surgery-Traumatic	0	In state provider	None	101 CITY DR S	B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
213480	Fee-for-Service	1023162567	1023162567	1	1	LIPIN, JOEL	7/21/2020	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	9153 RESEDA BLVD	None	NORTHRIDGE	CA	91324	3031	19	06037	34.236792	-118.536108	Los Angeles County
213493	Fee-for-Service	1144397555	1144397555	1	1	LEE, SHIU M MD	10/15/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72713	41	Internal Medicine	0	In state provider	None	613 S C ST	None	OXNARD	CA	93030	7016	56	06111	34.19604615	-119.1811325	Ventura County
213503	Fee-for-Service	1063179745	1063179745	1	1	LAUREEN A LESTER PSYD PSYCHO	12/23/2024	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LOGIST A PROFESSIONAL CO	8861 WILLIAMSON DR	STE 20	ELK GROVE	CA	95624	1878	34	06067	38.411424	-121.37598	Sacramento County
213528	Fee-for-Service	1487677977	1487677977	1	1	LAI, NAM M MD	7/19/2017	207R00000X	NA	Other	026	PHYSICIANS	53709	None	None	0	In state provider	None	3465 TORRANCE BLVD	SUITE W	TORRANCE	CA	90503	5804	19	06037	33.83763045	-118.346256	Los Angeles County
213534	Fee-for-Service	1902126287	1902126287	1	1	LEE, CAROL S MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125336	45	Nephrology (Renal-Kidney)	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
213549	Fee-for-Service	1417050782	1417050782	1	1	LADDARAN MEDICAL GROUP	4/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	2105 BEVERLY BLVD	STE 117	LOS ANGELES	CA	90057	2216	19	06037	34.06682861	-118.2706286	Los Angeles County
213551	Fee-for-Service	1053637967	1053637967	1	1	LANGDON, ANDREW W PSYD	8/7/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
213552	Fee-for-Service	1043239841	1043239841	1	1	LE, LARA L MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55073	41	Internal Medicine	0	In state provider	None	225 EAST 2ND AVENUE	None	ESCONDIDO	CA	92025	4249	37	06073	33.12175817	-117.0787555	San Diego County
213565	Fee-for-Service	1679190607	1679190607	1	1	LONG, CAMERYN CCC-SLP	5/7/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2208 CAMINO RAMON	None	SAN RAMON	CA	94583	1328	07	06013	37.77746122	-121.9677166	Contra Costa County
213586	Fee-for-Service	1699842914	1699842914	1	1	LISS, LEONARD MD	7/16/2021	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	4239 W NOBLE AVE	None	VISALIA	CA	93277	1633	54	06107	36.325989	-119.3381505	Tulare County
213597	Fee-for-Service	1033280508	1033280508	1	1	LAFLEUR, LISA	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
213603	Fee-for-Service	1801430467	1801430467	1	6	LANDMARK ANESTHESIA MEDICAL	9/19/2022	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP PRIME	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
213617	Fee-for-Service	1306173893	1306173893	1	1	LEE, SAMUEL H MD	9/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110394	18	Ophthalmology	0	In state provider	None	1515 RIVER PARK DR	STE 100	SACRAMENTO	CA	95815	4605	34	06067	38.599947	-121.437279	Sacramento County
213635	Fee-for-Service	1164786042	1164786042	1	1	LEE, JASON F MD	2/11/2025	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	134450	08	Family Practice	0	In state provider	None	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
213658	Fee-for-Service	1023245230	1023245230	1	1	LALEZARIAN, MICHAEL A MD	4/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109360	30	Radiology	0	In state provider	None	23845 MCBEAN PARKWAY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
213687	Fee-for-Service	1881663540	1881663540	1	1	LEE, SHERYL A	7/20/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	24012 CALLE DE LA PLATA	STE 200	LAGUNA HILLS	CA	92653	7624	30	06059	33.61012113	-117.7115908	Orange County
213689	Fee-for-Service	1477948206	1477948206	1	1	LOFTHUS, ALEXANDER MD	10/18/2023	208600000X	NA	General Surgery	026	PHYSICIANS	176150	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
213734	Fee-for-Service	1679644553	1679644553	1	1	LO, HENRY M MD	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81682	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	25405 HANCOCK AVE	STE 216	MURRIETA	CA	92562	5978	33	06065	33.5580833	-117.1850127	Riverside County
213738	Fee-for-Service	1356470181	1356470181	1	1	LOCKHART, ELIZABETH	3/29/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
213755	Fee-for-Service	1629070214	1629070214	1	1	LE, MICHELLE P MD	10/14/2020	207L00000X	NA	Other	026	PHYSICIANS	97635	05	Anesthesiology	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
213775	Fee-for-Service	1851406243	1851406243	1	1	LONG, MATTHEW T DO	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8553	08	Family Practice	0	In state provider	None	529 N AZUSA AVE	None	AZUSA	CA	91702	2936	19	06037	34.13082235	-117.9076262	Los Angeles County
213817	Fee-for-Service	1912904533	1912904533	1	1	LUTHRINGER, DANIEL J MD	2/28/1992	174400000X	NA	Other	026	PHYSICIANS	73180	22	Pathology (M.D. only)	0	In state provider	None	200 NORTH ROBERTSON	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
213823	Fee-for-Service	1902126287	1902126287	1	1	LEE, CAROL S MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125336	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
213852	Fee-for-Service	1811094915	1811094915	1	1	LEICHTLING,JONATHAN J MD	6/8/1979	208600000X	NA	General Surgery	026	PHYSICIANS	31362	02	General Surgery	0	In state provider	None	19 WILMOT STREET	None	SAN FRANCISCO	CA	94115	2716	38	06075	37.78761094	-122.4323478	San Francisco County
213867	Fee-for-Service	1205075348	1205075348	1	1	LE, HOANG U MD	1/18/2012	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	112732	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	501 N BRIDGE ST	None	VISALIA	CA	93291	5014	54	06107	36.334107	-119.289186	Tulare County
213903	Fee-for-Service	1477981355	1477981355	1	1	LATTA, RACHEL E CNM	1/1/2014	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	538 SUMMERFIELD ROAD	None	SANTA ROSA	CA	95405	5239	49	06097	38.45377578	-122.6710208	Sonoma County
213905	Fee-for-Service	1316011620	1316011620	1	1	LEE, FRANK M	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77569	36	Psychiatry	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
213921	Fee-for-Service	1871509836	1871509836	1	1	LUCEY, CATHERINE R MD	2/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	52495	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
213925	Fee-for-Service	1093133597	1093133597	1	1	LANGHEINRICH, KRISTOFER MD	6/19/2020	2085R0204X	NA	Other	026	PHYSICIANS	140611	30	Radiology	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
213958	Fee-for-Service	1316309776	1316309776	1	1	LU, DENISE Y DO	4/13/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15934	08	Family Practice	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
213981	Fee-for-Service	1396904876	1396904876	2	2	LAMALE-SMITH, LEAH M MD	7/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135831	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
213994	Fee-for-Service	1194781898	1194781898	1	1	LEE, THOMAS J MD	6/30/1995	207PE0004X	NA	Other	026	PHYSICIANS	60222	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
214022	Fee-for-Service	1679644553	1679644553	1	1	LO, HENRY M MD	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81682	41	Internal Medicine	0	In state provider	None	25405 HANCOCK AVE	STE 216	MURRIETA	CA	92562	5978	33	06065	33.5580833	-117.1850127	Riverside County
214049	Fee-for-Service	1386688117	1386688117	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1455 E NOBLE AVE	None	VISALIA	CA	93292	3042	54	06107	36.324369	-119.2765275	Tulare County
214060	Fee-for-Service	1710524566	1710524566	1	1	LUE, POU E NP	6/29/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	333 W EL CAMINO REAL	STE 230	SUNNYVALE	CA	94087	1969	43	06085	37.36899556	-122.0358929	Santa Clara County
214062	Fee-for-Service	1386654077	1386654077	1	1	LODI MEMORIAL HOSPITAL	8/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MEDICAL GROUP	2415 W VINE ST	STE 100	LODI	CA	95242	3731	39	06077	38.1228953	-121.3052826	San Joaquin County
214096	Fee-for-Service	1902131683	1902131683	1	1	LAPONIS, RYAN C MD	6/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110216	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
214097	Fee-for-Service	1710065511	1710065511	1	1	LONGMUIR, NICOLA J MD	2/28/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	36872	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
214136	Fee-for-Service	1851592455	1851592455	1	1	LEE, ANDREA M MD	9/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99458	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
214155	Fee-for-Service	1760613574	1760613574	1	1	LE, MAITHAO N MD	4/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112835	02	General Surgery	0	In state provider	None	1500 DUARTE RD	BLDG 149	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
214165	Fee-for-Service	1013918606	1013918606	1	1	LONSER, ROLAND E MD	3/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	15720	22	Pathology (M.D. only)	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
214172	Fee-for-Service	1225001027	1225001027	1	1	LEI, THOMAS D MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78558	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2101 FOREST AVE	STE 126	SAN JOSE	CA	95128	1424	43	06085	37.3270795	-121.93731	Santa Clara County
214211	Fee-for-Service	1871509836	1871509836	1	1	LUCEY, CATHERINE R MD	2/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	52495	38	Geriatrics	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
214216	Fee-for-Service	1780212449	1780212449	1	1	LI, JIEMIN J MD	7/23/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	STE 2500	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
214250	Fee-for-Service	1548201726	1548201726	1	1	LEE, JAY W MD	3/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84879	08	Family Practice	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
214264	Fee-for-Service	1134583669	1134583669	1	1	LOFTUS, PATRICK D MD	8/4/2021	207L00000X	NA	Other	026	PHYSICIANS	151430	None	None	0	In state provider	None	PUEBLO AT BATH STREETS	None	SANTA BARBARA	CA	93105	0000	42	06083	34.430526	-119.72196	Santa Barbara County
214283	Fee-for-Service	1598154189	1598154189	1	2	LA JOLLA ORTHOPEDIC TRAUMA I	9/19/2024	207XX0801X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	NC	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1224	37	06073	32.8865608	-117.2250386	San Diego County
214318	Fee-for-Service	1881697381	1881697381	1	1	LAKE COUNTY TRIBAL HEALTH	6/28/2024	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	925 BEVINS COURT	None	LAKEPORT	CA	95453	1950	17	06033	39.03772106	-122.9223338	Lake County
214347	Fee-for-Service	1639603798	1639603798	1	1	LADNER, ALYSSA M MD	1/28/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	159535	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
214368	Fee-for-Service	1285890087	1285890087	1	1	LEE, JOHN Y PHD	8/4/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	SUITE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
214411	Fee-for-Service	1588719116	1588719116	1	1	LOS ANGELES COUNTY CCS	7/15/2005	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	COVINA MTU	4400 N ROXBURGH AVE	None	COVINA	CA	91722	3032	19	06037	34.09296331	-117.918382	Los Angeles County
214416	Fee-for-Service	1639584220	1639584220	1	1	LUI, KINGWAI DO	2/7/2020	163WP0807X	NA	Other	026	PHYSICIANS	14405	36	Psychiatry	0	In state provider	None	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	15	06029	35.3540847	-119.0536548	Kern County
214417	Fee-for-Service	1043348618	1043348618	1	1	LIU, JESSE MD	4/22/2014	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	82162	None	None	0	In state provider	None	1700 CALIFORNIA STREET	SUITE 100	SAN FRANCISCO	CA	94109	4587	38	06075	37.79030099	-122.4230289	San Francisco County
214454	Fee-for-Service	1578956207	1578956207	1	1	LAWRENCE MILNE MD INC	7/14/2021	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7777 GREENBACK LANE	STE 103	CITRUS HEIGHTS	CA	95610	5800	34	06067	38.678868	-121.2777135	Sacramento County
214476	Fee-for-Service	1609832328	1609832328	1	1	LIBBY, GLENN F MD	8/22/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	27802	41	Internal Medicine	0	In state provider	None	2865 ATLANTIC AVE	STE 11	LONG BEACH	CA	90806	1740	19	06037	33.809418	-118.185058	Los Angeles County
214483	Fee-for-Service	1962501700	1962501700	1	1	LOUIE, DEXTER MD	2/8/2015	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	32880	04	Otology, Laryngology, Rhinology	0	In state provider	None	929 CLAY ST	STE 501	SAN FRANCISCO	CA	94108	1500	38	06075	37.79398652	-122.4083496	San Francisco County
214498	Fee-for-Service	1962563338	1962563338	1	1	LIBANATI, CESAR R MD	9/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	45441	41	Internal Medicine	0	In state provider	None	25815 BARTON RD	STE 102	LOMA LINDA	CA	92354	2033	36	06071	34.04825519	-117.2408344	San Bernardino County
214540	Fee-for-Service	1598928673	1598928673	1	1	LAWSON, BETHAMI L LCSW	6/13/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
214571	Fee-for-Service	1801430467	1801430467	1	3	LANDMARK ANESTHESIA MEDICAL	1/17/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP PRIME	5000 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
214594	Fee-for-Service	1568598308	1568598308	1	1	LIN LEVY, JENNIFER Y	1/31/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	None	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
214607	Fee-for-Service	1881697381	1881697381	1	1	LAKE COUNTY TRIBAL HEALTH	10/16/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	925 BEVINS COURT	None	LAKEPORT	CA	95453	1950	17	06033	39.03772106	-122.9223338	Lake County
214612	Fee-for-Service	1356383178	1356383178	2	1	LONGS DRUG STORES CALIFORNIA	5/17/2010	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	LLC	6877 SEBASTOPOL AVE	None	SEBASTOPOL	CA	95472	3416	49	06097	38.40229513	-122.8223642	Sonoma County
214645	Fee-for-Service	1942290903	1942290903	1	1	LIFE MEDICAL GROUP, INC	5/25/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	18897 COLIMA RD	STE A	ROWLAND HEIGHTS	CA	91748	2977	19	06037	33.98769974	-117.8912223	Los Angeles County
214652	Fee-for-Service	1932604048	1932604048	1	1	LAKEPORT POST ACUTE, LLC	4/1/2018	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1291 CRAIG AVE	None	LAKEPORT	CA	95453	5704	17	06033	39.035061	-122.9298525	Lake County
214669	Fee-for-Service	1619043312	1619043312	1	1	LOPEZ, CARMEN V CRNA	8/5/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	450 N ROXBURY DRIVE	SUITE 600	BEVERLY HILLS	CA	90210	4220	19	06037	34.06820793	-118.4070317	Los Angeles County
214686	Fee-for-Service	1962849265	1962849265	1	1	LEPORE, NOELLE G LMFT	2/24/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
214694	Fee-for-Service	1598016636	1598016636	1	1	LE, UYEN T MD	3/15/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168420	None	None	0	In state provider	None	2900 WHIPPLE	STE 132	REDWOOD CITY	CA	94062	2843	41	06081	37.4783072	-122.2551089	San Mateo County
214718	Fee-for-Service	1346404795	1346404795	1	1	LEE, CHRISTINA MD	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105864	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
214720	Fee-for-Service	1255423489	1255423489	1	1	LIN, JAMES JR MD	1/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	78149	None	None	0	In state provider	None	100 S RAYMOND AVENUE	#101	ALHAMBRA	CA	90006	2641	19	06037	34.09027878	-118.1450083	Los Angeles County
214743	Fee-for-Service	1588850861	1588850861	1	1	LEE, CHRIS I MD INC	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88926	08	Family Practice	0	In state provider	None	18897 COLIMA RD	STE B	ROWLAND HEIGHTS	CA	91748	2977	19	06037	33.98769974	-117.8912223	Los Angeles County
214775	Fee-for-Service	1679645428	1679645428	1	1	LAUMEYER, JEAN M MD	10/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	67876	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
214791	Fee-for-Service	1962563338	1962563338	1	1	LIBANATI, CESAR R MD	9/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	45441	38	Geriatrics	0	In state provider	None	25815 BARTON RD	STE 102	LOMA LINDA	CA	92354	2033	36	06071	34.04825519	-117.2408344	San Bernardino County
214820	Fee-for-Service	1154599785	1154599785	1	1	LAZAR, JOHN NP	4/9/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2900 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2730	19	06037	33.896799	-118.3959415	Los Angeles County
214844	Fee-for-Service	1023517273	1023517273	2	1	LITTLE, KELLY LMFT	7/21/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 W FOOTHILL BLVD	104	SAN DIMAS	CA	91773	1170	19	06037	34.1246263	-117.8074094	Los Angeles County
214860	Fee-for-Service	1801430467	1801430467	1	3	LANDMARK ANESTHESIA MEDICAL	11/7/2022	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP PRIME	5000 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
214892	Fee-for-Service	1669038865	1669038865	1	1	LABABIDI, AHMED MD	8/10/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185275	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
214896	Fee-for-Service	1881697381	1881697381	1	1	LAKE COUNTY TRIBAL HEALTH	9/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	925 BEVINS COURT	None	LAKEPORT	CA	95453	1950	17	06033	39.03772106	-122.9223338	Lake County
214905	Fee-for-Service	1447661657	1447661657	1	1	LEE, HAEWON MD	10/22/2019	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	161567	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
214932	Fee-for-Service	1942290903	1942290903	1	1	LIFE MEDICAL GROUP, INC	5/25/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	18897 COLIMA RD	STE A	ROWLAND HEIGHTS	CA	91748	2977	19	06037	33.98769974	-117.8912223	Los Angeles County
214948	Fee-for-Service	1669915666	1669915666	1	1	LOPEZ, JEHNETTE R NP	4/9/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	202 W WILLOW AVE	SUITE 302	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
214953	Fee-for-Service	1366450793	1366450793	1	1	LUEDERS, JONATHAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
214961	Fee-for-Service	1508036591	1508036591	1	1	LY, PETER P MD MED CORP	3/10/2008	207L00000X	NA	Other	026	PHYSICIANS	65780	05	Anesthesiology	0	In state provider	None	21530 S PIONEER BLVD	None	HAWAIIAN GARDENS	CA	90716	2608	19	06037	33.83358457	-118.0817796	Los Angeles County
214965	Fee-for-Service	1861534190	1861534190	1	1	LIBERTY HOMES	2/3/2000	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	PORTSMOUTH ICF/DD-H	27695 PORTSMOUTH AVE	None	HAYWARD	CA	94545	4010	01	06001	37.62490813	-122.102045	Alameda County
214977	Fee-for-Service	1134570708	1134570708	1	1	LE, ANHDAO V MD INC	7/25/2016	193400000X	NA	Other	026	PHYSICIANS	81117	01	General Practice	0	In state provider	None	1024 E PACIFIC COAST HWY	None	LONG BEACH	CA	90806	5017	19	06037	33.78982847	-118.1799135	Los Angeles County
215031	Fee-for-Service	1275573743	1275573743	1	1	LATTIN, JOHN E MD	11/27/1985	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	18756	40	Pediatrics	0	In state provider	None	4770 W HERNDON AVE	None	FRESNO	CA	93722	8401	10	06019	36.83717984	-119.8778388	Fresno County
215059	Fee-for-Service	1609370014	1609370014	1	1	LEE, MICHAEL DO	9/15/2023	207RA0201X	NA	Other	026	PHYSICIANS	19085	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
215086	Fee-for-Service	1417976051	1417976051	1	1	LOPEZ, VICTOR M MD	7/31/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	78453	40	Pediatrics	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
215099	Fee-for-Service	1831480946	1831480946	1	1	LAICO, REGINA T MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124296	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
215133	Fee-for-Service	1447447719	1447447719	1	1	LEE, ALICE S OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14709 S PRAIRIE AVE	None	LAWNDALE	CA	90260	1831	19	06037	33.89785517	-118.3439175	Los Angeles County
215180	Fee-for-Service	1134131030	1134131030	1	1	LAWRENCE HOSPITAL CENTER	11/14/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	55 PALMER AVE	None	BRONXVILLE	NY	10708	3403	00	None	40.94166754	-73.83643083	Westchester County
215183	Fee-for-Service	1881697381	1881697381	1	1	LAKE COUNTY TRIBAL HEALTH	8/26/2021	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	925 BEVINS COURT	None	LAKEPORT	CA	95453	1950	17	06033	39.03772106	-122.9223338	Lake County
215190	Fee-for-Service	1023482486	1023482486	1	1	LEE, JESSICA H PHD	7/5/2016	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3838 WEST CARSON ST	STE 330	TORRANCE	CA	90503	6701	19	06037	33.8313451	-118.3539221	Los Angeles County
215192	Fee-for-Service	1831209220	1831209220	1	1	LENSKY, MARINA G MD	6/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	104837	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
215251	Fee-for-Service	1093720666	1093720666	1	1	LOA, HEDY C MD	8/12/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	38337	41	Internal Medicine	0	In state provider	None	9675 MONTE VISTA AVE	STE D	MONTCLAIR	CA	91763	2213	36	06071	34.079004	-117.6982135	San Bernardino County
215337	Fee-for-Service	1033288014	1033288014	1	1	LOPEZ, JAIME R MD	6/30/1990	2084N0400X	NA	Neurology	026	PHYSICIANS	65342	13	Neurology (M.D. only)	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
215343	Fee-for-Service	1154308773	1154308773	1	1	LEJANO, ELENA MD	12/14/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	68323	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
215362	Fee-for-Service	1033386024	1033386024	1	1	LE, CATHERINE T MD	5/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112075	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	STE B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
215384	Fee-for-Service	1902514938	1902514938	1	1	LUJAN, ELIZABETH	11/17/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3437 W YALE AVE	None	FRESNO	CA	93722	6551	10	06019	36.76995676	-119.8540666	Fresno County
215439	Fee-for-Service	1780688036	1780688036	1	1	LANSANGAN, SUSANNA D MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	52671	41	Internal Medicine	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
215447	Fee-for-Service	1093841223	1093841223	1	1	LAW, AMY J CNM	9/20/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
215469	Fee-for-Service	1134131030	1134131030	1	1	LAWRENCE HOSPITAL CENTER	11/14/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	55 PALMER AVE	None	BRONXVILLE	NY	10708	3403	00	None	40.94166754	-73.83643083	Westchester County
215483	Fee-for-Service	1912174798	1912174798	1	1	LUMAN, KYLE N MD	7/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106660	41	Internal Medicine	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
215485	Fee-for-Service	1285833764	1285833764	1	1	LEE, YOUNG E MD	7/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130275	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1955 CITRACADO PKWY	STE 300	ESCONDIDO	CA	92029	4113	37	06073	33.11301099	-117.1202081	San Diego County
215541	Fee-for-Service	1497198337	1497198337	1	1	LENIS, ANDREW MD	5/9/2019	208800000X	NA	Other	026	PHYSICIANS	135949	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
215661	Fee-for-Service	1497985410	1497985410	1	1	LIDDELL, ALYSIA PHD	4/21/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5931 STANLEY AVE	STE # 1	CARMICHAEL	CA	95608	3846	34	06067	38.622978	-121.326966	Sacramento County
215671	Fee-for-Service	1053575886	1053575886	1	1	LY, EYONG J MD	3/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113044	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
215677	Fee-for-Service	1902514938	1902514938	1	1	LUJAN, ELIZABETH	11/17/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3437 W YALE AVE	None	FRESNO	CA	93722	6551	10	06019	36.76995676	-119.8540666	Fresno County
215707	Fee-for-Service	1962109033	1962109033	1	2	LOS ANGELES COUNTY DEPARTMEN	2/8/2024	261QP0905X	NA	Other	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	241 FIGUEROA ST	None	LOS ANGELES	CA	90012	2601	19	06037	34.05904423	-118.2502018	Los Angeles County
215719	Fee-for-Service	1013014968	1013014968	1	1	LEE, MARGARET M MD	6/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79768	None	None	0	In state provider	None	410 S MELROSE DR	STE 104	VISTA	CA	92081	6607	37	06073	33.19049793	-117.2538503	San Diego County
215735	Fee-for-Service	1548914591	1548914591	1	1	LIAO, HSUAN-LING NP	4/19/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	19	06037	34.13101049	-118.151532	Los Angeles County
215780	Fee-for-Service	1184639551	1184639551	1	1	LEE, LINA MD APC	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70424	05	Anesthesiology	0	In state provider	None	438 W LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
215792	Fee-for-Service	1811102791	1811102791	2	1	LESMONI INCORPORATED	9/28/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5241 CEDAR RIDGE WAY	None	ANTIOCH	CA	94531	8097	07	06013	37.95807816	-121.8004406	Contra Costa County
215815	Fee-for-Service	1508194184	1508194184	1	1	LEE, VICTOR S MD	10/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
215822	Fee-for-Service	1265813174	1265813174	1	1	LI, STEPHANIE MD	11/9/2019	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	161736	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
215846	Fee-for-Service	1073697058	1073697058	1	1	LAWRENCE, JENNIFER G MD	9/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	80072	01	General Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
215848	Fee-for-Service	1336466226	1336466226	1	1	LU, KUN NP	9/17/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
215853	Fee-for-Service	1649518630	1649518630	1	1	LONG, ANN L DO	3/23/2023	207P00000X	NA	Other	026	PHYSICIANS	19425	None	None	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
215857	Fee-for-Service	1073744504	1073744504	1	2	LUNA, LISA G CPO	5/20/2019	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	14450 HOOVER ST	None	WESTMINSTER	CA	92683	5319	30	06059	33.75270953	-117.9983297	Orange County
215911	Fee-for-Service	1619579174	1619579174	1	1	LIANG, OLIVIA PT	2/27/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
215931	Fee-for-Service	1124107263	1124107263	1	1	LOO, EVELYN M MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61631	41	Internal Medicine	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
215957	Fee-for-Service	1861557993	1861557993	2	1	LONGS DRUG STORES CALIFORNIA	9/21/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	255 MAIN ST	None	VENICE	CA	90291	5217	19	06037	33.99685459	-118.4784633	Los Angeles County
215962	Fee-for-Service	1477620334	1477620334	1	1	LUDLOW, RICHARD MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84289	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
215994	Fee-for-Service	1437238433	1437238433	1	1	LOCHRIDGE, ARTHUR G MD	8/1/1995	207L00000X	NA	Other	026	PHYSICIANS	30360	05	Anesthesiology	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
216002	Fee-for-Service	1225010077	1225010077	1	1	LOITZ, ROBERT D MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	43246	40	Pediatrics	0	In state provider	PACIFIC PEDIATRIC	50 BELLEFONTAINE ST	STE 405	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
216023	Fee-for-Service	1538407481	1538407481	1	1	LEE, CINDY CRNA	2/11/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
216033	Fee-for-Service	1457319709	1457319709	1	1	LUPERTE, ESTHERLOIDA P MD	12/21/2018	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
216050	Fee-for-Service	1457430886	1457430886	1	1	LEDUC, TRUONG S MD	6/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56656	41	Internal Medicine	0	In state provider	None	11160 WARNER AVE	STE 101	FOUNTAIN VALLEY	CA	92708	4010	30	06059	33.71630854	-117.934317	Orange County
216098	Fee-for-Service	1750841417	1750841417	1	1	LOELIGER, KELSEY B	6/5/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	179236	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
216101	Fee-for-Service	1255340535	1255340535	1	1	LIANG, TED S MD	10/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61596	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3555 KENYON ST	None	SAN DIEGO	CA	92110	5341	37	06073	32.75016963	-117.2160064	San Diego County
216114	Fee-for-Service	1558924787	1558924787	1	1	LEONARD, PERRY J MD	9/26/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	180517	None	None	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
216125	Fee-for-Service	1306078068	1306078068	1	1	LALLANDE, BEVERLY J MD	9/9/2019	2084P0804X	NA	Psychiatry	026	PHYSICIANS	113039	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
216136	Fee-for-Service	1568856797	1568856797	1	1	LAM, CHRISTOPHER D PT	11/17/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
216164	Fee-for-Service	1053468058	1053468058	1	1	LEE, DING D K MD	4/1/2016	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	53109	None	None	0	In state provider	None	3838 CALIFORNIA STREET	SUITE 805	SAN FRANCISCO	CA	94118	1522	38	06075	37.78591809	-122.4575439	San Francisco County
216182	Fee-for-Service	1427092873	1427092873	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1140 S MAIN ST	None	SALINAS	CA	93901	2263	27	06053	36.65973674	-121.6587789	Monterey County
216185	Fee-for-Service	1609823228	1609823228	1	1	LYNCH AMBULANCE	10/9/1986	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2950 E LA JOLLA ST	None	ANAHEIM	CA	92806	1307	30	06059	33.86009679	-117.8667305	Orange County
216209	Fee-for-Service	1790187920	1790187920	1	1	LIU, JING C MD	10/15/2017	207P00000X	NA	Other	026	PHYSICIANS	141160	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
216262	Fee-for-Service	1780890749	1780890749	1	1	LEE, JULIANE OD	5/9/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	207 S SANTA ANITA ST	STE P-25	SAN GABRIEL	CA	91776	1145	19	06037	34.10072807	-118.1066296	Los Angeles County
216280	Fee-for-Service	1710943170	1710943170	1	1	LEE, JAE WOO MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74476	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
216294	Fee-for-Service	1407277189	1407277189	1	1	LARSEN, TRACY B CRNA	1/14/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
216305	Fee-for-Service	1003127846	1003127846	1	1	LAI, YU KUANG MD	9/9/2019	207R00000X	NA	Other	026	PHYSICIANS	141834	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
216341	Fee-for-Service	1457430886	1457430886	1	1	LEDUC, TRUONG S MD	6/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56656	10	Gastroenterology (M.D. only)	0	In state provider	None	11160 WARNER AVE	STE 101	FOUNTAIN VALLEY	CA	92708	4010	30	06059	33.71630854	-117.934317	Orange County
216359	Fee-for-Service	1801814835	1801814835	1	1	LEFF, DAVID A MD	11/9/1976	208800000X	NA	Other	026	PHYSICIANS	11096	34	Urology and Urological Surgery	0	In state provider	None	1304 15TH ST	STE 200	SANTA MONICA	CA	90404	1811	19	06037	34.02600773	-118.486172	Los Angeles County
216364	Fee-for-Service	1275611055	1275611055	1	1	LARSEN, HEIDI L MD	1/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	75008	01	General Practice	0	In state provider	None	3043 SUMMIT ST	None	OAKLAND	CA	94609	3408	01	06001	37.81991034	-122.2644496	Alameda County
216367	Fee-for-Service	1093718546	1093718546	1	1	LUU, MYCHAEL MD	9/1/1998	207N00000X	NA	Dermatology	026	PHYSICIANS	61816	07	Dermatology	0	In state provider	None	2050 CLARMAR WAY	None	SAN JOSE	CA	95128	1704	43	06085	37.32627054	-121.934907	Santa Clara County
216386	Fee-for-Service	1255340535	1255340535	1	1	LIANG, TED S MD	10/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61596	41	Internal Medicine	0	In state provider	None	3555 KENYON ST	None	SAN DIEGO	CA	92110	5341	37	06073	32.75016963	-117.2160064	San Diego County
216402	Fee-for-Service	1871864660	1871864660	1	1	LOPEZ, ALBERTO LCSW	6/5/2021	103TP2700X	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9535 RESEDA BLVD	112	NORTHRIDGE	CA	91324	6022	19	06037	34.243128	-118.5361055	Los Angeles County
216491	Fee-for-Service	1205018439	1205018439	2	1	LAKE POINTE OPERATING COMPAN	4/24/2018	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER - LAKE POINTE	6800 SCENIC DRIVE	None	ROWLETT	TX	75088	4552	00	None	32.91809545	-96.50944902	Rockwall County
216495	Fee-for-Service	1063026961	1063026961	1	1	LA THERAPY & FAMILY COUNSELI	9/13/2022	101Y00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	NG, INC	4000 MAGNOLIA BLVD	A	BURBANK	CA	91505	2827	19	06037	34.16705225	-118.3493748	Los Angeles County
216510	Fee-for-Service	1619003860	1619003860	1	1	LEE, DAVID P MD	5/1/1999	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	79800	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
216554	Fee-for-Service	1750333837	1750333837	1	1	LAHUD, LUIS A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	14502 W MEEKER BLVD	None	SUN CITY WEST	AZ	85375	5282	00	None	33.660657	-112.3736175	Maricopa County
216566	Fee-for-Service	1881773513	1881773513	1	1	LE, VINH Q MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78552	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
216595	Fee-for-Service	1235185158	1235185158	1	1	LOMA LINDA RADIOLOGY MED	7/10/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GRP	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
216651	Fee-for-Service	1275611055	1275611055	1	1	LARSEN, HEIDI L MD	1/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	75008	41	Internal Medicine	0	In state provider	None	3043 SUMMIT ST	None	OAKLAND	CA	94609	3408	01	06001	37.81991034	-122.2644496	Alameda County
216675	Fee-for-Service	1598406761	1598406761	1	1	LE, JONATHAN NP	2/25/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	151 CLAYDELLE AVE	None	EL CAJON	CA	92020	4505	37	06073	32.794155	-116.958763	San Diego County
216679	Fee-for-Service	1992746150	1992746150	1	1	LOWENBERG, DAVID W MD	6/3/2010	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	59471	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
216742	Fee-for-Service	1184929945	1184929945	1	1	LUM, NANCY J LCSW	12/5/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	955 W IMPERIAL HWY	SUITE 110	BREA	CA	92821	3812	30	06059	33.91745451	-117.9133065	Orange County
216747	Fee-for-Service	1992061345	1992061345	1	1	LAI, STEVEN MD	12/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129180	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 WESTWOOD PLAZA	ROOM 14-19	LOS ANGELES	CA	90095	3075	19	06037	34.06633051	-118.4452686	Los Angeles County
216748	Fee-for-Service	1063494292	1063494292	1	1	LASER CARE SPECIALISTS	10/3/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3828 SCHAUFELE AVE	STE 300	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
216769	Fee-for-Service	1356545487	1356545487	1	1	LA PLACE, DANA MD	1/30/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	75878	05	Anesthesiology	0	In state provider	ATTN MGA OFFICE	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
216779	Fee-for-Service	1205018439	1205018439	2	1	LAKE POINTE OPERATING COMPAN	4/24/2018	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER - LAKE POINTE	6800 SCENIC DRIVE	None	ROWLETT	TX	75088	4552	00	None	32.91809545	-96.50944902	Rockwall County
216782	Fee-for-Service	1063026961	1063026961	1	1	LA THERAPY & FAMILY COUNSELI	12/12/2024	101Y00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	NG, INC	4000 MAGNOLIA BLVD	A	BURBANK	CA	91505	2827	19	06037	34.16705225	-118.3493748	Los Angeles County
216814	Fee-for-Service	1700061702	1700061702	1	1	LEONG, DARREN S MD	4/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82616	24	Plastic Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
216823	Fee-for-Service	1902368244	1902368244	1	1	LORUSSO VIVAS, GABRIELLA MD	6/28/2024	390200000X	NA	Other	026	PHYSICIANS	177069	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
216828	Fee-for-Service	1255814711	1255814711	1	1	LEE, HYUN DONG DC	10/20/2020	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	RY CLINIC	14591 NEWPORT AVENUE	SUITE 106	TUSTIN	CA	92780	6026	30	06059	33.7317307	-117.8285651	Orange County
216854	Fee-for-Service	1083641005	1083641005	1	1	LAHODA, JOSEPH G MD	6/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	67875	30	Radiology	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
216855	Fee-for-Service	1730169871	1730169871	1	1	LAND, WILLIAM MD	10/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77122	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
216857	Fee-for-Service	1902931637	1902931637	1	1	LOPEZ, GISELLE E LCSW	9/9/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5005 LA MART DR	STE 100B7	RIVERSIDE	CA	92507	8901	33	06065	33.959493	-117.3322255	Riverside County
216870	Fee-for-Service	1508988064	1508988064	1	1	LIANG, CHRISTINE A MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135929	07	Dermatology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
216891	Fee-for-Service	1972850873	1972850873	1	1	LEE, JENA MD	8/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126671	26	Psychiatry (child)	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
216898	Fee-for-Service	1942257191	1942257191	1	1	LONG BEACH MEMORIAL PATHOLOG	5/31/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PATHOLOGY MEDICAL GROUP	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
216923	Fee-for-Service	1225787583	1225787583	1	1	LANKERSHIM PHARMACY INC	6/2/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4605 LANKERSHIM BLVD	STE 125	NORTH HOLLYWOOD	CA	91602	1886	19	06037	34.15389329	-118.3679999	Los Angeles County
216940	Fee-for-Service	1497761324	1497761324	1	1	LOS ANGELES COUNTY	4/28/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	HUMPHREY FAMILY PLANNING	5850 S MAIN ST	None	LOS ANGELES	CA	90003	1215	19	06037	33.988536	-118.2739135	Los Angeles County
216966	Fee-for-Service	1467729384	1467729384	1	1	LI, YUXIN MD	2/20/2018	207U00000X	NA	Other	026	PHYSICIANS	117310	42	Nuclear Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
216987	Fee-for-Service	1083649651	1083649651	1	1	LA CO NEPHROLOGY	9/29/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ASSOCIATES AMC	3521 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1709	19	06037	34.02638712	-118.1977368	Los Angeles County
217020	Fee-for-Service	1497068720	1497068720	1	1	LAMORE, CARISSA R	5/29/2012	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4623 QUAIL LAKES DRIVE	None	STOCKTON	CA	95207	5258	39	06077	37.987257	-121.3401973	San Joaquin County
217021	Fee-for-Service	1417139130	1417139130	1	1	LANIER, DEREK MD	1/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131628	01	General Practice	0	In state provider	None	8510 BALBOA BLVD	SUITE 150	NORTHRIDGE	CA	91325	5810	19	06037	34.224507	-118.5026015	Los Angeles County
217104	Fee-for-Service	1912957309	1912957309	1	1	LAU, CHAI-KIONG MD INC	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	53742	41	Internal Medicine	0	In state provider	None	39271 MISSION BLVD	STE 105	FREMONT	CA	94539	3039	01	06001	37.56248629	-121.9589239	Alameda County
217106	Fee-for-Service	1730235482	1730235482	1	1	LAKEWOOD PEDIATRICS MED	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	GROUP INC	3650 SOUTH ST	STE 405	LAKEWOOD	CA	90712	1509	19	06037	33.86019847	-118.149255	Los Angeles County
217113	Fee-for-Service	1104875103	1104875103	1	1	LANCASTER GENERAL HOSP.	10/31/2000	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	555 N DUKE ST	None	LANCASTER	PA	17602	2207	00	None	40.04697276	-76.30531033	Lancaster County
217133	Fee-for-Service	1376289322	1376289322	1	1	LAKE COUNTY TRIBAL HEALTH CO	6/11/2024	332800000X	NA	Indian Health Care Provider	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RMACY	14440 OLYMPIC DRIVE	SUITE B	CLEARLAKE	CA	95422	9545	17	06033	38.96189799	-122.6409389	Lake County
217183	Fee-for-Service	1972850873	1972850873	1	1	LEE, JENA MD	8/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126671	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
217192	Fee-for-Service	1316144082	1316144082	1	1	LEE, DERRICK C MD	10/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	95970	05	Anesthesiology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
217236	Fee-for-Service	1013935139	1013935139	1	1	LE, YEN P MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	108931	08	Family Practice	0	In state provider	None	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
217242	Fee-for-Service	1497765820	1497765820	1	1	LEVIN, CAROLYN J MD	6/30/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	61435	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
217312	Fee-for-Service	1609080779	1609080779	1	1	LANDRY, COLLEEN A MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132912	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
217318	Fee-for-Service	1700166840	1700166840	1	1	LUO, ALBERT K MD	10/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114179	41	Internal Medicine	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
217361	Fee-for-Service	1417189416	1417189416	1	1	LANDAU, JOSEPH W MD AMC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	4281	07	Dermatology	0	In state provider	None	2428 SANTA MONICA BLVD	SUITE 401	SANTA MONICA	CA	90404	2047	19	06037	34.0317559	-118.4762013	Los Angeles County
217374	Fee-for-Service	1457387532	1457387532	1	1	LEE, BENJAMIN PH MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73276	66	Emergency Medicine (Urgent Care)	0	In state provider	None	654 CAMINO DE LOS MARES	None	SAN CLEMENTE	CA	92673	2827	30	06059	33.45756029	-117.6497373	Orange County
217391	Fee-for-Service	1720199623	1720199623	1	1	LU, PEI-HUA	11/14/1995	207R00000X	NA	Other	026	PHYSICIANS	46144	None	None	0	In state provider	None	45 S 17TH ST	None	SAN JOSE	CA	95112	2032	43	06085	37.34311801	-121.8738218	Santa Clara County
217402	Fee-for-Service	1104875103	1104875103	1	1	LANCASTER GENERAL HOSP.	10/31/2000	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	555 N DUKE ST	None	LANCASTER	PA	17602	2207	00	None	40.04697276	-76.30531033	Lancaster County
217421	Fee-for-Service	1174728968	1174728968	1	1	LABARBERA, MATTHEW P MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	107938	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
217462	Fee-for-Service	1235792789	1235792789	1	1	LANDEROS, JERAD M MD	8/4/2022	208M00000X	NA	Other	026	PHYSICIANS	180428	None	None	0	In state provider	None	2121 PINE ST	None	SAN FRANCISCO	CA	94115	2829	38	06075	37.78824776	-122.4311213	San Francisco County
217466	Fee-for-Service	1407836729	1407836729	1	1	LORA D BARKE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	RADIOLOGY IMAGING ASSC	2350 MEADOWS BLVD	None	CASTLE ROCK	CO	80109	8405	00	None	39.40523232	-104.8867306	Douglas County
217472	Fee-for-Service	1144308925	1144308925	1	1	LOFTUS, JOHN R MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58418	05	Anesthesiology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
217522	Fee-for-Service	1427091255	1427091255	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5408 YGNACIO VALLEY RD	None	CONCORD	CA	94521	3836	07	06013	37.94982189	-121.9603729	Contra Costa County
217523	Fee-for-Service	1710330352	1710330352	1	1	LITTLE STAR HEALTHCARE	1/16/2020	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	CARE	10590 TOWN CENTER DR	170	RANCHO CUCAMONGA	CA	91730	0360	36	06071	34.11101693	-117.5740616	San Bernardino County
217532	Fee-for-Service	1508889650	1508889650	1	1	LOS ANGELES CO	7/1/1995	282N00000X	NA	Hospitals	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	LA CO OLIVE VIEW MED CTR	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	19	06037	34.32450186	-118.4456317	Los Angeles County
217552	Fee-for-Service	1376284646	1376284646	1	1	LOUIS XVI, SOLANDE CNP	1/25/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2514 BERRYESSA RD	None	SAN JOSE	CA	95132	2947	43	06085	37.38738217	-121.8595232	Santa Clara County
217575	Fee-for-Service	1457072001	1457072001	1	1	LEE, HANNAH	5/14/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3184 COLLINS DR	None	MERCED	CA	95348	3132	24	06047	37.32178614	-120.4760525	Merced County
217580	Fee-for-Service	1316024250	1316024250	1	1	LUU, RICHARD MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	60952	41	Internal Medicine	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
217609	Fee-for-Service	1700166840	1700166840	1	1	LUO, ALBERT K MD	10/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114179	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
217619	Fee-for-Service	1285732560	1285732560	1	1	LINTZ, LISA S MD	8/1/1995	207W00000X	NA	Ophthalmology	026	PHYSICIANS	72467	18	Ophthalmology	0	In state provider	None	5363 BALBOA BLVD	STE 545	ENCINO	CA	91316	2854	19	06037	34.169058	-118.5011265	Los Angeles County
217625	Fee-for-Service	1619911062	1619911062	2	1	LONGS DRUG STORES CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2771 4TH ST.	None	SANTA ROSA	CA	95405	4726	49	06097	38.450538	-122.689737	Sonoma County
217661	Fee-for-Service	1568824183	1568824183	1	1	LEE, STEPHANIE S MD	5/9/2019	390200000X	NA	Other	026	PHYSICIANS	151865	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
217677	Fee-for-Service	1962482596	1962482596	1	1	LIN, AUSTIN S MD	12/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	84020	None	None	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
217705	Fee-for-Service	1356972061	1356972061	1	1	LA HOSPICE GROUP	3/16/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	232 N LAKE AVE	SUITE 214	PASADENA	CA	91101	1862	19	06037	34.150005	-118.1323505	Los Angeles County
217732	Fee-for-Service	1932258316	1932258316	1	1	LUALHATI, ANNETTE	2/28/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
217744	Fee-for-Service	1053553347	1053553347	1	1	LIN, CAROL H MD	5/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	107085	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVENUE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
217751	Fee-for-Service	1508953886	1508953886	1	1	LEE, JAU-DEAN MD	7/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95244	08	Family Practice	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
217754	Fee-for-Service	1649603093	1649603093	1	1	LOOK, KENDRA L NP	4/11/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
217783	Fee-for-Service	1720465024	1720465024	1	1	LEWIS, PRIYA G MD	7/10/2023	208200000X	NA	General Surgery	026	PHYSICIANS	143823	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
217815	Fee-for-Service	1710330352	1710330352	1	1	LITTLE STAR HEALTHCARE	5/21/2024	208000000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CARE	10590 TOWN CENTER DR	170	RANCHO CUCAMONGA	CA	91730	0360	36	06071	34.11101693	-117.5740616	San Bernardino County
217828	Fee-for-Service	1780811992	1780811992	1	1	LOPEZ, CRISTOBAL J LMFT	5/22/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
217838	Fee-for-Service	1619311222	1619311222	1	1	LAL, MITESH G MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138579	41	Internal Medicine	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
217880	Fee-for-Service	1124229216	1124229216	1	1	LIEBER, DIANE J R LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
217906	Fee-for-Service	1730640632	1730640632	1	1	LOPEZ, MELISSA MD	1/9/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181895	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
217926	Fee-for-Service	1932736691	1932736691	1	1	LENG-SMITH, AMANDA D MD	1/8/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	187122	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
217945	Fee-for-Service	1174654263	1174654263	1	1	LAKE TAHOE UNIFIED SD	1/1/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	1021 AL TAHOE BLVD	None	SOUTH LAKE TAHOE	CA	96150	4502	09	06017	38.9343633	-119.9758236	El Dorado County
217954	Fee-for-Service	1073661856	1073661856	1	1	LIU, DAVID C MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63050	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
217964	Fee-for-Service	1750484820	1750484820	2	1	LARK REXALL DRUGS INC	9/15/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16251 MAIN ST	None	GUERNEVILLE	CA	95446	8300	49	06097	38.50196181	-122.9981182	Sonoma County
217967	Fee-for-Service	1114004074	1114004074	1	1	LIBIRAN, JUANCHO R MD	3/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51792	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
217971	Fee-for-Service	1306860861	1306860861	1	1	LAZARO, STEVEN C MD	11/16/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	39292	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1665 ESPLANADE	None	CHICO	CA	95926	3312	04	06007	39.74388808	-121.8503372	Butte County
217994	Fee-for-Service	1356972061	1356972061	1	1	LA HOSPICE GROUP	3/16/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	232 N LAKE AVE	SUITE 214	PASADENA	CA	91101	1862	19	06037	34.150005	-118.1323505	Los Angeles County
217995	Fee-for-Service	1710952593	1710952593	1	1	LAM, RAYMOND L MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69872	05	Anesthesiology	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
218007	Fee-for-Service	1801887930	1801887930	1	1	LONG, THOMAS F MD	4/27/2006	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	23630	40	Pediatrics	0	In state provider	None	200 PORTER DR	STE 300	SAN RAMON	CA	94583	1524	07	06013	37.77372204	-121.9911155	Contra Costa County
218020	Fee-for-Service	1598802142	1598802142	1	1	LOWE, LUISA B LCSW	9/12/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 S VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.7892965	-118.2937327	Los Angeles County
218033	Fee-for-Service	1053553347	1053553347	1	1	LIN, CAROL H MD	5/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	107085	78	Neoplastic Diseases/Oncology	0	In state provider	None	1201 W LA VETA AVENUE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
218054	Fee-for-Service	1457316093	1457316093	1	1	LIN, LONNIE P MD	7/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99567	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	611 SOUTH MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
218123	Fee-for-Service	1518119478	1518119478	1	1	LEE, SUKJAE LAC	2/23/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	IC	4800 STOCKDALE HWY	STE 407	BAKERSFIELD	CA	93309	2636	15	06029	35.35431391	-119.0561684	Kern County
218131	Fee-for-Service	1902262967	1902262967	1	1	LIN, STEPHANIE MD	9/26/2023	390200000X	NA	Other	026	PHYSICIANS	187184	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
218147	Fee-for-Service	1003923368	1003923368	1	1	LOVELL, ALLISON A MD	9/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	45444	41	Internal Medicine	0	In state provider	None	7325 MEDICAL CENTER DR	STE 300	WEST HILLS	CA	91307	1964	19	06037	34.20369349	-118.629837	Los Angeles County
218160	Fee-for-Service	1477661619	1477661619	1	1	LOWRY, JOHN C DO	8/15/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	10380	36	Psychiatry	0	In state provider	None	1550 HOTEL CIR N	STE. 450	SAN DIEGO	CA	92108	2901	37	06073	32.75959113	-117.1772351	San Diego County
218186	Fee-for-Service	1407966500	1407966500	2	1	LIN, HENRY MD	4/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	70227	41	Internal Medicine	0	In state provider	None	8008 MONET AVE	STE 107	RANCHO CUCAMONGA	CA	91739	7509	36	06071	34.10783185	-117.5345753	San Bernardino County
218201	Fee-for-Service	1073537395	1073537395	1	1	LIN, GEORGE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 NE 139TH ST	None	VANCOUVER	WA	98686	2742	00	None	45.720117	-122.647986	Clark County
218206	Fee-for-Service	1790764108	1790764108	1	1	LEE, JOHN S MD	5/30/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72201	40	Pediatrics	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
218217	Fee-for-Service	1932544061	1932544061	1	1	LIU, BENJAMIN L DO	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14527	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	95433	3552	48	06095	38.26109552	-122.0470245	Solano County
218219	Fee-for-Service	1801373469	1801373469	1	2	LUCKY RIDERS INC	6/1/2022	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	12143 MAGNOLIA BLVD	None	VALLEY VILLAGE	CA	91607	2609	19	06037	34.16491167	-118.398042	Los Angeles County
218226	Fee-for-Service	1275685075	1275685075	1	1	LEE, EUNMEE A MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75991	36	Psychiatry	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
218229	Fee-for-Service	1518535855	1518535855	1	1	LIN, KRISTINA OD	7/6/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
218233	Fee-for-Service	1174654263	1174654263	1	1	LAKE TAHOE UNIFIED SD	7/1/1994	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1021 AL TAHOE BLVD	None	SOUTH LAKE TAHOE	CA	96150	4502	09	06017	38.9343633	-119.9758236	El Dorado County
218241	Fee-for-Service	1447736749	1447736749	1	1	LOPEZ, JOCELYN LMFT	2/6/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 N BRAND BLVD	STE 223	GLENDALE	CA	91203	2641	19	06037	34.14652066	-118.2549229	Los Angeles County
218245	Fee-for-Service	1588838080	1588838080	1	1	LWIN, MYO T MD	7/15/2008	207R00000X	NA	Other	026	PHYSICIANS	101706	41	Internal Medicine	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
218275	Fee-for-Service	1770743502	1770743502	1	1	LIN, JAMES L MD	8/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86198	10	Gastroenterology (M.D. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
218314	Fee-for-Service	1669553954	1669553954	1	1	LIN, SHAO-POW MD	12/14/2017	2085N0700X	NA	MRI Provider	026	PHYSICIANS	137408	30	Radiology	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
218322	Fee-for-Service	1053553347	1053553347	1	1	LIN, CAROL H MD	5/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	107085	68	Hematology	0	In state provider	None	1201 W LA VETA AVENUE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
218330	Fee-for-Service	1164607537	1164607537	1	1	LAVI, JOSEPH M MD A MEDICAL	11/21/2018	193400000X	NA	Other	026	PHYSICIANS	72094	41	Internal Medicine	0	In state provider	CORPORATION	27420 TOURNEY RD	STE 200	VALENCIA	CA	91355	5634	19	06037	34.42122797	-118.5787489	Los Angeles County
218390	Fee-for-Service	1316264641	1316264641	1	1	LAGUNA FAMILY PRACTICE INC	7/29/2010	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7811 LAGUNA BLVD	STE 161	ELK GROVE	CA	95758	7949	34	06067	38.423259	-121.4118945	Sacramento County
218395	Fee-for-Service	1295189827	1295189827	1	1	LIN, NANCY MD	12/3/2019	207R00000X	NA	Other	026	PHYSICIANS	151152	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
218401	Fee-for-Service	1720014038	1720014038	1	1	LANGENBERG, BRET J DO	3/11/2008	208600000X	NA	General Surgery	026	PHYSICIANS	9381	02	General Surgery	0	In state provider	None	4033 3RD AVE	STE #204	SAN DIEGO	CA	92103	2130	37	06073	32.75053781	-117.1627168	San Diego County
218405	Fee-for-Service	1003807876	1003807876	2	1	LEVINE, ANDREW J PHD	11/17/2021	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	801 CRESCENT WAY	SUITE 3	ARCATA	CA	95521	6781	12	06023	40.85906241	-124.0735719	Humboldt County
218430	Fee-for-Service	1609878123	1609878123	1	1	LEMOINE, PHILIPPE H MD	8/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	79758	33	Thoracic Surgery	0	In state provider	None	23550 HAWTHORNE	STE 140	TORRANCE	CA	90505	4767	19	06037	33.81149085	-118.3510183	Los Angeles County
218438	Fee-for-Service	1053765800	1053765800	1	1	LEPHONG, CHRISTOPHER D DO	4/25/2022	207ZP0213X	NA	Other	026	PHYSICIANS	18800	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
218449	Fee-for-Service	1578599262	1578599262	1	1	LAI, ANNIE Y F MD	8/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	54678	01	General Practice	0	In state provider	None	200 MED PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
218488	Fee-for-Service	1528295284	1528295284	1	1	LIN, CYNTHIA MD	11/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141268	41	Internal Medicine	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
218513	Fee-for-Service	1255742904	1255742904	1	1	LA MIRADA HEALTHCARE INC	10/1/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	11926 LA MIRADA BLVD	None	LA MIRADA	CA	90638	1303	19	06037	33.921846	-118.011833	Los Angeles County
218543	Fee-for-Service	1063049740	1063049740	1	1	LIDOFSKY, ANNA MD	9/16/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	179446	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	STE 210	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
218545	Fee-for-Service	1730342775	1730342775	1	1	LEDBETTER, LUKE MD	4/7/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	167981	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
218556	Fee-for-Service	1245685288	1245685288	1	1	LEWIN, BENJAMIN MD	11/9/2019	207P00000X	NA	Other	026	PHYSICIANS	160371	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
218558	Fee-for-Service	1205301397	1205301397	1	1	LACEY ZACK, MD INC	12/19/2019	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	1245 WILSHIRE BLVD	607	LOS ANGELES	CA	90017	4806	19	06037	34.05362775	-118.2661889	Los Angeles County
218569	Fee-for-Service	1518906841	1518906841	1	1	LIM, JENELYN C MD	7/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	67246	01	General Practice	0	In state provider	None	1343 NORTH GRAND AVENUE	STE 100	COVINA	CA	91724	4043	19	06037	34.1042269	-117.8727497	Los Angeles County
218570	Fee-for-Service	1356190193	1356190193	1	1	LARICK, JASON B NP	4/8/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95030298	-	NOT APPLICABLE	0	In state provider	None	17719 & 17727 E CYPRESS	None	COVINA	CA	91722	2634	19	06037	34.09589164	-117.9029004	Los Angeles County
218606	Fee-for-Service	1942257191	1942257191	1	2	LONG BEACH MEMORIAL PATHOLOG	3/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PATHOLOGY MEDICAL GRP	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
218612	Fee-for-Service	1801430467	1801430467	1	4	LANDMARK ANESTHESIA MEDICAL	11/7/2022	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP PRIME	1350 W COVINA BLVD	None	SAN DIMAS	CA	91773	3245	19	06037	34.09906108	-117.8343639	Los Angeles County
218661	Fee-for-Service	1558745745	1558745745	2	1	LIFESURE LLC	11/19/2019	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	3151 EXECUTIVE WAY	SUITE 2B	MIRAMAR	FL	33025	3953	00	None	25.97946763	-80.28642272	Broward County
218677	Fee-for-Service	1316264641	1316264641	1	1	LAGUNA FAMILY PRACTICE INC	7/29/2010	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	7811 LAGUNA BLVD	STE 161	ELK GROVE	CA	95758	7949	34	06067	38.423259	-121.4118945	Sacramento County
218686	Fee-for-Service	1043408834	1043408834	1	1	LUU, A/T JESSICA DPM INC	5/5/2006	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	15038 IMPERAL HWY	None	LA MIRADA	CA	90638	1301	19	06037	33.91707319	-118.009999	Los Angeles County
218699	Fee-for-Service	1316329782	1316329782	1	1	LIM, JOHN MD	7/1/2019	390200000X	NA	Other	026	PHYSICIANS	145184	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
218749	Fee-for-Service	1104935329	1104935329	2	1	LOPEZ-AGUADO, JORGE L MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	63333	40	Pediatrics	0	In state provider	None	325 LEXINGTON ST	None	DELANO	CA	93215	1076	15	06029	35.76027957	-119.2408675	Kern County
218756	Fee-for-Service	1497853592	1497853592	2	1	LEECH, IRENE P MD	7/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	41993	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1040 ELM AVE	SUITE 307	LONG BEACH	CA	90813	3267	19	06037	33.779799	-118.1879535	Los Angeles County
218769	Fee-for-Service	1053345959	1053345959	1	1	LAMENDOLA, JACK MD	4/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	37053	40	Pediatrics	0	In state provider	None	7248 S LAND PARK DR	None	SACRAMENTO	CA	95831	3660	34	06067	38.494602	-121.513743	Sacramento County
218772	Fee-for-Service	1295830768	1295830768	1	1	LIU, RUTH YORKPING MD	8/24/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	57017	08	Family Practice	0	In state provider	None	125 N LINCOLN ST	STE G	DIXON	CA	95620	3260	48	06095	38.44614779	-121.8364229	Solano County
218779	Fee-for-Service	1124025325	1124025325	1	1	LINDVALL, ERIC M DO	9/14/2000	174400000X	NA	Other	026	PHYSICIANS	7718	20	Orthopedic Surgery	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
218800	Fee-for-Service	1790712107	1790712107	1	1	LINDALL,SMITH E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	550 N HILLSIDE	None	WICHITA	KS	67214	4910	00	None	37.695312	-97.29903348	Sedgwick County
218832	Fee-for-Service	1154095990	1154095990	1	1	LI, KINCHEON B MD	10/23/2024	2080P0207X	NA	Hematology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
218837	Fee-for-Service	1558397588	1558397588	1	1	LIM, MARTIN HT MD	1/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87702	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
218839	Fee-for-Service	1760088918	1760088918	1	1	LAM, MICHAEL NP	8/16/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
218840	Fee-for-Service	1578548186	1578548186	1	1	LEVENSON, SCOTT D MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	71807	41	Internal Medicine	0	In state provider	None	1000 LAUREL ST	None	SAN CARLOS	CA	94070	3919	41	06081	37.50108476	-122.254647	San Mateo County
218872	Fee-for-Service	1801838628	1801838628	2	1	LONGS DRUG STORES CA LLC	12/26/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12940 SARATOGA SUNNYVALE	None	SARATOGA	CA	95070	4250	43	06085	37.28070359	-122.0322574	Santa Clara County
218875	Fee-for-Service	1881952588	1881952588	1	1	LE, CHRISTINE DO	1/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13065	41	Internal Medicine	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
218886	Fee-for-Service	1538516570	1538516570	1	1	LIU, ANDREW Z MD	10/4/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	191209	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
218900	Fee-for-Service	1801430467	1801430467	1	4	LANDMARK ANESTHESIA MEDICAL	1/17/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP PRIME	1350 W COVINA BLVD	None	SAN DIMAS	CA	91773	3245	19	06037	34.09906108	-117.8343639	Los Angeles County
218906	Fee-for-Service	1871557827	1871557827	1	1	LING, PAMELA M MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	65590	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
218945	Fee-for-Service	1861698151	1861698151	1	1	LIN, THOMAS B MD	9/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99016	30	Radiology	0	In state provider	None	5000 SAN BERNARDINO RD	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
219022	Fee-for-Service	1134755101	1134755101	1	1	LIU, FLORA MD	3/21/2024	207R00000X	NA	Other	026	PHYSICIANS	185858	41	Internal Medicine	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
219028	Fee-for-Service	1942257191	1942257191	1	4	LONG BEACH MEMORIAL PATHOLOG	5/31/1990	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
219035	Fee-for-Service	1851699532	1851699532	1	1	LAU, BIEN-AIMEE V MD	10/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115987	07	Dermatology	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
219048	Fee-for-Service	1235374497	1235374497	1	1	LOPEZ, GUADALUPE LCSW	5/10/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
219121	Fee-for-Service	1154095990	1154095990	1	1	LI, KINCHEON B MD	10/23/2024	2080P0207X	NA	Hematology	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
219128	Fee-for-Service	1578548186	1578548186	1	1	LEVENSON, SCOTT D MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	71807	10	Gastroenterology (M.D. only)	0	In state provider	None	1000 LAUREL ST	None	SAN CARLOS	CA	94070	3919	41	06081	37.50108476	-122.254647	San Mateo County
219151	Fee-for-Service	1386025773	1386025773	1	1	L A STAR MEDICAL GROUP, INC.	1/21/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4161 REDONDO BEACH BLVD	SUITE 100	LAWNDALE	CA	90260	1477	19	06037	33.87608777	-118.3477232	Los Angeles County
219199	Fee-for-Service	1952425712	1952425712	1	1	LEE, JUNGKU J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77321	01	General Practice	0	In state provider	None	601 E ARRELLAGA ST	STE 101	SANTA BARBARA	CA	93103	2275	42	06083	34.43383593	-119.7024663	Santa Barbara County
219224	Fee-for-Service	1679501993	1679501993	1	1	LANTER, PATRICIA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	87086	None	None	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
219260	Fee-for-Service	1104225978	1104225978	1	1	LAM, STEVEN MD	10/18/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	148923	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
219275	Fee-for-Service	1043239742	1043239742	1	1	LAM, MAN-WA OD	8/7/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1230 HARRISON ST	None	OAKLAND	CA	94612	3913	01	06001	37.802134	-122.2680264	Alameda County
219281	Fee-for-Service	1659794899	1659794899	1	1	LISTER, CHRISTINE E LMFT	8/29/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1800 E LAMBERT RD	230	BREA	CA	92821	4398	30	06059	33.9252218	-117.877552	Orange County
219296	Fee-for-Service	1497275630	1497275630	1	1	LARSEN, DANA M MD	6/17/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	169280	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
219299	Fee-for-Service	1679501993	1679501993	1	2	LANTER, PATRICIA MD	2/21/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	87086	15	Obstetrics (D.O. only)	0	In state provider	None	1745 N BROADWAY	STE 101	SANTA MARIA	CA	93454	1927	42	06083	34.971759	-120.4356175	Santa Barbara County
219318	Fee-for-Service	1093100927	1093100927	1	1	LING, DIANE C MD	8/18/2020	2085R0001X	NA	Other	026	PHYSICIANS	168533	32	Radiation Therapy (D.O. only)	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
219390	Fee-for-Service	1790727519	1790727519	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1123 S CALIFORNIA BLVD	None	WALNUT CREEK	CA	94596	4413	07	06013	37.89639	-122.0647185	Contra Costa County
219398	Fee-for-Service	1154409720	1154409720	1	1	LIU, CHUNNAN MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	80860	78	Neoplastic Diseases/Oncology	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
219414	Fee-for-Service	1316137987	1316137987	1	1	LIU, YONG MD	6/3/2009	207R00000X	NA	Other	026	PHYSICIANS	100772	41	Internal Medicine	0	In state provider	None	450 STANYAN STREET	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
219446	Fee-for-Service	1811197536	1811197536	1	1	LEE, CHANG L MD	8/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99010	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
219462	Fee-for-Service	1427110329	1427110329	1	8	LIVINGSTON COMMUNITY HEALTH	4/16/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	16233 KING STREET	None	DELHI	CA	95315	9460	24	06047	37.43319758	-120.7809931	Merced County
219483	Fee-for-Service	1700264736	1700264736	1	1	LUNDERVILLE, CHANTAL MD	9/22/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	146115	08	Family Practice	0	In state provider	None	26800 CROWN VALLEY PARKW	SUITE 120	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
219486	Fee-for-Service	1487205225	1487205225	1	1	LIMPRATHAN, SUPHANNEE NP	10/23/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
219496	Fee-for-Service	1194939660	1194939660	1	1	LEE, SUK C MD	2/28/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	72585	01	General Practice	0	In state provider	None	7321 SKYWAY	None	PARADISE	CA	95969	3228	04	06007	39.76644119	-121.6149258	Butte County
219524	Fee-for-Service	1992808331	1992808331	1	1	LOMBARD, JOHN T MD	4/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	38687	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
219543	Fee-for-Service	1295007144	1295007144	1	1	LY, NANCY L	1/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	125595	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
219560	Fee-for-Service	1942672779	1942672779	1	1	LOWE, LAUREN PSYD	4/24/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
219573	Fee-for-Service	1942257191	1942257191	1	7	LONG BEACH MEMORIAL PATHOLOG	5/9/2024	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	18111 BROOKHURST ST	None	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
219585	Fee-for-Service	1679501993	1679501993	1	2	LANTER, PATRICIA MD	2/21/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	87086	09	Gynecology (D.O. only)	0	In state provider	None	1745 N BROADWAY	STE 101	SANTA MARIA	CA	93454	1927	42	06083	34.971759	-120.4356175	Santa Barbara County
219595	Fee-for-Service	1134287576	1134287576	1	1	LIEST, DEBRA K CNM	4/27/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
219611	Fee-for-Service	1578544607	1578544607	1	1	LEE, JOHN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9440 BELLAIRE BLVD	STE 100	HOUSTON	TX	77036	4558	00	None	29.70500352	-95.5494675	Harris County
219649	Fee-for-Service	1235516501	1235516501	1	1	LEI, HAO T	12/18/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
219703	Fee-for-Service	1356609572	1356609572	1	1	LEE, TIM LAC	2/12/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	16025 GALE AVE	STE B7	CITY OF INDUSTRY	CA	91745	1633	19	06037	34.00908153	-117.9571941	Los Angeles County
219750	Fee-for-Service	1427110329	1427110329	1	8	LIVINGSTON COMMUNITY HEALTH	4/16/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	16233 KING STREET	None	DELHI	CA	95315	9460	24	06047	37.43319758	-120.7809931	Merced County
219773	Fee-for-Service	1669491403	1669491403	1	1	LEUNG, ALBERT Y MD	10/31/1995	207LP2900X	NA	Other	026	PHYSICIANS	80220	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
219776	Fee-for-Service	1952989402	1952989402	1	1	LU, KIMBERLY L MD	1/29/2025	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
219786	Fee-for-Service	1770747529	1770747529	1	1	LANCASTER, JOSEPH PSYD	10/17/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11325 PARK SQUARE DR	K102	BAKERSFIELD	CA	93311	8857	15	06029	35.32232807	-119.1301738	Kern County
219801	Fee-for-Service	1942477195	1942477195	1	1	LEE, CHRISTOPHER MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110581	05	Anesthesiology	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
219806	Fee-for-Service	1124226667	1124226667	1	1	LLACUNA, ALFONSO R MD	8/31/1993	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	48198	01	General Practice	0	In state provider	None	128 W ANAHEIM ST	None	WILMINGTON	CA	90744	4417	19	06037	33.77991264	-118.2631969	Los Angeles County
219830	Fee-for-Service	1528167061	1528167061	1	1	LAWRENCE, LARRY C MD	9/10/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	85700	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
219834	Fee-for-Service	1295007144	1295007144	1	1	LY, NANCY L	1/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	125595	01	General Practice	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
219844	Fee-for-Service	1124020755	1124020755	1	1	LAWRIE, THOMAS E MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74721	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
219864	Fee-for-Service	1619472438	1619472438	1	1	LI, YINGCHUAN MD	11/22/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	164241	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
219900	Fee-for-Service	1609212208	1609212208	1	1	LIM, MARY J DO	12/19/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	14080	18	Ophthalmology	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
219922	Fee-for-Service	1992752182	1992752182	1	1	LY, AN V MD	9/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85727	05	Anesthesiology	0	In state provider	None	5530 BIRDCAGE ST	STE 145	CITRUS HEIGHTS	CA	95610	7690	34	06067	38.667744	-121.273758	Sacramento County
219950	Fee-for-Service	1962421651	1962421651	1	1	LOPEZ, SANDRA MD	12/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73316	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1000 VALE TERRACE DR	None	VISTA	CA	92084	5218	37	06073	33.20904502	-117.2286439	San Diego County
219972	Fee-for-Service	1073289773	1073289773	1	1	LABERINTO-LASSLO, SHERILYN	12/2/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	NP	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
219988	Fee-for-Service	1730181116	1730181116	1	1	LEE, HANSON T MD	1/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	71457	41	Internal Medicine	0	In state provider	None	612 W DUARTE RD	STE 502	ARCADIA	CA	91007	9207	19	06037	34.12647805	-118.051994	Los Angeles County
219996	Fee-for-Service	1861577983	1861577983	1	1	LINCARE, INC	3/25/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	LINCARE, INC	3427 GONI ROAD	SUITE 106	CARSON CITY	NV	89706	7972	00	None	39.188961	-119.7466425	Consolidated Municipality of Carson City
220004	Fee-for-Service	1881774263	1881774263	1	1	LEE, MATTHEW D PT	11/7/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6387	43	06085	37.36777579	-122.0276404	Santa Clara County
220027	Fee-for-Service	1912210410	1912210410	1	1	LEE, SARAH J MD	10/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112487	38	Geriatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
220031	Fee-for-Service	1972121275	1972121275	1	1	LEE, ANGELINA	11/3/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1764 MARCO POLO WAY	None	BURLINGAME	CA	94010	4503	41	06081	37.59103278	-122.3859664	San Mateo County
220062	Fee-for-Service	1386252120	1386252120	1	1	LASZKIEWICZ, EMELYN LCSW	6/21/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
220122	Fee-for-Service	1073051223	1073051223	1	1	LWBBA GRISSELL CHAIT LLAMAS,	2/21/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	138938	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MD, INC	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
220132	Fee-for-Service	1124020755	1124020755	1	1	LAWRIE, THOMAS E MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74721	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
220151	Fee-for-Service	1497927909	1497927909	1	1	LOWELL JOINT SCHOOL DIST	12/12/2007	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	11019 VALLEY HOME AVE	None	WHITTIER	CA	90603	3042	19	06037	33.93284095	-117.976571	Los Angeles County
220153	Fee-for-Service	1306855010	1306855010	1	1	LANGE, LINDA M NP	11/4/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	20790 MADRONA AVE	None	TORRANCE	CA	90503	3777	19	06037	33.84145481	-118.344603	Los Angeles County
220169	Fee-for-Service	1245624691	1245624691	1	1	LIM, JANET T MD	9/1/2021	2080P0214X	NA	Pulmonology	026	PHYSICIANS	149921	None	None	0	In state provider	None	250 E CAROLINE ST	STE J	SAN BERNARDINO	CA	92408	3758	36	06071	34.0615203	-117.2793274	San Bernardino County
220185	Fee-for-Service	1396056610	1396056610	1	1	LUU, TRI MD	10/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126568	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
220201	Fee-for-Service	1760430995	1760430995	1	1	LEE, STEPHEN H MD	11/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76604	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
220210	Fee-for-Service	1134130313	1134130313	1	1	LEW, FELICIA J OD	12/19/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1414 E MAIN ST	None	SANTA MARIA	CA	93454	4806	42	06083	34.95286853	-120.4139295	Santa Barbara County
220238	Fee-for-Service	1962421651	1962421651	1	1	LOPEZ, SANDRA MD	12/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73316	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1000 VALE TERRACE DR	None	VISTA	CA	92084	5218	37	06073	33.20904502	-117.2286439	San Diego County
220261	Fee-for-Service	1114981990	1114981990	1	1	LIVINGSTON, EDWARD H MD	12/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	59396	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
220262	Fee-for-Service	1326001660	1326001660	1	1	LUU, TUAN ANH MD	10/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	73038	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
220277	Fee-for-Service	1730181116	1730181116	1	1	LEE, HANSON T MD	1/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	71457	10	Gastroenterology (M.D. only)	0	In state provider	None	612 W DUARTE RD	STE 502	ARCADIA	CA	91007	9207	19	06037	34.12647805	-118.051994	Los Angeles County
220423	Fee-for-Service	1073073649	1073073649	1	2	LEE, SHARON NP	2/7/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18785 BROOKHURST STREET	STE 101	FOUNTAIN VALLEY	CA	92708	7300	30	06059	33.68987636	-117.9542321	Orange County
220425	Fee-for-Service	1174628788	1174628788	1	1	LIN, SHIN KUAN MD INC	9/5/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	34420	05	Anesthesiology	0	In state provider	None	26816 VISTA TER	None	LAKE FOREST	CA	92630	8115	30	06059	33.6649298	-117.6631024	Orange County
220458	Fee-for-Service	1255325809	1255325809	1	1	LIN, IVY W OD	5/17/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11245 WASHINGTON BLVD	None	WHITTIER	CA	90606	3111	19	06037	33.97192651	-118.0711359	Los Angeles County
220488	Fee-for-Service	1760430995	1760430995	1	1	LEE, STEPHEN H MD	11/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76604	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
220492	Fee-for-Service	1407350382	1407350382	1	1	LOVASCIO, BRITTANY F MD	8/4/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	178586	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
220518	Fee-for-Service	1497184618	1497184618	1	1	LOGGINS, JANICE E	6/30/1988	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
220532	Fee-for-Service	1841784659	1841784659	1	1	LEE, CHARITY MD	6/13/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	165328	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
220562	Fee-for-Service	1497913057	1497913057	1	1	LICUANAN, JESUS L MD INC	11/25/1985	193400000X	NA	Other	026	PHYSICIANS	42300	08	Family Practice	0	In state provider	None	3300 E SOUTH ST	STE 205	LONG BEACH	CA	90805	4587	19	06037	33.86018093	-118.1537163	Los Angeles County
220568	Fee-for-Service	1790728525	1790728525	2	1	LONGS DRUG STORES CA LLC	12/26/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1387 W WHITTIER BLVD	None	LA HABRA	CA	90631	3612	30	06059	33.93937602	-117.961975	Orange County
220598	Fee-for-Service	1760563621	1760563621	1	1	LEGHA, PRITHVI S MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	55873	02	General Surgery	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
220615	Fee-for-Service	1730165903	1730165903	1	1	LEE, TIMOTHY S MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72498	01	General Practice	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
220634	Fee-for-Service	1295189728	1295189728	1	1	LATERREUR, JEFFREY O MD	8/16/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	162873	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3528	19	06037	33.89242734	-118.2947128	Los Angeles County
220643	Fee-for-Service	1659636587	1659636587	1	1	LENNON, KELLY M LCSW	12/11/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
220660	Fee-for-Service	1841428927	1841428927	1	1	LANATA, SERGGIO C MD	6/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125425	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
220676	Fee-for-Service	1760166045	1760166045	1	1	LEGER, MAXIME MD	7/12/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
220682	Fee-for-Service	1336119122	1336119122	1	1	LAM, VINH T MD	6/1/1998	193400000X	NA	Other	026	PHYSICIANS	80725	85	Surgery-Pediatric	0	In state provider	None	1140 W LA VETA AVE	STE 540	ORANGE	CA	92868	4221	30	06059	33.7802984	-117.8651669	Orange County
220712	Fee-for-Service	1336725035	1336725035	1	1	LOPEZ, ISABEL M MD	7/9/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
220732	Fee-for-Service	1861435034	1861435034	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	130 N GRAND AVE	None	GLENDORA	CA	91741	2434	19	06037	34.137045	-117.87057	Los Angeles County
220753	Fee-for-Service	1982959409	1982959409	1	1	LOS ANGELES CENTERS FOR	8/30/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	ALCOHOL AND DRUG ABUSE	10800 BENAVON STREET	ROOM H13	WHITTIER	CA	90606	3013	19	06037	33.97139647	-118.0785256	Los Angeles County
220763	Fee-for-Service	1649732025	1649732025	1	1	LUO, JERRY MD	7/24/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	179726	None	None	0	In state provider	None	1250 16TH STREET	2100	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
220770	Fee-for-Service	1962588467	1962588467	1	1	LOTSPEICH, LINDA J MD	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	63125	26	Psychiatry (child)	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
220780	Fee-for-Service	1023179876	1023179876	1	1	LIBERTY HEALTH SERVICES INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	OF VENTURA	5675 RALSTON STREET	SUITE C	VENTURA	CA	93003	6005	56	06111	34.26063446	-119.2142659	Ventura County
220790	Fee-for-Service	1205378833	1205378833	1	1	LOPEZ, ALEXANDRA LMFT	5/20/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
220838	Fee-for-Service	1740257609	1740257609	1	1	LANGROUDI, ANDREW R DPM	7/26/2009	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	FOOT & ANKLE CONCEPTS IN	650 HOBSON WAY	STE 104	OXNARD	CA	93030	6710	56	06111	34.19585039	-119.1880222	Ventura County
220842	Fee-for-Service	1720222433	1720222433	1	1	LAYTON, CHRISTLE J MD	7/8/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	None	None	None	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
220849	Fee-for-Service	1497913057	1497913057	1	1	LICUANAN, JESUS L MD INC	11/25/1985	193400000X	NA	Other	026	PHYSICIANS	42300	41	Internal Medicine	0	In state provider	None	3300 E SOUTH ST	STE 205	LONG BEACH	CA	90805	4587	19	06037	33.86018093	-118.1537163	Los Angeles County
220885	Fee-for-Service	1225187123	1225187123	1	1	LITTLE, CATHERINE J LMFT	5/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
220890	Fee-for-Service	1598927832	1598927832	1	1	LAI, LAWRENCE P MD	8/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	111449	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
220899	Fee-for-Service	1902093693	1902093693	1	1	LERNER, OLGA MD	12/3/2007	207R00000X	NA	Other	026	PHYSICIANS	97470	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
220903	Fee-for-Service	1407863871	1407863871	1	1	LIPNICK, MICHAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	900 CEDAR ST	None	JULESBURG	CO	80737	1121	00	None	40.99391368	-102.2693559	Sedgwick County
220904	Fee-for-Service	1730165903	1730165903	1	1	LEE, TIMOTHY S MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72498	08	Family Practice	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
220927	Fee-for-Service	1467596858	1467596858	1	1	LIESS, ANNA M MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108524	41	Internal Medicine	0	In state provider	None	701 E EL CAMINO REAL	M/S 31-113	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
220931	Fee-for-Service	1548623150	1548623150	1	1	LAU, JANICE Z DO	9/9/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	16114	25	Physical Medicine and Rehabilitation	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
220936	Fee-for-Service	1740292234	1740292234	1	1	LEE,JEAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1959 NE PACIFIC ST	None	SEATTLE	WA	98195	9110	00	None	47.65080692	-122.3081828	King County
220959	Fee-for-Service	1780745448	1780745448	1	1	LIEP, CATAREYA P MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78275	40	Pediatrics	0	In state provider	None	437 N CAMPUS AVE	None	ONTARIO	CA	91764	4229	36	06071	34.06797	-117.6415695	San Bernardino County
221007	Fee-for-Service	1699843524	1699843524	1	1	LEE PODIATRY GROUP OF	12/24/2014	193400000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	ARCADIA INC	650 W DUARTE RD	STE 105	LOS ANGELES	CA	91007	7628	19	06037	34.12621324	-118.0537434	Los Angeles
221068	Fee-for-Service	1023179876	1023179876	1	1	LIBERTY HEALTH SERVICES INC	9/14/2006	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	OF VENTURA	5675 RALSTON STREET	SUITE C	VENTURA	CA	93003	6005	56	06111	34.26063446	-119.2142659	Ventura County
221088	Fee-for-Service	1669735973	1669735973	1	1	LORD, ELIZABETH L MD	11/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127909	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
221103	Fee-for-Service	1356970875	1356970875	1	1	LOPEZ-PEREZ, EMANUEL MD	2/1/2023	207P00000X	NA	Other	026	PHYSICIANS	181362	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
221112	Fee-for-Service	1366918278	1366918278	1	1	LAGUE, LOAN T NP	12/12/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
221122	Fee-for-Service	1821073792	1821073792	1	1	LABORATORY CORPORATION OF AM	11/18/2021	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	ERICA	11603 CROSSWINDS WAY	STE 115	SAN ANTONIO	TX	78233	6005	00	None	29.54492946	-98.37607804	Bexar County
221140	Fee-for-Service	1497913057	1497913057	1	1	LICUANAN, JESUS L MD INC	11/25/1985	193400000X	NA	Other	026	PHYSICIANS	42300	02	General Surgery	0	In state provider	None	3300 E SOUTH ST	STE 205	LONG BEACH	CA	90805	4587	19	06037	33.86018093	-118.1537163	Los Angeles County
221146	Fee-for-Service	1144420399	1144420399	1	1	LACAPRIA, DINO CP	4/4/2007	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2328 N BATAVIA ST	#115	ORANGE	CA	92865	2026	30	06059	33.82696636	-117.8621073	Orange County
221204	Fee-for-Service	1598275307	1598275307	1	1	LUCERO, IRENE-NICOLE NP	4/27/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1335 N WATERMAN AVENUE	None	SAN BERNARDINO	CA	92404	5385	36	06071	34.124274	-117.2787625	San Bernardino County
221207	Fee-for-Service	1962729798	1962729798	1	1	LARKIN, JUSTIN S MD	2/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127531	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
221222	Fee-for-Service	1386177913	1386177913	1	1	LE, PETER P MD	4/21/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169371	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
221231	Fee-for-Service	1417909359	1417909359	1	1	LYONS, TIMOTHY C MD	7/26/2007	207L00000X	NA	Other	026	PHYSICIANS	85919	05	Anesthesiology	0	In state provider	None	10 WOODLAND RD	None	SAINT HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
221237	Fee-for-Service	1205130572	1205130572	1	1	LAVASANI, SAYEH M MD	7/18/2018	207RX0202X	NA	Oncology	026	PHYSICIANS	115057	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
221257	Fee-for-Service	1679787683	1679787683	1	1	LEO INDIANER MD LABORATO	3/1/1980	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	16260 VENTURA BLVD	STE 515	ENCINO	CA	91436	2243	19	06037	34.15687678	-118.4876342	Los Angeles County
221308	Fee-for-Service	1841596483	1841596483	1	1	LEUNG, JANET H MD	6/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118018	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
221378	Fee-for-Service	1902151657	1902151657	1	1	LOS ANGELES CENTERS FOR	8/30/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	ALCOHOL AND DRUG ABUSE	9401 S PAINTER AVENUE	None	WHITTIER	CA	90605	2729	19	06037	33.953337	-118.046439	Los Angeles County
221383	Fee-for-Service	1275638165	1275638165	1	1	LINDAMOOD, TIMOTHY E MD	5/31/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64180	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
221444	Fee-for-Service	1629007448	1629007448	1	1	LINCARE, INC	1/1/1979	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	None	2795 ANDERSON AVE	STE 107	KLAMATH FALLS	OR	97603	7863	00	None	42.18135868	-121.7555294	Klamath County
221450	Fee-for-Service	1881113058	1881113058	1	1	LO, YEE MD	9/15/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181592	None	None	0	In state provider	None	2081 BRONZE STAR DR	None	WOODLAND	CA	95776	5423	57	06113	38.67049812	-121.7238394	Yolo County
221454	Fee-for-Service	1851349146	1851349146	1	1	LEUNG, JONATHAN K MD	10/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	46488	01	General Practice	0	In state provider	None	412 W CARROLL AVE	STE 204	GLENDORA	CA	91741	4711	19	06037	34.13415622	-117.8702547	Los Angeles County
221464	Fee-for-Service	1306401096	1306401096	1	1	LE, BAO HAN MD	7/3/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	187086	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
221481	Fee-for-Service	1023050937	1023050937	1	1	LIM, DAVID C MD	12/31/1991	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	63561	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	415 E HARDING WAY	STE D	STOCKTON	CA	95204	6118	39	06077	37.96819912	-121.2900761	San Joaquin County
221500	Fee-for-Service	1528336047	1528336047	1	1	LYAPIS, VICTOR MD PROF CORP	7/15/2016	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	54424	None	None	0	In state provider	None	2186 GEARY BLVD	104	SAN FRANCISCO	CA	94115	3455	38	06075	37.78343395	-122.4392245	San Francisco County
221548	Fee-for-Service	1912079492	1912079492	1	1	LEE, CHARLES KI MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68835	05	Anesthesiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
221570	Fee-for-Service	1144520032	1144520032	1	1	LEE, CLARENCE M JR MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138879	01	General Practice	0	In state provider	None	3910 VISTA WAY	STE 106	OCEANSIDE	CA	92056	4513	37	06073	33.18382239	-117.2937426	San Diego County
221590	Fee-for-Service	1912403932	1912403932	1	1	LIANG, BRANDON M MD	6/20/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	167035	None	None	0	In state provider	None	2210 E ILLINOIS AVE	SUITE 401	FRESNO	CA	93701	2168	10	06019	36.74500687	-119.7846885	Fresno County
221596	Fee-for-Service	1841596483	1841596483	1	1	LEUNG, JANET H MD	6/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118018	67	Endocrinology	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
221600	Fee-for-Service	1386715282	1386715282	1	1	LIN, TONY K MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80138	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
221668	Fee-for-Service	1740290360	1740290360	1	1	LIGHTHEART, KENNETH MD MD	10/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	520 MEDICAL CENTER DR	STE 100	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
221793	Fee-for-Service	1700177847	1700177847	1	1	LOO, JERRY T MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122771	None	None	0	In state provider	None	10833 LE CONTE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
221802	Fee-for-Service	1023194552	1023194552	1	1	LIN, THOMAS T H MD	7/6/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69006	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
221812	Fee-for-Service	1316120694	1316120694	1	1	LERMA, LIZBETH P LMFT	12/30/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	310 N IRWIN ST	7	HANFORD	CA	93230	4479	16	06031	36.32789942	-119.6476719	Kings County
221817	Fee-for-Service	1710910153	1710910153	1	1	LA FOLLETTE, LIZELLEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	74050	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	559 SIR FRANCIS DRAKE BL	None	GREENBRAE	CA	94904	2305	21	06041	37.94808806	-122.5269228	Marin County
221821	Fee-for-Service	1649538174	1649538174	1	1	LIANG, AN NA DO	9/24/2018	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	13014	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
221829	Fee-for-Service	1083790505	1083790505	1	1	LE, TRANG D MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60068	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
221860	Fee-for-Service	1336131317	1336131317	1	1	LAZO, ELEANOR A MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50026	05	Anesthesiology	0	In state provider	None	901 CAMPUS DR	STE 102	DALY CITY	CA	94015	4930	41	06081	37.66535778	-122.4763793	San Mateo County
221864	Fee-for-Service	1285883835	1285883835	1	1	LEE, JUSTINE C MD	5/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119155	24	Plastic Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 465	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
221899	Fee-for-Service	1396771374	1396771374	1	1	LEARCH, THOMAS J MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	69556	30	Radiology	0	In state provider	None	333 S HOPE ST	STE C145	LOS ANGELES	CA	90071	3019	19	06037	34.05335946	-118.2526978	Los Angeles County
221911	Fee-for-Service	1467650119	1467650119	1	1	LINGMAN,JENIFER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3580 WEST 9000 SOUTH	None	WEST JORDEN	UT	84088	8812	00	None	40.590153	-111.974634	Salt Lake County
221915	Fee-for-Service	1730388729	1730388729	1	1	LAU, CINDY S MD	6/6/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	96849	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWAY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
221922	Fee-for-Service	1790813046	1790813046	1	1	LOWENTHAL, SARAH S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	80735	01	General Practice	0	In state provider	None	1001 POTRERO AVE	RM 4F	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
221957	Fee-for-Service	1740290360	1740290360	1	1	LIGHTHEART, KENNETH MD MD	10/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	520 MEDICAL CENTER DR	STE 100	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
221991	Fee-for-Service	1598721946	1598721946	1	1	LEE, ANGELA G MD	6/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91541	40	Pediatrics	0	In state provider	DR BANUELOS	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
222034	Fee-for-Service	1932207107	1932207107	1	1	LANDON, MARK MD INC	8/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	48586	05	Anesthesiology	0	In state provider	None	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	30	06059	33.746805	-117.834147	Orange County
222050	Fee-for-Service	1790856672	1790856672	1	1	LIANG, RAYMOND W MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60993	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
222081	Fee-for-Service	1134980048	1134980048	1	1	LUDY, CHASE K NP	7/15/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
222091	Fee-for-Service	1023194552	1023194552	1	1	LIN, THOMAS T H MD	7/6/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69006	40	Pediatrics	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
222092	Fee-for-Service	1437135886	1437135886	1	1	LABORATORY CORPORATION OF AM	10/19/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	ERICA HOLDINGS	1440 YORK CT	None	BURLINGTON	NC	27215	3361	00	None	36.100224	-79.4890395	Alamance County
222095	Fee-for-Service	1659429678	1659429678	1	1	LI, CONNIE JIANHUI MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	87985	40	Pediatrics	0	In state provider	None	200 S WELLS RD	STE 100	VENTURA	CA	93004	1302	56	06111	34.29321532	-119.1597424	Ventura County
222116	Fee-for-Service	1639299852	1639299852	1	1	LEE, ERIC C MD	9/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100994	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
222143	Fee-for-Service	1275977381	1275977381	1	1	LICKISS, JESSICA A DPM	11/21/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
222174	Fee-for-Service	1528414349	1528414349	1	1	LAWSON, ALEXXIS DO	8/14/2020	207P00000X	NA	Other	026	PHYSICIANS	18099	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
222202	Fee-for-Service	1730388729	1730388729	1	1	LAU, CINDY S MD	6/6/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	96849	08	Family Practice	0	In state provider	None	39400 PASEO PADRE PKWAY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
222209	Fee-for-Service	1790813046	1790813046	1	1	LOWENTHAL, SARAH S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	80735	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 4F	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
222230	Fee-for-Service	1437544632	1437544632	1	1	LASKAR, DEREK B MD	7/6/2020	207ZP0102X	NA	Other	026	PHYSICIANS	151830	22	Pathology (M.D. only)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
222260	Fee-for-Service	1962829325	1962829325	1	1	LAI, KUAN-CHI MD	6/21/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	139034	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
222265	Fee-for-Service	1770668444	1770668444	1	1	LAMBA, AMIT MD	10/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86480	22	Pathology (M.D. only)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
222271	Fee-for-Service	1760536981	1760536981	1	1	LEBOVITZ,YARON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	579A CRANBURY RD	None	EAST BRUNSWICK	NJ	08816	0000	00	None	40.41223012	-74.41781596	Middlesex County
222311	Fee-for-Service	1467670422	1467670422	1	1	LESLIE, JORI A LCSW	3/3/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	815 BAY AVE	None	CAPITOLA	CA	95010	2106	44	06087	36.98097987	-121.9554791	Santa Cruz County
222313	Fee-for-Service	1013966571	1013966571	1	1	LOURIE, DAVID J MD	6/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70873	01	General Practice	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
222323	Fee-for-Service	1003334509	1003334509	1	1	LIVERMORE, EMILY E PSYD	10/14/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
222346	Fee-for-Service	1215481916	1215481916	1	1	LOPEZ LEON, GEISHA Y LCSW	10/16/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
222418	Fee-for-Service	1609943414	1609943414	1	1	LUFTMAN, JOSEPH P MD	7/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63857	08	Family Practice	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
222460	Fee-for-Service	1497351209	1497351209	1	1	LI, ANGEL CNP	5/12/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2455 SAN RAMON VALLEY BL	None	SAN RAMON	CA	94583	1601	07	06013	37.77494737	-121.9771019	Contra Costa County
222479	Fee-for-Service	1164520714	1164520714	1	1	LOGAN, DWAYNE K MD	4/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	68583	18	Ophthalmology	0	In state provider	None	5991 E SPRING ST	None	LONG BEACH	CA	90808	3752	19	06037	33.81062147	-118.1154555	Los Angeles County
222490	Fee-for-Service	1174601256	1174601256	1	1	LIU, ROCK CHEN C MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91143	02	General Surgery	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
222494	Fee-for-Service	1467891416	1467891416	1	1	LEE, PAMELA MD INC	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	98007	28	Proctology (colon and rectal)	0	In state provider	None	520 W JUNIPERO ST	None	SANTA BARBARA	CA	93105	4212	42	06083	34.4292679	-119.7255944	Santa Barbara County
222516	Fee-for-Service	1437544632	1437544632	1	1	LASKAR, DEREK B MD	7/6/2020	207ZP0102X	NA	Other	026	PHYSICIANS	151830	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
222529	Fee-for-Service	1023134277	1023134277	1	1	LIPE, LISA A	12/24/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
222541	Fee-for-Service	1518059237	1518059237	1	1	LERNER, STEVEN A MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	48837	41	Internal Medicine	0	In state provider	None	301 N PRAIRIE AVE	STE 415	INGLEWOOD	CA	90301	4507	19	06037	33.965712	-118.3439965	Los Angeles County
222550	Fee-for-Service	1649560632	1649560632	1	1	LYO, VICTORIA MD	7/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123485	02	General Surgery	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
222552	Fee-for-Service	1124393210	1124393210	1	1	LYON, JESSE D MD	10/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126832	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
222570	Fee-for-Service	1639611387	1639611387	1	1	LEE, MIJA LPCC	6/4/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
222590	Fee-for-Service	1528194255	1528194255	1	1	LIAO, WILSON J MD	10/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89988	07	Dermatology	0	In state provider	None	1701 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3011	38	06075	37.78553106	-122.4399475	San Francisco County
222621	Fee-for-Service	1720367899	1720367899	1	1	LEGER, GABRIEL C MD	8/2/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	155902	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
222689	Fee-for-Service	1881150290	1881150290	1	1	LASALLE MEDICAL ASSOCIATES	2/17/2020	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	790 E FOOTHILL BLVD # D	None	RIALTO	CA	92376	5269	36	06071	34.10679349	-117.3556395	San Bernardino County
222694	Fee-for-Service	1801963814	1801963814	1	1	LLANES, JORGE L MD	12/4/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	41319	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
222715	Fee-for-Service	1912569773	1912569773	1	1	LEE, ALVIS DO	8/22/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	19228	None	None	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
222728	Fee-for-Service	1588673446	1588673446	1	1	LEJA, CATHERINE A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	73578	08	Family Practice	0	In state provider	None	459 W LINE ST	None	BISHOP	CA	93514	3333	14	06027	37.36140652	-118.398942	Inyo County
222741	Fee-for-Service	1427090240	1427090240	2	1	LONGS DRUG STORES CA LLC	11/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1707 GRANT AVE.	PO BOX 5010	NOVATO	CA	94945	2229	21	06041	38.10917048	-122.5789092	Marin County
222758	Fee-for-Service	1881616340	1881616340	1	1	LOUIE, ALAN K MD	7/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	45772	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
222783	Fee-for-Service	1467891416	1467891416	1	1	LEE, PAMELA MD INC	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	98007	02	General Surgery	0	In state provider	None	520 W JUNIPERO ST	None	SANTA BARBARA	CA	93105	4212	42	06083	34.4292679	-119.7255944	Santa Barbara County
222789	Fee-for-Service	1689621765	1689621765	1	1	LUNNY, PETER L MD	7/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	69757	None	None	0	In state provider	None	1999 MOWRY AVE	STE R	FREMONT	CA	94538	1723	01	06001	37.55783419	-121.9808484	Alameda County
222825	Fee-for-Service	1518096270	1518096270	1	1	LIU, MINGHSUN MD	3/27/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	85950	41	Internal Medicine	0	In state provider	None	22110 ROSCOE BLVD	STE 201	CANOGA PARK	CA	91304	3861	19	06037	34.21957849	-118.6082685	Los Angeles County
222852	Fee-for-Service	1417961632	1417961632	1	1	LAW, SIMON K MD	1/31/1995	207W00000X	NA	Ophthalmology	026	PHYSICIANS	62023	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	RM 1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
222879	Fee-for-Service	1578505301	1578505301	2	1	LONGS DRUG STORE CAL LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1063 C ST	None	GALT	CA	95632	1700	34	06067	38.254257	-121.296744	Sacramento County
222890	Fee-for-Service	1184668527	1184668527	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1966 MAIN ST	None	WATSONVILLE	CA	95076	3066	44	06087	36.91840525	-121.7820446	Santa Cruz County
222976	Fee-for-Service	1881150290	1881150290	1	1	LASALLE MEDICAL ASSOCIATES	2/17/2020	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	790 E FOOTHILL BLVD # D	None	RIALTO	CA	92376	5269	36	06071	34.10679349	-117.3556395	San Bernardino County
222987	Fee-for-Service	1093960643	1093960643	1	1	LONGWELL, ALEDA A J MD	6/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	86547	07	Dermatology	0	In state provider	None	910 MAPLE STREET	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
222989	Fee-for-Service	1275765240	1275765240	1	1	LIU, CHRIS Y K MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110536	41	Internal Medicine	0	In state provider	None	16200 SAND CANYON AVE	None	IRVINE	CA	92618	3714	30	06059	33.6617581	-117.7736362	Orange County
223003	Fee-for-Service	1952348849	1952348849	1	1	LIM HEYA, MARIA T MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	64444	40	Pediatrics	0	In state provider	None	3325 DIVISION ST	None	LOS ANGELES	CA	90065	2701	19	06037	34.10490046	-118.230147	Los Angeles County
223009	Fee-for-Service	1669416566	1669416566	1	1	LIEU, HSIAO D MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69724	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
223027	Fee-for-Service	1356388383	1356388383	1	1	LEUNG, LAWRENCE L MD	3/31/1986	207RH0003X	NA	Oncology	026	PHYSICIANS	56887	68	Hematology	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
223057	Fee-for-Service	1548528003	1548528003	1	1	LESAR, BENJAMIN J	6/15/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	167654	None	None	0	In state provider	None	225 W HOSPITALITY LN	102	SAN BERNARDINO	CA	92408	3244	36	06071	34.06586109	-117.2884682	San Bernardino County
223060	Fee-for-Service	1184157620	1184157620	1	1	LIU, JESICA F MD	11/22/2021	2080P0006X	NA	Psychiatry	026	PHYSICIANS	166312	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
223065	Fee-for-Service	1609825728	1609825728	1	1	LORI WILHELM MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	75-5653 KUAKINI HWY	STE 110	KAILUA KONA	HI	96740	1620	00	None	19.64127638	-155.9953077	Hawaii County
223067	Fee-for-Service	1720042377	1720042377	1	1	LAL, SATISH K MD	1/4/2009	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	34462	20	Orthopedic Surgery	0	In state provider	None	525 N 13TH AVE	STE B	UPLAND	CA	91786	4969	36	06071	34.09996045	-117.6334849	San Bernardino County
223077	Fee-for-Service	1588735138	1588735138	1	1	LUND, RYAN M	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1900 DRESDEN DRIVE	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
223080	Fee-for-Service	1417948621	1417948621	1	1	LEE, SCOTT S MD	6/30/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53241	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
223111	Fee-for-Service	1518096270	1518096270	1	1	LIU, MINGHSUN MD	3/27/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	85950	77	Infectious Disease	0	In state provider	None	22110 ROSCOE BLVD	STE 201	CANOGA PARK	CA	91304	3861	19	06037	34.21957849	-118.6082685	Los Angeles County
223173	Fee-for-Service	1811330111	1811330111	1	1	LEE, TIM H MD	10/29/2018	207L00000X	NA	Other	026	PHYSICIANS	132869	05	Anesthesiology	0	In state provider	None	250 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
223262	Fee-for-Service	1457397465	1457397465	1	1	LA JOLLA GASTROENTEROLOG	9/30/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	MEDICAL GROUP	9850 GENESEE AVE	STE 820	LA JOLLA	CA	92037	1219	37	06073	32.882913	-117.226341	San Diego County
223298	Fee-for-Service	1669416566	1669416566	1	1	LIEU, HSIAO D MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69724	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
223334	Fee-for-Service	1437183357	1437183357	1	1	LIFECARE HOSP NO NEVADA	8/1/1998	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	TAHOE PACIFIC HOSP	2375 E PRATER WAY	None	SPARKS	NV	89434	9641	00	None	39.54247495	-119.6975356	Washoe County
223346	Fee-for-Service	1194760991	1194760991	1	1	LARSEN, LINDA J H MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	73027	30	Radiology	0	In state provider	None	1441 EASTLAKE AVENUE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
223351	Fee-for-Service	1336567775	1336567775	1	1	LOU, JACQUELINE F MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138292	15	Obstetrics (D.O. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
223354	Fee-for-Service	1992043277	1992043277	1	1	LI SOUND USA	2/14/2008	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	18405 E COLIMA	# C	ROWLAND HEIGHTS	CA	91748	2788	19	06037	33.98841287	-117.9036487	Los Angeles County
223367	Fee-for-Service	1417948621	1417948621	1	1	LEE, SCOTT S MD	6/30/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53241	08	Family Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
223394	Fee-for-Service	1912585795	1912585795	1	1	LO, THERLINDER MD	8/4/2024	208M00000X	NA	Other	026	PHYSICIANS	191592	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
223415	Fee-for-Service	1568723674	1568723674	1	1	LEUNG, JOHNNY NP	5/10/2019	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
223486	Fee-for-Service	1699203695	1699203695	1	1	LO, TSAI H MD	11/13/2020	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
223494	Fee-for-Service	1598348625	1598348625	1	1	LEAVE IT TO MANNY INC	8/18/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1782 S SHERBOURNE DR	None	LOS ANGELES	CA	90035	4329	19	06037	34.04561133	-118.3809427	Los Angeles County
223516	Fee-for-Service	1447288204	1447288204	1	1	LEE, JENNIFER T MD	8/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89100	08	Family Practice	0	In state provider	None	3536 MENDOCINO AVE	STE 300	SANTA ROSA	CA	95403	3634	49	06097	38.473326	-122.725935	Sonoma County
223548	Fee-for-Service	1700957867	1700957867	1	1	LEW, RAYMOND T DC	2/1/2003	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	950 STOCKTON ST	STE 407B	SAN FRANCISCO	CA	94108	1616	38	06075	37.79469747	-122.4079497	San Francisco County
223578	Fee-for-Service	1225200256	1225200256	1	1	LE, GIAO Q MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
223582	Fee-for-Service	1730386533	1730386533	1	1	LABARBARA, ALLYSON M MD	6/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92440	None	None	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
223588	Fee-for-Service	1710454715	1710454715	1	1	LOGOS HOME HEALTH	1/8/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6851 LENNOX AVE	STE 400	VAN NUYS	CA	91405	4075	19	06037	34.19553967	-118.4454933	Los Angeles County
223597	Fee-for-Service	1982794061	1982794061	1	1	LAYNE, SCOTT PETER MD	6/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	46596	41	Internal Medicine	0	In state provider	None	100 MEDICAL PLAZA	#310	LOS ANGELES	CA	90024	0000	19	06037	34.06544724	-118.4459249	Los Angeles County
223608	Fee-for-Service	1295735520	1295735520	1	1	LEOPOLD, GARY A MD	10/25/1995	207L00000X	NA	Other	026	PHYSICIANS	55258	05	Anesthesiology	0	In state provider	None	3965 J ST	STE 106	SACRAMENTO	CA	95819	3624	34	06067	38.56967099	-121.4533629	Sacramento County
223628	Fee-for-Service	1902973753	1902973753	1	1	LIZARRAGA, PAMELA C NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3951 VAN BUREN BLVD	None	RIVERSIDE	CA	92503	3620	33	06065	33.92276786	-117.4483793	Riverside County
223634	Fee-for-Service	1174699151	1174699151	1	1	LIZAMA, MIGUEL R MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	49543	41	Internal Medicine	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
223636	Fee-for-Service	1083682298	1083682298	1	1	LAKSHMINRUSIMHA,	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150233	40	Pediatrics	0	In state provider	SATYANARAYANA MD	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
223639	Fee-for-Service	1336567775	1336567775	1	1	LOU, JACQUELINE F MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138292	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
223649	Fee-for-Service	1730226994	1730226994	1	1	LUNA, EMMANUEL C MD	2/18/2005	173000000X	NA	Other	026	PHYSICIANS	49643	66	Emergency Medicine (Urgent Care)	0	In state provider	FAAFP INC	1500 S CENTRAL AVE	SUITE 321	GLENDALE	CA	91204	2581	19	06037	34.12736888	-118.257777	Los Angeles County
223705	Fee-for-Service	1306227079	1306227079	1	1	LIN, DAVID MD	1/30/2023	207P00000X	NA	Other	026	PHYSICIANS	167318	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
223754	Fee-for-Service	1548574569	1548574569	1	1	LEW, CRYSTAL T OD	2/12/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1635 DIVISADERO STREET	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
223761	Fee-for-Service	1124290713	1124290713	1	1	LAM, TUAN T MD	4/6/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	69720	33	Thoracic Surgery	0	In state provider	None	11190 WARNER AVE	STE #303	FOUNTAIN VALLEY	CA	92708	4047	30	06059	33.714	-117.9333585	Orange County
223775	Fee-for-Service	1013145127	1013145127	1	1	LIU, JEFFREY W MD	6/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114765	18	Ophthalmology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
223853	Fee-for-Service	1932593993	1932593993	1	1	LOPEZ PEREZ, KARLA E LMFT	3/12/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
223881	Fee-for-Service	1982794061	1982794061	1	1	LAYNE, SCOTT PETER MD	6/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	46596	77	Infectious Disease	0	In state provider	None	100 MEDICAL PLAZA	#310	LOS ANGELES	CA	90024	0000	19	06037	34.06544724	-118.4459249	Los Angeles County
223920	Fee-for-Service	1174699151	1174699151	1	1	LIZAMA, MIGUEL R MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	49543	01	General Practice	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
223977	Fee-for-Service	1568653053	1568653053	1	1	LUCAS HEALTH PARTNERS	7/27/2001	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	MORNINGSIDE ADHC	11225 CRENSHAW BLVD	None	INGLEWOOD	CA	90303	2835	19	06037	33.932304	-118.326596	Los Angeles County
223984	Fee-for-Service	1376073858	1376073858	1	1	LEE, AARON LAC	6/21/2022	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2505 SAMARITAN DRIVE	305	SAN JOSE	CA	95124	4006	43	06085	37.25111447	-121.9483395	Santa Clara County
224033	Fee-for-Service	1265960108	1265960108	1	1	LI, YUEHUA MD	8/17/2021	207R00000X	NA	Other	026	PHYSICIANS	164863	None	None	0	In state provider	None	10430 S DE ANZA BLVD	110	CUPERTINO	CA	95014	3024	43	06085	37.3172651	-122.0321678	Santa Clara County
224058	Fee-for-Service	1982434080	1982434080	1	1	LEE, DIANE OD	10/23/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 E HERNDON AVE	STE 401	FRESNO	CA	93720	3326	10	06019	36.83744648	-119.7646425	Fresno County
224094	Fee-for-Service	1184666901	1184666901	2	1	LONGS DRUG STORES CA LLC	12/8/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	155 S ORCHARD PLZ	None	UKIAH	CA	95482	5013	23	06045	39.15059367	-123.1979455	Mendocino County
224095	Fee-for-Service	1659406825	1659406825	1	1	LAY, J. MARCUS D.O.	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	4146	84	Surgery-Head and Neck	0	In state provider	None	10098 SOQUEL DR	None	APTOS	CA	95003	4926	44	06087	36.97184668	-121.8760885	Santa Cruz County
224106	Fee-for-Service	1417978651	1417978651	1	1	LIBBY, EDWARD N	10/22/2024	207RH0000X	NA	Hematology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
224122	Fee-for-Service	1912160979	1912160979	1	1	LU, JAMES C MD	8/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111090	36	Psychiatry	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
224123	Fee-for-Service	1861837338	1861837338	1	1	LAM, JASON K	5/26/2020	208M00000X	NA	Other	026	PHYSICIANS	17253	41	Internal Medicine	0	In state provider	None	2626 COLORADO BLVD	None	LOS ANGELES	CA	90041	1070	19	06037	34.14236825	-118.2236654	Los Angeles County
224141	Fee-for-Service	1144290636	1144290636	1	1	LAIRD, JOHN R MD	8/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87764	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
224146	Fee-for-Service	1558108365	1558108365	1	1	LU, JOSHUA PT	12/9/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
224155	Fee-for-Service	1073813556	1073813556	1	1	LEE, HWA M MD INC	1/24/2012	207RP1001X	NA	Pulmonology	026	PHYSICIANS	33216	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3010 W ORANGE AVENUE	STE 103	ANAHEIM	CA	92804	3170	30	06059	33.82472315	-117.994133	Orange County
224165	Fee-for-Service	1932305190	1932305190	1	1	LUM, STEVEN J MD	7/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100696	22	Pathology (M.D. only)	0	In state provider	None	11500 BROOKSHIRE AVE	None	DOWNEY	CA	90241	4917	19	06037	33.93500365	-118.1321119	Los Angeles County
224195	Fee-for-Service	1144703000	1144703000	1	1	LAM, WILSON PT	4/1/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
224205	Fee-for-Service	1750509048	1750509048	1	1	LINDAU, SUSAN T LCSW	11/12/2009	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2001 S BARRINGTON AVE	STE 308	LOS ANGELES	CA	90025	5379	19	06037	34.03672191	-118.4500156	Los Angeles County
224217	Fee-for-Service	1295881837	1295881837	1	1	LOENICKER, GEROLD LMFT	11/20/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	43524	-	NOT APPLICABLE	0	In state provider	None	2425 BISSO LANE	STE 200	CONCORD	CA	94520	4886	07	06013	37.98393807	-122.0466953	Contra Costa County
224224	Fee-for-Service	1821157108	1821157108	1	1	LUECK, THERESA A MD	9/30/1989	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	56657	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
224228	Fee-for-Service	1497135214	1497135214	1	1	LEARNING TREE THERAPY, INC	8/15/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4300 LONG BEACH BLVD	760	LONG BEACH	CA	90807	2011	19	06037	33.83662572	-118.1900605	Los Angeles County
224235	Fee-for-Service	1285648345	1285648345	1	1	LESS, ADRIENNE L LMFT	9/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2790 SKYPARK DRIVE	SUITE 307	TORRANCE	CA	90505	5388	19	06037	33.80456075	-118.3357569	Los Angeles County
224240	Fee-for-Service	1467565283	1467565283	1	1	LOS ANGELES CO-DHS	12/27/2010	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	LITTLEROCK COMMUNITY CLN	8201 PEARBLOSSOM HWY	None	LITTLEROCK	CA	93543	3042	19	06037	34.52113349	-117.983412	Los Angeles County
224253	Fee-for-Service	1811974272	1811974272	1	1	LUTHER, GLENN D MD INC	4/19/1993	207RH0003X	NA	Oncology	026	PHYSICIANS	76321	78	Neoplastic Diseases/Oncology	0	In state provider	None	35900 BOB HOPE DR	STE 175	RANCHO MIRAGE	CA	92270	1764	33	06065	33.790311	-116.405864	Riverside County
224336	Fee-for-Service	1124145263	1124145263	1	1	LAUGESON, ELIZABETH A	4/18/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PHD	760 WESTWOOD PLZ	STE 68-230	LOS ANGELES	CA	90024	5055	19	06037	34.06633181	-118.4451729	Los Angeles County
224337	Fee-for-Service	1427038017	1427038017	1	1	LARSON, THOMAS K MD	1/1/1982	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	34674	10	Gastroenterology (M.D. only)	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
224347	Fee-for-Service	1922253491	1922253491	1	1	LOWE, ROBERT J MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120154	18	Ophthalmology	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
224383	Fee-for-Service	1952361461	1952361461	1	1	LEYBLE, EUGENE R MD	7/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93856	41	Internal Medicine	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.66859	-121.3118055	Sacramento County
224399	Fee-for-Service	1083292833	1083292833	1	1	LEVECKIS, EILEEN LMFT	1/15/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	480B TESCONI CIR	None	SANTA ROSA	CA	95401	4691	49	06097	38.44950583	-122.7351601	Sonoma County
224429	Fee-for-Service	1144290636	1144290636	1	1	LAIRD, JOHN R MD	8/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87764	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
224442	Fee-for-Service	1073813556	1073813556	1	1	LEE, HWA M MD INC	1/24/2012	207RP1001X	NA	Pulmonology	026	PHYSICIANS	33216	41	Internal Medicine	0	In state provider	None	3010 W ORANGE AVENUE	STE 103	ANAHEIM	CA	92804	3170	30	06059	33.82472315	-117.994133	Orange County
224477	Fee-for-Service	1780698340	1780698340	2	1	LE, KIM C MD	6/11/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	61348	14	Neurological Surgery	0	In state provider	None	1414 S GRAND AVE	SUITE 100	LOS ANGELES	CA	90015	3048	19	06037	34.03661142	-118.2657227	Los Angeles County
224499	Fee-for-Service	1376070193	1376070193	1	1	LEE, ESTHER MD	10/1/2024	208600000X	NA	General Surgery	026	PHYSICIANS	163228	02	General Surgery	0	In state provider	None	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
224507	Fee-for-Service	1831419258	1831419258	1	1	LOPEZ, MELVIN A MD	11/9/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	118690	01	General Practice	0	In state provider	None	117 WEST BUNNY AVE	None	SANTA MARIA	CA	93458	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
224510	Fee-for-Service	1821255258	1821255258	1	1	LIZA DE LOS ANGELES	12/9/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1305 S COURSON DR	None	ANAHEIM	CA	92804	4721	30	06059	33.81538283	-118.0042354	Orange County
224530	Fee-for-Service	1467565283	1467565283	1	1	LOS ANGELES CO-DHS	10/3/2000	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	LITTLEROCK COMMUNITY CLN	8201 PEARBLOSSOM HWY	None	LITTLEROCK	CA	93543	3042	19	06037	34.52113349	-117.983412	Los Angeles County
224541	Fee-for-Service	1811974272	1811974272	1	1	LUTHER, GLENN D MD INC	4/19/1993	207RH0003X	NA	Oncology	026	PHYSICIANS	76321	41	Internal Medicine	0	In state provider	None	35900 BOB HOPE DR	STE 175	RANCHO MIRAGE	CA	92270	1764	33	06065	33.790311	-116.405864	Riverside County
224601	Fee-for-Service	1801956669	1801956669	1	1	LATTA, GEORGE H III MD	2/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	50705	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 W MINERAL KING	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
224602	Fee-for-Service	1396107132	1396107132	1	1	LUXENBERG, ADAM A MD	8/6/2020	207R00000X	NA	Other	026	PHYSICIANS	153981	41	Internal Medicine	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
224607	Fee-for-Service	1336907013	1336907013	1	1	LEVERT, MARIA E BIRTH DOULA	3/8/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
224613	Fee-for-Service	1548369093	1548369093	2	1	LUU, HUNG Q T MD	12/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	99801	None	None	0	In state provider	None	901 34TH STREET	None	BAKERSFIELD	CA	93301	2101	15	06029	35.39048393	-119.0119266	Kern County
224616	Fee-for-Service	1740220201	1740220201	1	1	LEWIS, RICHARD A MD	11/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	89240	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
224668	Fee-for-Service	1295773489	1295773489	1	1	LI, GARY A MD	8/31/1989	207P00000X	NA	Other	026	PHYSICIANS	66693	None	None	0	In state provider	None	1720 BROOKLYN AVE	None	LOS ANGELES	CA	90033	2462	19	06037	34.040502	-118.191954	Los Angeles County
224675	Fee-for-Service	1669479853	1669479853	1	1	LOGSDON, MARK D MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84635	30	Radiology	0	In state provider	None	5151 F ST	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
224713	Fee-for-Service	1912945668	1912945668	1	1	LOEW, PETER M MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23906	30	Radiology	0	In state provider	None	700 17TH ST	None	MODESTO	CA	95354	1209	50	06099	37.64283069	-120.9903982	Stanislaus County
224716	Fee-for-Service	1457447120	1457447120	1	1	LUTZKER, STEVEN L MD	1/30/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	51801	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
224753	Fee-for-Service	1144325259	1144325259	1	1	LEE, SHELLEY Y MD	7/9/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76637	40	Pediatrics	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 604	GARDEN GROVE	CA	92843	1920	30	06059	33.77450141	-117.9123364	Orange County
224764	Fee-for-Service	1780698340	1780698340	2	1	LE, KIM C MD	6/11/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	61348	45	Nephrology (Renal-Kidney)	0	In state provider	None	1414 S GRAND AVE	SUITE 100	LOS ANGELES	CA	90015	3048	19	06037	34.03661142	-118.2657227	Los Angeles County
224776	Fee-for-Service	1538258082	1538258082	1	1	LUXFORD, WILLIAM M MD	1/1/1982	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	32368	01	General Practice	0	In state provider	None	2122 W 3RD ST	None	LOS ANGELES	CA	90057	1902	19	06037	34.0630888	-118.2733329	Los Angeles County
224782	Fee-for-Service	1225526775	1225526775	1	1	LI, DAVID Y MD	6/22/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	174545	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
224785	Fee-for-Service	1376070193	1376070193	1	1	LEE, ESTHER MD	10/1/2024	208600000X	NA	General Surgery	026	PHYSICIANS	163228	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
224798	Fee-for-Service	1598795668	1598795668	1	1	LUTHRA, INDERMOHAN S	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	50564	13	Neurology (M.D. only)	0	In state provider	None	81709 DR CARREON BLVD	STE B1	INDIO	CA	92201	5510	33	06065	33.70733082	-116.2400326	Riverside County
224802	Fee-for-Service	1649585944	1649585944	1	1	LAKHAN, SHAHEEN E MD	10/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123286	13	Neurology (M.D. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
224804	Fee-for-Service	1063867711	1063867711	1	1	LIYANTO, BRIAN MD	10/1/2019	207L00000X	NA	Other	026	PHYSICIANS	143981	05	Anesthesiology	0	In state provider	None	900 S ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	4716	19	06037	34.049623	-118.1388014	Los Angeles County
224816	Fee-for-Service	1467565283	1467565283	1	1	LOS ANGELES CO-DHS	10/3/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	LITTLEROCK COMMUNITY CLN	8201 PEARBLOSSOM HWY	None	LITTLEROCK	CA	93543	3042	19	06037	34.52113349	-117.983412	Los Angeles County
224827	Fee-for-Service	1811974272	1811974272	1	1	LUTHER, GLENN D MD INC	4/19/1993	207RH0003X	NA	Oncology	026	PHYSICIANS	76321	68	Hematology	0	In state provider	None	35900 BOB HOPE DR	STE 175	RANCHO MIRAGE	CA	92270	1764	33	06065	33.790311	-116.405864	Riverside County
224833	Fee-for-Service	1326181454	1326181454	1	1	LIN, MIAO Z CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	523 BROADWAY	None	SACRAMENTO	CA	95818	2001	34	06067	38.565666	-121.506237	Sacramento County
224836	Fee-for-Service	1285777318	1285777318	1	1	LAFORCE, BRANNON LPCC	2/26/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
224864	Fee-for-Service	1033565148	1033565148	1	1	LOPEZ, KARISSA LPCC	4/4/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
224886	Fee-for-Service	1174726715	1174726715	1	1	LANDO, ULF MD INC	1/1/1993	193200000X	NA	Other	026	PHYSICIANS	35558	41	Internal Medicine	0	In state provider	None	16133 VENTURA BLVD	STE 350	ENCINO	CA	91436	2426	19	06037	34.15656164	-118.4849569	Los Angeles County
224889	Fee-for-Service	1801956669	1801956669	1	1	LATTA, GEORGE H III MD	2/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	50705	40	Pediatrics	0	In state provider	None	400 W MINERAL KING	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
224891	Fee-for-Service	1245287960	1245287960	1	1	LISSAUR, RALPH MD	8/18/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	88975	None	None	0	In state provider	None	2131 ELKS	104	SAN BERNARDINO	CA	92404	5544	36	06071	34.13470788	-117.262434	San Bernardino County
224897	Fee-for-Service	1417977661	1417977661	1	1	LEVIN, PHILLIP M MD	4/20/1972	2086S0129X	NA	General Surgery	026	PHYSICIANS	21219	02	General Surgery	0	In state provider	None	435 N BEDFORD DR	None	BEVERLY HILLS	CA	90210	4321	19	06037	34.06851281	-118.4056736	Los Angeles County
224927	Fee-for-Service	1558796771	1558796771	1	1	LI, HAO MD	8/28/2018	208M00000X	NA	Other	026	PHYSICIANS	144913	08	Family Practice	0	In state provider	None	8120 TIMBERLAKE WAY	SUITE 107	SACRAMENTO	CA	95823	5413	34	06067	38.461023	-121.41414	Sacramento County
224933	Fee-for-Service	1275850489	1275850489	1	1	LE, NGUYEN M MD	9/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157430	01	General Practice	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
224936	Fee-for-Service	1942245576	1942245576	1	1	LARSEN,TIMOTHY J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	7400	00	None	0	0	None
224941	Fee-for-Service	1396787214	1396787214	1	1	LEE, SYLVIA K OD	7/25/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	211B EL CAMINO REAL	None	GREENFIELD	CA	93927	5125	27	06053	36.32123296	-121.2438342	Monterey County
224950	Fee-for-Service	1356690424	1356690424	1	1	LITVAK, ALEXIS H LCSW	10/30/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91376	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
224991	Fee-for-Service	1386023604	1386023604	1	1	LETTICE, LEALA B DO	8/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15609	01	General Practice	0	In state provider	None	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
225039	Fee-for-Service	1235219486	1235219486	1	1	LLENDERROZOS, HECTOR MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86047	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
225050	Fee-for-Service	1659533115	1659533115	1	1	LEE, DANIEL J MD	3/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109759	20	Orthopedic Surgery	0	In state provider	None	1902 ROYALTY DRIVE	#130	POMONA	CA	91767	3055	19	06037	34.07791925	-117.746146	Los Angeles County
225062	Fee-for-Service	1356384796	1356384796	1	1	LEE, SANG H MD	1/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	61812	None	None	0	In state provider	None	1900 MOWRY AVE	STE 401	FREMONT	CA	94538	1722	01	06001	37.55862396	-121.9799952	Alameda County
225069	Fee-for-Service	1730544016	1730544016	1	1	LI, HENRY MD	8/7/2023	207U00000X	NA	Other	026	PHYSICIANS	164023	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
225078	Fee-for-Service	1063771970	1063771970	1	1	LEE, LYDIA C MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118069	20	Orthopedic Surgery	0	In state provider	None	11190 WARNER AVE	SUITE 300	FOUNTAIN VALLEY	CA	92708	4045	30	06059	33.714	-117.9333585	Orange County
225093	Fee-for-Service	1649585944	1649585944	1	1	LAKHAN, SHAHEEN E MD	10/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123286	36	Psychiatry	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
225097	Fee-for-Service	1003448184	1003448184	1	1	LINCO PHARMACY, INC.	2/9/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5755 W ADAMS BLVD	None	LOS ANGELES	CA	90016	2440	19	06037	34.03247446	-118.3687695	Los Angeles County
225101	Fee-for-Service	1124110853	1124110853	1	1	LINDEN, MINGLIH E OD	9/17/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	477 E COLORADO BLVD	None	PASADENA	CA	91101	2024	19	06037	34.14587948	-118.140561	Los Angeles County
225111	Fee-for-Service	1013177690	1013177690	1	1	LEE, LLOYD M DO	8/11/2018	2084P0804X	NA	Psychiatry	026	PHYSICIANS	11719	26	Psychiatry (child)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
225122	Fee-for-Service	1063572907	1063572907	1	1	LIN, JULIE H MD	9/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142478	07	Dermatology	0	In state provider	None	165 SAINT DOMINICS RD	STE 140	MANTECA	CA	95337	7802	39	06077	37.79882972	-121.2447835	San Joaquin County
225151	Fee-for-Service	1689850802	1689850802	1	1	LESSING IVERSON	12/21/2007	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4615 CAMEO DR	None	ORCUTT	CA	93455	4552	42	06083	34.86993848	-120.4015741	Santa Barbara County
225216	Fee-for-Service	1962109033	1962109033	1	17	LOS ANGELES COUNTY DEPARTMEN	12/21/2023	3336C0002X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	C HEALTH PHARMACY DEPT.	241 N FIGUEROA ST	ROOM B-9	LOS ANGELES	CA	90012	2601	19	06037	34.05904423	-118.2502018	Los Angeles County
225240	Fee-for-Service	1801627062	1801627062	1	1	LIFELINE RX INC	11/14/2024	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6005 VINELAND AVE	STE 102	NORTH HOLLYWOOD	CA	91606	4985	19	06037	34.179921	-118.3703275	Los Angeles County
225278	Fee-for-Service	1578541496	1578541496	1	1	LOS ANGELES HOSPICE, INC	12/23/2003	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3580 WILSHIRE BLVD	STE 1290	LOS ANGELES	CA	90010	2514	19	06037	34.06170677	-118.302787	Los Angeles County
225333	Fee-for-Service	1649245747	1649245747	1	1	LALAJI, ANAND P MD	10/20/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	53843	None	None	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
225334	Fee-for-Service	1346983434	1346983434	1	1	LUNA PHARMACY INC	5/18/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2809 N GLENOAKS BLVD	UNIT B	BURBANK	CA	91504	2604	19	06037	34.20334909	-118.3346827	Los Angeles County
225357	Fee-for-Service	1831120781	1831120781	1	1	LOOK, RODNEY B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	90710	None	None	0	In state provider	None	400 N MCDOWELL BLVD	None	PETALUMA	CA	94954	2339	49	06097	38.25477	-122.63175	Sonoma County
225359	Fee-for-Service	1962635763	1962635763	1	1	LA VINE, DAVID B MD	11/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113694	38	Geriatrics	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
225367	Fee-for-Service	1740849785	1740849785	1	1	LCM TRANSPORT INC.	7/16/2019	344600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	6 CENTERPOINTE DR	700	LA PALMA	CA	90623	2503	30	06059	33.86052378	-118.0296232	Orange County
225386	Fee-for-Service	1760425516	1760425516	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1109 COUNTRY CLUB DR	None	MADERA	CA	93638	1537	20	06039	36.97568041	-120.0741943	Madera County
225403	Fee-for-Service	1689845083	1689845083	1	1	LEUNG, RICHARD J MD	6/1/2005	207W00000X	NA	Ophthalmology	026	PHYSICIANS	48263	18	Ophthalmology	0	In state provider	None	3075 HEALTH CENTER DR	STE 403	SAN DIEGO	CA	92123	2773	37	06073	32.79963065	-117.1556197	San Diego County
225415	Fee-for-Service	1043394760	1043394760	1	1	LOUIS P. GIANUTSOS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	550 16TH AVE	STE 100	SEATTLE	WA	98122	5636	00	None	47.60743396	-122.311502	King County
225416	Fee-for-Service	1962588475	1962588475	1	1	LEE, NOLAN E MD	7/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72096	08	Family Practice	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
225430	Fee-for-Service	1184798407	1184798407	1	1	LEE, JOHN M MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76410	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
225560	Fee-for-Service	1205141322	1205141322	1	1	LAHSAEIZADEH, SABA MD	7/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119365	41	Internal Medicine	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
225566	Fee-for-Service	1578541496	1578541496	1	1	LOS ANGELES HOSPICE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3580 WILSHIRE BLVD	STE 1290	LOS ANGELES	CA	90010	2514	19	06037	34.06170677	-118.302787	Los Angeles County
225605	Fee-for-Service	1639219876	1639219876	1	1	LOCKHART, ANN B MD	9/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80812	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
225625	Fee-for-Service	1821433533	1821433533	1	1	LEE, MOSES A DO	2/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15570	41	Internal Medicine	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	1000	19	06037	34.12811155	-118.2577764	Los Angeles County
225647	Fee-for-Service	1962635763	1962635763	1	1	LA VINE, DAVID B MD	11/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113694	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
225651	Fee-for-Service	1306534375	1306534375	1	1	LAU, PING	5/18/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2262 N. 1ST ST	None	SAN JOSE	CA	95131	2022	43	06085	37.37772646	-121.921374	Santa Clara County
225658	Fee-for-Service	1518371384	1518371384	1	1	LUI, MICKEY Y DO	1/9/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	14387	25	Physical Medicine and Rehabilitation	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
225703	Fee-for-Service	1285707638	1285707638	2	1	LONG, DAYNA A MD	12/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	75109	01	General Practice	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
225711	Fee-for-Service	1992040968	1992040968	1	1	LUCAS, MARYLYN S	9/27/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5819 CHENAULT DR	None	MODESTO	CA	95356	9621	50	06099	37.72444069	-120.9913184	Stanislaus County
225811	Fee-for-Service	1316055809	1316055809	1	1	LEEHEALEY, CHRISTINE J	7/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77339	83	Rheumatology	0	In state provider	MD	4950 BARRANCA PKWY	STE 205B	IRVINE	CA	92604	8646	30	06059	33.67620851	-117.7948348	Orange County
225814	Fee-for-Service	1316093099	1316093099	2	1	LARSON, DAVID B MD	10/8/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	55867	None	None	0	In state provider	None	1101 VAN NESS AVE	3RD FLOOR	SAN FRANCISCO	CA	94109	6919	38	06075	37.78610439	-122.421569	San Francisco County
225819	Fee-for-Service	1174137244	1174137244	1	1	LA JOLLA COVE HOLDINGS LLC	9/23/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	740 HOLMES STREET	None	LIVERMORE	CA	94550	4258	01	06001	37.67353972	-121.7802281	Alameda County
225833	Fee-for-Service	1073002721	1073002721	1	1	LALANI, KARIM MD	9/11/2024	390200000X	NA	Other	026	PHYSICIANS	None	77	Infectious Disease	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
225854	Fee-for-Service	1780079509	1780079509	1	1	LEKIM, REBECCA M DO	8/19/2020	208M00000X	NA	Other	026	PHYSICIANS	15015	41	Internal Medicine	0	In state provider	None	20101 LAKE CHABOT RD	4TH FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
225873	Fee-for-Service	1548232044	1548232044	1	1	LAREDO TEXAS HOSPITAL	5/18/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	COMPANY LP	1700 E SAUNDERS ST	None	LAREDO	TX	78041	5401	00	None	27.532971	-99.478116	Webb County
225883	Fee-for-Service	1083981591	1083981591	1	1	LEE, LORETTA Y W	6/28/2012	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3460 E LA PALMA AVE	None	ANAHEIM	CA	92806	2020	30	06059	33.85429451	-117.8446551	Orange County
225884	Fee-for-Service	1932701158	1932701158	1	1	LENHARDT, JULIE	7/28/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
225891	Fee-for-Service	1356030399	1356030399	1	1	LEGACY PROSTHETICS & ORTHOTI	2/7/2025	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	& ORTHOTICS	43576 WASHINGTON ST	STE. 220	LA QUINTA	CA	92253	8565	33	06065	33.73203949	-116.3037712	Riverside County
225908	Fee-for-Service	1023196623	1023196623	1	1	LIN, DONGHUI MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	66444	22	Pathology (M.D. only)	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
225964	Fee-for-Service	1033287305	1033287305	1	1	LOPEZ, GRACIELA MD	2/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91860	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
226012	Fee-for-Service	1407998081	1407998081	1	1	LAM, HAZEL P	3/26/2007	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1234 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3911	38	06075	37.781144	-122.4390035	San Francisco County
226013	Fee-for-Service	1770910382	1770910382	1	1	LUCAS, KRISTINE	5/23/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8665 WILSHIRE BLVD	STE 412	BEVERLY HILLS	CA	90211	2975	19	06037	34.06625528	-118.380319	Los Angeles County
226016	Fee-for-Service	1982615563	1982615563	1	1	LEE'S NILES DRUG STORE	2/4/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1405 NILES ST	None	BAKERSFIELD	CA	93305	4731	15	06029	35.37932655	-118.9799113	Kern County
226038	Fee-for-Service	1225251093	1225251093	1	1	LOWRY, NOATHAN S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
226047	Fee-for-Service	1083956593	1083956593	1	1	LANCE, SIMONE CNM	8/28/2017	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
226063	Fee-for-Service	1487769063	1487769063	1	1	LANDO, ULF MD	3/18/2009	207R00000X	NA	Other	026	PHYSICIANS	35558	41	Internal Medicine	0	In state provider	None	16133 VENTURA BLVD	STE 350	ENCINO	CA	91436	2426	19	06037	34.15656164	-118.4849569	Los Angeles County
226105	Fee-for-Service	1205319068	1205319068	1	2	LINARES, LINDA LMFT	10/28/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10601 CIVIC CENTER DR	STE 120B	RANCHO CUCAMONGA	CA	91730	3878	36	06071	34.1023554	-117.5735696	San Bernardino County
226117	Fee-for-Service	1235257759	1235257759	1	1	LEVITT, BRIAN S MD	10/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99206	10	Gastroenterology (M.D. only)	0	In state provider	None	2340 MONTPELIER DR	STE A	SAN JOSE	CA	95116	1622	43	06085	37.36500087	-121.8478263	Santa Clara County
226145	Fee-for-Service	1265513196	1265513196	1	1	LEE, TIMMY C MD	1/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83051	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
226158	Fee-for-Service	1548232044	1548232044	1	1	LAREDO TEXAS HOSPITAL	5/18/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	COMPANY LP	1700 E SAUNDERS ST	None	LAREDO	TX	78041	5401	00	None	27.532971	-99.478116	Webb County
226184	Fee-for-Service	1659704906	1659704906	1	1	LYNCH, PAULA CPO	4/14/2014	222Z00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2761 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3405	38	06075	37.78213625	-122.4487832	San Francisco County
226202	Fee-for-Service	1255374088	1255374088	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5333 ELKHORN BLVD	None	SACRAMENTO	CA	95842	2526	34	06067	38.686572	-121.340574	Sacramento County
226212	Fee-for-Service	1962109033	1962109033	1	4	LOS ANGELES COUNTY DEPARTMEN	2/8/2024	261QP0905X	NA	Other	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	501 N GLENDALE AVE	None	GLENDALE	CA	91206	3312	19	06037	34.15307402	-118.243996	Los Angeles County
226214	Fee-for-Service	1396730719	1396730719	1	1	LE, TRACY T OD	11/24/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	301 N JACKSON AVE	STE 1	SAN JOSE	CA	95133	2344	43	06085	37.36606741	-121.8510444	Santa Clara County
226216	Fee-for-Service	1982864393	1982864393	1	1	LO, MARVIN Y MD	6/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87179	20	Orthopedic Surgery	0	In state provider	None	1800 SULLIVAN AVE	RM 402	DALY CITY	CA	94015	2224	41	06081	37.68077723	-122.4728941	San Mateo County
226258	Fee-for-Service	1174552541	1174552541	1	1	LEE, EDMOND, DPM	4/16/2011	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	711 W COLLEGE ST	STE 520	LOS ANGELES	CA	90012	1246	19	06037	34.06541412	-118.2414102	Los Angeles County
226262	Fee-for-Service	1750358735	1750358735	1	1	LEE, JAMES J MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	72933	10	Gastroenterology (M.D. only)	0	In state provider	None	1201 W LA VETA AVE	STE 211	ORANGE	CA	92868	4207	30	06059	33.78034779	-117.8655767	Orange County
226286	Fee-for-Service	1871533851	1871533851	1	1	LEIDIG, FRITZ MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50938	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
226295	Fee-for-Service	1972902823	1972902823	1	1	LAU, NATALIE OD	9/14/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2101 STONE BLVD	STE 150	WEST SACRAMENTO	CA	95691	4054	57	06113	38.56318049	-121.5379228	Yolo County
226298	Fee-for-Service	1215940697	1215940697	1	1	LOWE, NANCY J LAC	7/7/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	624 FREDERICK ST	None	SANTA CRUZ	CA	95062	2203	44	06087	36.98007098	-122.0043791	Santa Cruz County
226319	Fee-for-Service	1689961039	1689961039	1	1	LACUESTA, CARMEN P LMFT	8/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
226344	Fee-for-Service	1174980528	1174980528	1	1	LEE, ANNA N PSYD	7/23/2021	101YA0400X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
226347	Fee-for-Service	1235290305	1235290305	1	1	LEE, PAUL A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
226369	Fee-for-Service	1659462380	1659462380	1	1	LIN, STAN T MD	11/30/1983	2084N0400X	NA	Neurology	026	PHYSICIANS	38562	13	Neurology (M.D. only)	0	In state provider	None	2324 SANTA RITA RD	STE 5	PLEASANTON	CA	94566	4150	01	06001	37.68217511	-121.8757097	Alameda County
226371	Fee-for-Service	1962109033	1962109033	1	3	LOS ANGELES COUNTY DEPARTMEN	2/8/2024	261QP0905X	NA	Other	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	ITE CLINIC	522 SAN PEDRO ST	None	LOS ANGELES	CA	90013	2102	19	06037	34.0436196	-118.2442541	Los Angeles County
226379	Fee-for-Service	1942398367	1942398367	1	1	LOS ANGELES CHRSTN HLTH CTRS	12/1/2004	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTERS	311 WINSTON ST	None	LOS ANGELES	CA	90013	1519	19	06037	34.0454147	-118.2447356	Los Angeles County
226389	Fee-for-Service	1801232129	1801232129	1	1	LOWRY, ROBERT N MD	6/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147905	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
226403	Fee-for-Service	1316938657	1316938657	1	1	LEE, JOHN W MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	55578	30	Radiology	0	In state provider	None	7130 N MILLBROOK AVE	STE 112	FRESNO	CA	93720	3347	10	06019	36.83832032	-119.7632391	Fresno County
226415	Fee-for-Service	1407483704	1407483704	1	1	LAQUERRE, SUMMER R CRNA	9/21/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
226431	Fee-for-Service	1336327196	1336327196	1	1	LOZANO, ALFREDO LMFT	7/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3097 WILLOW AVE	2	CLOVIS	CA	93612	4747	10	06019	36.79616247	-119.7272892	Fresno County
226486	Fee-for-Service	1245326826	1245326826	1	1	LI, KASEY K MD	5/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	74099	47	Miscellaneous	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
226527	Fee-for-Service	1194803833	1194803833	1	1	LUE, ALLEN J MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78478	04	Otology, Laryngology, Rhinology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
226548	Fee-for-Service	1942237532	1942237532	1	1	LIEDERMAN, PAUL C MD	1/1/1979	2084P0800X	NA	Psychiatry	026	PHYSICIANS	7813	36	Psychiatry	0	In state provider	None	9250 MOLLYWOODS AVE	None	LA MESA	CA	91941	4122	37	06073	32.77591246	-116.998715	San Diego County
226562	Fee-for-Service	1922294008	1922294008	1	1	LARSON, JONATHAN D MD	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101354	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
226572	Fee-for-Service	1871533851	1871533851	1	1	LEIDIG, FRITZ MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50938	08	Family Practice	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
226599	Fee-for-Service	1326221045	1326221045	1	1	LEE, SUSAN W DO	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11095	13	Neurology (M.D. only)	0	In state provider	None	23430 HAWTHORNE BLVD	STE 105 BLDG 3	TORRANCE	CA	90505	4777	19	06037	33.81316465	-118.3510077	Los Angeles County
226609	Fee-for-Service	1356835243	1356835243	1	1	LAMON, MATTHEW DO	11/14/2022	207QA0401X	NA	Adult Primary Care	026	PHYSICIANS	17818	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
226619	Fee-for-Service	1386990919	1386990919	1	1	LOCKLIN, ANASTASIA L LMFT	12/10/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12821 NEWPORT AVE	None	TUSTIN	CA	92780	2711	30	06059	33.75101941	-117.8093474	Orange County
226657	Fee-for-Service	1659462380	1659462380	1	1	LIN, STAN T MD	11/30/1983	2084N0400X	NA	Neurology	026	PHYSICIANS	38562	41	Internal Medicine	0	In state provider	None	2324 SANTA RITA RD	STE 5	PLEASANTON	CA	94566	4150	01	06001	37.68217511	-121.8757097	Alameda County
226662	Fee-for-Service	1336134204	1336134204	1	1	LEMON GROVE HEALTH	6/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES, LLC	8351 BROADWAY	None	LEMON GROVE	CA	91945	2009	37	06073	32.74628447	-117.017576	San Diego County
226665	Fee-for-Service	1942398367	1942398367	1	1	LOS ANGELES CHRSTN HLTH CTRS	12/1/2004	207R00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTERS	311 WINSTON ST	None	LOS ANGELES	CA	90013	1519	19	06037	34.0454147	-118.2447356	Los Angeles County
226678	Fee-for-Service	1801232129	1801232129	1	1	LOWRY, ROBERT N MD	6/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147905	01	General Practice	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
226690	Fee-for-Service	1316938657	1316938657	1	1	LEE, JOHN W MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	55578	01	General Practice	0	In state provider	None	7130 N MILLBROOK AVE	STE 112	FRESNO	CA	93720	3347	10	06019	36.83832032	-119.7632391	Fresno County
226715	Fee-for-Service	1396233565	1396233565	1	1	LIM, GARRETT H MD	5/17/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
226759	Fee-for-Service	1033439765	1033439765	1	1	LEE, HARRISON MD	2/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12200	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
226782	Fee-for-Service	1811028665	1811028665	2	1	LABBE, CAROLYN A LMFT	9/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11239 TAMPA AVENUE	206	NORTHRIDGE	CA	91326	3781	19	06037	34.27438144	-118.5565018	Los Angeles County
226783	Fee-for-Service	1134581168	1134581168	1	1	LUO, ALAN MD	9/24/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	150560	08	Family Practice	0	In state provider	None	1851 N RIVERSIDE AVE	None	RIALTO	CA	92376	8069	36	06071	34.133238	-117.3704145	San Bernardino County
226792	Fee-for-Service	1407948847	1407948847	1	1	LAMONT, DANIEL H MD	8/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75589	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	24411 HEALTH CENTER DR	STE 350	LAGUNA HILLS	CA	92653	3687	30	06059	33.6087201	-117.7076948	Orange County
226817	Fee-for-Service	1194803833	1194803833	1	1	LUE, ALLEN J MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78478	84	Surgery-Head and Neck	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
226820	Fee-for-Service	1194953539	1194953539	1	1	LENOIR, PIERRETTE MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126298	08	Family Practice	0	In state provider	None	350 30TH STREET	SUITE 407	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
226845	Fee-for-Service	1669767406	1669767406	1	1	LE, VICTOR N MD	7/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111657	41	Internal Medicine	0	In state provider	None	1700 CESAR E CHAVEZ AVE	STE 3300	LOS ANGELES	CA	90033	2469	19	06037	34.05101259	-118.217259	Los Angeles County
226850	Fee-for-Service	1922294008	1922294008	1	1	LARSON, JONATHAN D MD	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101354	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
226886	Fee-for-Service	1326221045	1326221045	1	1	LEE, SUSAN W DO	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11095	01	General Practice	0	In state provider	None	23430 HAWTHORNE BLVD	STE 105 BLDG 3	TORRANCE	CA	90505	4777	19	06037	33.81316465	-118.3510077	Los Angeles County
226916	Fee-for-Service	1588160550	1588160550	1	1	LI, ZI YING	7/12/2023	207R00000X	NA	Other	026	PHYSICIANS	173309	None	None	0	In state provider	None	782 MEDICAL CENTER DR	305	CLOVIS	CA	93611	6889	10	06019	36.84379626	-119.6609117	Fresno County
226917	Fee-for-Service	1154717015	1154717015	1	1	LEWIS, STEWART A DO	4/28/2021	207LP2900X	NA	Other	026	PHYSICIANS	13858	None	None	0	In state provider	None	3111 CAMINO DEL RIO	STE 625	SAN DIEGO	CA	92108	5718	37	06073	32.77510996	-117.1277427	San Diego County
226937	Fee-for-Service	1326173154	1326173154	1	1	LEVIN, CHERYL L MD	1/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105466	07	Dermatology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
226948	Fee-for-Service	1366510943	1366510943	1	1	LEUNG, TIMOTHY MD INC	2/8/2015	208200000X	NA	General Surgery	026	PHYSICIANS	60992	24	Plastic Surgery	0	In state provider	None	905 SAN RAMON VALLEY BLV	STE 110	DANVILLE	CA	94526	4035	07	06013	37.80823414	-121.9922059	Contra Costa County
226951	Fee-for-Service	1598845638	1598845638	1	1	LARSEN, KATHRYN M MD	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	48790	08	Family Practice	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
226964	Fee-for-Service	1225890494	1225890494	1	1	LE ROLLAND, MAUD PSYD	6/21/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
226986	Fee-for-Service	1891089777	1891089777	1	1	LAURENCE, DENNIS M MD	2/3/2022	207RC0200X	NA	Other	026	PHYSICIANS	139206	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
227002	Fee-for-Service	1235728692	1235728692	1	1	LOFGREN, SUSAN LMFT	8/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1917 N SERRANO AVE	None	LOS ANGELES	CA	90027	1621	19	06037	34.10593535	-118.3071696	Los Angeles County
227040	Fee-for-Service	1811975113	1811975113	2	1	LEE, FELIX H MD	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	83216	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
227053	Fee-for-Service	1740421445	1740421445	1	1	LIN, JENNIFER H MD	1/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115949	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
227110	Fee-for-Service	1194953539	1194953539	1	1	LENOIR, PIERRETTE MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126298	01	General Practice	0	In state provider	None	350 30TH STREET	SUITE 407	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
227121	Fee-for-Service	1801036751	1801036751	1	1	LIFESCAPE IMAGING CYPRESS	10/12/2010	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	10601 WALKER STREET	STE 100	CYPRESS	CA	90630	4733	30	06059	33.809724	-118.036976	Orange County
227122	Fee-for-Service	1871919654	1871919654	1	1	LEGACY HOME HEALTH &	5/26/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	REHABILITATION LLC	9672 VIA EXCELENCIA	STE 103	SAN DIEGO	CA	92126	4573	37	06073	32.89824532	-117.1179082	San Diego County
227161	Fee-for-Service	1235189572	1235189572	1	1	LEVINE, ALAN MD	4/29/1999	207L00000X	NA	Other	026	PHYSICIANS	70870	05	Anesthesiology	0	In state provider	None	400 E MAIN ST	# 200	STOCKTON	CA	95202	3000	39	06077	37.95344497	-121.2852303	San Joaquin County
227172	Fee-for-Service	1558317883	1558317883	1	1	LOMA LINDA RAD MED GRP	6/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	INC	25333 BARTON RD	None	LOMA LINDA	CA	92354	3123	36	06071	34.04801656	-117.251334	San Bernardino County
227175	Fee-for-Service	1659490308	1659490308	1	1	LA MAESTRA FAMILY CLINIC INC	10/29/2004	261QD0000X	NA	Dental Clinic	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	4305 UNIVERSITY AVE	STE 150	SAN DIEGO	CA	92105	1690	37	06073	32.74957853	-117.101439	San Diego County
227185	Fee-for-Service	1629285309	1629285309	1	1	LO, THOMAS P JR MD	12/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	97641	14	Neurological Surgery	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
227281	Fee-for-Service	1780941963	1780941963	1	1	LEE, JASON MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141490	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
227287	Fee-for-Service	1124665732	1124665732	1	1	LOON, GILLIAN W CRNA	2/24/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
227288	Fee-for-Service	1366416596	1366416596	1	1	LOOKING GLASS OPTOMETRY INC	3/30/2010	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	401 GREGORY LANE	STE 100	PLEASANT HILL	CA	94523	2851	07	06013	37.94798358	-122.073455	Contra Costa County
227312	Fee-for-Service	1447307418	1447307418	1	1	LIN, ADAM	12/19/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
227333	Fee-for-Service	1982017695	1982017695	1	1	LI, GRACE X MD	8/30/2020	207R00000X	NA	Other	026	PHYSICIANS	144150	68	Hematology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
227334	Fee-for-Service	1891873998	1891873998	1	1	LOBO, DEBORAH MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	67910	07	Dermatology	0	In state provider	None	5600 STONERIDGE MALL RD	None	PLEASANTON	CA	94588	2820	01	06001	37.6921981	-121.9276072	Alameda County
227395	Fee-for-Service	1831426642	1831426642	1	12	LAKESIDE MEDICAL	4/13/2010	207RE0101X	NA	Endocrinology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	222 W EULALIA STREET	SUITE 200	GLENDALE	CA	91204	2851	19	06037	34.12653215	-118.257121	Los Angeles County
227401	Fee-for-Service	1629092143	1629092143	1	1	LEMLEY, KEVIN V MD	12/31/1996	2080P0210X	NA	Nephrology	026	PHYSICIANS	82159	45	Nephrology (Renal-Kidney)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
227417	Fee-for-Service	1346535549	1346535549	1	1	LIN, JENNIFER J MD	11/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131291	01	General Practice	0	In state provider	None	3100 TELEGRAPH AVE	SUITE 2102	OAKLAND	CA	94609	3210	01	06001	37.82037533	-122.2667839	Alameda County
227464	Fee-for-Service	1659490308	1659490308	1	1	LA MAESTRA FAMILY CLINIC INC	10/29/2004	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	4305 UNIVERSITY AVE	STE 150	SAN DIEGO	CA	92105	1690	37	06073	32.74957853	-117.101439	San Diego County
227488	Fee-for-Service	1447367669	1447367669	1	1	LANG, GREGORY S MD	2/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	70868	01	General Practice	0	In state provider	None	2971 OLIVE HWY	None	OROVILLE	CA	95966	6109	04	06007	39.50299062	-121.5396004	Butte County
227523	Fee-for-Service	1750443420	1750443420	1	1	LAHANA, LISETTE R LCSW	4/27/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
227544	Fee-for-Service	1528121126	1528121126	1	1	LIN, THEODORE K MD	12/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108992	18	Ophthalmology	0	In state provider	None	1810 FULLERTON AVE	STE 206	CORONA	CA	92881	3110	33	06065	33.85971	-117.5503495	Riverside County
227547	Fee-for-Service	1417048406	1417048406	1	1	LUNA, JENNELYN PT	12/14/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1626 SWEETWATER ROAD	SUITES A & B	NATIONAL CITY	CA	91950	7645	37	06073	32.66147525	-117.0818981	San Diego County
227565	Fee-for-Service	1063497980	1063497980	1	1	LEVITAN, LYNNE ANN MD	8/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79213	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
227588	Fee-for-Service	1003555871	1003555871	1	1	LUI, TIFFANY OT	1/9/2023	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12900B GARDEN GROVE BLVD	STE. 235	GARDEN GROVE	CA	92843	2018	30	06059	33.77433148	-117.9075735	Orange County
227623	Fee-for-Service	1841337045	1841337045	1	1	LING, STEPHEN E MD	2/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	61961	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
227632	Fee-for-Service	1063063386	1063063386	1	1	LEANO, THERESE M CRNA	9/22/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
227633	Fee-for-Service	1710967310	1710967310	1	1	LIAO, WENNIE C MD	12/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87414	07	Dermatology	0	In state provider	None	2950 RESEARCH PARK DRIVE	None	SOQUEL	CA	95073	2000	44	06087	36.98692657	-121.9685264	Santa Cruz County
227652	Fee-for-Service	1508849928	1508849928	1	1	LUDWICK, JOSEPH M MD	4/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3006 S MARYLAND PKWY	STE 690	LAS VEGAS	NV	89109	2297	00	None	36.135288	-115.1368705	Clark County
227661	Fee-for-Service	1922345412	1922345412	1	1	LAM, MICHELLE K CNP	6/21/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
227752	Fee-for-Service	1215186598	1215186598	1	1	LEE, LINA OD	1/5/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 SYLVAN AVE	SUITE A	MODESTO	CA	95350	1693	50	06099	37.68896459	-120.979468	Stanislaus County
227775	Fee-for-Service	1447367669	1447367669	1	1	LANG, GREGORY S MD	2/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	70868	34	Urology and Urological Surgery	0	In state provider	None	2971 OLIVE HWY	None	OROVILLE	CA	95966	6109	04	06007	39.50299062	-121.5396004	Butte County
227779	Fee-for-Service	1114960945	1114960945	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6378 COMMERCE BLVD	None	ROHNERT PARK	CA	94928	2404	49	06097	38.3464523	-122.7095907	Sonoma County
227834	Fee-for-Service	1043746639	1043746639	1	2	LE, KHOI M MD	12/31/2020	207R00000X	NA	Other	026	PHYSICIANS	159331	None	None	0	In state provider	None	3330 LOMITA BLVD	CARDIOLOGY DEPARTMENT	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
227870	Fee-for-Service	1174567523	1174567523	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1043 EMERALD BAY RD	None	SOUTH LAKE TAHOE	CA	96150	6210	09	06017	38.91175542	-120.0036697	El Dorado County
227916	Fee-for-Service	1033643135	1033643135	1	1	LEE, LILY DO	6/14/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
227920	Fee-for-Service	1558787804	1558787804	1	1	LEON, TATIANA V CCC-SLP	9/21/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5250 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91601	3186	19	06037	34.1665161	-118.3755868	Los Angeles County
227922	Fee-for-Service	1225188808	1225188808	1	1	LOS ANGELES ENDOSCOPY CENTER	7/30/2018	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	266 S HARVARD BLVD	STE 200	LOS ANGELES	CA	90004	4339	19	06037	34.069221	-118.3041245	Los Angeles County
227926	Fee-for-Service	1144263930	1144263930	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	348 GELLERT BLVD	None	DALY CITY	CA	94015	2611	41	06081	37.66670877	-122.4688569	San Mateo County
227927	Fee-for-Service	1427534304	1427534304	1	1	LAM, LINA U NP	5/11/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3501 S HARBOR BLVD	None	SANTA ANA	CA	92704	6919	30	06059	33.69981147	-117.9194272	Orange County
227941	Fee-for-Service	1508849928	1508849928	1	1	LUDWICK, JOSEPH M MD	4/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	3006 S MARYLAND PKWY	STE 690	LAS VEGAS	NV	89109	2297	00	None	36.135288	-115.1368705	Clark County
227966	Fee-for-Service	1922430495	1922430495	1	1	LIMCHAIYAWAT, PAULA T OD	6/13/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9333 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2141	19	06037	33.90413858	-118.1346616	Los Angeles County
228006	Fee-for-Service	1013047224	1013047224	1	1	LEE, ANNE H LMFT	2/19/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
228019	Fee-for-Service	1043694052	1043694052	1	1	LOS ANGELES CENTERS FOR	12/24/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	ALCOHOL AND DRUG ABUSE	9515 HANEY STREET	None	PICO RIVERA	CA	90660	3622	19	06037	33.98268775	-118.0862399	Los Angeles County
228032	Fee-for-Service	1598097651	1598097651	1	1	LOPEZ, CARLOS LCSW	6/12/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 E ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
228033	Fee-for-Service	1861460990	1861460990	2	1	LAXER, KENNETH D MD	4/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	28500	13	Neurology (M.D. only)	0	In state provider	None	2100 WEBSTER ST	STE 115	SAN FRANCISCO	CA	94115	2379	38	06075	37.7904826	-122.4324477	San Francisco County
228062	Fee-for-Service	1477596054	1477596054	1	1	LIANG, YONG Y MD	5/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79056	08	Family Practice	0	In state provider	DR YON LIANG MED OFFICE	888 N HILL ST	None	LOS ANGELES	CA	90012	2321	19	06037	34.06401134	-118.2388998	Los Angeles County
228082	Fee-for-Service	1053408021	1053408021	1	1	LUISI, MARCIA A MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	61709	25	Physical Medicine and Rehabilitation	0	In state provider	None	990 SONOMA AVE	STE 3	SANTA ROSA	CA	95404	4813	49	06097	38.439729	-122.701545	Sonoma County
228111	Fee-for-Service	1396499430	1396499430	1	1	LEWELLYN, ANNETTE CMF	5/3/2022	224900000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2500 MOWRY AVE	SUITE #130	FREMONT	CA	94538	1605	01	06001	37.555011	-121.9801005	Alameda County
228124	Fee-for-Service	1861490559	1861490559	1	1	LECKIE, ROBERT G MD	3/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86763	30	Radiology	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
228137	Fee-for-Service	1720199052	1720199052	1	1	LINK, NAN ABRA MD	5/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43967	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
228196	Fee-for-Service	1710257597	1710257597	1	1	LOPEZ, TIMOTHY J MD	10/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139216	41	Internal Medicine	0	In state provider	None	675 ARROYO PKWY	None	PASADENA	CA	91105	3263	19	06037	34.13385453	-118.1474229	Los Angeles County
228197	Fee-for-Service	1972551786	1972551786	1	1	LUO, YING MD	6/2/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79124	08	Family Practice	0	In state provider	None	1015 E MAIN ST	None	TURLOCK	CA	95380	3406	50	06099	37.50297054	-120.8343858	Stanislaus County
228219	Fee-for-Service	1174671028	1174671028	1	1	LEE, JON P MD	1/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94430	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
228271	Fee-for-Service	1811495948	1811495948	1	1	LEAHY, DIEP H CNP	10/18/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2791 AGOURA RD	None	THOUSAND OAKS	CA	91361	3101	56	06111	34.15068671	-118.8255597	Ventura County
228279	Fee-for-Service	1508228115	1508228115	1	1	LAWLER, SCOTT M MD	7/7/2020	207R00000X	NA	Other	026	PHYSICIANS	163075	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
228282	Fee-for-Service	1770661829	1770661829	1	1	LEWIS, DANIEL R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	19975	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
228284	Fee-for-Service	1437171543	1437171543	1	1	LOMI SCHOOL FOUNDATION	7/22/2014	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	534 B ST	None	SANTA ROSA	CA	95401	5211	49	06097	38.44296	-122.7177585	Sonoma County
228323	Fee-for-Service	1902003460	1902003460	1	1	LOVELAND, KERRY L MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124705	20	Orthopedic Surgery	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
228352	Fee-for-Service	1548490162	1548490162	1	1	LOEB, TEOMA L	7/21/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
228369	Fee-for-Service	1053408021	1053408021	1	1	LUISI, MARCIA A MD	7/1/2004	208100000X	NA	Physical Medicine and Rehabilitation	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	990 SONOMA AVE	STE 3	SANTA ROSA	CA	95404	4813	49	06097	38.439729	-122.701545	Sonoma County
228423	Fee-for-Service	1598056939	1598056939	1	1	LEE, LEANNA M MD	12/1/2015	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	11175 CAMPUS ST	CP-A1121	LOMA LINDA	CA	92354	3450	36	06071	34.05060717	-117.2656018	San Bernardino County
228429	Fee-for-Service	1023541752	1023541752	1	1	LABANIEH, HISHAM A MD	12/9/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	167286	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
228477	Fee-for-Service	1659302230	1659302230	1	1	LAVADIA, CYNTHIA V MD	12/1/2001	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45839	None	None	0	In state provider	None	100 E VALENCIA MESA DR	STE 100	FULLERTON	CA	92835	3816	30	06059	33.89343304	-117.9279349	Orange County
228495	Fee-for-Service	1154610327	1154610327	1	1	LAU, BRIAN C MD	8/6/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	132046	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
228539	Fee-for-Service	1679685150	1679685150	1	1	LONG,ANN MARY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	460 MYLAN PARK LANE	None	MORGANTOWN	WV	26501	2243	00	None	39.63776756	-80.03415629	Monongalia County
228542	Fee-for-Service	1942322862	1942322862	1	1	LING, EDGAR H MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85297	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
228549	Fee-for-Service	1225585938	1225585938	1	1	LUCAS, LINDA S LMFT	11/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1740 PLUM LN	STE B	REDLANDS	CA	92374	0109	36	06071	34.06899169	-117.2145582	San Bernardino County
228555	Fee-for-Service	1346380482	1346380482	1	1	LEE, AMANDA C MD	6/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139318	41	Internal Medicine	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91350	1847	56	06111	34.2064445	-118.8824085	Ventura County
228603	Fee-for-Service	1962437772	1962437772	1	1	LOUANNE JONES	4/19/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
228612	Fee-for-Service	1962989293	1962989293	1	1	LEGACY HOSPICE LLC	6/11/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	146 N SAN FERNANDO BLVD	SUITE 219	BURBANK	CA	91502	1238	19	06037	34.18151411	-118.30954	Los Angeles County
228642	Fee-for-Service	1306209796	1306209796	1	1	LUTTRELL, JOHN T MD	7/1/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	154344	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
228668	Fee-for-Service	1073260691	1073260691	1	1	LUNA, KRISTENE V LCSW	6/14/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
228695	Fee-for-Service	1760935845	1760935845	1	1	LIN, JIM K	7/1/2019	207R00000X	NA	Other	026	PHYSICIANS	161182	41	Internal Medicine	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
228696	Fee-for-Service	1184770976	1184770976	1	1	LINDSAY, JANE LOUISE	8/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	80035	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
228697	Fee-for-Service	1871557330	1871557330	1	1	LONGWAY, SHARON R MD	7/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	54419	22	Pathology (M.D. only)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
228711	Fee-for-Service	1598056939	1598056939	1	1	LEE, LEANNA M MD	8/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122078	40	Pediatrics	0	In state provider	None	11175 CAMPUS ST	CP-A1121	LOMA LINDA	CA	92354	3450	36	06071	34.05060717	-117.2656018	San Bernardino County
228725	Fee-for-Service	1821451964	1821451964	1	1	LIGUORI, ELLEN F NP	10/29/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	58471 29 PALMS HWY	STE 201	YUCCA VALLEY	CA	92284	5818	36	06071	34.13270029	-116.3881647	San Bernardino County
228758	Fee-for-Service	1073829909	1073829909	1	1	LEE, SUJIN MD	3/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121810	25	Physical Medicine and Rehabilitation	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
228793	Fee-for-Service	1568088110	1568088110	1	1	LEROUX, IVAN MD	8/11/2023	207R00000X	NA	Other	026	PHYSICIANS	183662	None	None	0	In state provider	None	10 CONGRESS ST	STE 208	PASADENA	CA	91105	3027	19	06037	34.13396893	-118.1528162	Los Angeles County
228807	Fee-for-Service	1558741389	1558741389	1	1	LI, LI C OD	11/2/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	563 N MOUTAIN AVE	None	UPLAND	CA	91786	5016	36	06071	34.100505	-117.6703307	San Bernardino County
228829	Fee-for-Service	1942322862	1942322862	1	1	LING, EDGAR H MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85297	04	Otology, Laryngology, Rhinology	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
228873	Fee-for-Service	1154777480	1154777480	1	1	LEE, BRANDON K DO	7/1/2020	207P00000X	NA	Other	026	PHYSICIANS	17907	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
228883	Fee-for-Service	1548423601	1548423601	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5495 LA JOLLA BLVD	None	LA JOLLA	CA	92037	7649	37	06073	32.81224264	-117.267873	San Diego County
228897	Fee-for-Service	1205839974	1205839974	1	1	LUKSCHU, MICHAEL L MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86271	40	Pediatrics	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
228902	Fee-for-Service	1962989293	1962989293	1	1	LEGACY HOSPICE LLC	6/11/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	146 N SAN FERNANDO BLVD	SUITE 219	BURBANK	CA	91502	1238	19	06037	34.18151411	-118.30954	Los Angeles County
228917	Fee-for-Service	1508012501	1508012501	1	1	LYDA, JAMES L PHD	7/22/2020	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	409 13TH	STE 1900	OAKLAND	CA	94612	2605	01	06001	37.80326679	-122.2707988	Alameda County
228938	Fee-for-Service	1508972456	1508972456	2	1	LTL CO OF MARY SAN PEDRO	8/2/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	LTL CO OF MRY SN PED HSP	1300 WEST 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
228957	Fee-for-Service	1720250079	1720250079	1	1	LEE, MIN K MD	9/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101662	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	20034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
228964	Fee-for-Service	1962898783	1962898783	1	1	LEGGE, JOHN D MD	8/6/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	160797	13	Neurology (M.D. only)	0	In state provider	None	47647 CALEO BAY DR	SUITE 101	LA QUINTA	CA	92253	8857	33	06065	33.70305235	-116.2936509	Riverside County
228967	Fee-for-Service	1154572345	1154572345	1	1	LEWIS, ERICA J MD	4/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109167	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
228974	Fee-for-Service	1598889081	1598889081	1	1	LODI OBSTETRICS &	9/17/1985	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	GYNECOLOGY MEDICAL GROUP	999 S FAIRMONT AVE	STE 200	LODI	CA	95240	5141	39	06077	38.1206163	-121.2858323	San Joaquin County
228991	Fee-for-Service	1417215179	1417215179	1	1	LE, PHUONG H MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126623	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
229022	Fee-for-Service	1538534946	1538534946	1	1	LOS PALOS GASTROENTEROLOGY S	8/3/2022	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PECIALISTS INC	1083 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65821658	-121.6450795	Monterey County
229025	Fee-for-Service	1053315739	1053315739	1	1	LIVINGSTON MEMORIAL VNA	12/1/1977	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	1996 EASTMAN AVE	STE 101	VENTURA	CA	93003	7789	56	06111	34.25489954	-119.2300167	Ventura County
229060	Fee-for-Service	1114943859	1114943859	1	1	LEWIS, JUDY D LMFT	9/7/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	330 S FAIRMONT AVE	7	LODI	CA	95240	3843	39	06077	38.12892266	-121.2858458	San Joaquin County
229084	Fee-for-Service	1598001661	1598001661	1	1	LAREAU-MEREDITH, BENNETT NP	11/7/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
229085	Fee-for-Service	1528049251	1528049251	1	1	LERNER, STUART A MD	9/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	32444	26	Psychiatry (child)	0	In state provider	None	3721 OCEANHILL WAY	None	MALIBU	CA	90265	5639	19	06037	34.04524254	-118.5722369	Los Angeles County
229090	Fee-for-Service	1841688041	1841688041	1	1	LEWIS, CASSIE M NP	10/31/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7500 HOSPITAL DRIVE	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
229103	Fee-for-Service	1912481961	1912481961	1	1	LIANG, PATRICIA OD	6/21/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8275 SIERRA AVE.	SUITE 103	FONTANA	CA	92335	3557	36	06071	34.103448	-117.435754	San Bernardino County
229120	Fee-for-Service	1255406187	1255406187	1	1	LIN, DARLENE D MD	11/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96223	34	Urology and Urological Surgery	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
229142	Fee-for-Service	1235318015	1235318015	1	1	LO, ANGUS MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	63413	41	Internal Medicine	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
229168	Fee-for-Service	1487732582	1487732582	1	1	LEAVITT, ANDREW M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29791	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
229187	Fee-for-Service	1154926418	1154926418	1	1	LIYANAGE, MONICA NP	4/17/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7677 CENTER AVE	STE 214	HUNTINGTON BEACH	CA	92647	9102	30	06059	33.736257	-117.995535	Orange County
229202	Fee-for-Service	1063795938	1063795938	1	1	LEE, JAMES MD	4/23/2018	207ZP0102X	NA	Other	026	PHYSICIANS	123221	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	25 S RAYMOND AVE STE 113	None	ALHAMBRA	CA	91801	7143	19	06037	34.09042452	-118.1450725	Los Angeles County
229216	Fee-for-Service	1528402336	1528402336	1	1	LAKE COUNTY TRIBAL HEALTH	11/17/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CONSORTIUM INC	925 BEVINS CT	None	LAKEPORT	CA	95453	9754	17	06033	39.03772106	-122.9223338	Lake County
229250	Fee-for-Service	1790980969	1790980969	2	1	LIFELINK HEALTH PROVIDERS	3/7/2012	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	211 W FOOTHILL BLVD	SUITE A	GLENDORA	CA	91741	3357	19	06037	34.13603747	-117.8672175	Los Angeles County
229262	Fee-for-Service	1780768077	1780768077	1	1	LE, AN V	4/30/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1801 PARK COURT	STE E105	SANTA ANA	CA	92701	5039	30	06059	33.74986153	-117.8429355	Orange County
229285	Fee-for-Service	1033400163	1033400163	1	1	LOW, JUSTIN T MD	10/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129437	41	Internal Medicine	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
229323	Fee-for-Service	1710279138	1710279138	1	1	LIN, MAX CHUNG M D	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	93809	05	Anesthesiology	0	In state provider	PROFESSIONAL CORPORATION	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
229366	Fee-for-Service	1457399925	1457399925	1	1	LYONS GAFFANEY, CECILIA	4/25/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	62139	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3325 PALO VERDE AVE	STE 105	LONG BEACH	CA	90808	4132	19	06037	33.81701249	-118.1078791	Los Angeles County
229440	Fee-for-Service	1629260864	1629260864	1	1	LEE, WILLIAM M MD	7/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100561	02	General Surgery	0	In state provider	None	1520 SAN PABLO STREET	SUITE 4300	LOS ANGELES	CA	90033	5330	19	06037	34.06269295	-118.2030006	Los Angeles County
229473	Fee-for-Service	1497009245	1497009245	1	1	LOS ANGELES CHRISTIAN HEALTH	6/30/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTERS	1920 MARENGO ST	None	LOS ANGELES	CA	90033	1317	19	06037	34.05751768	-118.2095235	Los Angeles County
229487	Fee-for-Service	1679346639	1679346639	1	1	LIVIA ADULT DAY CARE	3/12/2025	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	18331 SHERMAN WAY	None	RESEDA	CA	91335	4425	19	06037	34.20120646	-118.533114	Los Angeles County
229532	Fee-for-Service	1336823293	1336823293	1	1	LI, WAN CHEN	7/18/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
229549	Fee-for-Service	1356550586	1356550586	1	1	LIPPE, JOYCE E MD	9/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126672	40	Pediatrics	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95661	2912	31	06061	38.74730831	-121.2613758	Placer County
229558	Fee-for-Service	1265664338	1265664338	1	1	LEE, JEFFREY W	1/3/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
229577	Fee-for-Service	1144266123	1144266123	1	1	LEV, RONEET MD	10/30/1990	207P00000X	NA	Other	026	PHYSICIANS	48648	None	None	0	In state provider	None	1688 E MAIN ST	None	EL CAJON	CA	92021	5204	37	06073	32.81173156	-116.9190219	San Diego County
229579	Fee-for-Service	1053896100	1053896100	1	1	LOCKETT, TIAWNY B LCSW	7/5/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16195 SISKIYOU RD.	120B	APPLE VALLEY	CA	92307	1346	36	06071	34.54549098	-117.2671509	San Bernardino County
229581	Fee-for-Service	1265698104	1265698104	1	1	LISENBEY, GENEVIEVE LMFT	12/4/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
229586	Fee-for-Service	1750351268	1750351268	1	1	LONGACRE, AMY L OD	6/1/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3901B SANTA RITA RD	None	PLEASANTON	CA	94588	3462	01	06001	37.69535683	-121.8775886	Alameda County
229592	Fee-for-Service	1982851804	1982851804	1	1	LEE, SANDY C MD	5/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104945	30	Radiology	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5317	19	06037	34.06269295	-118.2030006	Los Angeles County
229611	Fee-for-Service	1891728531	1891728531	1	1	LOREDO, JOSE S MD	1/31/1993	207RC0200X	NA	Other	026	PHYSICIANS	67450	01	General Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
229642	Fee-for-Service	1699712927	1699712927	1	1	LIN, BEELEIN MD	1/13/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	88217	18	Ophthalmology	0	In state provider	None	320 S. GARFIELD AVE.	SUITE 226	ALHAMBRA	CA	91801	3886	19	06037	34.09184212	-118.1245127	Los Angeles County
229683	Fee-for-Service	1336404235	1336404235	1	2	LARS ANKER M.D. A MEDICAL CO	4/30/2018	193400000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	RPORATION	1310 W STEWART DR	212	ORANGE	CA	92868	3854	30	06059	33.78236048	-117.8664975	Orange County
229694	Fee-for-Service	1346253390	1346253390	1	1	LIEBHABER, MYRON I MD	7/20/1976	207K00000X	NA	Other	026	PHYSICIANS	25873	08	Family Practice	0	In state provider	None	2501 MIDDLEFIELD RD	None	REDWOOD CITY	CA	94063	2825	41	06081	37.47878043	-122.2145154	San Mateo County
229737	Fee-for-Service	1316206832	1316206832	1	1	LAN, HOWARD W DO	7/31/2019	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	13025	41	Internal Medicine	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
229757	Fee-for-Service	1497009245	1497009245	1	1	LOS ANGELES CHRISTIAN HEALTH	6/30/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTERS	1920 MARENGO ST	None	LOS ANGELES	CA	90033	1317	19	06037	34.05751768	-118.2095235	Los Angeles County
229778	Fee-for-Service	1073596912	1073596912	1	1	LU, HERMAN D MD	7/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55284	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4500 BROCKTON AVE	315	RIVERSIDE	CA	92501	4028	33	06065	33.97785263	-117.3836152	Riverside County
229793	Fee-for-Service	1801023155	1801023155	1	1	LAM, WENDY S DO	11/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11499	08	Family Practice	0	In state provider	None	2020 SUTTER PLACE	STE 101	DAVIS	CA	95616	6217	57	06113	38.56287659	-121.7715536	Yolo County
229814	Fee-for-Service	1013935089	1013935089	1	1	LUBLINER, GUY H MD	6/21/2001	207RI0008X	NA	Gastroenterology	026	PHYSICIANS	75269	41	Internal Medicine	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
229815	Fee-for-Service	1326192055	1326192055	1	1	LEE CSAPOSS, KATHRYN S	7/9/2007	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2030 SUTTER PL	STE 1000	DAVIS	CA	95616	6201	57	06113	38.56292466	-121.7715423	Yolo County
229835	Fee-for-Service	1609044569	1609044569	1	1	LIBERTY DIALYSIS NW RENO LLC	2/23/2011	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	None	6144 MAE ANN AVENUE	None	RENO	NV	89523	4700	00	None	39.52886262	-119.8844301	Washoe County
229898	Fee-for-Service	1891728531	1891728531	1	1	LOREDO, JOSE S MD	1/31/1993	207RC0200X	NA	Other	026	PHYSICIANS	67450	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
229908	Fee-for-Service	1477763829	1477763829	1	1	LEE, THOMAS T MD INC	10/31/1991	207VM0101X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	GRAND MED GRP OB/GYN INC	703 EAST E ST	None	ONTARIO	CA	91764	4196	36	06071	34.068429	-117.6411555	San Bernardino County
229928	Fee-for-Service	1598951311	1598951311	1	1	LEE, VERONIQUE PSYD	6/17/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
229939	Fee-for-Service	1528599214	1528599214	1	1	LEGEROS, SHELBY MD	10/19/2021	207P00000X	NA	Other	026	PHYSICIANS	160700	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
229958	Fee-for-Service	1073909651	1073909651	1	1	LEE, SANDRINE DO	10/10/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15068	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
229961	Fee-for-Service	1366761447	1366761447	1	1	LIN, RENEE L MD	1/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11171	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
229971	Fee-for-Service	1053324715	1053324715	1	1	LOS ANGELES COUNTY	4/28/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	HUDSON FAMILY PLANNING	2829 S GRAND AVE	None	LOS ANGELES	CA	90007	3304	19	06037	34.02452751	-118.2735513	Los Angeles County
229991	Fee-for-Service	1780139030	1780139030	1	1	LEE, CHARLIE	10/31/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
230025	Fee-for-Service	1316206832	1316206832	1	1	LAN, HOWARD W DO	7/31/2019	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	13025	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
230054	Fee-for-Service	1639238462	1639238462	1	1	LONGHURST, CHRISTOPHER A	7/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80051	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
230069	Fee-for-Service	1215191051	1215191051	1	1	LYON, KIRSTIN O LMFT	1/23/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27871 BERWICK DR	None	CARMEL	CA	93923	8555	27	06053	36.52206982	-121.8086305	Monterey County
230090	Fee-for-Service	1366856304	1366856304	1	1	LOPEZ, MARCO OLIVER D NP	5/6/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
230129	Fee-for-Service	1053841387	1053841387	1	1	LIU, JESSIE MD	8/10/2018	390200000X	NA	Other	026	PHYSICIANS	157344	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
230172	Fee-for-Service	1447309513	1447309513	1	1	LEE, CARRIE G LCSW	7/31/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
230246	Fee-for-Service	1326011503	1326011503	1	1	LOPEZ, J ANTONIO MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	56032	41	Internal Medicine	0	In state provider	None	5301 F ST	STE 117	SACRAMENTO	CA	95819	3220	34	06067	38.571354	-121.4368695	Sacramento County
230271	Fee-for-Service	1972323095	1972323095	1	1	LEIGH, CHRISTIAN PT	1/31/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
230335	Fee-for-Service	1992732606	1992732606	1	1	LEVINE, NEIL D MD	4/29/1999	207R00000X	NA	Other	026	PHYSICIANS	64553	None	None	0	In state provider	None	910 SYCAMORE AVE	STE 270	VISTA	CA	92081	7852	37	06073	33.15991913	-117.2205623	San Diego County
230348	Fee-for-Service	1033133434	1033133434	1	1	LEVINE, DAVID H	5/31/1989	207L00000X	NA	Other	026	PHYSICIANS	65577	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
230349	Fee-for-Service	1508924788	1508924788	1	1	LARA, FIDEL M JR MD	10/22/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69653	None	None	0	In state provider	LARA MEDICAL CLINIC INC	8033 VINELAND AVE	None	SUN VALLEY	CA	91352	3951	19	06037	34.21705161	-118.3703599	Los Angeles County
230402	Fee-for-Service	1477047629	1477047629	1	1	LOEZA, JOANA MD	9/26/2019	390200000X	NA	Other	026	PHYSICIANS	164607	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
230425	Fee-for-Service	1255592390	1255592390	1	1	LUEDEMAN, MICHAEL S MD	12/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
230468	Fee-for-Service	1669489571	1669489571	1	1	LOMA LINDA KIDNEY CENTER	9/1/1991	282N00000X	NA	Hospitals	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	11375 ANDERSON ST	None	LOMA LINDA	CA	92354	3407	36	06071	34.046865	-117.2610915	San Bernardino County
230475	Fee-for-Service	1942419544	1942419544	1	1	LIFSHUTZ-GRINBERG, JESSICA B	8/9/2010	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	18661 OLD COAST HIGHWAY	None	FORT BRAGG	CA	95437	8260	23	06045	39.41472517	-123.8094471	Mendocino County
230485	Fee-for-Service	1427032630	1427032630	1	1	LEE, JOHN S MD	10/8/2008	2086X0206X	NA	General Surgery	026	PHYSICIANS	87978	02	General Surgery	0	In state provider	None	1020 29TH ST	STE 580	SACRAMENTO	CA	95816	5216	34	06067	38.572803	-121.4685	Sacramento County
230514	Fee-for-Service	1841291648	1841291648	1	1	LIN, HUABAO B MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82992	05	Anesthesiology	0	In state provider	None	332 S JUNIPER ST	STE 108	ESCONDIDO	CA	92025	4941	37	06073	33.12066536	-117.0770413	San Diego County
230536	Fee-for-Service	1326011503	1326011503	1	1	LOPEZ, J ANTONIO MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	56032	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5301 F ST	STE 117	SACRAMENTO	CA	95819	3220	34	06067	38.571354	-121.4368695	Sacramento County
230558	Fee-for-Service	1508985565	1508985565	1	1	LEVINE, BENJAMIN D MD	7/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89503	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
230575	Fee-for-Service	1528010451	1528010451	1	1	LAKEVIEW HOSP	8/9/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	630 MEDICAL DR	None	BOUNTIFUL	UT	84010	4908	00	None	40.88671331	-111.8683023	Davis County
230588	Fee-for-Service	1750645743	1750645743	1	2	LAFRENIERRE, STEFANI MD	12/30/2024	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	127530	-	NOT APPLICABLE	0	In state provider	None	68 RIO RANCHO RD	UNIT 201-202	POMONA	CA	91766	4898	19	06037	34.02838295	-117.7610355	Los Angeles County
230592	Fee-for-Service	1487115929	1487115929	1	1	LAM, DAVID MD	9/27/2022	207P00000X	NA	Other	026	PHYSICIANS	177162	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
230613	Fee-for-Service	1235245275	1235245275	1	1	LA CLINICA DE LA RAZA	8/21/2006	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CLINICA ALTA VISTA	1515 FRUITVALE AVE	None	OAKLAND	CA	94601	2355	01	06001	37.77910723	-122.2251233	Alameda County
230624	Fee-for-Service	1154369924	1154369924	1	1	LINDENBERG, DANIA J MD	6/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92094	40	Pediatrics	0	In state provider	DR BANUELOS	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
230661	Fee-for-Service	1417248758	1417248758	1	1	LEE, HEATHER N MD	9/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126670	41	Internal Medicine	0	In state provider	None	3687 MT DIABLO BLVD	200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
230670	Fee-for-Service	1316188543	1316188543	1	1	LA CLINICA DE LA RAZA INC	7/23/2009	261QF0400X	NA	Federally Qualified Health Center	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	50 E LEWELLING BLVD	None	SAN LORENZO	CA	94580	1732	01	06001	37.688571	-122.122539	Alameda County
230700	Fee-for-Service	1982668687	1982668687	1	1	LEE, PAUL P MD	3/31/1983	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	19090	30	Radiology	0	In state provider	None	10250 ARTESIA BLVD	None	BELLFLOWER	CA	90706	6720	19	06037	33.8728535	-118.1154555	Los Angeles County
230729	Fee-for-Service	1689307340	1689307340	1	1	LIU, ANGELA MD	3/15/2024	390200000X	NA	Other	026	PHYSICIANS	188887	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
230743	Fee-for-Service	1972753515	1972753515	1	1	LEVENZON, SERGIO MD INC	5/13/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	520 N MAIN ST	STE 100	SANTA ANA	CA	92701	4623	30	06059	33.749316	-117.868123	Orange County
230746	Fee-for-Service	1396595245	1396595245	1	1	LOMPOC SURGERY CENTER LLC	12/26/2024	208600000X	NA	General Surgery	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	215 N H ST	B	LOMPOC	CA	93436	6021	42	06083	34.641333	-120.457899	Santa Barbara County
230753	Fee-for-Service	1831296532	1831296532	1	1	LARSEN, HANS CRNA	3/29/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1000 GREENLEY ROAD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
230772	Fee-for-Service	1427032630	1427032630	1	1	LEE, JOHN S MD	10/8/2008	2086X0206X	NA	General Surgery	026	PHYSICIANS	87978	78	Neoplastic Diseases/Oncology	0	In state provider	None	1020 29TH ST	STE 580	SACRAMENTO	CA	95816	5216	34	06067	38.572803	-121.4685	Sacramento County
230776	Fee-for-Service	1043631294	1043631294	1	1	LAPSIWALA, PAREEN R DO	5/25/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18445	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
230834	Fee-for-Service	1043382864	1043382864	1	1	LATT, KYAW K MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	56263	41	Internal Medicine	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
230860	Fee-for-Service	1528010451	1528010451	1	1	LAKEVIEW HOSP	8/9/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	630 MEDICAL DR	None	BOUNTIFUL	UT	84010	4908	00	None	40.88671331	-111.8683023	Davis County
230862	Fee-for-Service	1508116955	1508116955	1	1	LIU, YING OD	5/7/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4353 LA JOLLA VILLAGE DR	SUITE H20	SAN DIEGO	CA	92122	1242	37	06073	32.870061	-117.2120625	San Diego County
230881	Fee-for-Service	1710574637	1710574637	1	1	LY, KIM M NP	2/4/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
230883	Fee-for-Service	1518969971	1518969971	1	1	LAM, EDDIE K MD	4/27/2006	207R00000X	NA	Other	026	PHYSICIANS	72336	41	Internal Medicine	0	In state provider	None	500 N GARFIELD AVE	STE 306-308	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
230900	Fee-for-Service	1235245275	1235245275	1	1	LA CLINICA DE LA RAZA	6/20/2005	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CLINICA ALTA VISTA	1515 FRUITVALE AVE	None	OAKLAND	CA	94601	2355	01	06001	37.77910723	-122.2251233	Alameda County
230926	Fee-for-Service	1780159806	1780159806	1	1	LE, DIEM-TRINH CNP	3/31/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	850 E FOOTHILL BLVD	None	RIALTO	CA	92376	5230	36	06071	34.10679449	-117.3542535	San Bernardino County
230928	Fee-for-Service	1659417483	1659417483	1	1	LOPEZ, JOSE A PHD	5/11/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
230930	Fee-for-Service	1730717737	1730717737	1	1	LI, LILIAN DO	10/5/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20729	None	None	0	In state provider	None	253 S DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	1606	19	06037	34.02108125	-117.8103432	Los Angeles County
230941	Fee-for-Service	1285676098	1285676098	2	1	LONGS DRUG STORES CA LLC	12/26/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1640 E HATCH RD	None	MODESTO	CA	95351	5017	50	06099	37.60918934	-120.9669364	Stanislaus County
230951	Fee-for-Service	1962107391	1962107391	1	1	LEPE ROMERO, JUAN LMSW	8/2/2023	106H00000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
230961	Fee-for-Service	1316188543	1316188543	1	1	LA CLINICA DE LA RAZA INC	7/23/2009	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	50 E LEWELLING BLVD	None	SAN LORENZO	CA	94580	1732	01	06001	37.688571	-122.122539	Alameda County
230999	Fee-for-Service	1952962896	1952962896	1	1	LYNCH, HANNAH K	4/20/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8120 TIMBERLAKE WAY	STE 211	SACRAMENTO	CA	95823	5414	34	06067	38.461023	-121.41414	Sacramento County
231013	Fee-for-Service	1144450917	1144450917	1	1	LOH, ERN MD	10/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109730	07	Dermatology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
231034	Fee-for-Service	1427381326	1427381326	1	1	LINTHICUM, JONATHAN J MD INC	8/31/2009	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	90405	20	Orthopedic Surgery	0	In state provider	None	84 MADRONE ST	None	WILLITS	CA	95490	4249	23	06045	39.40096275	-123.3520916	Mendocino County
231035	Fee-for-Service	1427130723	1427130723	1	1	LIM, ERIC G MD	1/1/1996	207R00000X	NA	Other	026	PHYSICIANS	81428	41	Internal Medicine	0	In state provider	None	1580 VALENCIA ST	STE 111	SAN FRANCISCO	CA	94110	4415	38	06075	37.74746923	-122.4202583	San Francisco County
231053	Fee-for-Service	1457748915	1457748915	1	1	LEICHTMAN, JENNIFER OT	10/17/2024	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	333 GELLERT BLVD	128	DALY CITY	CA	94015	2694	41	06081	37.66672018	-122.4685948	San Mateo County
231099	Fee-for-Service	1326810482	1326810482	1	1	L AND G NON EMERGENCY MEDICA	1/19/2024	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	L TRANSPORTATION, INC.	17419 FLANDERS ST	None	GRANADA HILLS	CA	91344	2211	19	06037	34.27996586	-118.5131421	Los Angeles County
231120	Fee-for-Service	1225047475	1225047475	1	1	LALOR, JULIE B PHD	10/24/2006	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8772 CUYAMACA ST	SUITE 104	SANTEE	CA	92071	4218	37	06073	32.83473094	-116.983917	San Diego County
231131	Fee-for-Service	1154978559	1154978559	1	1	LIVING STONES HOSPICE CARE	3/16/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	LLC	960 W SAN MARCOS BLVD	SUITE 220	SAN MARCOS	CA	92078	1148	37	06073	33.13514201	-117.1869714	San Diego County
231141	Fee-for-Service	1366479446	1366479446	1	1	LI, JOY M MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63655	40	Pediatrics	0	In state provider	None	2750 E WASHINGTON BLVD	STE 360	PASADENA	CA	91107	6203	19	06037	34.1680038	-118.0943955	Los Angeles County
231149	Fee-for-Service	1891395695	1891395695	1	1	LAU, CHRISTIE PT	5/1/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18 RANCHO CAMINO DR	STE 201	POMONA	CA	91766	7010	19	06037	34.0273637	-117.760137	Los Angeles County
231188	Fee-for-Service	1235245275	1235245275	1	1	LA CLINICA DE LA RAZA	6/20/2005	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CLINICA ALTA VISTA	1515 FRUITVALE AVE	None	OAKLAND	CA	94601	2355	01	06001	37.77910723	-122.2251233	Alameda County
231192	Fee-for-Service	1770590036	1770590036	1	1	LOMA LINDA UNIVERSITY	6/1/1983	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
231213	Fee-for-Service	1427082593	1427082593	1	1	LIU, REX C MD	1/2/2008	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	99743	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	330 S GARFIELD AVE	STE 208	ALHAMBRA	CA	91801	3893	19	06037	34.09137167	-118.1241735	Los Angeles County
231248	Fee-for-Service	1316188543	1316188543	1	1	LA CLINICA DE LA RAZA INC	7/23/2009	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	50 E LEWELLING BLVD	None	SAN LORENZO	CA	94580	1732	01	06001	37.688571	-122.122539	Alameda County
231305	Fee-for-Service	1104381235	1104381235	1	1	LEWIS, CORTINA RCP	12/30/2024	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
231326	Fee-for-Service	1104110592	1104110592	1	1	LU, JONI M DO	3/14/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	20538	None	None	0	In state provider	None	207 S SANTA ANITA ST	310	SAN GABRIEL	CA	91776	1146	19	06037	34.10072807	-118.1066296	Los Angeles County
231369	Fee-for-Service	1962677831	1962677831	1	1	LUNA, MARLEN MD	10/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117215	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
231400	Fee-for-Service	1104142884	1104142884	1	1	LORI KATHLEEN JOHNSON	2/4/2011	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	36937 MEADOWN BROOK WAY	None	BEAUMONT	CA	92223	8000	33	06065	33.95339237	-117.019147	Riverside County
231420	Fee-for-Service	1154978559	1154978559	1	1	LIVING STONES HOSPICE CARE	3/16/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	LLC	960 W SAN MARCOS BLVD	SUITE 220	SAN MARCOS	CA	92078	1148	37	06073	33.13514201	-117.1869714	San Diego County
231421	Fee-for-Service	1003163791	1003163791	1	1	LUMIA, CHARLIN A LMFT	9/20/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1210 CENTRAL BLVD	125	BRENTWOOD	CA	94513	2242	07	06013	37.93851243	-121.6981458	Contra Costa County
231423	Fee-for-Service	1881148831	1881148831	1	1	LOW, ANDREA LAC	4/4/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	6000 FAIRWAY DR	STE 2	ROCKLIN	CA	95677	4244	31	06061	38.79220243	-121.2621624	Placer County
231463	Fee-for-Service	1811374044	1811374044	1	1	LEIGHTON, MORGAN E MD	8/7/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169203	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
231474	Fee-for-Service	1952359259	1952359259	1	1	LATHAM, JOHN A MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69309	18	Ophthalmology	0	In state provider	None	1011 SYLVAN AVE	STE C	MODESTO	CA	95350	1693	50	06099	37.68896459	-120.979468	Stanislaus County
231476	Fee-for-Service	1831653872	1831653872	1	1	LIM, RYAN B RCP	2/15/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
231487	Fee-for-Service	1134271067	1134271067	1	1	LYASS, OLGA E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	93366	30	Radiology	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
231491	Fee-for-Service	1316507262	1316507262	1	1	LEVINE, SAMANTHA LCSW	6/20/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11303 WASHINGTON BLVD	SUITE 100	LOS ANGELES	CA	90095	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
231498	Fee-for-Service	1437125846	1437125846	1	1	LUKE, TIMOTHY A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89451	20	Orthopedic Surgery	0	In state provider	None	1101 B GALE WILSON BLVD	STE 106	FAIRFIELD	CA	94533	3771	48	06095	38.26103575	-122.0462501	Solano County
231500	Fee-for-Service	1205926367	1205926367	1	1	LOELIGER, SCOTT F MD	5/21/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	71388	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
231557	Fee-for-Service	1265876981	1265876981	1	1	LENZ, ALEXIS A G DO	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14510	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
231660	Fee-for-Service	1013072149	1013072149	1	1	LIU, DAVID S MD	12/26/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	89643	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
231706	Fee-for-Service	1104142884	1104142884	1	1	LORI KATHLEEN JOHNSON	2/4/2011	163W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	36937 MEADOWN BROOK WAY	None	BEAUMONT	CA	92223	8000	33	06065	33.95339237	-117.019147	Riverside County
231713	Fee-for-Service	1831426642	1831426642	1	21	LAKESIDE MEDICAL	4/13/2010	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	612 E JANSS ROAD	None	THOUSAND OAKS	CA	91360	5113	56	06111	34.19957051	-118.8666284	Ventura County
231758	Fee-for-Service	1356384689	1356384689	2	1	LONGS DRUG STORES CALFOR	9/16/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7465 RUSH RIVER DR	STE 500	SACRAMENTO	CA	95831	5270	34	06067	38.485881	-121.5347175	Sacramento County
231770	Fee-for-Service	1235510694	1235510694	1	1	LEE, JOSEPH B MD	1/16/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178894	None	None	0	In state provider	None	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	30	06059	33.80318951	-118.066068	Orange County
231782	Fee-for-Service	1235241225	1235241225	1	1	LA JOLLA DISCOUNT PHARM	10/8/1992	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9850 GENESEE AVE	STE 160	LA JOLLA	CA	92037	1226	37	06073	32.882913	-117.226341	San Diego County
231786	Fee-for-Service	1801202395	1801202395	1	1	LOPEZ, SARAH E OD	2/19/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
231792	Fee-for-Service	1205926367	1205926367	1	1	LOELIGER, SCOTT F MD	5/21/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	71388	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
231815	Fee-for-Service	1942216106	1942216106	1	1	LAM, VERONICA J OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	50 CABRILLO HWY N	STE 4	HALF MOON BAY	CA	94019	6105	41	06081	37.46940881	-122.4343269	San Mateo County
231847	Fee-for-Service	1780138701	1780138701	1	1	LEONG, DAVID T LMFT	10/5/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
231850	Fee-for-Service	1437105251	1437105251	1	1	LIM, GREGORY M MD	1/1/1994	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	71887	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
231928	Fee-for-Service	1710956016	1710956016	1	1	LIN, PAUL C OD	11/14/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2720 E PALMDALE BLVD	None	PALMDALE	CA	93550	4930	19	06037	34.58012347	-118.0800855	Los Angeles County
231933	Fee-for-Service	1902552003	1902552003	1	1	LILLIAN CHOI MD INC	4/27/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	None	None	0	In state provider	None	360 E YOSEMITE AVE	STE 300	MERCED	CA	95340	8201	24	06047	37.33211252	-120.464307	Merced County
231947	Fee-for-Service	1760978795	1760978795	1	1	LUU, KIMBERLY MD	9/19/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	162642	04	Otology, Laryngology, Rhinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
231972	Fee-for-Service	1821592379	1821592379	1	1	LOWE, SARINA C MD	5/9/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	164740	41	Internal Medicine	0	In state provider	None	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
232003	Fee-for-Service	1831426642	1831426642	1	21	LAKESIDE MEDICAL	4/13/2010	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	612 E JANSS ROAD	None	THOUSAND OAKS	CA	91360	5113	56	06111	34.19957051	-118.8666284	Ventura County
232015	Fee-for-Service	1881199008	1881199008	1	1	LAKIN, STACEY B MD	10/7/2022	207P00000X	NA	Other	026	PHYSICIANS	166587	None	None	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
232020	Fee-for-Service	1841348166	1841348166	1	1	LAURITZEN, DEREK B MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77319	None	None	0	In state provider	None	1270 PEACH ST	None	SAN LUIS OBISPO	CA	93401	2856	40	06079	35.28673322	-120.6595429	San Luis Obispo County
232038	Fee-for-Service	1932171022	1932171022	1	1	LAZDINS, ANDRIS J MD	4/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	37941	08	Family Practice	0	In state provider	None	433 W EATON AVE	None	TRACY	CA	95376	3420	39	06077	37.74339147	-121.4321389	San Joaquin County
232054	Fee-for-Service	1619237468	1619237468	1	1	LE, HUY Q MD	1/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127469	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
232070	Fee-for-Service	1588097679	1588097679	1	1	LIU, MICHAEL X MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132487	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
232100	Fee-for-Service	1144265547	1144265547	1	1	LEE, DON W MD AMC	9/1/2001	207RI0011X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	CALIFORNIA CARDIAC INST	710 S CENTRAL AVENUE	200,210,250	GLENDALE	CA	91204	4614	19	06037	34.13746423	-118.2578296	Los Angeles County
232119	Fee-for-Service	1922366780	1922366780	1	1	LEM, BRENT M MD	12/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119419	40	Pediatrics	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
232163	Fee-for-Service	1750645743	1750645743	1	1	LAFRENIERRE, STEFANI A MD	4/12/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	127530	36	Psychiatry	0	In state provider	None	595 E COLORADO BLVD STE	324	PASADENA	CA	91101	2021	19	06037	34.14588202	-118.1380722	Los Angeles County
232198	Fee-for-Service	1942465968	1942465968	1	1	LEE, PATRICK S OD	10/1/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3111 SAINT ALBANS DRIVE	None	LOS ALAMITOS	CA	90720	4504	30	06059	33.78905159	-118.0798134	Orange County
232260	Fee-for-Service	1821592379	1821592379	1	1	LOWE, SARINA C MD	5/9/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	164740	10	Gastroenterology (M.D. only)	0	In state provider	None	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
232281	Fee-for-Service	1841370244	1841370244	1	1	LEMKE, DANIEL S MD	11/21/2022	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
232283	Fee-for-Service	1609946060	1609946060	1	1	LINCOLN, KEVIN C	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
232286	Fee-for-Service	1578591517	1578591517	1	1	LEE, JONATHAN Y, MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	77838	None	None	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
232297	Fee-for-Service	1831426642	1831426642	1	20	LAKESIDE MEDICAL	4/13/2010	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3605 ALAMO STREET	SUITE 100	SIMI VALLEY	CA	93063	2186	56	06111	34.28647147	-118.726119	Ventura County
232307	Fee-for-Service	1346506359	1346506359	1	1	LOKKO, CARL MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150685	02	General Surgery	0	In state provider	None	11370 ANDERSON STREET	SUITE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
232324	Fee-for-Service	1386832939	1386832939	1	1	LIU, MELISSA L MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104483	08	Family Practice	0	In state provider	None	260 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
232329	Fee-for-Service	1891106464	1891106464	1	1	LUONG, HAN N DO	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14663	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
232345	Fee-for-Service	1275895203	1275895203	1	1	LABELLE, NATASHA P MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126562	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
232349	Fee-for-Service	1780007245	1780007245	1	1	LOPEZ, NATALIA CCC-SLP	5/23/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	745 E LOCUST AVE	STE. 110	FRESNO	CA	93720	3000	10	06019	36.84055248	-119.7718605	Fresno County
232363	Fee-for-Service	1952538340	1952538340	1	1	LIU, JUNE C MD	2/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117134	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
232364	Fee-for-Service	1013043942	1013043942	1	1	LOPEZ, SHERRY DO	11/24/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	7392	-	NOT APPLICABLE	0	In state provider	None	1646 S COURT STREET	None	VISALIA	CA	93277	4962	54	06107	36.315774	-119.2913235	Tulare County
232388	Fee-for-Service	1144265547	1144265547	1	1	LEE, DON W MD AMC	9/1/2001	207RI0011X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	42	Nuclear Medicine	0	In state provider	CALIFORNIA CARDIAC INST	710 S CENTRAL AVENUE	200,210,250	GLENDALE	CA	91204	4614	19	06037	34.13746423	-118.2578296	Los Angeles County
232395	Fee-for-Service	1306473186	1306473186	1	1	LEYSON, KRISTIE ANGELI A NP	9/30/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
232409	Fee-for-Service	1982919916	1982919916	1	1	LOWE, PHILLIP T PSYD	6/23/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY STREET	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
232432	Fee-for-Service	1578520763	1578520763	1	1	LUU, MICHAEL Q MD	8/31/1990	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	60018	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1060 E GREEN ST	STE 105	PASADENA	CA	91106	2413	19	06037	34.14454353	-118.1282715	Los Angeles County
232445	Fee-for-Service	1477634251	1477634251	1	1	LEWIS, TODD E MD	3/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	63048	40	Pediatrics	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
232446	Fee-for-Service	1184215030	1184215030	1	1	LEE, HANNAH LCSW	12/17/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
232465	Fee-for-Service	1124275268	1124275268	1	1	LONA, ADRIANNE MD	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112737	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
232481	Fee-for-Service	1619970480	1619970480	1	1	LEAHY, DENNIS R MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	29437	30	Radiology	0	In state provider	None	550 E GRAND AVE	None	ESCONDIDO	CA	92025	3306	37	06073	33.12444254	-117.0747678	San Diego County
232522	Fee-for-Service	1366741852	1366741852	1	1	LAHHAM, SHADI MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128379	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
232523	Fee-for-Service	1588696819	1588696819	1	1	LEE, MARK YUN MD	10/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82721	66	Emergency Medicine (Urgent Care)	0	In state provider	None	380 W CENTRAL AVE	None	BREA	CA	92821	3002	30	06059	33.93197087	-117.901779	Orange County
232528	Fee-for-Service	1619130218	1619130218	1	1	LEE, JAY H MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103704	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
232536	Fee-for-Service	1609362441	1609362441	1	1	LEE, GRACE E PHD	10/26/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
232552	Fee-for-Service	1962109033	1962109033	1	11	LOS ANGELES COUNTY DEPARTMEN	2/8/2024	261QP0905X	NA	Other	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	3834 S WESTERN AVE	None	LOS ANGELES	CA	90062	1104	19	06037	34.016157	-118.3088825	Los Angeles County
232560	Fee-for-Service	1144618760	1144618760	1	1	LOYA, PAUL E LMFT	4/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	S	73929 LARREA ST	SUITE 1B	PALM DESERT	CA	92260	4305	33	06065	33.71878454	-116.375094	Riverside County
232603	Fee-for-Service	1679063952	1679063952	1	1	LO, BONNIE	11/8/2023	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
232611	Fee-for-Service	1154697340	1154697340	1	1	LEE, WILSON T MD	9/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127387	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
232623	Fee-for-Service	1962988816	1962988816	1	1	LEMONCELLI, MEGAN PT	1/28/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	30428 HAUN RD.	STE. 810	MENIFEE	CA	92584	6824	33	06065	33.67819649	-117.1755448	Riverside County
232711	Fee-for-Service	1043722374	1043722374	1	1	LODESPOTO MEDICAL OF CALIFOR	4/27/2020	2085N0700X	NA	MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	NIA PC	8717 LA TIJERA BLVD	None	LOS ANGELES	CA	90045	3906	19	06037	33.95788109	-118.3936725	Los Angeles County
232753	Fee-for-Service	1073797221	1073797221	1	1	LIN, ALEXANDER Y MD	5/17/2022	208200000X	NA	General Surgery	026	PHYSICIANS	87415	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
232774	Fee-for-Service	1508218777	1508218777	1	1	LOSETH, CAITLIN MD	10/1/2024	2086S0127X	NA	General Surgery	026	PHYSICIANS	153306	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
232777	Fee-for-Service	1023020914	1023020914	1	1	LUNDIE ROBB MD	6/3/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2180 MAIN ST	None	WAILUKU	HI	96793	1625	00	None	20.88706871	-156.5045126	Maui County
232818	Fee-for-Service	1861655474	1861655474	1	1	LIU, DAVID D MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116548	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
232827	Fee-for-Service	1811981517	1811981517	1	1	LABIA, JOHN A MD	11/30/1992	207L00000X	NA	Other	026	PHYSICIANS	49110	05	Anesthesiology	0	In state provider	None	1900 POINT WEST WAY	STE 222	SACRAMENTO	CA	95815	4704	34	06067	38.599677	-121.431447	Sacramento County
232898	Fee-for-Service	1861417586	1861417586	1	1	LEE, LE-YOUNG	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	77879	None	None	0	In state provider	None	880 S ATLANTIC BLVD	STE 307	MONTEREY PARK	CA	91754	4700	19	06037	34.05038485	-118.1383456	Los Angeles County
232910	Fee-for-Service	1639155468	1639155468	1	1	LUBARSKY, LAURA A MD	11/30/1990	207RP1001X	NA	Pulmonology	026	PHYSICIANS	70164	01	General Practice	0	In state provider	None	1010 MURRAY AVE	None	SAN LUIS OBISPO	CA	93405	8800	40	06079	35.292168	-120.6658665	San Luis Obispo County
232918	Fee-for-Service	1770055634	1770055634	1	1	LIN, LINA RCP	8/29/2020	2278P3900X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
232952	Fee-for-Service	1265960512	1265960512	1	1	LOVE AND LIGHT COUNSELING	10/25/2017	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SERVICES	3505 LONG BEACH BLVD	STE 2D	LONG BEACH	CA	90807	3947	19	06037	33.82054429	-118.1893881	Los Angeles County
232957	Fee-for-Service	1942593702	1942593702	1	1	LE-NGUYEN, XUAN T MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150117	18	Ophthalmology	0	In state provider	None	11370 ANDERSON ST	STE 1800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
232960	Fee-for-Service	1336782481	1336782481	1	1	LAKESHORE HOSPICE INC	4/21/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	20700 VENTURA BLVD	STE 327	WOODLAND HILLS	CA	91364	6259	19	06037	34.16687239	-118.5840442	Los Angeles County
232969	Fee-for-Service	1396966636	1396966636	1	1	LIM, LILY A NP	10/18/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9333 E ROSECRANS AVE	None	BELLFLOWER	CA	90706	2141	19	06037	33.90413858	-118.1346616	Los Angeles County
233011	Fee-for-Service	1073801718	1073801718	1	1	LEE, DERRICK A MD	7/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141619	40	Pediatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
233028	Fee-for-Service	1356470058	1356470058	1	1	LIM ENG, GERALDINE A E OD	5/21/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 WEST VALLEY BLVD	SUITE 115	SAN GABRIEL	CA	91776	3784	19	06037	34.07958215	-118.1021957	Los Angeles County
233039	Fee-for-Service	1245353671	1245353671	1	1	LEE, CHUAN TUNG	5/1/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	RBS	2844 SUMMIT ST	STE 200	OAKLAND	CA	94609	3642	01	06001	37.81754276	-122.2646445	Alameda County
233042	Fee-for-Service	1578507505	1578507505	1	1	LEW, MARK F MD	10/31/1991	2084N0400X	NA	Neurology	026	PHYSICIANS	45068	13	Neurology (M.D. only)	0	In state provider	None	1510 SAN PABLO ST	STE 268	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
233058	Fee-for-Service	1700379716	1700379716	1	1	LIU, ANGELA J	10/18/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181433	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
233069	Fee-for-Service	1942230230	1942230230	1	1	LAMBERT, RHONDA E MD	3/31/1991	207RR0500X	NA	Other	026	PHYSICIANS	41349	83	Rheumatology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
233071	Fee-for-Service	1437110996	1437110996	1	1	LIN, RAY MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61565	30	Radiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
233090	Fee-for-Service	1396270278	1396270278	1	1	LIOTTA, BENJAMIN I MD	9/7/2020	207P00000X	NA	Other	026	PHYSICIANS	158160	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
233144	Fee-for-Service	1902978729	1902978729	1	1	LEE, DAHLIA M MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69794	20	Orthopedic Surgery	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
233163	Fee-for-Service	1639635154	1639635154	1	1	LOVE FOCUS INERNATIONAL	9/24/2021	No Taxonomy Provided	NA	None	095	PRIVATE NON-PROFIT PROPRIETARY AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	108 W ALEXANDER AVE	None	MERCED	CA	95348	3033	24	06047	37.31501241	-120.4714007	Merced County
233167	Fee-for-Service	1306917158	1306917158	1	1	LUCIO, SIMON J MD	10/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	72884	40	Pediatrics	0	In state provider	MEUMAYR, LYNNE MD INC	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
233181	Fee-for-Service	1922028810	1922028810	1	1	LEVERONI, GINA R LMFT	4/7/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	33387	-	NOT APPLICABLE	0	In state provider	None	401 S. STREET	None	SACRAMENTO	CA	95811	6919	34	06067	38.572677	-121.5050805	Sacramento County
233198	Fee-for-Service	1639155468	1639155468	1	1	LUBARSKY, LAURA A MD	11/30/1990	207RP1001X	NA	Pulmonology	026	PHYSICIANS	70164	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1010 MURRAY AVE	None	SAN LUIS OBISPO	CA	93405	8800	40	06079	35.292168	-120.6658665	San Luis Obispo County
233204	Fee-for-Service	1437112349	1437112349	1	1	LAYLE, STACEY L MD	4/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54351	08	Family Practice	0	In state provider	None	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
233220	Fee-for-Service	1730246984	1730246984	1	1	LIN, LEE-TZU MD	11/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	70872	41	Internal Medicine	0	In state provider	None	7275 E SOUTHGATE DR	STE 406	SACRAMENTO	CA	95823	2632	34	06067	38.493576	-121.436559	Sacramento County
233226	Fee-for-Service	1538494620	1538494620	1	1	LEY, BRETT J MD	4/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112254	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94123	2202	38	06075	37.76344756	-122.4581992	San Francisco County
233245	Fee-for-Service	1336782481	1336782481	1	1	LAKESHORE HOSPICE INC	4/21/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	20700 VENTURA BLVD	STE 327	WOODLAND HILLS	CA	91364	6259	19	06037	34.16687239	-118.5840442	Los Angeles County
233257	Fee-for-Service	1427254689	1427254689	1	1	LUIS G DIAZ RANGEL MD PA	10/7/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	777 E 25TH ST	STE 118	HIALEAH	FL	33013	3804	00	None	25.8449845	-80.26837881	Miami-Dade County
233258	Fee-for-Service	1609854397	1609854397	1	1	LACOUNT, ANISSA Y MD	7/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78550	08	Family Practice	0	In state provider	None	1454 E 2ND ST	None	SAN BERNARDINO	CA	92408	0118	36	06071	34.1035953	-117.2563723	San Bernardino County
233260	Fee-for-Service	1821094012	1821094012	1	1	LIN, NING MD	7/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	80829	18	Ophthalmology	0	In state provider	None	812 W YOSEMITE AVE	STE 101	MADERA	CA	93637	4588	20	06039	36.95604937	-120.068076	Madera County
233263	Fee-for-Service	1659734853	1659734853	1	1	LEE, RANDALL W MD	10/10/2019	207P00000X	NA	Other	026	PHYSICIANS	153362	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
233265	Fee-for-Service	1639401243	1639401243	1	1	LIN, ANDREW T	2/15/2010	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	24005 PRAGUE ST	None	MISSION VIEJO	CA	92691	3847	30	06059	33.61363401	-117.6822821	Orange County
233289	Fee-for-Service	1184708828	1184708828	1	1	LEE, MARK K MD	11/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72497	77	Infectious Disease	0	In state provider	None	350 30TH ST	STE 511	OAKLAND	CA	94609	3426	01	06001	37.81892183	-122.2640154	Alameda County
233318	Fee-for-Service	1043241052	1043241052	1	2	LINK INSTITUTE FOR WOMEN'S H	10/25/2019	207RX0202X	NA	Oncology	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	EALTH	230 S MAIN ST	STE 100	ORANGE	CA	92868	3851	30	06059	33.785154	-117.867318	Orange County
233328	Fee-for-Service	1982111290	1982111290	1	1	LAWS, LANELLE P LMFT	1/11/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	127886	-	NOT APPLICABLE	0	In state provider	None	10221 S. COMPTON AVE,	SUITE 105 & 103	LOS ANGELES	CA	90002	2802	19	06037	33.943518	-118.246236	Los Angeles County
233355	Fee-for-Service	1942230230	1942230230	1	1	LAMBERT, RHONDA E MD	3/31/1991	207RR0500X	NA	Other	026	PHYSICIANS	41349	41	Internal Medicine	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
233372	Fee-for-Service	1376963736	1376963736	1	1	LATTA, BRITTANY ANNE PT	10/8/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	815 TUCKER RD	B	TEHACHAPI	CA	93561	2513	15	06029	35.123004	-118.4678255	Kern County
233377	Fee-for-Service	1043343247	1043343247	1	1	LANGLOIS MEDICAL CORPORATION	3/8/2023	2081P2900X	NA	Physical Medicine and Rehabilitation	022	PHYSICIANS GROUP	-	None	None	0	In state provider	DICAL CLINICAL INC	230 S MONTCLAIR ST	SUITE 101	BAKERSFIELD	CA	93309	3117	15	06029	35.35252191	-119.0555354	Kern County
233427	Fee-for-Service	1205879343	1205879343	1	1	LOUNSBERRY, DAVID V MD	11/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51701	01	General Practice	0	In state provider	None	2450 ORO DAM BLVD	SUITE D	OROVILLE	CA	95966	6133	04	06007	39.50570174	-121.5470597	Butte County
233438	Fee-for-Service	1215009063	1215009063	1	1	LAUTERBACH, KAREN F MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	61644	40	Pediatrics	0	In state provider	None	4785 N 1ST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
233454	Fee-for-Service	1346248085	1346248085	1	1	LEVINE, WENDY R	8/24/2015	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
233467	Fee-for-Service	1104913425	1104913425	1	1	LEE, JUSTIN T MD	8/29/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	95245	None	None	0	In state provider	None	500 OLD RIVER RD	STE 200	BAKERSFIELD	CA	93311	9505	15	06029	35.35127492	-119.1142991	Kern County
233474	Fee-for-Service	1164470407	1164470407	1	2	LIN, MAX C MD	11/1/2019	207L00000X	NA	Other	026	PHYSICIANS	93809	05	Anesthesiology	0	In state provider	None	11500 BROOKSHIRE AVENUE	None	DOWNEY	CA	90241	4917	19	06037	33.93500365	-118.1321119	Los Angeles County
233486	Fee-for-Service	1831274075	1831274075	1	1	LACY, AMA LINDIWE AMANDA MD	3/22/2010	208600000X	NA	General Surgery	026	PHYSICIANS	63380	02	General Surgery	0	In state provider	None	760 S WASHBURN AVE	#8A	CORONA	CA	92882	3303	33	06065	33.87374611	-117.567875	Riverside County
233487	Fee-for-Service	1639155468	1639155468	1	1	LUBARSKY, LAURA A MD	11/30/1990	207RP1001X	NA	Pulmonology	026	PHYSICIANS	70164	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1010 MURRAY AVE	None	SAN LUIS OBISPO	CA	93405	8800	40	06079	35.292168	-120.6658665	San Luis Obispo County
233507	Fee-for-Service	1730246984	1730246984	1	1	LIN, LEE-TZU MD	11/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	70872	01	General Practice	0	In state provider	None	7275 E SOUTHGATE DR	STE 406	SACRAMENTO	CA	95823	2632	34	06067	38.493576	-121.436559	Sacramento County
233522	Fee-for-Service	1114019049	1114019049	1	1	LICUANAN, LLOYD T MD	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136348	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
233534	Fee-for-Service	1366591620	1366591620	1	1	LEE, MICHAEL W MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	63816	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
233569	Fee-for-Service	1124279203	1124279203	1	1	LEE, NICHOLAS H MD	6/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124330	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
233575	Fee-for-Service	1184708828	1184708828	1	1	LEE, MARK K MD	11/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72497	41	Internal Medicine	0	In state provider	None	350 30TH ST	STE 511	OAKLAND	CA	94609	3426	01	06001	37.81892183	-122.2640154	Alameda County
233619	Fee-for-Service	1689633125	1689633125	1	1	LEE, SELIN & GRIMES MDS	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	17400 IRVINE BLVD	STE F	TUSTIN	CA	92780	3083	30	06059	33.74814651	-117.828558	Orange County
233670	Fee-for-Service	1629616388	1629616388	1	1	LEIGH, LINDSEY CNP	2/11/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2791 AGOURA RD	None	THOUSAND OAKS	CA	91361	3101	56	06111	34.15068671	-118.8255597	Ventura County
233697	Fee-for-Service	1447682836	1447682836	1	1	LOPEZ ASAAH, VANESSA LCSW	9/17/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
233700	Fee-for-Service	1033827274	1033827274	1	1	LINZEY, DAVID J	11/29/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
233768	Fee-for-Service	1518288687	1518288687	1	1	LEE, YICHIEN E	11/20/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	11038	None	None	0	In state provider	None	8253 SIERRA AVE	SUITE 200	FONTANA	CA	92335	3578	36	06071	34.10379	-117.4357525	San Bernardino County
233782	Fee-for-Service	1144727363	1144727363	1	1	LIU, JIMMY D MD	7/11/2022	207L00000X	NA	Other	026	PHYSICIANS	176555	None	None	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
233797	Fee-for-Service	1730246984	1730246984	1	1	LIN, LEE-TZU MD	11/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	70872	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	7275 E SOUTHGATE DR	STE 406	SACRAMENTO	CA	95823	2632	34	06067	38.493576	-121.436559	Sacramento County
233837	Fee-for-Service	1497432801	1497432801	1	1	LI, BETTY Z OD	8/16/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
233844	Fee-for-Service	1952328585	1952328585	1	1	LIN, JIMMY J MD	7/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	38878	41	Internal Medicine	0	In state provider	None	2411 FOREST AVE	None	SAN JOSE	CA	95128	1505	43	06085	37.32698647	-121.9468005	Santa Clara County
233862	Fee-for-Service	1629128608	1629128608	1	1	LESPERANCE, RICHARD R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34087	30	Radiology	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
233867	Fee-for-Service	1962109033	1962109033	1	9	LOS ANGELES COUNTY DEPARTMEN	2/8/2024	261QP0905X	NA	Other	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	13300 VAN NUYS BLVD	None	PACOIMA	CA	91331	3004	19	06037	34.26531092	-118.4231386	Los Angeles County
233885	Fee-for-Service	1083657308	1083657308	2	1	LONGS DRUG STORE CA LLC	11/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	49980 JEFFERSON ST	None	INDIO	CA	92201	9720	33	06065	33.685785	-116.2685905	Riverside County
233891	Fee-for-Service	1518983519	1518983519	1	1	LEE, TUN SEIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36424	01	General Practice	0	In state provider	SUITE 220	5575 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	5801	01	06001	37.69214859	-121.8796532	Alameda County
233894	Fee-for-Service	1710917315	1710917315	1	1	LAM, TIEN H MD	4/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75397	08	Family Practice	0	In state provider	None	1455 MONTEGO	STE 205	WALNUT CREEK	CA	94598	2957	07	06013	37.91046956	-122.0418669	Contra Costa County
233923	Fee-for-Service	1912264722	1912264722	1	3	LEILA BOZORGNIA MD INC	11/17/2023	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2990 S SEPULVEDA BLVD	202	LOS ANGELES	CA	90064	3973	19	06037	34.02759083	-118.4287969	Los Angeles County
233937	Fee-for-Service	1245657923	1245657923	1	1	LE, PHILLIP DO MD	8/1/2018	207P00000X	NA	Other	026	PHYSICIANS	16053	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 NORTH TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
233952	Fee-for-Service	1942615448	1942615448	1	1	LEE, JUDITH H Y OD	4/13/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1183 E FOOTHILL BLVD	SUITE 140	UPLAND	CA	91786	4049	36	06071	34.10724648	-117.6359175	San Bernardino County
233995	Fee-for-Service	1710033071	1710033071	1	1	LADD, AMY L MD	1/31/1989	2086S0105X	NA	General Surgery	026	PHYSICIANS	68666	20	Orthopedic Surgery	0	In state provider	None	211 QUARRY RD	# N345	PALO ALTO	CA	94304	1416	43	06085	37.44198478	-122.1694088	Santa Clara County
234025	Fee-for-Service	1720600430	1720600430	1	1	LATOPCARE HOSPICE	9/17/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10999 RIVERSIDE DR	STE 306B	NORTH HOLLYWOOD	CA	91602	2239	19	06037	34.15230395	-118.3693888	Los Angeles County
234033	Fee-for-Service	1144272923	1144272923	1	1	LE, LUAN C MD	7/31/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51296	08	Family Practice	0	In state provider	None	1062 S K ST	None	TULARE	CA	93274	6421	54	06107	36.19548226	-119.3433058	Tulare County
234070	Fee-for-Service	1104869437	1104869437	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4445 MISSION BLVD	None	SAN DIEGO	CA	92109	3919	37	06073	32.79538256	-117.255108	San Diego County
234083	Fee-for-Service	1801981600	1801981600	1	1	LUU, KEVIN K MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90478	05	Anesthesiology	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
234147	Fee-for-Service	1417139973	1417139973	1	1	LEE, AVA A MD	2/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	72095	08	Family Practice	0	In state provider	None	260 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
234161	Fee-for-Service	1861691479	1861691479	1	1	LOWEN, STACEY M MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106826	40	Pediatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
234194	Fee-for-Service	1083715908	1083715908	1	1	LONDON, STUART S MD	3/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	27002	30	Radiology	0	In state provider	None	3330 TELEGRAPH AVE	None	OAKLAND	CA	94609	3028	01	06001	37.82202586	-122.2663483	Alameda County
234205	Fee-for-Service	1386387090	1386387090	1	1	LUSHANKO, CAILEY G CRNA	10/24/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	603 E LATHAM AVE	None	HEMET	CA	92543	4342	33	06065	33.74933852	-116.96598	Riverside County
234212	Fee-for-Service	1366832297	1366832297	1	1	LAMB, MIRIAM T LMFT	12/1/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4100 W ALAMEDA AVE FL 3	STE 365	BURBANK	CA	91505	4191	19	06037	34.1526111	-118.3447742	Los Angeles County
234238	Fee-for-Service	1306060835	1306060835	1	1	LIVA, MAUD E MD	1/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118112	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1409 E BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	50	06099	37.66742737	-120.9731413	Stanislaus County
234250	Fee-for-Service	1497157986	1497157986	1	1	LOPEZ, ALYSA LCSW	10/7/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
234282	Fee-for-Service	1710033071	1710033071	1	1	LADD, AMY L MD	1/31/1989	2086S0105X	NA	General Surgery	026	PHYSICIANS	68666	46	Hand Surgery	0	In state provider	None	211 QUARRY RD	# N345	PALO ALTO	CA	94304	1416	43	06085	37.44198478	-122.1694088	Santa Clara County
234298	Fee-for-Service	1144576489	1144576489	1	1	LEW, REBECCA L NP	4/6/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
234299	Fee-for-Service	1720001902	1720001902	1	1	LANG, LAURENCE A MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	32239	89	Surgery-Traumatic	0	In state provider	None	2701 W ALAMEDA AVE	STE 405	BURBANK	CA	91505	4409	19	06037	34.15751343	-118.3303715	Los Angeles County
234315	Fee-for-Service	1720600430	1720600430	1	1	LATOPCARE HOSPICE	9/17/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10999 RIVERSIDE DR	STE 306B	NORTH HOLLYWOOD	CA	91602	2239	19	06037	34.15230395	-118.3693888	Los Angeles County
234331	Fee-for-Service	1326076217	1326076217	1	1	LARSON, CHARLES P MD	5/29/1987	207L00000X	NA	Other	026	PHYSICIANS	18587	05	Anesthesiology	0	In state provider	None	715 FRENCHMANS RD	None	STANFORD	CA	94305	1004	43	06085	37.41719416	-122.1636277	Santa Clara County
234360	Fee-for-Service	1073680807	1073680807	1	1	LEAKE, BRETT A MD	3/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	74900	20	Orthopedic Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
234371	Fee-for-Service	1801981600	1801981600	1	1	LUU, KEVIN K MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90478	40	Pediatrics	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
234380	Fee-for-Service	1861686172	1861686172	1	1	LIN, ABRAHAM G MD	5/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90709	20	Orthopedic Surgery	0	In state provider	None	10666 N. TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
234385	Fee-for-Service	1245358993	1245358993	1	1	LEWINSON, STEPHEN M DPM	3/17/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	7737 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90046	6269	19	06037	34.09087352	-118.3577406	Los Angeles County
234387	Fee-for-Service	1790882561	1790882561	1	1	LIEM,TIMOTHY K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PK	RD	PORTLAND	OR	97239	3098	00	None	45.49936609	-122.6856232	Multnomah County
234421	Fee-for-Service	1467615435	1467615435	1	1	LUX, MATTHEW M MD	9/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108525	34	Urology and Urological Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
234427	Fee-for-Service	1245686559	1245686559	1	1	LEE, EUNICE MD	6/6/2019	207L00000X	NA	Other	026	PHYSICIANS	144801	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
234439	Fee-for-Service	1649098336	1649098336	1	1	LC MARRIAGE AND FAMILY THERA	1/4/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	PY PROFESSIONAL CORPORAT	614 GRAND AVE	203	OAKLAND	CA	94610	3554	01	06001	37.80970653	-122.2493811	Alameda County
234440	Fee-for-Service	1245662519	1245662519	1	1	LEE, JONATHAN M LMFT	12/20/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	244 CALIFORNIA	STE 300	SAN FRANCISCO	CA	94111	4302	38	06075	37.79331375	-122.3995607	San Francisco County
234485	Fee-for-Service	1689089609	1689089609	1	1	LAKSHMANAN, REUBEN MD	5/12/2018	207P00000X	NA	Other	026	PHYSICIANS	148771	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	33	06065	33.5580705	-117.1835458	Riverside County
234524	Fee-for-Service	1093094427	1093094427	1	1	LALEZARI, DAVID B	10/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117709	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
234557	Fee-for-Service	1457403255	1457403255	1	1	LAGERA, JOSE E MD	3/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78424	22	Pathology (M.D. only)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
234566	Fee-for-Service	1851568844	1851568844	1	1	LENA WEINMAN MD	1/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1700 E 19TH ST	None	THE DALLES	OR	97058	3317	00	None	45.58806554	-121.164498	Wasco County
234585	Fee-for-Service	1720001902	1720001902	1	1	LANG, LAURENCE A MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	32239	05	Anesthesiology	0	In state provider	None	2701 W ALAMEDA AVE	STE 405	BURBANK	CA	91505	4409	19	06037	34.15751343	-118.3303715	Los Angeles County
234589	Fee-for-Service	1609818426	1609818426	2	1	LONGS DRUG STORES CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	35720 FREMONT BLVD	None	FREMONT	CA	94536	3421	01	06001	37.56721965	-122.0248246	Alameda County
234620	Fee-for-Service	1225353352	1225353352	1	1	LONG, VICTOR V MD	1/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119226	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
234637	Fee-for-Service	1780608190	1780608190	1	1	LEWIS, DENNIS P MD	7/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78417	08	Family Practice	0	In state provider	None	200 MEDICAL PLAZA	#220	LOS ANGELES	CA	90024	1628	19	06037	34.06527974	-118.4462792	Los Angeles County
234676	Fee-for-Service	1144477530	1144477530	1	1	LYAPIS, ANNA V MD	10/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124524	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
234686	Fee-for-Service	1083123616	1083123616	1	1	LI, DARIN H C	3/5/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1454	07	06013	37.77580025	-121.9664884	Contra Costa County
234716	Fee-for-Service	1598881179	1598881179	1	1	LEE, NICK H MD	5/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	61218	41	Internal Medicine	0	In state provider	None	809 N HILL STREET	SUITE K	LOS ANGELES	CA	90012	2394	19	06037	34.06312917	-118.2394531	Los Angeles County
234735	Fee-for-Service	1609074822	1609074822	1	1	LUEDKE, ERIC A MD	7/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129266	None	None	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
234736	Fee-for-Service	1265887202	1265887202	1	1	LIU, MICHAEL MD	1/27/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	151078	None	None	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
234745	Fee-for-Service	1457880809	1457880809	1	1	LONG, JAYCE E	1/14/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	STE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
234788	Fee-for-Service	1376811406	1376811406	1	1	LEE, LARISSE MD PC	2/6/2012	2086S0129X	NA	General Surgery	026	PHYSICIANS	117214	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4955 VAN NUYS BLVD	STE 301	SHERMAN OAKS	CA	91403	1815	19	06037	34.160805	-118.4487295	Los Angeles County
234862	Fee-for-Service	1942352307	1942352307	1	1	LIU, ANLO MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	56340	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
234906	Fee-for-Service	1578765277	1578765277	1	1	LAI, JEAN MD	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99672	84	Surgery-Head and Neck	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
234966	Fee-for-Service	1912688656	1912688656	1	1	LEOMAR HEALTH GROUP INC	12/2/2024	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1530 JAMACHA RD	SUITE U	EL CAJON	CA	92019	3700	37	06073	32.768073	-116.9278985	San Diego County
234971	Fee-for-Service	1689901530	1689901530	2	1	LABONTE, DAVID J LMFT	9/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4930 CAMPUS DRIVE	None	NEWPORT BEACH	CA	92660	2119	30	06059	33.66873996	-117.8580947	Orange County
234981	Fee-for-Service	1861666919	1861666919	1	1	LEIBEL, SYDNEY A MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116427	03	Allergy	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
234988	Fee-for-Service	1710170253	1710170253	1	1	LALEZARY, MAZIAR MD	8/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120462	18	Ophthalmology	0	In state provider	None	36949 COOK ST	STE 101	RIVERSIDE	CA	92211	6080	33	06065	33.779889	-116.358264	Riverside
234992	Fee-for-Service	1801974563	1801974563	1	1	LAMBIE, PAUL B MD	4/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	59737	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
234993	Fee-for-Service	1023087657	1023087657	1	1	LAI, EUGENE Y, M D	5/22/1996	207L00000X	NA	Other	026	PHYSICIANS	78647	01	General Practice	0	In state provider	None	301 VICTORIA ST	None	COSTA MESA	CA	92627	1995	30	06059	33.65258952	-117.9121545	Orange County
235055	Fee-for-Service	1336299734	1336299734	1	1	LAWRENCE, PAMELA A MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	41231	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
235059	Fee-for-Service	1295100931	1295100931	1	1	LI, ANNIE NP	9/13/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
235067	Fee-for-Service	1205034733	1205034733	1	1	LOPEZ, OSCAR A MD	3/3/2015	207R00000X	NA	Other	026	PHYSICIANS	108837	10	Gastroenterology (M.D. only)	0	In state provider	None	207 WEST LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
235082	Fee-for-Service	1033563945	1033563945	1	1	LEE, AUDREY T DO	7/29/2022	207L00000X	NA	Other	026	PHYSICIANS	16390	None	None	0	In state provider	None	2425 SAMARITAN DRIVE	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
235084	Fee-for-Service	1912219650	1912219650	1	1	LEE, JUSTIN P MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119292	41	Internal Medicine	0	In state provider	None	3687 MT DIABLO BLVD	#200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
235097	Fee-for-Service	1649533803	1649533803	1	1	LEWALLEN, ROBIN S MD	10/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144323	07	Dermatology	0	In state provider	None	401 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6367	43	06085	37.36777579	-122.0276404	Santa Clara County
235106	Fee-for-Service	1306852561	1306852561	1	1	LEE, CHARLES C MD	1/31/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	73537	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
235107	Fee-for-Service	1144618596	1144618596	1	1	LC STUBBLEFIELD FAMILY	7/24/2015	261Q00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	CHIROPRACTIC INC	870 W ONSTOTT FRONTAGE R	STE G	YUBA CITY	CA	95991	3500	51	06101	39.137211	-121.634938	Sutter County
235124	Fee-for-Service	1023116811	1023116811	1	1	LONG BEACH DEPT OF HLTH	1/2/1976	251K00000X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AND HUMAN SERVICES	2525 GRAND AVE	None	LONG BEACH	CA	90815	1765	19	06037	33.8026265	-118.1480993	Los Angeles County
235155	Fee-for-Service	1316041908	1316041908	1	1	LINSKEY, MARK E MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74205	14	Neurological Surgery	0	In state provider	None	101 THE CITY DR S	STE 313	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
235168	Fee-for-Service	1841361813	1841361813	1	1	LEDEZMA, MATEO L MD	6/22/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	79231	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
235181	Fee-for-Service	1194143289	1194143289	1	1	LOUDIN, NATASHA N MD	5/25/2020	207WX0110X	NA	Ophthalmology	026	PHYSICIANS	142343	18	Ophthalmology	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
235182	Fee-for-Service	1982893582	1982893582	2	1	LALITHMOHAN, ADAMANE MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	32849	41	Internal Medicine	0	In state provider	None	108 LYNCH CREEK WAY	STE 3	PETALUMA	CA	94954	2310	49	06097	38.25209087	-122.6340827	Sonoma County
235185	Fee-for-Service	1477680650	1477680650	1	1	LEE-MORANT, JENNIFER J LCSW	4/27/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
235197	Fee-for-Service	1013483635	1013483635	1	1	LASSWELL, EVE N PSYD	1/22/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
235249	Fee-for-Service	1285122499	1285122499	1	1	LEE, MICHELLE NP	6/27/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
235255	Fee-for-Service	1326500216	1326500216	1	1	LAWSON, TINA MD	8/28/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
235256	Fee-for-Service	1912688656	1912688656	1	1	LEOMAR HEALTH GROUP INC	12/2/2024	101YM0800X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1530 JAMACHA RD	SUITE U	EL CAJON	CA	92019	3700	37	06073	32.768073	-116.9278985	San Diego County
235269	Fee-for-Service	1861666919	1861666919	1	1	LEIBEL, SYDNEY A MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116427	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
235299	Fee-for-Service	1144726936	1144726936	1	1	LEVY, AVIYA L MD	9/1/2024	2080P0216X	NA	Other	026	PHYSICIANS	None	83	Rheumatology	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
235328	Fee-for-Service	1205322914	1205322914	1	1	LIFESAVERS TRANSPORTATION	10/17/2018	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LLC	1515 AURORA DR	SUITE 101B	SAN LEANDRO	CA	94577	3105	01	06001	37.70878423	-122.1892174	Alameda County
235336	Fee-for-Service	1598384166	1598384166	1	1	LONG, NINA DO	4/11/2025	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	20140	13	Neurology (M.D. only)	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
235343	Fee-for-Service	1336299734	1336299734	1	1	LAWRENCE, PAMELA A MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	41231	01	General Practice	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
235353	Fee-for-Service	1104936459	1104936459	1	1	LEONG, LUCILLE A MD	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43999	68	Hematology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
235369	Fee-for-Service	1477331098	1477331098	1	1	LANNON, EDWARD W PHD	10/16/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
235387	Fee-for-Service	1679993893	1679993893	1	1	LEE, JENNIFER G MD	11/30/2022	208M00000X	NA	Other	026	PHYSICIANS	183484	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
235393	Fee-for-Service	1578915237	1578915237	1	1	LEE, CHRISTOPHER D MD	11/24/2019	207P00000X	NA	Other	026	PHYSICIANS	162008	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
235401	Fee-for-Service	1942872544	1942872544	1	1	LEE, DONG EUN	12/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
235402	Fee-for-Service	1285695262	1285695262	1	1	LARSEN,BRENT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	630 E MEDICAL DRIVE	None	BOUNTIFUL	UT	84010	4908	00	None	40.88671331	-111.8683023	Davis County
235453	Fee-for-Service	1841361813	1841361813	1	1	LEDEZMA, MATEO L MD	6/22/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	79231	45	Nephrology (Renal-Kidney)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
235471	Fee-for-Service	1437183449	1437183449	1	1	LOREDO, LILIA N MD	11/30/1993	2085R0001X	NA	Other	026	PHYSICIANS	55787	30	Radiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
235504	Fee-for-Service	1447432042	1447432042	1	1	LEFF, VICTORIA R LCSW	9/21/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	10461	-	NOT APPLICABLE	0	In state provider	None	1816 SCENIC AVE	None	BERKELEY	CA	94709	1324	01	06001	37.87558576	-122.2622904	Alameda County
235517	Fee-for-Service	1922019900	1922019900	1	1	LEAVITT, DOUGLAS L MD	4/17/1989	207P00000X	NA	Other	026	PHYSICIANS	46018	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
235527	Fee-for-Service	1881910149	1881910149	1	1	LEDFORD, JODIANN T MD	6/3/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	120777	None	None	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
235536	Fee-for-Service	1144565763	1144565763	1	1	LEE, JENNIFER NP	10/11/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
235560	Fee-for-Service	1487811162	1487811162	1	1	LA BARBERA, JACLIN M MD	11/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108258	40	Pediatrics	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3014	37	06073	32.781195	-117.0070695	San Diego County
235584	Fee-for-Service	1144726936	1144726936	1	1	LEVY, AVIYA L MD	9/1/2024	2080P0216X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
235586	Fee-for-Service	1831112358	1831112358	1	1	LEGACY EMANUEL HOSPITAL	5/1/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	& HEALTH CENTER	2801 N GANTENBEIN AVE	None	PORTLAND	OR	97227	1623	00	None	45.54387841	-122.6696022	Multnomah County
235634	Fee-for-Service	1033606397	1033606397	1	1	LIN, CHRISTOPHER DO	3/17/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	20422	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
235641	Fee-for-Service	1104936459	1104936459	1	1	LEONG, LUCILLE A MD	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43999	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
235653	Fee-for-Service	1508389032	1508389032	1	1	LABA, ALINA V OD	8/6/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	114 MISSION RANCH BLVD	STE 50	CHICO	CA	95926	5137	04	06007	39.75356438	-121.8600403	Butte County
235678	Fee-for-Service	1184739039	1184739039	2	1	LAVI, ALFRED DO	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	7653	08	Family Practice	0	In state provider	None	2324 W PICO BLVD	None	LOS ANGELES	CA	90006	4002	19	06037	34.0472397	-118.28722	Los Angeles County
235724	Fee-for-Service	1679579817	1679579817	1	1	LOOMBA, MUNISH MD	11/5/2018	207LP2900X	NA	Other	026	PHYSICIANS	136636	05	Anesthesiology	0	In state provider	None	12712 HEACOCK ST	SUITE 9A	MORENO VALLEY	CA	92553	3039	33	06065	33.936165	-117.2437645	Riverside County
235728	Fee-for-Service	1295804292	1295804292	1	1	LEE, TED T MD	4/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	95764	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
235744	Fee-for-Service	1912746025	1912746025	1	1	LIZA NAGY	2/5/2025	193400000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4001 HALLMARK PKWY	None	SAN BERNARDINO	CA	92407	1876	36	06071	34.16311738	-117.3353622	San Bernardino County
235751	Fee-for-Service	1487389805	1487389805	1	1	LEE, MAI OD	3/16/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
235805	Fee-for-Service	1790892735	1790892735	1	1	LIM, DEAN W MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	42616	78	Neoplastic Diseases/Oncology	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
235817	Fee-for-Service	1083373302	1083373302	1	1	LUXURY LIVING SENIOR CARE	11/16/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	LLC	139 S LINCOLN ST	None	ORANGE	CA	92866	2235	30	06059	33.78711332	-117.8379148	Orange County
235837	Fee-for-Service	1710366059	1710366059	1	1	LIU, YUCHEN MD	7/1/2021	207L00000X	NA	Other	026	PHYSICIANS	159502	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
235840	Fee-for-Service	1932479201	1932479201	1	1	LAKE HEALTH DISTRICT	2/27/2012	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	PHYSICIANS GROUP	700 SOUTH J STREET	None	LAKEVIEW	OR	97630	1623	00	None	42.181335	-120.351489	Lake County
235859	Fee-for-Service	1205142908	1205142908	1	1	LICHTENSTEIN, BRIAN J MD	9/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118611	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
235866	Fee-for-Service	1568874089	1568874089	1	1	LU, YAN NP	2/9/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
235873	Fee-for-Service	1073729257	1073729257	1	1	LIEM, WIEKE H MD	12/1/1997	207N00000X	NA	Dermatology	026	PHYSICIANS	70387	04	Otology, Laryngology, Rhinology	0	In state provider	None	1506 E CHAPMAN AVE	None	ORANGE	CA	92866	2231	30	06059	33.78778851	-117.837621	Orange County
235875	Fee-for-Service	1831112358	1831112358	1	1	LEGACY EMANUEL HOSPITAL	5/1/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	& HEALTH CENTER	2801 N GANTENBEIN AVE	None	PORTLAND	OR	97227	1623	00	None	45.54387841	-122.6696022	Multnomah County
235901	Fee-for-Service	1699773127	1699773127	1	1	LILLIS, CHRISTOPHER MD	12/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137799	41	Internal Medicine	0	In state provider	None	2825 J STREET	STE 300	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
235902	Fee-for-Service	1184631541	1184631541	1	1	LEW,HENRY L MD	11/1/2000	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	69723	25	Physical Medicine and Rehabilitation	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
235918	Fee-for-Service	1184874307	1184874307	1	1	LOUIE, JENNIFER S MD	1/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102957	40	Pediatrics	0	In state provider	None	5400 TELEGRAPH AVE	None	OAKLAND	CA	94609	1965	01	06001	37.83925524	-122.2620144	Alameda County
235929	Fee-for-Service	1104936459	1104936459	1	1	LEONG, LUCILLE A MD	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43999	41	Internal Medicine	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
236002	Fee-for-Service	1932141769	1932141769	2	1	LONGS DRUG STORE CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6450 PONY EXPRESS TRAIL	None	POLLOCK PINES	CA	95726	9601	09	06017	38.76284727	-120.5797935	El Dorado County
236051	Fee-for-Service	1083649651	1083649651	1	2	LA CO NEPHROLOGY	10/31/1990	174400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	A MEDICAL CORPORATION	3114 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	19	06037	34.02383346	-118.137193	Los Angeles County
236053	Fee-for-Service	1467956672	1467956672	1	1	LORENTE, KARLA MD	7/27/2022	207VF0040X	NA	Obstetrics & Gynecology	026	PHYSICIANS	178558	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
236059	Fee-for-Service	1306241526	1306241526	1	2	LOVE, TAMIKO D LCSW	2/19/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1225 W 190TH ST	SUITE 310	GARDENA	CA	90248	4320	19	06037	33.85835623	-118.2987754	Los Angeles County
236062	Fee-for-Service	1932467198	1932467198	1	1	LEISHMAN, LISA L MD	8/7/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	-	None	None	1	Border provider	None	748 STATE ST	None	MEDFORD	OR	97504	8473	00	None	42.315624	-122.8303995	Jackson County
236065	Fee-for-Service	1962650168	1962650168	1	1	LAMB, KRISTY A MD	7/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111733	08	Family Practice	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
236075	Fee-for-Service	1427382985	1427382985	1	1	LE, MICHAEL S MD	3/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111337	10	Gastroenterology (M.D. only)	0	In state provider	None	23625 HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
236090	Fee-for-Service	1093708174	1093708174	1	1	LISS, VERNA S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42661	08	Family Practice	0	In state provider	None	612 E JANSS RD	None	THOUSAND OAKS	CA	91360	5113	56	06111	34.19957051	-118.8666284	Ventura County
236094	Fee-for-Service	1790892735	1790892735	1	1	LIM, DEAN W MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	42616	41	Internal Medicine	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
236136	Fee-for-Service	1134870728	1134870728	1	2	LANE, SCOTT NP	11/13/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95019746	-	NOT APPLICABLE	0	In state provider	None	13212 & 13222 CHAPMAN AV	None	GARDEN GROVE	CA	92840	4414	30	06059	33.7888215	-117.901998	Orange County
236149	Fee-for-Service	1104978410	1104978410	1	1	LEE, KICHUN J MD	6/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76565	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
236157	Fee-for-Service	1215050422	1215050422	1	1	LEWIS, ARTIS C LCSW	3/17/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
236163	Fee-for-Service	1578997557	1578997557	1	1	LAWSON, KATY L MD	3/22/2022	207ZP0102X	NA	Other	026	PHYSICIANS	159190	None	None	0	In state provider	None	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
236252	Fee-for-Service	1053653782	1053653782	1	1	LONG BEACH MEMORIAL MEDICAL	9/22/2016	3336H0001X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CENTER	455 E COLUMBIA ST	None	LONG BEACH	CA	90806	1620	19	06037	33.80900524	-118.1874314	Los Angeles County
236254	Fee-for-Service	1407088602	1407088602	1	1	LUONG, SAMANTHA V PT	1/3/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	20940 BURBANK BLVD	None	WOODLAND HILLS	CA	91365	6701	19	06037	34.1719401	-118.5881418	Los Angeles County
236263	Fee-for-Service	1265449730	1265449730	1	1	LIAO, JUDY C OD	3/7/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	311 S BROADWAY	None	LOS ANGELES	CA	90013	1207	19	06037	34.0507959	-118.2482177	Los Angeles County
236272	Fee-for-Service	1275607558	1275607558	1	1	LE, ANTHONY D MD	5/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95759	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
236304	Fee-for-Service	1689604423	1689604423	1	1	LASKEY, JERRY I OD	3/31/1993	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	680 RIO LINDO AVE	STE 20	CHICO	CA	95926	1849	04	06007	39.75305508	-121.8474749	Butte County
236308	Fee-for-Service	1578675724	1578675724	1	1	LUNDAHL, ROBERT E MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84819	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
236315	Fee-for-Service	1942221742	1942221742	1	1	LO, TAKKIN MD	3/31/1989	207RP1001X	NA	Pulmonology	026	PHYSICIANS	60988	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92411	1217	36	06071	34.131303	-117.3225325	San Bernardino County
236317	Fee-for-Service	1194221036	1194221036	1	1	LUTLEY, KEVIN M MD	8/19/2021	207R00000X	NA	Other	026	PHYSICIANS	163773	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
236334	Fee-for-Service	1316191166	1316191166	1	1	LE, PHONG	11/21/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	500 UNIVERSITY AVE	STE 100	SACRAMENTO	CA	95825	6527	34	06067	38.568402	-121.418019	Sacramento County
236353	Fee-for-Service	1962650168	1962650168	1	1	LAMB, KRISTY A MD	7/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111733	36	Psychiatry	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
236382	Fee-for-Service	1790892735	1790892735	1	1	LIM, DEAN W MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	42616	68	Hematology	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
236384	Fee-for-Service	1750473674	1750473674	1	1	LAYTEN, DENISE LMFT	5/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1303 JEFFERSON ST	SUITE 710A	NAPA	CA	94559	2442	28	06055	38.30015229	-122.2932731	Napa County
236387	Fee-for-Service	1699185306	1699185306	1	1	LEMUS-HERNANDEZ, ARMANDO J	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139049	01	General Practice	0	In state provider	MD	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3139	36	06071	34.04805253	-117.249534	San Bernardino County
236403	Fee-for-Service	1861441552	1861441552	1	1	LE, SON T MD	1/8/2010	207R00000X	NA	Other	026	PHYSICIANS	63381	41	Internal Medicine	0	In state provider	None	8887 WESTMINSTER AVE	None	GARDEN GROVE	CA	92844	2608	30	06059	33.75942652	-117.974097	Orange County
236404	Fee-for-Service	1578820197	1578820197	1	1	LOPEZ, ROSEMARY NP	1/2/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26357 MCBEAN PARKWAY	None	VALENCIA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
236432	Fee-for-Service	1942781281	1942781281	1	1	LUCERO, JOEL T NP	2/22/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
236452	Fee-for-Service	1750595286	1750595286	1	1	LAVOY, MICHAEL S LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
236469	Fee-for-Service	1093874661	1093874661	1	1	LIU, PAUL C MD	5/17/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	76545	20	Orthopedic Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
236486	Fee-for-Service	1164033031	1164033031	1	1	LOBATO, ANNETTE L LMFT	3/29/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
236488	Fee-for-Service	1740380393	1740380393	1	1	LIN, HSIUNG-WEI MD	8/31/1980	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36375	01	General Practice	0	In state provider	None	425 W MAIN ST	STE 101	ALHAMBRA	CA	91801	7439	19	06037	34.09289212	-118.1317673	Los Angeles County
236491	Fee-for-Service	1982969846	1982969846	1	1	LANIER, PAUL DO	9/27/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	18085	None	None	0	In state provider	None	805 E MOUNTAIN VIEW ST	None	BARSTOW	CA	92311	3033	36	06071	34.89343047	-117.0171832	San Bernardino County
236526	Fee-for-Service	1396157038	1396157038	1	1	LI, YUNJIE MD	8/30/2021	207ZP0102X	NA	Other	026	PHYSICIANS	153342	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
236541	Fee-for-Service	1811986599	1811986599	1	1	LIEBERMAN, RONALD E DPM	8/25/2014	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1011 DEVONSHIRE DR	STE F	ENCINITAS	CA	92024	5136	37	06073	33.03945	-117.285914	San Diego County
236570	Fee-for-Service	1164582359	1164582359	1	1	LISSKA, MEGAN C MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	76321	36	Psychiatry	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
236580	Fee-for-Service	1184866634	1184866634	1	1	LA PORTE, DOREEN M	8/5/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
236602	Fee-for-Service	1942221742	1942221742	1	1	LO, TAKKIN MD	3/31/1989	207RP1001X	NA	Pulmonology	026	PHYSICIANS	60988	41	Internal Medicine	0	In state provider	None	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92411	1217	36	06071	34.131303	-117.3225325	San Bernardino County
236629	Fee-for-Service	1841857240	1841857240	1	1	LEE, CATHERINE B MD	9/27/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178282	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
236702	Fee-for-Service	1891182184	1891182184	1	1	LOSAK, MICHAEL J MD	6/25/2019	207P00000X	NA	Other	026	PHYSICIANS	146293	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
236724	Fee-for-Service	1275649238	1275649238	1	1	LIU, CRAIG C OD	8/14/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
236733	Fee-for-Service	1649358748	1649358748	1	1	LIPPERT, ALEXANDER MD	9/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	35472	08	Family Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
236819	Fee-for-Service	1811966641	1811966641	1	1	LEWIS, MICHAEL S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1015 NW 22ND AVE	None	PORTLAND	OR	97210	3025	00	None	45.53024175	-122.6966202	Multnomah County
236828	Fee-for-Service	1699194167	1699194167	1	1	LAZARO, RONDY M MD	9/13/2024	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	148781	25	Physical Medicine and Rehabilitation	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
236853	Fee-for-Service	1336182674	1336182674	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2455 SAN RAMON VALLEY BL	None	SAN RAMON	CA	94583	1601	07	06013	37.77494737	-121.9771019	Contra Costa County
236874	Fee-for-Service	1104913425	1104913425	1	2	LEE, JUSTIN T MD	11/1/2021	207VF0040X	NA	Obstetrics & Gynecology	026	PHYSICIANS	95245	None	None	0	In state provider	None	117 BUNNY AVE	None	SANTA MARIA	CA	93458	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
236884	Fee-for-Service	1033115803	1033115803	1	1	LEWIS, KIRK J MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	36046	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
236909	Fee-for-Service	1124041173	1124041173	1	1	LAI, S PATRICK DPM	6/1/1977	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1110 E MAIN ST	# 101	ALHAMBRA	CA	91801	4111	19	06037	34.10060555	-118.1153572	Los Angeles County
236924	Fee-for-Service	1316092752	1316092752	1	1	LAYUG, MICHELLE D NP	2/26/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
236926	Fee-for-Service	1124053830	1124053830	1	1	LEWIS, GENA L MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61397	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
236965	Fee-for-Service	1518062223	1518062223	1	1	LIM, JUE L OD	1/1/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	17094 MAGNOLIA ST	None	FOUNTAIN VALLEY	CA	92708	3204	30	06059	33.71456028	-117.9717331	Orange County
237001	Fee-for-Service	1710158449	1710158449	2	1	LANDES MOBILE X-RAY CORP	9/7/2022	193400000X	NA	Other	028	PORTABLE X-RAY	-	-	NOT APPLICABLE	0	In state provider	None	2096 FELSINA AVE	None	MANTECA	CA	95337	8111	39	06077	37.77099004	-121.1962772	San Joaquin County
237010	Fee-for-Service	1386956498	1386956498	1	1	LITT, ROBIN R NP	10/17/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNAUSS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	0	0	None
237018	Fee-for-Service	1649358748	1649358748	1	1	LIPPERT, ALEXANDER MD	9/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	35472	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
237039	Fee-for-Service	1720066095	1720066095	1	1	LUND, DEBORAH S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
237065	Fee-for-Service	1316987472	1316987472	1	1	LEE, RANDALL J MD	1/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	58505	06	Cardiovascular Disease (M.D. only)	0	In state provider	FL SE	400 PARNASSUS AVE	APT 5TH	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
237127	Fee-for-Service	1225218944	1225218944	1	1	LE, TUONG-VI H OD	5/28/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	600 INTERNATIONAL BLVD	STE 101	OAKLAND	CA	94606	2993	01	06001	37.79488125	-122.2528163	Alameda County
237187	Fee-for-Service	1497866495	1497866495	1	1	LAUREN GAIL BREIHAN, M.D.	11/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	167 N MAIN ST	PO BOX 600	TUBA CITY	AZ	86045	0000	00	None	36.13538929	-111.2397388	Coconino County
237189	Fee-for-Service	1265531172	1265531172	1	1	LIEPPMAN, MICHAEL MD INC	2/8/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	32245	18	Ophthalmology	0	In state provider	None	1760 TERMINO AVE	STE 107	LONG BEACH	CA	90804	2157	19	06037	33.78889871	-118.1458784	Los Angeles County
237208	Fee-for-Service	1215966452	1215966452	1	1	L'ARMAND, JILL MD	9/6/1990	207L00000X	NA	Other	026	PHYSICIANS	32253	05	Anesthesiology	0	In state provider	None	14500 SHERMAN CIR	None	VAN NUYS	CA	91405	3052	19	06037	34.20025916	-118.4500763	Los Angeles County
237220	Fee-for-Service	1205986080	1205986080	1	1	LEE, SUE Y MD	1/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	73481	26	Psychiatry (child)	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
237251	Fee-for-Service	1346489192	1346489192	1	1	LAKHIANI, RESHMA A MD	8/31/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106721	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
237307	Fee-for-Service	1518947886	1518947886	1	1	LOCKE, KENNETH D DO	11/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	5330 S HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
237318	Fee-for-Service	1265711253	1265711253	1	1	LEWIS, ELIZABETH P MD	6/18/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	137502	08	Family Practice	0	In state provider	None	1850 SPRING RIDGE DR	None	SUSANVILLE	CA	95971	9507	18	06035	40.43814074	-120.6259249	Lassen County
237333	Fee-for-Service	1336223262	1336223262	1	1	LIU, DARICE MD	8/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81362	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
237357	Fee-for-Service	1245273036	1245273036	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	60 N MOORPARK RD	None	THOUSAND OAKS	CA	91360	4454	56	06111	34.17998081	-118.8761177	Ventura County
237401	Fee-for-Service	1700207115	1700207115	1	1	LOGAN OPTOMETRICS INC	2/20/2014	332H00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9186 W PICO BLVD	None	LOS ANGELES	CA	90035	1320	19	06037	34.0552227	-118.3918095	Los Angeles County
237405	Fee-for-Service	1245310499	1245310499	1	1	LIPPA, LINDA S M MD	4/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	79629	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
237413	Fee-for-Service	1164629028	1164629028	1	1	LOMAZOW, WHITNEY A MD	7/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113205	18	Ophthalmology	0	In state provider	None	2240 N HARBOR BLVD	SUITE 210	FULLERTON	CA	92835	2633	30	06059	33.89764434	-117.929218	Orange County
237455	Fee-for-Service	1629525332	1629525332	1	1	LEE, BRIAN A PT	4/13/2022	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2261 OHIO AVE	None	SIGNAL HILL	CA	90755	3913	19	06037	33.79823201	-118.1600948	Los Angeles County
237462	Fee-for-Service	1992076129	1992076129	1	1	LWIN, THANDAR MD	10/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122863	08	Family Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
237466	Fee-for-Service	1871262345	1871262345	1	1	LAWRY, DALLAS R NP	10/19/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
237472	Fee-for-Service	1396988788	1396988788	1	1	LEE, VINCENT P MD	4/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	107138	41	Internal Medicine	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
237482	Fee-for-Service	1649282856	1649282856	2	1	LOMPOC VALLEY MEDICAL CENTER	9/16/2022	208D00000X	NA	Adult Primary Care	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	136 N 3RD ST	None	LOMPOC	CA	93436	7002	42	06083	34.64013944	-120.4451768	Santa Barbara County
237491	Fee-for-Service	1255622890	1255622890	1	1	LAU, MACY K MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124766	40	Pediatrics	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
237504	Fee-for-Service	1356479877	1356479877	1	1	LONG-TERM CARE MEDICAL GROUP	7/12/2017	207RG0300X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	3003 N MARIPOSA ST	None	FRESNO	CA	93703	1127	10	06019	36.777735	-119.779307	Fresno County
237519	Fee-for-Service	1447254396	1447254396	1	1	LY, PETER NGHI-KIEN DPM	2/8/2015	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6244 EL CAJON BLVD	STE 29	SAN DIEGO	CA	92115	3918	37	06073	32.76342577	-117.0636924	San Diego County
237520	Fee-for-Service	1588009245	1588009245	1	1	LOTZ, NATALIA V MD	9/1/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	155835	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
237539	Fee-for-Service	1326035726	1326035726	1	1	LIMON-OLIVARES, JOSE G MD	6/19/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	80753	40	Pediatrics	0	In state provider	None	3605 HOSPITAL RD	None	ATWATER	CA	95301	5173	24	06047	37.36678073	-120.576731	Merced County
237547	Fee-for-Service	1528355120	1528355120	1	1	LI, LI MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145066	40	Pediatrics	0	In state provider	None	2335 E KASHIAN LANE	SUITE 301	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
237567	Fee-for-Service	1467690818	1467690818	1	1	LEMOINE, ANNE M	6/22/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3900 E PACIFIC COAST HWY	None	LONG BEACH	CA	90804	2013	19	06037	33.78982251	-118.1462265	Los Angeles County
237595	Fee-for-Service	1083135214	1083135214	1	1	LEE, MIN YOUNG DO	7/15/2020	207R00000X	NA	Other	026	PHYSICIANS	17255	41	Internal Medicine	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
237615	Fee-for-Service	1922531292	1922531292	1	1	LEE, MAN CHEUNG MD	6/6/2022	207L00000X	NA	Other	026	PHYSICIANS	164440	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
237663	Fee-for-Service	1043296122	1043296122	1	1	LINKLATER, DEREK R MD	1/1/2022	207PP0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
237717	Fee-for-Service	1770014276	1770014276	1	1	LEYDON, KATHERINE L DO	3/22/2022	207R00000X	NA	Other	026	PHYSICIANS	18565	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
237736	Fee-for-Service	1477964831	1477964831	1	1	LITTLEPAGE, MEAGAN M MD INC	9/22/2016	193400000X	NA	Other	026	PHYSICIANS	108647	25	Physical Medicine and Rehabilitation	0	In state provider	None	355 DARDANELLI LANE	None	LOS GATOS	CA	95032	0000	43	06085	37.262493	-121.967456	Santa Clara County
237742	Fee-for-Service	1881987519	1881987519	1	1	LINKER, ALEX H MD	11/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122263	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
237753	Fee-for-Service	1487665436	1487665436	1	1	LLOREN, RICHARD S MD	10/31/1989	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	68799	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
237754	Fee-for-Service	1497241376	1497241376	1	1	LU, SOPHIA LCSW	10/17/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	100387	-	NOT APPLICABLE	0	In state provider	None	845 E ARROW HWY	None	POMONA	CA	91767	2535	19	06037	34.09032048	-117.734769	Los Angeles County
237773	Fee-for-Service	1811374234	1811374234	1	1	LUU, LISA P DO	7/20/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	15361	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
237775	Fee-for-Service	1649282856	1649282856	2	1	LOMPOC VALLEY MEDICAL CENTER	10/26/2022	208D00000X	NA	Adult Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	136 N 3RD ST	None	LOMPOC	CA	93436	7002	42	06083	34.64013944	-120.4451768	Santa Barbara County
237777	Fee-for-Service	1164635363	1164635363	1	1	LOPEZ, CYNTHIA G M MD	7/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	52879	01	General Practice	0	In state provider	None	2900 FRESNO STREET	SUITE 102	FRESNO	CA	93721	1439	10	06019	36.74256783	-119.7827878	Fresno County
237792	Fee-for-Service	1356479877	1356479877	1	1	LONG-TERM CARE MEDICAL GROUP	7/12/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	3003 N MARIPOSA ST	None	FRESNO	CA	93703	1127	10	06019	36.777735	-119.779307	Fresno County
237814	Fee-for-Service	1699959635	1699959635	1	1	LEE, RACHEL N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120552	None	None	0	In state provider	None	10 WOODLAND ROAD	None	ST HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
237851	Fee-for-Service	1093893570	1093893570	1	1	LEDEAN, TIMOTHY A DO	11/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8463	01	General Practice	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
237871	Fee-for-Service	1982779716	1982779716	1	1	LANGLINAIS, BRANDON MD	6/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102812	30	Radiology	0	In state provider	None	3700 CALIFORNIA ST	#G350	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
237899	Fee-for-Service	1073814760	1073814760	1	1	LIN, FELIX F DO	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11453	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
237908	Fee-for-Service	1235859158	1235859158	1	1	LV PHARMACY INC	11/18/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14100 MAGNOLIA BLVD	None	SHERMAN OAKS	CA	91423	1119	19	06037	34.16483149	-118.440333	Los Angeles County
237939	Fee-for-Service	1871535971	1871535971	1	1	LEE, JAY MD	3/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83417	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6630	19	06037	34.05682871	-118.360716	Los Angeles County
237943	Fee-for-Service	1649556309	1649556309	1	1	LIU, CHRISTINE M NP	1/9/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2110-A N SANTA FE AVE	None	COMPTON	CA	90222	2822	19	06037	33.91171674	-118.2166547	Los Angeles County
237972	Fee-for-Service	1972024024	1972024024	1	1	LI, YIXING A DO	5/26/2023	390200000X	NA	Other	026	PHYSICIANS	17820	None	None	0	In state provider	None	1211 W. LA PALMA AVE.	SUITE 404	ANAHEIM	CA	92801	2806	30	06059	33.84718298	-117.933758	Orange County
238022	Fee-for-Service	1386693125	1386693125	1	1	LAMB, PHILINA M MD	2/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	69924	07	Dermatology	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
238023	Fee-for-Service	1093866469	1093866469	1	1	LIAO, PETER MD	5/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55573	41	Internal Medicine	0	In state provider	None	420 W ROWLAND STREET	None	COVINA	CA	91723	2943	19	06037	34.078949	-117.8963031	Los Angeles County
238045	Fee-for-Service	1245887033	1245887033	1	1	LA BEST HOSPICE CARE	12/10/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13746 VICTORY BLVD	STE 201	VAN NUYS	CA	91401	6717	19	06037	34.18664551	-118.432764	Los Angeles County
238064	Fee-for-Service	1649282856	1649282856	2	1	LOMPOC VALLEY MEDICAL CENTER	2/4/2020	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	136 N 3RD ST	None	LOMPOC	CA	93436	7002	42	06083	34.64013944	-120.4451768	Santa Barbara County
238097	Fee-for-Service	1699959635	1699959635	1	1	LEE, RACHEL N MD	3/30/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	120552	-	NOT APPLICABLE	0	In state provider	None	10 WOODLAND ROAD	None	ST HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
238101	Fee-for-Service	1013950856	1013950856	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	40044 HIGHWAY 49	#F	OAKHURST	CA	93644	8875	20	06039	37.330533	-119.6591805	Madera County
238118	Fee-for-Service	1700300308	1700300308	1	1	LAPID, MICHELLE H AU	1/1/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
238120	Fee-for-Service	1518209444	1518209444	1	1	LEHMAN, FAITH R CNP	7/1/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6501 COYLE AVENUE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
238128	Fee-for-Service	1457512162	1457512162	1	1	LOBER, ROBERT M MD	7/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109245	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
238146	Fee-for-Service	1245793819	1245793819	1	1	LIM, CHRISTINA OD	8/24/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9170 HAVEN AVE	SUITE 102	RANCHO CUCAMONGA	CA	91730	5416	36	06071	34.087491	-117.5758895	San Bernardino County
238150	Fee-for-Service	1194737106	1194737106	1	1	LILA N O'MAHONY, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY NE	None	SEATTLE	WA	98105	3900	00	None	47.66165594	-122.2864502	King County
238206	Fee-for-Service	1316077456	1316077456	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	31021 STATE HIGHWAY 79	None	TEMECULA	CA	92592	2991	33	06065	33.47575935	-117.119891	Riverside County
238258	Fee-for-Service	1932402732	1932402732	1	1	LAPP, SAMANTHA W LMFT	11/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 HUMBOLDT RD	SUITE 3	CHICO	CA	95928	8100	04	06007	39.73660489	-121.8115227	Butte County
238293	Fee-for-Service	1780607648	1780607648	1	1	LANGENBERG, ANDRIA MD	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	52236	07	Dermatology	0	In state provider	None	1001 POTRERO AVE	RM 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
238302	Fee-for-Service	1245462969	1245462969	1	1	LUTHERAN SOCIAL SERVICES OF	5/12/2022	No Taxonomy Provided	NA	None	095	PRIVATE NON-PROFIT PROPRIETARY AGENCY	-	-	NOT APPLICABLE	0	In state provider	NORTHERN CALIFORNIA	4390 47TH AVENUE	None	SACRAMENTO	CA	95824	3700	34	06067	38.509461	-121.456935	Sacramento County
238307	Fee-for-Service	1982833273	1982833273	1	1	LITVIN, TARAS V OD	11/29/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1033 THIRD STREET	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
238309	Fee-for-Service	1679515456	1679515456	1	1	LEN DU	7/17/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	SENTER PHARMACY	2643 SENTER RD	STE A	SAN JOSE	CA	95111	1184	43	06085	37.30242209	-121.8424654	Santa Clara County
238310	Fee-for-Service	1215223748	1215223748	1	1	LU, LINH M MD	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12349	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
238333	Fee-for-Service	1245887033	1245887033	1	1	LA BEST HOSPICE CARE	12/10/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13746 VICTORY BLVD	STE 201	VAN NUYS	CA	91401	6717	19	06037	34.18664551	-118.432764	Los Angeles County
238334	Fee-for-Service	1568405306	1568405306	2	1	LONGS DRUG STORES CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1105 MYRTLE AVE	None	EUREKA	CA	95501	1222	12	06023	40.79952037	-124.1480198	Humboldt County
238351	Fee-for-Service	1730190323	1730190323	1	1	LAWRENCE, PETER F MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85162	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
238370	Fee-for-Service	1669859666	1669859666	1	1	LEW, DANIEL MD	7/8/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	144634	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
238412	Fee-for-Service	1699891747	1699891747	1	1	LIN, HUGH MD	10/2/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	104637	18	Ophthalmology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
238413	Fee-for-Service	1588924260	1588924260	1	1	LEWIS, MEREDITH P MD	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130626	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
238451	Fee-for-Service	1164038717	1164038717	1	1	LEE, JUNE RENEE S PT	3/13/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10250 SANTA MONICA BLVD	2440	LOS ANGELES	CA	90067	6469	19	06037	34.05998846	-118.4200204	Los Angeles County
238479	Fee-for-Service	1932276144	1932276144	1	1	LEE, HOWARD DO	4/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7475	45	Nephrology (Renal-Kidney)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
238493	Fee-for-Service	1396149332	1396149332	1	1	LUU, ALLISON S MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132800	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
238498	Fee-for-Service	1972597672	1972597672	1	2	LAI, EDWARD M MD AMC	2/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	33474	22	Pathology (M.D. only)	0	In state provider	None	100 S RAYMOND AVE	None	ALHAMBRA	CA	91801	3166	19	06037	34.09027878	-118.1450083	Los Angeles County
238503	Fee-for-Service	1083638530	1083638530	1	1	LONG BEACH CITY DEPT. OF	2/13/1996	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH & HUMAN SERVICES	2525 GRAND AVE	None	LONG BEACH	CA	90815	1765	19	06037	33.8026265	-118.1480993	Los Angeles County
238506	Fee-for-Service	1932284577	1932284577	1	1	LUETMER, LOIS PT	2/13/2007	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	101 S 1ST ST	STE 1800	BURBANK	CA	91502	1959	19	06037	34.17942444	-118.3096895	Los Angeles County
238508	Fee-for-Service	1851474217	1851474217	1	1	LIM, JUNG J DO	6/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8767	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	TOTAL VASCULAR SURG INC	5 MEDICAL PLAZA DRIVE	SUITE 200	ROSEVILLE	CA	95661	2867	31	06061	38.76604411	-121.2466761	Placer County
238513	Fee-for-Service	1184644031	1184644031	1	1	LYNCH, ROBERT L II MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	65277	01	General Practice	0	In state provider	None	2603 N PATTERSON ROAD	SUITE 2	RIVERBANK	CA	95367	3407	50	06099	37.73272653	-120.949119	Stanislaus County
238514	Fee-for-Service	1528184587	1528184587	1	1	LAM, MICHAEL N MD	7/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91292	01	General Practice	0	In state provider	None	140 W VALLEY BLVD	STE 220	SAN GABRIEL	CA	91776	3787	19	06037	34.07958215	-118.1021957	Los Angeles County
238545	Fee-for-Service	1598115677	1598115677	1	1	LAZZAROTTO, MANA DO	2/27/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16752	None	None	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
238549	Fee-for-Service	1790096089	1790096089	1	1	LOEHR, JORDANN E MD	2/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131479	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	45 NIELSON ST	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7925859	Santa Cruz County
238556	Fee-for-Service	1508863499	1508863499	1	1	LEE, EDWARD JUNG MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75527	41	Internal Medicine	0	In state provider	None	1182 N EUCLID ST	None	ANAHEIM	CA	92801	1900	30	06059	33.849909	-117.9416115	Orange County
238568	Fee-for-Service	1043262314	1043262314	1	1	LEVI, LEAH MD	11/30/1990	207W00000X	NA	Ophthalmology	026	PHYSICIANS	50037	18	Ophthalmology	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
238631	Fee-for-Service	1508807140	1508807140	1	1	LO, SHUYUN DAVID MD	3/9/2004	2084P0800X	NA	Psychiatry	026	PHYSICIANS	60210	36	Psychiatry	0	In state provider	None	1080 EMELINE AVE	None	SANTA CRUZ	CA	95060	1966	44	06087	36.99191102	-122.0176744	Santa Cruz County
238680	Fee-for-Service	1730316969	1730316969	1	1	LESHIKAR, DAVID E MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114064	02	General Surgery	0	In state provider	None	863 N DOUGLAS ST	STE 100	EL SEGUNDO	CA	90245	2081	19	06037	33.92830583	-118.3831669	Los Angeles County
238682	Fee-for-Service	1174747778	1174747778	1	1	LAMBRECHT, CHASE T DO	9/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8887	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
238686	Fee-for-Service	1548377641	1548377641	1	1	LIU, JIAFAN MD	8/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104053	None	None	0	In state provider	None	2215 TRUXTON AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
238690	Fee-for-Service	1134326366	1134326366	1	1	LEO DAMASCO	10/5/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	91-2141 FORT WEAVER RD	None	EWA BEACH	HI	96706	1993	00	None	21.3717827	-158.02605	Honolulu County
238721	Fee-for-Service	1750928826	1750928826	1	1	LIPKIN, KARINA NP	6/14/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
238733	Fee-for-Service	1912497629	1912497629	1	1	LIU, AMANDA MD	7/5/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	165073	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
238745	Fee-for-Service	1376601732	1376601732	1	1	LIAO, SHU-YUAN MD	4/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32172	22	Pathology (M.D. only)	0	In state provider	None	280 S MAIN ST	None	ORANGE	CA	92868	3852	30	06059	33.784695	-117.867327	Orange County
238759	Fee-for-Service	1174864870	1174864870	1	1	LAC, KIM-MY L	3/28/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
238790	Fee-for-Service	1255794970	1255794970	1	1	LIN, RYAN MD	7/29/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	150393	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
238795	Fee-for-Service	1154521433	1154521433	1	1	LAPLACA, MARTIN B LCSW	8/17/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	286 EUCLID AVE	STE 102	SAN DIEGO	CA	92114	3611	37	06073	32.70706919	-117.0850896	San Diego County
238799	Fee-for-Service	1184644031	1184644031	1	1	LYNCH, ROBERT L II MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	65277	41	Internal Medicine	0	In state provider	None	2603 N PATTERSON ROAD	SUITE 2	RIVERBANK	CA	95367	3407	50	06099	37.73272653	-120.949119	Stanislaus County
238818	Fee-for-Service	1629367644	1629367644	1	1	LE, DENNY H MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135220	05	Anesthesiology	0	In state provider	None	4445 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
238829	Fee-for-Service	1457379836	1457379836	1	1	LUDWIG, BARRY I MD	1/1/1982	2084N0400X	NA	Neurology	026	PHYSICIANS	36708	13	Neurology (M.D. only)	0	In state provider	None	301 N PRAIRIE AVE	STE 40	INGLEWOOD	CA	90301	4507	19	06037	33.965712	-118.3439965	Los Angeles County
238844	Fee-for-Service	1801259007	1801259007	1	1	LEUNG, KENNETH K MD	6/9/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	161172	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
238848	Fee-for-Service	1770770752	1770770752	1	1	LUCICH, BRADLEY B CPO	3/29/2016	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	295 W CROMWELL AVE	SUITE 102	FRESNO	CA	93711	6167	10	06019	36.84754253	-119.7978435	Fresno County
238880	Fee-for-Service	1730251059	1730251059	1	1	LEONG, LILIAN W DO	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9598	08	Family Practice	0	In state provider	None	1455 MONTEGO	STE 205	WALNUT CREEK	CA	94598	2957	07	06013	37.91046956	-122.0418669	Contra Costa County
238918	Fee-for-Service	1508807140	1508807140	1	1	LO, SHUYUN DAVID MD	3/9/2004	2084P0800X	NA	Psychiatry	026	PHYSICIANS	60210	26	Psychiatry (child)	0	In state provider	None	1080 EMELINE AVE	None	SANTA CRUZ	CA	95060	1966	44	06087	36.99191102	-122.0176744	Santa Cruz County
238936	Fee-for-Service	1669995916	1669995916	1	1	LE, HELEN W OD	12/19/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	554 E SAN BERNARDINO RD	STE 102	COVINA	CA	91723	1748	19	06037	34.09085021	-117.8800144	Los Angeles County
238951	Fee-for-Service	1063590636	1063590636	1	1	LIN, HTEIN MD	11/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82553	41	Internal Medicine	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
238967	Fee-for-Service	1790070308	1790070308	1	1	LAU, LYNETTE PHD	6/27/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
238973	Fee-for-Service	1265519102	1265519102	1	1	LY, HANG T MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73970	18	Ophthalmology	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
238980	Fee-for-Service	1679703417	1679703417	1	1	LUNG, ALLERGY & SLEEP	12/23/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	DISORDER CENTER, INC	1162 LIVE OAK BLVD	None	YUBA CITY	CA	95991	3407	51	06101	39.14528873	-121.6208232	Sutter County
239001	Fee-for-Service	1437259132	1437259132	1	1	LEWIS-BARRETO, ANNABELLE	5/3/2006	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1014 LONGFELLOW CT	None	OCEANSIDE	CA	92057	2657	37	06073	33.27006976	-117.2995338	San Diego County
239016	Fee-for-Service	1750420535	1750420535	1	1	LEWIS, YOLANDA F LMFT	4/27/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	35627	-	NOT APPLICABLE	0	In state provider	None	503 OCEAN FRONT WALK	None	VENICE	CA	90291	2403	19	06037	33.99316887	-118.4791801	Los Angeles County
239031	Fee-for-Service	1063667681	1063667681	1	1	LARGE, BELINDA NP	4/22/2024	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
239032	Fee-for-Service	1104400951	1104400951	1	1	LITTLE, LORRAINE LCSW	12/14/2021	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	45445 PORTOLA AVE	SUITE 1	PALM DESERT	CA	92260	4844	33	06065	33.7186073	-116.3737698	Riverside County
239052	Fee-for-Service	1447373436	1447373436	1	1	LIM, STEVE Y	10/7/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
239071	Fee-for-Service	1962038828	1962038828	1	1	LOKOS, HANNAH C MD	7/1/2023	207R00000X	NA	Other	026	PHYSICIANS	178625	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
239092	Fee-for-Service	1508184615	1508184615	1	1	LAI, TERRANCE C MD	5/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137101	None	None	0	In state provider	None	8700 BEVERLY BLVD	SUITE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
239093	Fee-for-Service	1164648390	1164648390	1	1	LIN, SI ZHE AC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	6506 LOBER PL	None	SAN GABRIEL	CA	91775	1841	19	06037	34.11677165	-118.0795478	Los Angeles County
239104	Fee-for-Service	1952443897	1952443897	1	1	LIAO, JANE C OD	5/17/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	38069 MARTHA AVE	SUITE 200	FREMONT	CA	94536	3815	01	06001	37.55978715	-121.991892	Alameda County
239151	Fee-for-Service	1356665657	1356665657	1	1	LEE, PAMELA C MD	2/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	98007	02	General Surgery	0	In state provider	None	520 W JUNIPERO STREET	None	SANTA BARBARA	CA	93105	4212	42	06083	34.4292679	-119.7255944	Santa Barbara County
239157	Fee-for-Service	1083030324	1083030324	1	1	LEVINE, DELISA L LMFT	7/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3655 ALAMO ST	SUITE 300	SIMI VALLEY	CA	93063	2187	56	06111	34.28646704	-118.7257456	Ventura County
239174	Fee-for-Service	1154409233	1154409233	1	1	LEVENFELD, BRENT M MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76524	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
239193	Fee-for-Service	1144939927	1144939927	1	1	LEACH, KELLY E PT	6/14/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1200 41ST AVE	SUITE H	CAPITOLA	CA	95010	3900	44	06087	36.969003	-121.964871	Santa Cruz County
239199	Fee-for-Service	1619541703	1619541703	1	1	LOS CARE HOMEHEALTH INC	8/20/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3206 HONOLULU AVE	STE A	LA CRESCENTA	CA	91214	3327	19	06037	34.22068785	-118.2491099	Los Angeles County
239225	Fee-for-Service	1437822137	1437822137	1	1	LOUIS, TONI LCSW	6/28/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
239229	Fee-for-Service	1518233311	1518233311	1	1	LANIOUS, OKSANA A PHD	11/7/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
239235	Fee-for-Service	1952394553	1952394553	1	1	LEE, SOON T MD	4/13/1995	207W00000X	NA	Ophthalmology	026	PHYSICIANS	44312	18	Ophthalmology	0	In state provider	None	3300 TELEGRAPH AVE	None	OAKLAND	CA	94609	3028	01	06001	37.82176506	-122.266417	Alameda County
239262	Fee-for-Service	1649373887	1649373887	1	1	LOVELACE HEALTH SYSTEMS INC	4/2/2006	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	10501 GOLF COURSE ROAD	NE	ALBUQUERQUE	NM	87114	5019	00	None	35.20789535	-106.6764549	Bernalillo County
239267	Fee-for-Service	1679703417	1679703417	1	1	LUNG, ALLERGY & SLEEP	12/23/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	DISORDER CENTER, INC	1162 LIVE OAK BLVD	None	YUBA CITY	CA	95991	3407	51	06101	39.14528873	-121.6208232	Sutter County
239268	Fee-for-Service	1942519178	1942519178	1	1	LINGAS, PETER C	2/4/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3501 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2150	15	06029	35.35408422	-119.0424307	Kern County
239276	Fee-for-Service	1124171392	1124171392	1	1	LINDSAY UNIFIED SD	1/1/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	371 E HERMOSA AVE	None	LINDSAY	CA	93247	2172	54	06107	36.20613243	-119.0882208	Tulare County
239279	Fee-for-Service	1710173026	1710173026	1	1	LEE, JUSTIN J MD	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119949	05	Anesthesiology	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
239284	Fee-for-Service	1417562463	1417562463	1	1	LAUREN D. COSTINE, PH, D., A	12/21/2021	103T00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	PSYCHOLOGY CORPORATION	21243 VENTURA BLVD	118	WOODLAND HILLS	CA	91364	2162	19	06037	34.16736368	-118.5947825	Los Angeles County
239289	Fee-for-Service	1982260204	1982260204	1	1	LONG, LI DO	3/11/2025	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
239291	Fee-for-Service	1467451971	1467451971	1	1	LISMAN, KEVIN A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	HOUSTON CARDIOVASCULAR	6560 FANNIN, SUITE 1654	None	HOUSTON	TX	77030	0000	00	None	29.71042898	-95.40043393	Harris County
239292	Fee-for-Service	1700409273	1700409273	1	1	LUONG, ANHTHI Q AU	10/21/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
239299	Fee-for-Service	1346426954	1346426954	1	1	LAURENCE OF OAKLAND INC	9/28/2007	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2190 MERIDIAN PARK BLVD	STE E	CONCORD	CA	94520	5715	07	06013	37.97722817	-122.0572904	Contra Costa County
239313	Fee-for-Service	1750746285	1750746285	1	1	LA PORTE HOSPITAL COMPANY LL	6/23/2024	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1331 STATE ST	None	LA PORTE	IN	46350	3112	00	None	41.60900794	-86.7277076	LaPorte County
239323	Fee-for-Service	1114596061	1114596061	1	1	LYNN, WILLIAM MD	11/27/2024	207PE0004X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1325 COTTONWOOD ST	None	WOODLAND	CA	95695	5131	57	06113	38.664027	-121.7933505	Yolo County
239326	Fee-for-Service	1427042118	1427042118	1	1	LETCHFORD, CHARLENE A MD	2/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
239352	Fee-for-Service	1215126115	1215126115	1	1	LIN, DENNIS OD INC	11/7/2007	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	537 S ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	3815	19	06037	34.05506574	-118.1355856	Los Angeles County
239355	Fee-for-Service	1437185295	1437185295	1	1	LAM, THOMAS S MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	44280	41	Internal Medicine	0	In state provider	None	2409 N BROADWAY	None	LOS ANGELES	CA	90031	2218	19	06037	34.07365452	-118.216595	Los Angeles County
239359	Fee-for-Service	1932433117	1932433117	1	1	LEE, ALAN C MD	8/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109467	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
239375	Fee-for-Service	1538248273	1538248273	1	1	LEE, STEVEN MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	77881	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
239379	Fee-for-Service	1699009340	1699009340	1	1	LOVE, NIC E MSW LCSW	8/18/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
239384	Fee-for-Service	1821031170	1821031170	2	1	LONGS DRUG STORES CA LLC	12/26/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	759 BLITHEDALE AVE	None	MILL VALLEY	CA	94941	1565	21	06041	37.90291388	-122.5241229	Marin County
239414	Fee-for-Service	1013267640	1013267640	1	1	LOUIE, MONICA L	3/26/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	SUITE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
239429	Fee-for-Service	1144683269	1144683269	1	1	LIN, LIU YI MD	5/20/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	172720	36	Psychiatry	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
239432	Fee-for-Service	1568860153	1568860153	1	1	LAMAS, ALONZO PSYD	8/2/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
239438	Fee-for-Service	1831169002	1831169002	1	1	LAMI, JOSE LUIS M MD	8/31/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51463	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3275 SKYPARK DR	None	TORRANCE	CA	90505	5027	19	06037	33.80825394	-118.343391	Los Angeles County
239469	Fee-for-Service	1700391752	1700391752	1	2	LIFE OF HOPE	10/17/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	301 W HUNTINGTON DR	116	ARCADIA	CA	91007	3462	19	06037	34.13481053	-118.0425638	Los Angeles County
239477	Fee-for-Service	1255442760	1255442760	1	1	LEE, ANDREW H DO	9/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9348	30	Radiology	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
239497	Fee-for-Service	1295890333	1295890333	1	1	LINDER, DAVID N MD	7/24/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	53024	36	Psychiatry	0	In state provider	None	508 GISON DRIVE	SUITE 150	ROSEVILLE	CA	95650	1234	31	06061	38.77866166	-121.2745528	Placer County
239499	Fee-for-Service	1871670729	1871670729	1	1	LOFTUS, JUANITA S MD	1/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	64555	40	Pediatrics	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
239503	Fee-for-Service	1871538686	1871538686	1	1	LEMAY, LIN G MD	12/10/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	64760	13	Neurology (M.D. only)	0	In state provider	None	2701 WEST ALEMEDA AVE	STE 500	BURBANK	CA	91505	4410	19	06037	34.15751343	-118.3303715	Los Angeles County
239519	Fee-for-Service	1487169819	1487169819	1	1	LUI, JESSICA PT	6/30/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
239526	Fee-for-Service	1477733012	1477733012	1	1	LISS, MICHAEL A MD	3/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101260	34	Urology and Urological Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
239538	Fee-for-Service	1366543340	1366543340	1	1	LEE, KAREN MARIE RN	7/29/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	6255 E CLINTON AVENUE	None	FRESNO	CA	93727	1406	10	06019	36.77207733	-119.6773789	Fresno County
239543	Fee-for-Service	1487807335	1487807335	1	1	LONGE, OLUWOLE O MD	9/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	125667	05	Anesthesiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
239546	Fee-for-Service	1649373887	1649373887	1	1	LOVELACE HEALTH SYSTEMS INC	6/15/2013	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	10501 GOLF COURSE ROAD	NE	ALBUQUERQUE	NM	87114	5019	00	None	35.20789535	-106.6764549	Bernalillo County
239549	Fee-for-Service	1619016615	1619016615	1	1	LAURA BARON MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6644 E BAYWOOD AVE	None	MESA	AZ	85206	1747	00	None	33.411159	-111.688686	Maricopa County
239554	Fee-for-Service	1952742207	1952742207	1	1	LEE, JOHN Y MD	7/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126392	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	SUITE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
239565	Fee-for-Service	1558796052	1558796052	1	1	LINDERMAN, ANNE S NP	5/21/2021	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
239573	Fee-for-Service	1417562463	1417562463	1	1	LAUREN D. COSTINE, PH, D., A	12/21/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYCHOLOGY CORPORATION	21243 VENTURA BLVD	118	WOODLAND HILLS	CA	91364	2162	19	06037	34.16736368	-118.5947825	Los Angeles County
239587	Fee-for-Service	1346426954	1346426954	1	1	LAURENCE OF OAKLAND INC	1/1/2014	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	2190 MERIDIAN PARK BLVD	STE E	CONCORD	CA	94520	5715	07	06013	37.97722817	-122.0572904	Contra Costa County
239598	Fee-for-Service	1750746285	1750746285	1	1	LA PORTE HOSPITAL COMPANY LL	6/23/2024	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1331 STATE ST	None	LA PORTE	IN	46350	3112	00	None	41.60900794	-86.7277076	LaPorte County
239603	Fee-for-Service	1073856068	1073856068	1	1	LOUIS, DENITHA E NP	7/28/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43112 N 15TH WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
239633	Fee-for-Service	1487051512	1487051512	1	1	LOCKE, STELLA JO	7/17/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	28195 HEMLOCK AVE	None	MORENO VALLEY	CA	92555	5433	33	06065	33.94271497	-117.1710216	Riverside County
239649	Fee-for-Service	1265432967	1265432967	1	1	LEI, CALVIN MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	54048	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
239683	Fee-for-Service	1396871521	1396871521	1	1	LAWALL, CARSON T MD	9/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	96942	13	Neurology (M.D. only)	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
239740	Fee-for-Service	1063426898	1063426898	1	1	LOS ANGELES COUNTY	4/28/1997	261Q00000X	NA	Other	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	LONG BEACH FAM PLANNING	1333 CHESTNUT AVE	None	LONG BEACH	CA	90813	2944	19	06037	33.78354312	-118.1963702	Los Angeles County
239767	Fee-for-Service	1528019932	1528019932	1	1	LIU, JUN MD	5/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	131073	22	Pathology (M.D. only)	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
239769	Fee-for-Service	1770075657	1770075657	1	1	LEMELLE, STANLEY LMFT	9/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
239801	Fee-for-Service	1902338296	1902338296	1	1	LINDQUIST, ROBERT A MD	6/27/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	159985	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
239825	Fee-for-Service	1366543340	1366543340	1	1	LEE, KAREN MARIE RN	4/1/2006	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	6255 E CLINTON AVENUE	None	FRESNO	CA	93727	1406	10	06019	36.77207733	-119.6773789	Fresno County
239842	Fee-for-Service	1427034255	1427034255	1	1	LEE, BRETT C MD	7/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85946	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
239857	Fee-for-Service	1639270093	1639270093	1	1	LA PUENTE VALLEY MED GRP	2/28/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	18335 VALLEY BLVD	None	LA PUENTE	CA	91744	5968	19	06037	34.00550085	-117.9026349	Los Angeles County
239875	Fee-for-Service	1891869343	1891869343	1	1	LIBUS, SVETLANA MD	2/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67141	36	Psychiatry	0	In state provider	None	850 E WARDLOW RD	None	LONG BEACH	CA	90807	4628	19	06037	33.81888054	-118.182069	Los Angeles County
239883	Fee-for-Service	1821171521	1821171521	1	1	LOZON, MRAIE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 E MEDICAL CENTER DR	None	ANN ARBOR	MI	48109	5000	00	None	42.28391347	-83.72716554	Washtenaw County
239914	Fee-for-Service	1407238561	1407238561	1	1	LAU, AMANDA MD	10/17/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
239922	Fee-for-Service	1487051512	1487051512	1	1	LOCKE, STELLA JO	7/17/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	28195 HEMLOCK AVE	None	MORENO VALLEY	CA	92555	5433	33	06065	33.94271497	-117.1710216	Riverside County
239924	Fee-for-Service	1659508315	1659508315	1	1	LEE, YVONNE MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114956	67	Endocrinology	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
239942	Fee-for-Service	1033881917	1033881917	1	1	LA UNITED HOME HEALTH CARE	9/29/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	8133 SAN FERNANDO RD	STE 4	SUN VALLEY	CA	91352	4064	19	06037	34.21826224	-118.3677976	Los Angeles County
239955	Fee-for-Service	1598850174	1598850174	1	1	LANGELY, LEIGH M DO	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9493	40	Pediatrics	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
239959	Fee-for-Service	1972640142	1972640142	1	1	LI, WEIGUO MD INC	8/15/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63308	08	Family Practice	0	In state provider	None	25 S RAYMOND AVE	STE 111	ALHAMBRA	CA	91801	7142	19	06037	34.09042452	-118.1450725	Los Angeles County
239972	Fee-for-Service	1174728943	1174728943	1	1	LEE, AMY C LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
239988	Fee-for-Service	1619991056	1619991056	1	1	LANE, CORNELIUS W MD INC	12/11/2002	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	25743	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3200 BELL RD	None	AUBURN	CA	95603	9244	31	06061	38.94193574	-121.103139	Placer County
240006	Fee-for-Service	1124119979	1124119979	1	1	LI & WONG MDS INC	10/30/1975	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	819 W CESAR E CHAVEZ AVE	None	LOS ANGELES	CA	90012	2130	19	06037	34.06156387	-118.2449673	Los Angeles County
240060	Fee-for-Service	1033196001	1033196001	1	1	LABORATORY CORPORATION OF AM	4/23/2009	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	ERICA HOLDINGS	1904 TW ALEXANDER DRIVE	SUITE C	RESEARCH TRIANGLE	NC	27709	0153	00	None	35.9196317	-78.82847976	Durham County
240070	Fee-for-Service	1770923039	1770923039	1	1	LI, JUANA W OD	1/25/2019	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	36 W YOKUTS AVE	STE 1	STOCKTON	CA	95207	5713	39	06077	37.99833959	-121.3074229	San Joaquin County
240099	Fee-for-Service	1508945007	1508945007	1	1	LAU, HELEN NP	2/7/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
240145	Fee-for-Service	1639270093	1639270093	1	1	LA PUENTE VALLEY MED GRP	2/28/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	18335 VALLEY BLVD	None	LA PUENTE	CA	91744	5968	19	06037	34.00550085	-117.9026349	Los Angeles County
240153	Fee-for-Service	1578216925	1578216925	1	1	LE, HUONG	7/30/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
240174	Fee-for-Service	1134363336	1134363336	1	1	LICHTASH, CHARLENE T MD	2/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113898	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
240181	Fee-for-Service	1679874648	1679874648	1	1	LEWIS, MICHELLE M DO LTD	4/1/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	-	15	Obstetrics (D.O. only)	1	Border provider	None	1701 N GREEN VALLEY PKWY	SUITE 3A	HENDERSON	NV	89074	5886	00	None	36.036333	-115.0874955	Clark County
240196	Fee-for-Service	1376710467	1376710467	1	1	LU, CHONG-PING C MD INC	10/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	35138	33	Thoracic Surgery	0	In state provider	None	1000 E LATHAM AVE	STE E	HEMET	CA	92543	4409	33	06065	33.74942449	-116.961741	Riverside County
240197	Fee-for-Service	1124468426	1124468426	1	1	LAUGHLIN, LESLIE S LCSW	4/27/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	748 N MARKET ST	None	REDDING	CA	96003	3606	45	06089	40.5960907	-122.38781	Shasta County
240210	Fee-for-Service	1932588365	1932588365	1	1	LEE, CHRISTINA L MD	10/24/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	178592	None	None	0	In state provider	None	2000 STOCKTON BLVD	2300	SACRAMENTO	CA	95817	1348	34	06067	38.559222	-121.462362	Sacramento County
240228	Fee-for-Service	1669233896	1669233896	1	1	LEE, JAE SUNG NP	1/17/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
240244	Fee-for-Service	1316011380	1316011380	1	1	LEONG, SHIRLEY J MD	9/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77125	40	Pediatrics	0	In state provider	None	101 CALLAN AVE	STE 401	SAN LEANDRO	CA	94577	4523	01	06001	37.72594042	-122.1562404	Alameda County
240245	Fee-for-Service	1972640142	1972640142	1	1	LI, WEIGUO MD INC	8/15/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63308	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25 S RAYMOND AVE	STE 111	ALHAMBRA	CA	91801	7142	19	06037	34.09042452	-118.1450725	Los Angeles County
240261	Fee-for-Service	1518151968	1518151968	1	1	LOUIE, ANDREW D MD	6/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103150	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4101 TORRANCE BLVD	EM DEPT	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
240263	Fee-for-Service	1235698002	1235698002	1	1	LAMBECK, ALEXANDRA C MD	6/1/2022	207P00000X	NA	Other	026	PHYSICIANS	176849	None	None	0	In state provider	None	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	39	06077	38.12188356	-121.285872	San Joaquin County
240292	Fee-for-Service	1124119979	1124119979	1	1	LI & WONG MDS INC	10/30/1975	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	819 W CESAR E CHAVEZ AVE	None	LOS ANGELES	CA	90012	2130	19	06037	34.06156387	-118.2449673	Los Angeles County
240296	Fee-for-Service	1568568988	1568568988	1	1	LILEY, FASHA F MD	12/1/2003	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60432	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
240357	Fee-for-Service	1215248307	1215248307	1	1	LOVELACE, CANDICE R DO	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13660	41	Internal Medicine	0	In state provider	None	5400 W HILLSDALE AVE	STE 150	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
240361	Fee-for-Service	1124297957	1124297957	1	1	LAANO, ALICIA Z MD	6/16/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	30080	40	Pediatrics	0	In state provider	None	2228 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05727195	-118.2786237	Los Angeles County
240387	Fee-for-Service	1790705705	1790705705	1	1	LEVINE, ARNOLD W MD	7/1/1984	2086S0129X	NA	General Surgery	026	PHYSICIANS	52613	02	General Surgery	0	In state provider	None	2940 WEBSTER ST	None	OAKLAND	CA	94609	3407	01	06001	37.81832319	-122.2634921	Alameda County
240401	Fee-for-Service	1417174905	1417174905	1	1	LEE, SOK K MD	10/22/1982	207RA0201X	NA	Other	026	PHYSICIANS	30081	40	Pediatrics	0	In state provider	None	3875 WILSHIRE BLVD	STE 410	LOS ANGELES	CA	90010	3205	19	06037	34.06172052	-118.3111875	Los Angeles County
240406	Fee-for-Service	1912326398	1912326398	1	1	LA SHANDRA JACKSON-HICKS	4/25/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	7903 ELM AVE	SUITE 299	RANCHO CUCAMONGA	CA	91730	6854	36	06071	34.10977964	-117.561534	San Bernardino County
240429	Fee-for-Service	1144783358	1144783358	1	1	LIBERTY HOME HEALTH CARE	8/16/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7226 SEPULVEDA BLVD	UNIT 1	VAN NUYS	CA	91405	2003	19	06037	34.20198	-118.4661725	Los Angeles County
240430	Fee-for-Service	1336216159	1336216159	1	1	LIM, RICARDO S MD	12/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	60812	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
240457	Fee-for-Service	1447888375	1447888375	1	1	LIN, CHARLENE MD	8/28/2023	207R00000X	NA	Other	026	PHYSICIANS	184851	None	None	0	In state provider	None	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
240470	Fee-for-Service	1679874648	1679874648	1	1	LEWIS, MICHELLE M DO LTD	4/1/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	-	09	Gynecology (D.O. only)	1	Border provider	None	1701 N GREEN VALLEY PKWY	SUITE 3A	HENDERSON	NV	89074	5886	00	None	36.036333	-115.0874955	Clark County
240484	Fee-for-Service	1104390384	1104390384	1	1	LAVENDER HOME HEALTH	11/19/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14827 VENTURA BLVD	STE 218	SHERMAN OAKS	CA	91403	5208	19	06037	34.15219597	-118.4563128	Los Angeles County
240485	Fee-for-Service	1376710467	1376710467	1	1	LU, CHONG-PING C MD INC	10/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	35138	41	Internal Medicine	0	In state provider	None	1000 E LATHAM AVE	STE E	HEMET	CA	92543	4409	33	06065	33.74942449	-116.961741	Riverside County
240494	Fee-for-Service	1508285115	1508285115	1	1	LIU, GRACE Y MD	10/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	137569	-	NOT APPLICABLE	0	In state provider	None	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	43	06085	37.34293689	-121.9270392	Santa Clara County
240502	Fee-for-Service	1487734521	1487734521	1	1	LEE, JOHN G MD	8/8/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63678	41	Internal Medicine	0	In state provider	None	98 MONTGOMERY DR	STE C	SANTA ROSA	CA	95404	6615	49	06097	38.443113	-122.704884	Sonoma County
240520	Fee-for-Service	1467038869	1467038869	1	1	LUCERO, JOVANNY MD	7/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
240532	Fee-for-Service	1972640142	1972640142	1	1	LI, WEIGUO MD INC	8/15/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63308	01	General Practice	0	In state provider	None	25 S RAYMOND AVE	STE 111	ALHAMBRA	CA	91801	7142	19	06037	34.09042452	-118.1450725	Los Angeles County
240562	Fee-for-Service	1891973699	1891973699	1	1	LEE, SHIRLEY MD	12/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99765	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
240581	Fee-for-Service	1124119979	1124119979	1	1	LI & WONG MDS INC	10/30/1975	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	819 W CESAR E CHAVEZ AVE	None	LOS ANGELES	CA	90012	2130	19	06037	34.06156387	-118.2449673	Los Angeles County
240585	Fee-for-Service	1568568988	1568568988	1	1	LILEY, FASHA F MD	12/1/2003	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60432	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
240602	Fee-for-Service	1669779310	1669779310	1	1	LG PHARMACY, INC.	7/28/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5400 HOLLYWOOD BLVD	UNIT A	LOS ANGELES	CA	90027	3406	19	06037	34.10170948	-118.3073355	Los Angeles County
240604	Fee-for-Service	1902821655	1902821655	1	1	LUTTENEGGER,THOMAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1024 LEMAY	None	FORT COLLINS	CO	80527	0000	00	None	40.571712	-105.055668	Larimer County
240607	Fee-for-Service	1437226446	1437226446	1	1	LIPSON CASSUTT, JODI DO	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	6181	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
240612	Fee-for-Service	1780038000	1780038000	1	1	LEON, JEANETTE NP	5/17/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
240663	Fee-for-Service	1477763829	1477763829	1	2	LEE, THOMAS T MD INC	10/31/1991	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	GRAND MED GRP OB/GYN INC	5450 JEFFERSON AVE	STE 1	CHINO	CA	91710	3522	36	06071	34.0247326	-117.6862355	San Bernardino County
240693	Fee-for-Service	1912326398	1912326398	1	1	LA SHANDRA JACKSON-HICKS	4/25/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	7903 ELM AVE	SUITE 299	RANCHO CUCAMONGA	CA	91730	6854	36	06071	34.10977964	-117.561534	San Bernardino County
240697	Fee-for-Service	1881093813	1881093813	1	1	LEE, NARA MD	8/17/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	150047	68	Hematology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
240699	Fee-for-Service	1487635298	1487635298	1	1	LEE, CHARLES K MD	8/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82918	24	Plastic Surgery	0	In state provider	None	1001 POTRERO AVENUE	RM 3A36	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
240718	Fee-for-Service	1821259342	1821259342	1	1	LUNG, DERRICK D MD	6/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107783	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
240778	Fee-for-Service	1376710467	1376710467	1	1	LU, CHONG-PING C MD INC	10/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	35138	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1000 E LATHAM AVE	STE E	HEMET	CA	92543	4409	33	06065	33.74942449	-116.961741	Riverside County
240782	Fee-for-Service	1982975892	1982975892	1	1	LYNNE JONATHAN E MD	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128902	01	General Practice	0	In state provider	None	4053 LONE TREE WAY	STE 100	ANTIOCH	CA	94531	6210	07	06013	37.97569499	-121.800733	Contra Costa County
240789	Fee-for-Service	1487734521	1487734521	1	1	LEE, JOHN G MD	8/8/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63678	10	Gastroenterology (M.D. only)	0	In state provider	None	98 MONTGOMERY DR	STE C	SANTA ROSA	CA	95404	6615	49	06097	38.443113	-122.704884	Sonoma County
240800	Fee-for-Service	1659459238	1659459238	1	1	LEE, JOSEPH H MD	11/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83505	34	Urology and Urological Surgery	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
240854	Fee-for-Service	1366594749	1366594749	1	1	LIN, MARK T MD	5/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93025	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
240869	Fee-for-Service	1144653809	1144653809	1	1	LAU, YOLANDA C MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126871	40	Pediatrics	0	In state provider	None	20101 LAKE CHABOT RD	3RD FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
240874	Fee-for-Service	1568568988	1568568988	1	1	LILEY, FASHA F MD	12/1/2003	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60432	45	Nephrology (Renal-Kidney)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
240877	Fee-for-Service	1770561094	1770561094	1	1	LABORATORY CORPORATION OF	5/4/2015	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	AMERICA	1122 WEST WASHINGTON BLV	STE 340	LOS ANGELES	CA	90015	3349	19	06037	34.03888475	-118.2820708	Los Angeles County
240884	Fee-for-Service	1457887556	1457887556	1	1	LEUNG, BOBBY DPM	12/11/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1755 W HAMMER LANE	SUITE 7	STOCKTON	CA	95209	2900	39	06077	38.02145403	-121.3355659	San Joaquin County
240911	Fee-for-Service	1780035220	1780035220	1	1	LONG, CHARLES L MD	2/14/2023	390200000X	NA	Other	026	PHYSICIANS	172378	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
240934	Fee-for-Service	1568437655	1568437655	1	1	LEGRAND, MILTON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2160 S 1ST AVE	None	MAYWOOD	IL	60153	3328	00	None	41.86025379	-87.83381752	Cook County
240941	Fee-for-Service	1457743015	1457743015	1	1	LANCE, PHILIP J PHD	4/16/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8271 MELROSE AVENUE	110	LOS ANGELES	CA	90046	6800	19	06037	34.08372747	-118.3696965	Los Angeles County
240944	Fee-for-Service	1861580524	1861580524	1	1	LEUNG, ANNA S MD	8/30/1989	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	61661	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	616 WITMER ST	None	LOS ANGELES	CA	90017	2308	19	06037	34.0549933	-118.2658354	Los Angeles County
241044	Fee-for-Service	1891949426	1891949426	1	1	LEJEUNE, COREY M DPM	4/23/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	300 N EUCLID ST	STE A	FULLERTON	CA	92832	1623	30	06059	33.87250373	-117.9419615	Orange County
241132	Fee-for-Service	1518056571	1518056571	1	1	LEE, BRIAN K MD	8/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97745	45	Nephrology (Renal-Kidney)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
241150	Fee-for-Service	1235322009	1235322009	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6490 CLAYTON RD	None	CLAYTON	CA	94517	1153	07	06013	37.94256219	-121.9313401	Contra Costa County
241155	Fee-for-Service	1801099486	1801099486	1	1	LA COMMUNITY CARE MED	11/1/1997	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	ASSOCIATES	11633 HAWTHORNE BLVD	STE 103	HAWTHORNE	CA	90250	2323	19	06037	33.928488	-118.3527475	Los Angeles County
241181	Fee-for-Service	1063060358	1063060358	1	1	LISSNER, SEAN P PT	7/19/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
241183	Fee-for-Service	1356416333	1356416333	1	1	LABORATORY CORPORATION	2/5/2007	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	OF AMERICA INC	1008 RILEY ST	STE 4	FOLSOM	CA	95630	3262	34	06067	38.669607	-121.1694075	Sacramento County
241215	Fee-for-Service	1265489751	1265489751	1	1	LOS ANGELES CLINICA MED	5/3/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GENERAL MEDICAL CTR, INC	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
241240	Fee-for-Service	1225787468	1225787468	1	1	LEE, OSCAR DO	12/3/2024	207P00000X	NA	Other	026	PHYSICIANS	21972	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
241262	Fee-for-Service	1558107847	1558107847	1	1	LEVI, LIRIT MD	10/10/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
241289	Fee-for-Service	1114917143	1114917143	1	1	LAM,WARREN W MD	8/1/1993	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	76496	30	Radiology	0	In state provider	None	65 N MADISON AVE	None	PASADENA	CA	91101	2035	19	06037	34.14705803	-118.1384317	Los Angeles County
241324	Fee-for-Service	1497238984	1497238984	1	1	LAKE, JOSEPH V NP	12/4/2019	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
241338	Fee-for-Service	1972763621	1972763621	1	1	LIM, DAVID M I DO	10/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14703	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
241355	Fee-for-Service	1497803472	1497803472	1	1	LASAM, MARIA C MD	1/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74231	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
241384	Fee-for-Service	1477633519	1477633519	1	1	LIE, DESIREE A MD	10/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	48196	08	Family Practice	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
241387	Fee-for-Service	1477697563	1477697563	1	1	LORENZ, HERMANN P MD	5/31/1990	208600000X	NA	General Surgery	026	PHYSICIANS	65307	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
241427	Fee-for-Service	1942257191	1942257191	1	5	LONG BEACH MEMORIAL PATHOLOG	5/9/2024	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
241443	Fee-for-Service	1801099486	1801099486	1	1	LA COMMUNITY CARE MED	11/1/1997	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ASSOCIATES	11633 HAWTHORNE BLVD	STE 103	HAWTHORNE	CA	90250	2323	19	06037	33.928488	-118.3527475	Los Angeles County
241448	Fee-for-Service	1063875359	1063875359	1	1	LOCKARY, DEBRA A	4/18/2016	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2415 HIGH SCHOOL AVE	STE 300	CONCORD	CA	94520	1815	07	06013	37.98481374	-122.0347555	Contra Costa County
241453	Fee-for-Service	1538102868	1538102868	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2605 W MARCH LANE	None	STOCKTON	CA	95207	6522	39	06077	37.98486981	-121.340739	San Joaquin County
241489	Fee-for-Service	1568530939	1568530939	1	1	LOMA LINDA UNIVERSITY	6/29/2009	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	11092 ANDERSON ST	None	LOMA LINDA	CA	92350	1706	36	06071	34.05203016	-117.2623278	San Bernardino County
241506	Fee-for-Service	1265489751	1265489751	1	1	LOS ANGELES CLINICA MED	8/6/2021	261QP2300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GENERAL MEDICAL CTR, INC	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
241540	Fee-for-Service	1902937600	1902937600	1	1	LANCON, DANIELLE R LCSW	3/6/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
241556	Fee-for-Service	1821138355	1821138355	1	1	LEE, ROZANDA Y MD	11/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86900	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
241564	Fee-for-Service	1326139916	1326139916	1	1	LE, AMANDA NGAN MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76812	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
241579	Fee-for-Service	1679612584	1679612584	1	1	LONE PINE UNIFIED	5/27/2004	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	301 S HAY ST	None	LONE PINE	CA	93545	0000	14	06027	36.60275465	-118.0600973	Inyo County
241580	Fee-for-Service	1407992001	1407992001	1	1	LAI, JAMES E MD	9/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137051	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
241589	Fee-for-Service	1053392092	1053392092	1	1	LOZANO, EMILY MD	6/11/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
241622	Fee-for-Service	1760435960	1760435960	1	1	LOEWEN, JOHN W MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130732	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2333 BUCHANAN STREET	EMERGENCY DEPT	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
241644	Fee-for-Service	1548310568	1548310568	1	1	LEE, WINIFRED H MD	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97638	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
241673	Fee-for-Service	1619154689	1619154689	1	1	LEILA BOLANDGRAY, M.D. INC.	7/24/2020	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
241679	Fee-for-Service	1083810113	1083810113	1	1	LO, CHRISTINA MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87824	45	Nephrology (Renal-Kidney)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
241737	Fee-for-Service	1639456403	1639456403	1	1	LAKSHMAN, VISHVA G MD	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118159	41	Internal Medicine	0	In state provider	None	215 WEST JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
241747	Fee-for-Service	1831263177	1831263177	1	1	LINCARE INC.	11/16/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	105 W GOLDFIELD AVE	UNIT B	YERINGTON	NV	89447	2294	00	None	38.99383967	-119.1646981	Lyon County
241759	Fee-for-Service	1629257035	1629257035	1	1	LEE, CHRISTOPHER E MD	9/15/2009	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	95761	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
241785	Fee-for-Service	1295094324	1295094324	1	1	LAI, TIM T MD	4/4/2017	390200000X	NA	Other	026	PHYSICIANS	128380	13	Neurology (M.D. only)	0	In state provider	None	11100 WARNER AVE	STE 152	FOUNTAIN VALLEY	CA	92708	7506	30	06059	33.716291	-117.9355051	Orange County
241794	Fee-for-Service	1265489751	1265489751	1	1	LOS ANGELES CLINICA MED	8/28/2020	261QP2300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GENERAL MEDICAL CTR, INC	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
241800	Fee-for-Service	1609801760	1609801760	2	1	LANDAU, JOSEPH W MD	5/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	4281	07	Dermatology	0	In state provider	None	2428 SANTA MONICA BLVD	SUITE 401	SANTA MONICA	CA	90404	2047	19	06037	34.0317559	-118.4762013	Los Angeles County
241831	Fee-for-Service	1083628283	1083628283	1	1	LEVIN, ABRAM MD	12/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84667	08	Family Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
241844	Fee-for-Service	1932592763	1932592763	1	1	LEE, CHARLES S OD	9/30/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1200 DISCOVERY PLAZA	None	BAKERSFIELD	CA	93311	1318	15	06029	35.36397746	-119.0589062	Kern County
241864	Fee-for-Service	1538283643	1538283643	1	1	LINDBERG, JENNIFER CRNA	4/11/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
241908	Fee-for-Service	1114349578	1114349578	1	1	LARSEN, SAMANTHA L MFT	7/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	49	06097	38.26876442	-122.6598332	Sonoma County
241940	Fee-for-Service	1043253834	1043253834	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5090 FOOTHILLS BLVD	None	ROSEVILLE	CA	95747	6517	31	06061	38.76114494	-121.3102164	Placer County
241948	Fee-for-Service	1811067556	1811067556	1	1	LOMBOY, MARYANNE G MD	8/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	61851	40	Pediatrics	0	In state provider	None	16300 SAND CANYON AVE	SUITE 311	IRVINE	CA	92618	3703	30	06059	33.66115075	-117.7742405	Orange County
241958	Fee-for-Service	1437587615	1437587615	1	1	LANNI, KIMBERLY E PHD	11/30/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1643 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
241965	Fee-for-Service	1083810113	1083810113	1	1	LO, CHRISTINA MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87824	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
241993	Fee-for-Service	1629335849	1629335849	1	1	LU, NINA T MD	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115685	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
242053	Fee-for-Service	1922201318	1922201318	1	1	LIU, TZU-SHANG T MD	2/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112382	20	Orthopedic Surgery	0	In state provider	None	16008 KAMANA RD	SUITE 100	APPLE VALLEY	CA	92307	1308	36	06071	34.54191149	-117.2725046	San Bernardino County
242078	Fee-for-Service	1265489751	1265489751	1	1	LOS ANGELES CLINICA MED	3/5/1996	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GENERAL MEDICAL CTR, INC	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
242096	Fee-for-Service	1477667285	1477667285	1	1	LOU, LAY-HWA MD	11/26/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	53161	None	None	0	In state provider	None	1900 MOWRY AVE	STE 309	FREMONT	CA	94538	1722	01	06001	37.55862396	-121.9799952	Alameda County
242128	Fee-for-Service	1821008350	1821008350	1	1	LAFFERTY, CHRISTOPHER MD	7/18/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	59603	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
242177	Fee-for-Service	1285958751	1285958751	1	1	LAV K SINGH, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	820 CLARKSVILLE STREET	None	PARIS	TX	75460	6027	00	None	33.66028621	-95.54711357	Lamar County
242197	Fee-for-Service	1790337855	1790337855	2	1	LAKSMI ANANTA INC	5/1/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	525 OREGON ST	None	VALLEJO	CA	94590	3201	48	06095	38.11827873	-122.2491077	Solano County
242206	Fee-for-Service	1477596583	1477596583	1	1	LONG BEACH MEMORIAL MEDICAL	1/12/2001	282NC2000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
242238	Fee-for-Service	1942566963	1942566963	1	1	LIN, VINCENT S MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128897	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
242240	Fee-for-Service	1124028733	1124028733	1	1	LIM, JONATHAN R MD	6/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80939	08	Family Practice	0	In state provider	None	5575 W LAS POSITAS BLVD	STE 130	PLEASANTON	CA	94588	5800	01	06001	37.69214859	-121.8796532	Alameda County
242275	Fee-for-Service	1326118977	1326118977	1	1	LEE, DAE Y MD	1/31/1987	207L00000X	NA	Other	026	PHYSICIANS	31152	01	General Practice	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
242339	Fee-for-Service	1154773281	1154773281	1	1	LANDO, BRETT M	8/15/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	582 S SUNNYVALE AVE	None	SUNNYVALE	CA	94086	6125	43	06085	37.36886669	-122.0316101	Santa Clara County
242342	Fee-for-Service	1922201318	1922201318	1	1	LIU, TZU-SHANG T MD	2/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112382	01	General Practice	0	In state provider	None	16008 KAMANA RD	SUITE 100	APPLE VALLEY	CA	92307	1308	36	06071	34.54191149	-117.2725046	San Bernardino County
242364	Fee-for-Service	1568651040	1568651040	1	1	LOREDO, SAMUEL MD INC	2/28/1990	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55263	26	Psychiatry (child)	0	In state provider	None	139 W EL PORTAL DR	STE A	MERCED	CA	95348	2844	24	06047	37.32672952	-120.469851	Merced County
242370	Fee-for-Service	1699843508	1699843508	1	1	LACSON, STEPHANIE M MD	5/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95241	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
242386	Fee-for-Service	1912346099	1912346099	1	1	LA, STEVEN S DPM	2/6/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4910 AIRPORT PLAZA DR	STE 100	LONG BEACH	CA	90515	1264	19	06037	33.80854316	-118.1359209	Los Angeles County
242401	Fee-for-Service	1346206463	1346206463	1	1	LEUNG, KAREN L MD	2/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	74370	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
242419	Fee-for-Service	1821008350	1821008350	1	1	LAFFERTY, CHRISTOPHER MD	7/18/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	59603	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
242466	Fee-for-Service	1285829861	1285829861	1	1	LEE, YUWEN OD	9/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
242482	Fee-for-Service	1477879864	1477879864	1	1	LY, DAVID MD	1/23/2021	2085R0001X	NA	Other	026	PHYSICIANS	141368	None	None	0	In state provider	None	1443 W 7TH ST	None	HANFORD	CA	93230	4937	16	06031	36.32550091	-119.6678789	Kings County
242492	Fee-for-Service	1477596583	1477596583	1	1	LONG BEACH MEMORIAL MEDICAL	1/12/2001	282NC2000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
242496	Fee-for-Service	1376623744	1376623744	1	1	LANGSTON, CATHERINE J DO	6/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	5330 S HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
242502	Fee-for-Service	1679518815	1679518815	1	1	LOMA LINDA UNIV FACULTY	4/1/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY	11370 ANDERSON ST	STE 1000	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
242527	Fee-for-Service	1538471875	1538471875	1	1	LARY, SARA DO	7/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	11296	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
242528	Fee-for-Service	1841262193	1841262193	1	1	LABEL, LORNE S MD	10/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	47623	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	STE B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
242574	Fee-for-Service	1265543185	1265543185	1	1	LEKOVIC, JILL MD	4/2/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53366	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
242584	Fee-for-Service	1962490078	1962490078	1	1	LODI ORTHOPAEDIC MED GRP	1/1/1987	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	INC	924 S FAIRMONT AVE	None	LODI	CA	95240	5119	39	06077	38.1221312	-121.2857767	San Joaquin County
242600	Fee-for-Service	1629412135	1629412135	1	1	LOWERY, JANEL M CRNA	12/8/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
242605	Fee-for-Service	1689848590	1689848590	1	1	LINSTROM, NATHAN J MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114711	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
242620	Fee-for-Service	1891993705	1891993705	1	1	LEE, PATRICK MD	5/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103149	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
242626	Fee-for-Service	1295769230	1295769230	1	1	LOBEL, JOSEF MD	9/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88599	41	Internal Medicine	0	In state provider	None	14649 VICTORY BLVD	None	VAN NUYS	CA	91411	4187	19	06037	34.18669152	-118.452393	Los Angeles County
242655	Fee-for-Service	1972847101	1972847101	1	1	LAI, PUI YING MD	5/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123550	40	Pediatrics	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
242674	Fee-for-Service	1245472034	1245472034	1	1	LIBERTY CARE AND INVESTMENT	1/25/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	922 E. HOLT AVE	None	POMONA	CA	91767	5719	19	06037	34.06276637	-117.7322189	Los Angeles County
242683	Fee-for-Service	1831139997	1831139997	1	1	LIU, JAMES C MD	10/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	47984	18	Ophthalmology	0	In state provider	None	5150 GRAVES AVE	STE 1	SAN JOSE	CA	95129	5001	43	06085	37.29450218	-121.9927703	Santa Clara County
242723	Fee-for-Service	1770642357	1770642357	1	1	LIN, JOHNNY C MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	62797	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
242728	Fee-for-Service	1114321668	1114321668	1	1	LEONARD, CHALON L	3/11/2015	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1261 TRAVIS BLVD	SUITE 140	FAIRFIELD	CA	94533	4800	48	06095	38.25812361	-122.0495417	Solano County
242731	Fee-for-Service	1538901707	1538901707	1	1	LEFEVRE, DANIELLE LMFT	7/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
242747	Fee-for-Service	1396788147	1396788147	2	1	LONGS DRUG STORE CA LLC	11/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	129 N EL CAMINO REAL	None	ENCINITAS	CA	92024	2802	37	06073	33.0474669	-117.2594818	San Diego County
242786	Fee-for-Service	1184981821	1184981821	1	1	LIAO, GEORGE P MD	2/8/2020	208600000X	NA	General Surgery	026	PHYSICIANS	147588	02	General Surgery	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
242819	Fee-for-Service	1154406387	1154406387	2	1	LINCARE, INC	6/6/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1273-1275 S MAIN ST	None	YREKA	CA	96097	3433	47	06093	41.71819851	-122.6397304	Siskiyou County
242866	Fee-for-Service	1700265139	1700265139	1	1	LEE, AARON MD	7/15/2020	207P00000X	NA	Other	026	PHYSICIANS	150630	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
242872	Fee-for-Service	1134428584	1134428584	1	1	LUEVANO, ARLENE CCC-SLP	2/21/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	599 S BARRANCA AVE	STE 555	COVINA	CA	91723	2791	19	06037	34.079373	-117.881338	Los Angeles County
243000	Fee-for-Service	1922008408	1922008408	1	1	LAKEPORT COUNTY FIRE	1/31/1992	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	PROTECTION DISTRICT	445 N MAIN ST	None	LAKEPORT	CA	95453	4809	17	06033	39.04507498	-122.9151701	Lake County
243005	Fee-for-Service	1659326221	1659326221	1	1	LAWRENCE, LYNN M MD	12/10/2019	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
243026	Fee-for-Service	1841229143	1841229143	1	1	LONGWITH, GARY A PHD	1/1/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1800 WESTWIND DR	STE 101	BAKERSFIELD	CA	93301	3031	15	06029	35.37531587	-119.0424856	Kern County
243041	Fee-for-Service	1952322521	1952322521	1	1	LAI, KIM T OD	1/9/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8956 CORBIN AVE	None	NORTHRIDGE	CA	91324	3311	19	06037	34.23337673	-118.5622875	Los Angeles County
243050	Fee-for-Service	1942221593	1942221593	2	1	LEE, ERNEST Y	7/23/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8716 CORD AVE	None	PICO RIVERA	CA	90660	5507	19	06037	33.95543046	-118.1010026	Los Angeles County
243061	Fee-for-Service	1689107930	1689107930	1	1	LE, NHATRANG H DO	9/10/2022	390200000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	2425 SAMARITAN DRIVE	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
243111	Fee-for-Service	1184655581	1184655581	1	1	LAKEWOOD REGIONAL	5/31/2002	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER	3700 SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
243131	Fee-for-Service	1740580471	1740580471	1	1	LEE, SEUNG H	2/19/2019	171000000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	C	6319 N FRESNO ST	SUITE 102	FRESNO	CA	93710	5281	10	06019	36.8287238	-119.7814178	Fresno County
243157	Fee-for-Service	1306846886	1306846886	1	1	LOURIM,JAMES F MD	12/1/2003	207L00000X	NA	Other	026	PHYSICIANS	79328	05	Anesthesiology	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
243160	Fee-for-Service	1598851255	1598851255	1	1	LEE, JAUMAAN MD	6/12/2010	225400000X	NA	Other	026	PHYSICIANS	69090	25	Physical Medicine and Rehabilitation	0	In state provider	None	223 N GARFIELD AVE	STE 105	MONTEREY PARK	CA	91754	1700	19	06037	34.0646166	-118.1228948	Los Angeles County
243163	Fee-for-Service	1114747607	1114747607	1	1	LEDBETTER, AARON NP	1/16/2025	2085R0202X	NA	Mammography/MRI Provider	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
243254	Fee-for-Service	1497153282	1497153282	1	1	LIN, YUNGHUI NP	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
243258	Fee-for-Service	1003941915	1003941915	1	1	LANE, WANDALYN LMFT	5/21/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1254 WATERMAN	STE 44	SAN BERNARDINO	CA	92408	2811	36	06071	34.07886	-117.278817	San Bernardino County
243273	Fee-for-Service	1174853311	1174853311	1	1	LAU, AUDREY H MD	5/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110691	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
243290	Fee-for-Service	1326229550	1326229550	1	1	LAVENDER, KATHERINE R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
243309	Fee-for-Service	1427269604	1427269604	1	1	LAURENCE, NANCY K MD	8/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120152	30	Radiology	0	In state provider	None	2801 K ST	STE 502	SACRAMENTO	CA	95816	5616	34	06067	38.572947	-121.46904	Sacramento County
243320	Fee-for-Service	1942309497	1942309497	1	1	LINCOLN HEIGHTS FAMILY	3/21/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INDUST GRP	2409 N BROADWAY	None	LOS ANGELES	CA	90031	2218	19	06037	34.07365452	-118.216595	Los Angeles County
243341	Fee-for-Service	1467463406	1467463406	1	1	LEE, JUNE H MD	8/16/1993	207R00000X	NA	Other	026	PHYSICIANS	77417	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
243346	Fee-for-Service	1417371113	1417371113	1	1	LA, KATHERINE T CRNA	4/27/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
243354	Fee-for-Service	1255667374	1255667374	1	1	LY, OLIVIA P LCSW	11/15/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	70123	-	NOT APPLICABLE	0	In state provider	None	7761 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92841	4200	30	06059	33.77387145	-117.9966555	Orange County
243356	Fee-for-Service	1639187412	1639187412	1	1	LANGELADE MEMORIAL HOSP	2/8/2008	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	112 EAST FIFTH AVE	None	ANTIGO	WI	54409	2710	00	None	45.14047412	-89.13917913	Langlade County
243376	Fee-for-Service	1730256595	1730256595	1	1	LAUDERBACK-YRIBE, KRYSTYN K	4/5/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
243380	Fee-for-Service	1164465993	1164465993	2	1	LONGS DRUG STORES CA LLC	12/26/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5059 BUSINESS CENTER DR	None	FAIRFIELD	CA	94534	1631	48	06095	38.21490436	-122.1428943	Solano County
243386	Fee-for-Service	1699925032	1699925032	1	1	LY, BECKY L CRNA	5/26/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
243393	Fee-for-Service	1699900324	1699900324	1	1	LANATA, CRISTINA M MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126237	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
243398	Fee-for-Service	1184655581	1184655581	1	1	LAKEWOOD REGIONAL	5/31/2002	261QA1903X	NA	Other	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER	3700 SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
243441	Fee-for-Service	1053404376	1053404376	1	1	LAGMAN, ROSARIO MD	10/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	38515	40	Pediatrics	0	In state provider	None	1300 N VERMONT AVE	STE 802A	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
243490	Fee-for-Service	1003234550	1003234550	1	1	LIU, PEI MD	4/19/2019	390200000X	NA	Other	026	PHYSICIANS	139170	13	Neurology (M.D. only)	0	In state provider	None	4234 RIVERWALK PKWY	280	RIVERSIDE	CA	92505	3370	33	06065	33.90290859	-117.4941562	Riverside County
243508	Fee-for-Service	1275577793	1275577793	1	1	LEVEQUE, ERIC A DO	10/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8385	66	Emergency Medicine (Urgent Care)	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
243533	Fee-for-Service	1790785046	1790785046	1	1	LYSEIGHT, NADINE S MD	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79351	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
243538	Fee-for-Service	1982961892	1982961892	1	1	LIN, SOPO MD	5/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154952	30	Radiology	0	In state provider	None	18133 VENTURA BLVD	STE 100	TARZANA	CA	91356	7134	19	06037	34.1657808	-118.5283188	Los Angeles County
243558	Fee-for-Service	1225135650	1225135650	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1843 S LA CINEGA BLVD	None	LOS ANGELES	CA	90035	4603	19	06037	34.04410366	-118.3768223	Los Angeles County
243562	Fee-for-Service	1174853311	1174853311	1	1	LAU, AUDREY H MD	5/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110691	10	Gastroenterology (M.D. only)	0	In state provider	None	725 WELCH RD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
243589	Fee-for-Service	1285007427	1285007427	1	1	LEBUS, RIE E PHD	12/11/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
243596	Fee-for-Service	1427269604	1427269604	1	1	LAURENCE, NANCY K MD	8/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120152	40	Pediatrics	0	In state provider	None	2801 K ST	STE 502	SACRAMENTO	CA	95816	5616	34	06067	38.572947	-121.46904	Sacramento County
243615	Fee-for-Service	1457548992	1457548992	1	1	LAKEWOOD EYE PHYSICIANS	5/30/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	& SURGEONS INC A MED GRP	3801 KATELLA AVE	STE 130	LOS ALAMITOS	CA	90720	3362	30	06059	33.80318951	-118.066068	Orange County
243630	Fee-for-Service	1467463406	1467463406	1	1	LEE, JUNE H MD	8/16/1993	207R00000X	NA	Other	026	PHYSICIANS	77417	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
243639	Fee-for-Service	1255667374	1255667374	1	1	LY, OLIVIA P LCSW	12/23/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7761 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92841	4200	30	06059	33.77387145	-117.9966555	Orange County
243642	Fee-for-Service	1639187412	1639187412	1	1	LANGELADE MEMORIAL HOSP	2/8/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	112 EAST FIFTH AVE	None	ANTIGO	WI	54409	2710	00	None	45.14047412	-89.13917913	Langlade County
243670	Fee-for-Service	1053594770	1053594770	1	1	LEEDY, ALEXANDRIA PHD	2/22/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
243711	Fee-for-Service	1467520189	1467520189	1	1	LOCKE, JOHN S MD	11/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	77841	20	Orthopedic Surgery	0	In state provider	None	341 MAGNOLIA AVE	SUITE 101	CORONA	CA	92879	3331	33	06065	33.85291987	-117.5664344	Riverside County
243724	Fee-for-Service	1891145264	1891145264	1	1	LO, MICHELLE MD	11/14/2020	208M00000X	NA	Other	026	PHYSICIANS	164537	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
243731	Fee-for-Service	1093396483	1093396483	1	1	LAI, BRIAN T DO	8/7/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20406	08	Family Practice	0	In state provider	None	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
243746	Fee-for-Service	1861626798	1861626798	1	1	LAIMAYUM, MONICA S MD	7/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121946	01	General Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
243770	Fee-for-Service	1831426642	1831426642	1	10	LAKESIDE MEDICAL	4/13/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	777A FLOWER STREET	None	GLENDALE	CA	91201	3000	19	06037	34.15804875	-118.2812939	Los Angeles County
243781	Fee-for-Service	1750311718	1750311718	1	1	LOO, LAWRENCE K MD	11/27/1985	207R00000X	NA	Other	026	PHYSICIANS	48152	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	# 3600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
243786	Fee-for-Service	1043475387	1043475387	1	1	LAM, LISA MD	9/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103148	01	General Practice	0	In state provider	None	222 W 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
243788	Fee-for-Service	1033253067	1033253067	1	1	LOUIE, GARY M OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	34724 ALVARADO NILES RD	None	UNION CITY	CA	94587	4502	01	06001	37.58633142	-122.0180412	Alameda County
243809	Fee-for-Service	1205807419	1205807419	1	1	LEHMAN, RONALD G MD	1/28/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	31613	40	Pediatrics	0	In state provider	None	2330 1ST AVE	STE 201	SAN DIEGO	CA	92101	1504	37	06073	32.72973932	-117.1639702	San Diego County
243828	Fee-for-Service	1710180419	1710180419	1	1	LEE, TSZ Y MD	12/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99205	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	365	LOS ANGELES	CA	90024	7002	19	06037	34.06527974	-118.4462792	Los Angeles County
243881	Fee-for-Service	1780776120	1780776120	1	1	LYLE, DOUGLAS P MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	36916	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	24411 HEALTH CENTER DR	STE 350	LAGUNA HILLS	CA	92653	3687	30	06059	33.6087201	-117.7076948	Orange County
243885	Fee-for-Service	1518212588	1518212588	1	1	LEE, JESSICA A MD	9/26/2019	208200000X	NA	General Surgery	026	PHYSICIANS	165047	24	Plastic Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
243896	Fee-for-Service	1366865206	1366865206	1	1	LUNDBERG, MICHAEL C DO	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
243905	Fee-for-Service	1457548992	1457548992	1	1	LAKEWOOD EYE PHYSICIANS	10/31/2024	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	& SURGEONS INC A MED GRP	3801 KATELLA AVE	STE 130	LOS ALAMITOS	CA	90720	3362	30	06059	33.80318951	-118.066068	Orange County
243917	Fee-for-Service	1467463406	1467463406	1	1	LEE, JUNE H MD	8/16/1993	207R00000X	NA	Other	026	PHYSICIANS	77417	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
243940	Fee-for-Service	1336663251	1336663251	1	1	LA VIDA HOSPICE INC	11/20/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	732 WEST 9TH STREET	STE 202	SAN PEDRO	CA	90731	3629	19	06037	33.73607447	-118.293102	Los Angeles County
243941	Fee-for-Service	1568761724	1568761724	1	1	LOZANO JR, JESUS MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107782	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
243967	Fee-for-Service	1730654658	1730654658	1	1	LY, SUE C NP	12/30/2022	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
243968	Fee-for-Service	1629093091	1629093091	1	1	LIEBESKIND, DAVID S MD	9/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62587	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA 3B200	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
243976	Fee-for-Service	1275614562	1275614562	1	1	LATNER, BARRY P MD	9/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	55864	90	Pathology-Forensic	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
243981	Fee-for-Service	1083804801	1083804801	1	1	LE, HAI X MD	7/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100947	41	Internal Medicine	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	1310	19	06037	34.03719097	-118.2654105	Los Angeles County
243995	Fee-for-Service	1992148530	1992148530	1	1	LAM, HUY D MD	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139794	01	General Practice	0	In state provider	None	10362 BOLSA AVE	None	WESTMINSTER	CA	92683	6763	30	06059	33.74488248	-117.94806	Orange County
244016	Fee-for-Service	1760472500	1760472500	1	1	LODER, DANIEL	8/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91446	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
244020	Fee-for-Service	1992793574	1992793574	1	1	LAURENCE OF OAKLAND INC	1/1/2014	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	3324 WEBSTER ST	None	OAKLAND	CA	94609	1305	01	06001	37.82153667	-122.2621207	Alameda County
244027	Fee-for-Service	1376720037	1376720037	1	1	LOS ANGELES CENTERS FOR ALCO	8/30/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	426 SAN PEDRO ST	None	LOS ANGELES	CA	90013	2119	19	06037	34.04510882	-118.2433551	Los Angeles County
244033	Fee-for-Service	1831426642	1831426642	1	16	LAKESIDE MEDICAL	4/13/2010	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	14901 RINALDI STREET	SUITE 200-201	MISSION HILLS	CA	91345	1254	19	06037	34.27903452	-118.457433	Los Angeles County
244072	Fee-for-Service	1043475387	1043475387	1	1	LAM, LISA MD	9/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103148	08	Family Practice	0	In state provider	None	222 W 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
244076	Fee-for-Service	1548585748	1548585748	1	1	LALEFAR, NAHAL R MD	12/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111500	40	Pediatrics	0	In state provider	None	2828 FRESNO ST	STE 203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
244090	Fee-for-Service	1780761353	1780761353	1	1	LEE, RICHARD W MD	9/1/2010	207RN0300X	NA	Nephrology	026	PHYSICIANS	85452	41	Internal Medicine	0	In state provider	None	16415 S COLORADO AVE	#208	PARAMOUNT	CA	90723	5054	19	06037	33.8853075	-118.1614695	Los Angeles County
244104	Fee-for-Service	1861951170	1861951170	1	1	LUETHY, ANDREA MD	1/2/2023	207R00000X	NA	Other	026	PHYSICIANS	179012	None	None	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
244135	Fee-for-Service	1104830207	1104830207	1	1	LEVINSON, DOUGLAS F MD	12/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87700	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
244170	Fee-for-Service	1447514252	1447514252	1	1	LEVY, DANIELLE H LMFT	5/8/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
244173	Fee-for-Service	1154479061	1154479061	1	1	LIM, PEARLIE MD	9/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85642	08	Family Practice	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
244189	Fee-for-Service	1710123575	1710123575	1	1	LOVE, KREG J DO	4/3/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19334	None	None	0	In state provider	None	6789 N BLACKSTONE AVE	None	FRESNO	CA	93710	3530	10	06019	36.83695148	-119.7904013	Fresno County
244200	Fee-for-Service	1326692211	1326692211	1	1	LEE, SHANNA M CNP	12/7/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
244208	Fee-for-Service	1922103340	1922103340	1	1	LIDDELL, JESSICA A PHD	1/30/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2008 MORSE AVENUE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
244228	Fee-for-Service	1336663251	1336663251	1	1	LA VIDA HOSPICE INC	11/20/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	732 WEST 9TH STREET	STE 202	SAN PEDRO	CA	90731	3629	19	06037	33.73607447	-118.293102	Los Angeles County
244237	Fee-for-Service	1104857424	1104857424	1	1	LIM, ALBERT L MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50346	None	None	0	In state provider	None	5755 E KINGS CANYON RD	STE 104	FRESNO	CA	93727	4744	10	06019	36.7362951	-119.6933795	Fresno County
244288	Fee-for-Service	1699265850	1699265850	1	1	LORI L VANYO MD FACS INC	4/2/2019	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	2140 GRAND AVE	120	CHINO HILLS	CA	91709	6800	36	06071	33.99623518	-117.7579477	San Bernardino County
244303	Fee-for-Service	1730182510	1730182510	1	1	LUDER, MICHAEL R	12/14/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6425	08	Family Practice	0	In state provider	None	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	27	06053	36.68590557	-121.8010492	Monterey County
244309	Fee-for-Service	1992023253	1992023253	1	1	LIN, WEILI LMFT	9/24/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	350 S LAKE AVE	SUITE 282	PASADENA	CA	91101	3530	19	06037	34.1397069	-118.1322284	Los Angeles County
244310	Fee-for-Service	1023185972	1023185972	1	1	LOHNER, THOMAS MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	38451	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
244311	Fee-for-Service	1992793574	1992793574	1	1	LAURENCE OF OAKLAND INC	7/1/1996	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	3324 WEBSTER ST	None	OAKLAND	CA	94609	1305	01	06001	37.82153667	-122.2621207	Alameda County
244321	Fee-for-Service	1831426642	1831426642	1	16	LAKESIDE MEDICAL	10/18/2023	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	14901 RINALDI STREET	SUITE 200-201	MISSION HILLS	CA	91345	1254	19	06037	34.27903452	-118.457433	Los Angeles County
244329	Fee-for-Service	1689701310	1689701310	1	1	LE, JULIE L DO	8/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9208	36	Psychiatry	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
244341	Fee-for-Service	1154498293	1154498293	1	1	LEINSTEINER, TERRI	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
244347	Fee-for-Service	1740213107	1740213107	1	1	LING, HUICHUNG T MD	10/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124567	68	Hematology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
244377	Fee-for-Service	1780761353	1780761353	1	1	LEE, RICHARD W MD	9/1/2010	207RN0300X	NA	Nephrology	026	PHYSICIANS	85452	45	Nephrology (Renal-Kidney)	0	In state provider	None	16415 S COLORADO AVE	#208	PARAMOUNT	CA	90723	5054	19	06037	33.8853075	-118.1614695	Los Angeles County
244383	Fee-for-Service	1568586428	1568586428	1	1	LAMPHIER, KYLE A MD	7/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107774	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
244433	Fee-for-Service	1831426642	1831426642	1	4	LAKESIDE MEDICAL	4/13/2010	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	7325 MEDICAL CENTER DRIV	SUITE 300	WEST HILLS	CA	91307	4117	19	06037	34.20369349	-118.629837	Los Angeles County
244439	Fee-for-Service	1972740942	1972740942	1	1	LY, HONGDU K DO	9/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	11259	None	None	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
244480	Fee-for-Service	1659443406	1659443406	1	1	LIE, AN K MD	1/2/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	50274	01	General Practice	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
244490	Fee-for-Service	1851759435	1851759435	1	1	LINGTONG CHEN	4/18/2022	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 1ST AVE	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
244494	Fee-for-Service	1629662382	1629662382	1	1	LA CASA CARE HOSPICE INC	11/30/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6309 VAN NUYS BLVD	STE 104	VAN NUYS	CA	91401	6613	19	06037	34.18496271	-118.4487785	Los Angeles County
244522	Fee-for-Service	1952632028	1952632028	1	1	LAL, SHARLEEN L LMFT	8/29/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	525 N PARKER ST	None	ORANGE	CA	92868	1323	30	06059	33.7956127	-117.8596317	Orange County
244609	Fee-for-Service	1831426642	1831426642	1	16	LAKESIDE MEDICAL	7/3/2013	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	14901 RINALDI STREET	SUITE 200-201	MISSION HILLS	CA	91345	1254	19	06037	34.27903452	-118.457433	Los Angeles County
244621	Fee-for-Service	1831119700	1831119700	1	1	LAU, PHILLIP K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	93289	05	Anesthesiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
244634	Fee-for-Service	1740213107	1740213107	1	1	LING, HUICHUNG T MD	10/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124567	78	Neoplastic Diseases/Oncology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
244651	Fee-for-Service	1841200128	1841200128	1	1	LAMPERT, BARBARA MD	11/15/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	47041	36	Psychiatry	0	In state provider	None	100 PINE ST	STE 1250	SAN FRANCISCO	CA	94111	5235	38	06075	37.79237874	-122.3989278	San Francisco County
244675	Fee-for-Service	1023404860	1023404860	1	1	LIM, HUAT C MD	6/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147344	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
244676	Fee-for-Service	1619033826	1619033826	1	1	LIFE'S GOLDEN HORIZONS INC	1/17/2001	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	44902 10TH STREET WEST	STE 8	LANCASTER	CA	93534	2314	19	06037	34.699158	-118.148051	Los Angeles County
244681	Fee-for-Service	1912214347	1912214347	1	1	LE, DAN D MD	6/26/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	158790	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11180 WARNER AVE	STE 269	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
244722	Fee-for-Service	1831426642	1831426642	1	4	LAKESIDE MEDICAL	4/13/2010	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	7325 MEDICAL CENTER DRIV	SUITE 300	WEST HILLS	CA	91307	4117	19	06037	34.20369349	-118.629837	Los Angeles County
244724	Fee-for-Service	1215221015	1215221015	1	1	LEE, PAUL CHE-HOO DO	8/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11665	05	Anesthesiology	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
244762	Fee-for-Service	1194928002	1194928002	1	1	LIN, TOM Y MD	9/5/2019	208600000X	NA	General Surgery	026	PHYSICIANS	146460	02	General Surgery	0	In state provider	None	3660 PARK SIERRA DRIVE	SUITE 105	RIVERSIDE	CA	92505	3071	33	06065	33.90330693	-117.4707039	Riverside County
244768	Fee-for-Service	1598788275	1598788275	1	1	LOH, MICHELLE H MD	7/1/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	79327	40	Pediatrics	0	In state provider	None	17577 ARROW BLVD	None	FONTANA	CA	92335	4011	36	06071	34.09938951	-117.421272	San Bernardino County
244770	Fee-for-Service	1437256211	1437256211	1	1	LIM, GRACE W	6/21/2000	2080P0201X	NA	Neurology	026	PHYSICIANS	34863	03	Allergy	0	In state provider	None	3128 E GETTYSBURG AVE	STE A	FRESNO	CA	93726	0400	10	06019	36.80128921	-119.7705975	Fresno County
244771	Fee-for-Service	1952630659	1952630659	1	1	LAFFAYE, CHARLENE PHD	11/18/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
244783	Fee-for-Service	1629662382	1629662382	1	1	LA CASA CARE HOSPICE INC	11/30/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6309 VAN NUYS BLVD	STE 104	VAN NUYS	CA	91401	6613	19	06037	34.18496271	-118.4487785	Los Angeles County
244787	Fee-for-Service	1780983411	1780983411	1	1	LIN, ERIN H DO	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	11452	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
244791	Fee-for-Service	1821431602	1821431602	1	1	LIN, YU-SHIU DO	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14070	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
244800	Fee-for-Service	1194278937	1194278937	1	1	LLANOS, YVETTE LMFT	2/3/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	155 HOSPITALITY LN	245	SAN BERNARDINO	CA	92408	3305	36	06071	34.06580948	-117.2856915	San Bernardino County
244813	Fee-for-Service	1063630077	1063630077	1	1	LA GRAVE, THOMAS	3/21/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14420 CIVIC DR	4	VICTORVILLE	CA	92392	2928	36	06071	34.51268102	-117.3236867	San Bernardino County
244829	Fee-for-Service	1326290842	1326290842	1	1	LEE, KYLE H DO	1/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10548	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
244847	Fee-for-Service	1184039661	1184039661	1	1	LEW, MELISSA M DO	8/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14472	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
244869	Fee-for-Service	1396041679	1396041679	1	1	LAWRENCE, KELLY M MD	7/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
244884	Fee-for-Service	1629048012	1629048012	1	1	LE, KHOI M MD	11/12/2015	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	77166	41	Internal Medicine	0	In state provider	None	6323 N FRESNO STREET	SUITE 104	FRESNO	CA	93710	5282	10	06019	36.82867612	-119.7814182	Fresno County
244916	Fee-for-Service	1114952017	1114952017	1	1	LEWIN, LAURENCE MD	2/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	20764	41	Internal Medicine	0	In state provider	None	1310 W STEWART DR	STE 210	ORANGE	CA	92868	3837	30	06059	33.78236048	-117.8664975	Orange County
244964	Fee-for-Service	1376804757	1376804757	1	1	LEE, SUN I MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140655	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
244976	Fee-for-Service	1336216258	1336216258	1	1	LIM, AARON H MD	7/1/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	54586	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
244977	Fee-for-Service	1073947636	1073947636	1	2	LUMICERA HEALTH SERVICES, LL	3/1/2020	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	C	310 INTEGRITY DRIVE	None	MADISON	WI	53717	1416	00	None	43.062021	-89.50385548	Dane County
245003	Fee-for-Service	1174558027	1174558027	1	1	LEVE, CLAIRE H MD	5/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89535	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11795 EDUCATION ST	STE 232	AUBURN	CA	95602	2469	31	06061	38.94433757	-121.098912	Placer County
245010	Fee-for-Service	1831426642	1831426642	1	4	LAKESIDE MEDICAL	4/13/2010	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	7325 MEDICAL CENTER DRIV	SUITE 300	WEST HILLS	CA	91307	4117	19	06037	34.20369349	-118.629837	Los Angeles County
245092	Fee-for-Service	1710146915	1710146915	1	1	LI, ALDON Y MD	11/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102396	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
245097	Fee-for-Service	1245765221	1245765221	1	1	LI, VIRGINIA G MD	6/15/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157497	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
245122	Fee-for-Service	1396823092	1396823092	1	1	LIEN, KENNETH W MD	4/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72098	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
245167	Fee-for-Service	1376681973	1376681973	1	1	LIM, SILVESTER R MD	12/5/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	93107	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
245172	Fee-for-Service	1629048012	1629048012	1	1	LE, KHOI M MD	11/12/2015	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	77166	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	6323 N FRESNO STREET	SUITE 104	FRESNO	CA	93710	5282	10	06019	36.82867612	-119.7814182	Fresno County
245176	Fee-for-Service	1265797153	1265797153	1	1	LABARO, ANNA M G MD	5/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135314	40	Pediatrics	0	In state provider	None	3100 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3866	31	06061	38.74399612	-121.2349547	Placer County
245181	Fee-for-Service	1215905724	1215905724	1	1	LUCKS, MATTHEW A MD	6/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91447	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	320 SANTA FE DR	STE 204	ENCINITAS	CA	92024	5179	37	06073	33.038847	-117.285579	San Diego County
245182	Fee-for-Service	1003043340	1003043340	1	1	LIPTON, SHIRA B MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106374	07	Dermatology	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
245185	Fee-for-Service	1790839710	1790839710	1	1	LA MESA PHYSICAL THERAPY	10/28/2008	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	8939 LA MESA BLVD	SUITE 1	LA MESA	CA	91941	4057	37	06073	32.77474557	-117.0045237	San Diego County
245203	Fee-for-Service	1114952017	1114952017	1	1	LEWIN, LAURENCE MD	2/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	20764	45	Nephrology (Renal-Kidney)	0	In state provider	None	1310 W STEWART DR	STE 210	ORANGE	CA	92868	3837	30	06059	33.78236048	-117.8664975	Orange County
245209	Fee-for-Service	1912357518	1912357518	1	1	LASS, LAUREL A LCSW	2/27/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6695 E PACIFIC COAST HWY	SUITE 135	LONG BEACH	CA	90803	4235	19	06037	33.75412596	-118.1075029	Los Angeles County
245213	Fee-for-Service	1275820888	1275820888	1	1	LARSEN, JAIVA B MD	6/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130178	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15630 18TH AVENUE	None	CLEARLAKE	CA	95422	6710	17	06033	38.93612361	-122.6201499	Lake County
245266	Fee-for-Service	1851529846	1851529846	1	1	LEE, JANE J OD	8/14/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
245284	Fee-for-Service	1053728824	1053728824	1	1	LODHI, SHAINA K MD	8/7/2020	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	145165	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
245286	Fee-for-Service	1538103361	1538103361	2	1	LONGS DRUG STORES CA LLC	12/8/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	572 FLETCHER PKWY	None	EL CAJON	CA	92020	2509	37	06073	32.80780546	-116.9692245	San Diego County
245327	Fee-for-Service	1376172239	1376172239	1	1	LIANG, KIRA L MD	7/31/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	186546	None	None	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
245352	Fee-for-Service	1932285442	1932285442	1	1	LOU, JEFFREY J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	27070	01	General Practice	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
245359	Fee-for-Service	1750319497	1750319497	2	1	LECLAIR, GARTH P AUD	1/31/2005	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
245369	Fee-for-Service	1144355843	1144355843	1	1	LEE-ANCAJAS JULIE C PHD	3/1/2000	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
245420	Fee-for-Service	1972845816	1972845816	1	1	LEDESMA, YERANUI MD	6/7/2019	208600000X	NA	General Surgery	026	PHYSICIANS	134041	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
245443	Fee-for-Service	1740221019	1740221019	1	1	LEVIN, FREDERICK M MD	4/1/1998	207P00000X	NA	Other	026	PHYSICIANS	40115	None	None	0	In state provider	None	218 N SANTA ANITA ST	None	SAN GABRIEL	CA	91775	2918	19	06037	34.10510572	-118.1045763	Los Angeles County
245467	Fee-for-Service	1023065109	1023065109	3	1	LAL SURESH	5/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
245471	Fee-for-Service	1760983738	1760983738	1	1	LARSON, CHRISTINE LPT	3/21/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
245552	Fee-for-Service	1487756219	1487756219	1	1	LEVINE, ZENA	9/6/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	46798	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
245560	Fee-for-Service	1891001079	1891001079	1	1	LIAO, CHARLES E MD	7/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113343	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
245564	Fee-for-Service	1609944958	1609944958	1	2	LEE, MIN HEE LAC	8/8/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2120 W 8TH ST	SUITE 380	LOS ANGELES	CA	90057	4036	19	06037	34.05522552	-118.2786479	Los Angeles County
245566	Fee-for-Service	1205462207	1205462207	1	1	LIM, ANDREA MD	9/1/2023	207R00000X	NA	Other	026	PHYSICIANS	184565	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
245608	Fee-for-Service	1124294145	1124294145	1	1	LEE, CONNERY NP	9/28/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7761 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92841	4200	30	06059	33.77387145	-117.9966555	Orange County
245644	Fee-for-Service	1245870799	1245870799	1	1	LOGAN WELLNESS ADVANCED NURS	2/11/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	ING PRACTICE CORP	538 N DETROIT ST	None	LOS ANGELES	CA	90036	1949	19	06037	34.081425	-118.3451315	Los Angeles County
245661	Fee-for-Service	1225100035	1225100035	1	1	LEE, SONIA S MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67766	40	Pediatrics	0	In state provider	None	401 PARADISE RD	STE E	MODESTO	CA	95351	3104	50	06099	37.62692973	-121.0131742	Stanislaus County
245682	Fee-for-Service	1063750099	1063750099	1	1	LANKFORD, DAWUD O MD	8/22/2020	208800000X	NA	Other	026	PHYSICIANS	150490	34	Urology and Urological Surgery	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
245692	Fee-for-Service	1720185192	1720185192	1	1	LINDSAY, ANN D MD	12/7/2015	261QP2300X	NA	Other	026	PHYSICIANS	40774	01	General Practice	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
245696	Fee-for-Service	1578880506	1578880506	1	1	LIN, FRANK S MD	8/25/2017	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	148165	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	315 N THIRD AVE	STE 207	COVINA	CA	91723	1915	19	06037	34.08873786	-117.8923869	Los Angeles County
245707	Fee-for-Service	1154652642	1154652642	1	1	LOOMIS, ELEANOR A MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127388	25	Physical Medicine and Rehabilitation	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
245733	Fee-for-Service	1063724839	1063724839	1	1	LEE, EUN HWA	8/16/2010	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	303 W LINCOLN AVE	SUITE 140	ANAHEIM	CA	92805	2959	30	06059	33.83508976	-117.9177981	Orange County
245739	Fee-for-Service	1093900961	1093900961	1	1	LIU, STEPHEN K MD INC	2/6/2008	2085R0204X	NA	Other	026	PHYSICIANS	50939	30	Radiology	0	In state provider	None	1552 COFFEE RD	None	MODESTO	CA	95355	3107	50	06099	37.666872	-120.975684	Stanislaus County
245775	Fee-for-Service	1396907119	1396907119	1	1	LALA, MOINAKHTAR M Y MD	9/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	112731	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	7640 TAMPA AVE	STE 101	RESEDA	CA	91335	1735	19	06037	34.20951144	-118.5534786	Los Angeles County
245781	Fee-for-Service	1538425103	1538425103	1	1	LIN, DANA	6/1/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
245789	Fee-for-Service	1093836710	1093836710	1	1	LU, BRANDON S MD	7/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100954	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2351 CLAY STREET	STE 501	SAN FRANCISCO	CA	94115	1931	38	06075	37.79101512	-122.4316059	San Francisco County
245793	Fee-for-Service	1316989494	1316989494	1	1	LIEBELT, GRETA J NP	7/31/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
245815	Fee-for-Service	1003955758	1003955758	1	2	LASSEN MEDICAL GROUP INC	12/1/2000	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2450 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	52	06103	40.14921426	-122.2216794	Tehama County
245818	Fee-for-Service	1225011737	1225011737	1	1	LOGHMANPOUR, SUSAN MD	3/1/1999	207L00000X	NA	Other	026	PHYSICIANS	53997	None	None	0	In state provider	None	3700 SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
245819	Fee-for-Service	1962275743	1962275743	1	1	LEAVITT MARRIAGE AND FAMILY	8/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	THERAPY, A MARRIAGE AND	21700 OXNARD ST	STE 400	WOODLAND HILLS	CA	91367	7559	19	06037	34.17913947	-118.6020135	Los Angeles County
245828	Fee-for-Service	1477113074	1477113074	1	1	LIPINSKI, CHRISTOPHER K MD	10/4/2022	163WG0000X	NA	Other	026	PHYSICIANS	179604	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
245867	Fee-for-Service	1073553210	1073553210	1	1	LALVANI, AJAY M MD	10/1/1998	207L00000X	NA	Other	026	PHYSICIANS	60441	05	Anesthesiology	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
245887	Fee-for-Service	1811007065	1811007065	1	1	LEE, SELWYN MD	12/1/1991	207LP2900X	NA	Other	026	PHYSICIANS	63817	05	Anesthesiology	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
245936	Fee-for-Service	1376558833	1376558833	1	1	LASKEY, WARREN KENNETH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
245949	Fee-for-Service	1154373207	1154373207	1	1	LAWAS-ALEJO, PERPETUA MD	3/9/1994	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	52878	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	250 S GRAND AVE	None	GLENDORA	CA	91741	4218	19	06037	34.132842	-117.872523	Los Angeles County
245956	Fee-for-Service	1194731935	1194731935	1	1	LOMA LINDA UNIVERSITY	6/1/1983	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER INC	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2871	36	06071	34.049547	-117.264078	San Bernardino County
245965	Fee-for-Service	1619648581	1619648581	1	1	LUCKY HOME HEALTH CARE	10/17/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14549 ARCHWOOD ST	STE 311	VAN NUYS	CA	91405	4633	19	06037	34.19296379	-118.4505327	Los Angeles County
245975	Fee-for-Service	1265472534	1265472534	1	1	LOCKHART, STEPHEN H MD	11/1/1994	207L00000X	NA	Other	026	PHYSICIANS	60176	05	Anesthesiology	0	In state provider	CPMC	CLAY & BUCHANAN	None	SAN FRANCISCO	CA	94120	0000	38	06075	37.791126	-122.4309105	San Francisco County
245981	Fee-for-Service	1720185192	1720185192	1	1	LINDSAY, ANN D MD	12/7/2015	261QP2300X	NA	Other	026	PHYSICIANS	40774	08	Family Practice	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
245996	Fee-for-Service	1114920428	1114920428	1	1	LEMBERT, EDWARD A MD	9/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	35648	20	Orthopedic Surgery	0	In state provider	None	6095 N 1ST ST	None	FRESNO	CA	93710	5444	10	06019	36.82524765	-119.7723922	Fresno County
246007	Fee-for-Service	1932336435	1932336435	1	1	LEWIS, ALEX J MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128893	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
246010	Fee-for-Service	1275011249	1275011249	1	1	LI, WENTING RCP	10/3/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
246032	Fee-for-Service	1245659598	1245659598	1	1	LIAO, XIN A MD	5/25/2020	207R00000X	NA	Other	026	PHYSICIANS	141361	41	Internal Medicine	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
246077	Fee-for-Service	1093836710	1093836710	1	1	LU, BRANDON S MD	7/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100954	41	Internal Medicine	0	In state provider	None	2351 CLAY STREET	STE 501	SAN FRANCISCO	CA	94115	1931	38	06075	37.79101512	-122.4316059	San Francisco County
246086	Fee-for-Service	1083658884	1083658884	1	1	LEE, ALEXANDER S MD	10/28/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77568	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27300 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.89552551	-117.186021	Riverside County
246099	Fee-for-Service	1003955758	1003955758	1	2	LASSEN MEDICAL GROUP INC	12/1/2000	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2450 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	52	06103	40.14921426	-122.2216794	Tehama County
246136	Fee-for-Service	1720021116	1720021116	1	1	LI, HONGTAI MD	10/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66817	30	Radiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
246155	Fee-for-Service	1184796104	1184796104	1	1	LEE, TERRY M MD	1/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	62452	05	Anesthesiology	0	In state provider	MD MEDICAL CENTER INC	600 N GARFIELD AVE	STE 111	MONTEREY PARK	CA	91754	1167	19	06037	34.06820797	-118.1228835	Los Angeles County
246164	Fee-for-Service	1396761136	1396761136	1	1	LE, HEATHER H MD	8/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80776	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
246187	Fee-for-Service	1790975407	1790975407	1	1	LEE, HEUN-JIN	9/9/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
246233	Fee-for-Service	1316750722	1316750722	1	1	LACTATIONHUB	1/29/2025	163WL0100X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
246244	Fee-for-Service	1194731935	1194731935	1	1	LOMA LINDA UNIVERSITY	4/8/1981	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER INC	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2871	36	06071	34.049547	-117.264078	San Bernardino County
246253	Fee-for-Service	1235169319	1235169319	1	1	LONGOBARDI, JAMES J DPM INC	4/13/2010	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	450 4TH AVE	STE 401	CHULA VISTA	CA	91910	4430	37	06073	32.63513513	-117.0820663	San Diego County
246282	Fee-for-Service	1144551342	1144551342	1	1	LINDO, JUSTIN E PT	12/22/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4318 SPYRES WAY	None	MODESTO	CA	95356	9259	50	06099	37.70194177	-120.9988293	Stanislaus County
246286	Fee-for-Service	1245250745	1245250745	1	1	LIU, JUDY S MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104351	30	Radiology	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
246304	Fee-for-Service	1124100110	1124100110	1	1	LITMAN, VANESSA A MD	6/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87509	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
246315	Fee-for-Service	1316359672	1316359672	1	1	LARACH, DANIEL B MD	8/8/2019	207L00000X	NA	Other	026	PHYSICIANS	160433	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
246342	Fee-for-Service	1326451352	1326451352	1	1	LIU, JULIA DO	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15439	40	Pediatrics	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
246348	Fee-for-Service	1316053309	1316053309	1	1	LUNDEEN, LINDA R MD	1/30/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	60123	08	Family Practice	0	In state provider	LA CLINICA DEL LA RAZA	1515 FRUITVALE AVE	None	OAKLAND	CA	94601	2322	01	06001	37.77910723	-122.2251233	Alameda County
246372	Fee-for-Service	1477500460	1477500460	1	1	LESSER, IRA M MD	2/1/1984	2084P0805X	NA	Psychiatry	026	PHYSICIANS	29799	36	Psychiatry	0	In state provider	None	593 27TH ST	None	MANHATTAN BEACH	CA	90266	2209	19	06037	33.89624648	-118.410075	Los Angeles County
246387	Fee-for-Service	1003955758	1003955758	1	2	LASSEN MEDICAL GROUP INC	12/1/2000	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	2450 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	52	06103	40.14921426	-122.2216794	Tehama County
246397	Fee-for-Service	1457748998	1457748998	1	1	LOCKARD, STACEY W MD	10/5/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163686	08	Family Practice	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
246404	Fee-for-Service	1801945514	1801945514	1	1	LIM, RIZAL MD	6/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137007	24	Plastic Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 465	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
246431	Fee-for-Service	1053990754	1053990754	1	1	LEE, JI YOUNG MD	10/2/2024	207R00000X	NA	Other	026	PHYSICIANS	183653	41	Internal Medicine	0	In state provider	None	1919 SANTA MONICA BLVD	STE 210	SANTA MONICA	CA	90604	1970	19	06037	34.0284492	-118.4803274	Los Angeles County
246439	Fee-for-Service	1184796104	1184796104	1	1	LEE, TERRY M MD	1/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	62452	08	Family Practice	0	In state provider	MD MEDICAL CENTER INC	600 N GARFIELD AVE	STE 111	MONTEREY PARK	CA	91754	1167	19	06037	34.06820797	-118.1228835	Los Angeles County
246474	Fee-for-Service	1821277344	1821277344	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1794 ASHLAN AVE	None	CLOVIS	CA	93611	5190	10	06019	36.79388247	-119.682855	Fresno County
246495	Fee-for-Service	1386772770	1386772770	1	1	LOMONOSOFF, CATHERINE F NP	9/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	352176	-	NOT APPLICABLE	0	In state provider	None	200 7TH AVENUE	SUITE 150	SANTA CRUZ	CA	95062	4669	44	06087	36.96438797	-121.998448	Santa Cruz County
246544	Fee-for-Service	1972642817	1972642817	1	1	LEW, LESTER K OD INC	6/1/1995	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	230 E MAIN ST	None	ALHAMBRA	CA	91801	3517	19	06037	34.09637406	-118.1240055	Los Angeles County
246550	Fee-for-Service	1932593118	1932593118	1	1	LEGACY HEALTH SERVICES INC	1/10/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13781 ROSWELL AVE	SUITE C	CHINO	CA	91710	5475	36	06071	34.00240379	-117.721769	San Bernardino County
246561	Fee-for-Service	1841845138	1841845138	1	2	LAND OF PEACE 3	4/10/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	22600 KITTRIDGE ST	None	WEST HILLS	CA	91307	3608	19	06037	34.19147449	-118.6188255	Los Angeles County
246583	Fee-for-Service	1225213267	1225213267	1	1	LI, KING C MD	8/11/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	44814	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
246652	Fee-for-Service	1891007787	1891007787	1	1	LY, THOMAS C	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
246715	Fee-for-Service	1437253663	1437253663	1	1	LEE, JAMES C DPM	11/28/2005	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5475 E LA PALMA AVE	STE 208	ANAHEIM	CA	92807	6009	30	06059	33.85997926	-117.7958236	Orange County
246724	Fee-for-Service	1265772560	1265772560	1	1	LEE, JAY J LAC	6/7/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	NCTURE	1613 W CARSON ST	106	TORRANCE	CA	90501	3893	19	06037	33.83152051	-118.307061	Los Angeles County
246750	Fee-for-Service	1265458707	1265458707	1	1	LIAU, HENRY MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	35858	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
246798	Fee-for-Service	1841516184	1841516184	1	1	LABADZHYAN, ARTAK MD	7/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119446	67	Endocrinology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
246800	Fee-for-Service	1023549433	1023549433	1	1	LA, DAVID DO	3/29/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	16726	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
246838	Fee-for-Service	1932593118	1932593118	1	1	LEGACY HEALTH SERVICES INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13781 ROSWELL AVE	SUITE C	CHINO	CA	91710	5475	36	06071	34.00240379	-117.721769	San Bernardino County
246851	Fee-for-Service	1598729410	1598729410	1	1	LE, BINH KHAC MD	4/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54968	01	General Practice	0	In state provider	None	2020 COFFEE RD	STE A3	MODESTO	CA	95355	2407	50	06099	37.672569	-120.9757125	Stanislaus County
246859	Fee-for-Service	1013236769	1013236769	1	1	LANDA, WHITNEY E MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113340	26	Psychiatry (child)	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
246862	Fee-for-Service	1306113360	1306113360	2	1	LEWIS, JOSHUA F MD	6/13/2023	207R00000X	NA	Other	026	PHYSICIANS	127535	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
246898	Fee-for-Service	1902965577	1902965577	1	1	LEE, MARIAN L MD	2/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	63999	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
246908	Fee-for-Service	1649233842	1649233842	1	1	LIN, HUA MD	5/30/2017	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	33475	10	Gastroenterology (M.D. only)	0	In state provider	None	2225 19TH ST	None	BAKERSFIELD	CA	93301	3608	15	06029	35.37622542	-119.0277065	Kern County
246924	Fee-for-Service	1245551852	1245551852	1	1	LAZAR BEGLARIAN, VERONICA L	1/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CSW	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
246942	Fee-for-Service	1477877066	1477877066	1	1	LARES, MELISSA B MD	12/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118921	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
246955	Fee-for-Service	1881671048	1881671048	1	1	LAU, FRED G MD	9/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	71747	30	Radiology	0	In state provider	None	1301 ROSE DR	None	PLACENTIA	CA	92870	3802	30	06059	33.8868003	-117.8420447	Orange County
246965	Fee-for-Service	1154414944	1154414944	1	1	LITTLE, LISA M MD	9/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92334	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7345 MEDICAL CENTER DR	STE 500	WEST HILLS	CA	91307	1964	19	06037	34.20369349	-118.629837	Los Angeles County
246966	Fee-for-Service	1457607517	1457607517	1	1	LEE, SARAH K NP	9/28/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
247032	Fee-for-Service	1386692283	1386692283	1	1	LEE, MARGARET MD	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	65971	30	Radiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
247042	Fee-for-Service	1538129838	1538129838	1	1	LANE, JOHN P LCSW	8/5/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1150 BROOKSIDE AVE	STE J3	REDLANDS	CA	92373	6303	36	06071	34.04884441	-117.1975972	San Bernardino County
247051	Fee-for-Service	1871565796	1871565796	1	1	LOPEZ, JOB P NP	12/14/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	81767 DR CARREON BLVD	STE 102	INDIO	CA	92201	5598	33	06065	33.70738112	-116.237755	Riverside County
247089	Fee-for-Service	1861448433	1861448433	1	1	LA FONE, HEATHER OD	11/26/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE STREET	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
247109	Fee-for-Service	1861510356	1861510356	1	1	LANE,RONI D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CITY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
247110	Fee-for-Service	1184121709	1184121709	1	1	LABOVE, GABRIELLE A MD	8/1/2024	390200000X	NA	Other	026	PHYSICIANS	166572	24	Plastic Surgery	0	In state provider	None	101 THE CITY DR S	BLDG 55	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
247119	Fee-for-Service	1851651475	1851651475	1	1	LAWRENCE, MARLENE L LCSW	8/15/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	76157	-	NOT APPLICABLE	0	In state provider	None	801 11TH STREET	None	MODESTO	CA	95354	2324	50	06099	37.63952026	-120.9974274	Stanislaus County
247152	Fee-for-Service	1912276163	1912276163	1	1	LU, ANN K CRNA	2/7/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
247160	Fee-for-Service	1871655274	1871655274	1	1	LANDIS, CLAUDIA A MD	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	6063	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
247177	Fee-for-Service	1710402672	1710402672	1	1	LAI, KENT M DO	11/1/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15870	08	Family Practice	0	In state provider	None	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
247181	Fee-for-Service	1396180600	1396180600	1	1	LIN, MENG C OD	1/9/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
247188	Fee-for-Service	1043328933	1043328933	1	1	LAM, ANH T MD	4/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56193	41	Internal Medicine	0	In state provider	None	1600 NORTH ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
247190	Fee-for-Service	1013005321	1013005321	1	1	LARSON, PAUL S MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76564	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
247218	Fee-for-Service	1689875163	1689875163	1	1	LHP ADULT DAY-CARE CTR	4/6/2015	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	LOS ANGELES ADHC CENTER	3060 WEST OLYMPIC BLVD	SUITE 120	LOS ANGELES	CA	90006	0000	19	06037	34.05260654	-118.302237	Los Angeles County
247243	Fee-for-Service	1033464110	1033464110	1	1	LAZZARO, CYNTHIA C DO	1/4/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	12781	07	Dermatology	0	In state provider	None	11525 BROOKSHIRE AVE	STE 300	DOWNEY	CA	90241	4892	19	06037	33.93544635	-118.1318321	Los Angeles County
247274	Fee-for-Service	1619947108	1619947108	1	1	LEONG AND LOW ODS	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	#11-B	621 E CAMPBELL AVE	None	CAMPBELL	CA	95008	2139	43	06085	37.28710676	-121.9386967	Santa Clara County
247348	Fee-for-Service	1699267922	1699267922	1	1	LABERGE, CLAIRE A	7/2/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	206 N JACKSON ST	SUITE 202	GLENDALE	CA	91206	4330	19	06037	34.14852285	-118.2501237	Los Angeles County
247353	Fee-for-Service	1295768786	1295768786	1	1	LAKE, JON P MD	10/31/1987	207ZC0500X	NA	Other	026	PHYSICIANS	35430	22	Pathology (M.D. only)	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
247360	Fee-for-Service	1366529208	1366529208	1	1	LAUFFER, JASON L MD	8/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	68494	18	Ophthalmology	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
247369	Fee-for-Service	1790704864	1790704864	1	1	LA DUCA, BROOKE A MD	4/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	78475	08	Family Practice	0	In state provider	None	450 E SPRING STREET	STE 1	LONG BEACH	CA	90806	1625	19	06037	33.8099218	-118.1872346	Los Angeles County
247375	Fee-for-Service	1679347165	1679347165	1	1	LIHA ADULT DAY HEALTH CARE	2/20/2025	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	10086 MILLS STATION RD	None	SACRAMENTO	CA	95827	2204	34	06067	38.5811979	-121.3115252	Sacramento County
247416	Fee-for-Service	1912163619	1912163619	1	1	LORILLA, IVY ROSE L MD	1/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127118	08	Family Practice	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
247436	Fee-for-Service	1760501951	1760501951	1	1	LOPEZ, ALBINA LMFT	6/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
247513	Fee-for-Service	1780263939	1780263939	1	1	LE, AMY DO	2/28/2025	208M00000X	NA	Other	026	PHYSICIANS	20681	41	Internal Medicine	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
247540	Fee-for-Service	1710991138	1710991138	1	1	LESAVOY, MALCOLM MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	26213	24	Plastic Surgery	0	In state provider	None	16311 VENTURA BLVD	STE 550	ENCINO	CA	91436	4314	19	06037	34.15706864	-118.4885978	Los Angeles County
247576	Fee-for-Service	1558657676	1558657676	1	1	LOTFY MOHAMMED, KARIM G MD	2/21/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	134920	None	None	0	In state provider	None	560 COHASSET RD	None	CHICO	CA	95926	2281	04	06007	39.7519137	-121.8477606	Butte County
247588	Fee-for-Service	1669484127	1669484127	1	1	LINDE, RANDOLPH B MD	7/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	41234	01	General Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
247614	Fee-for-Service	1962858704	1962858704	1	1	LOPEZ, EUSEBIO DAN P NP	9/6/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
247616	Fee-for-Service	1326163825	1326163825	1	1	LEYNES-LE, ELIZABETH MD	9/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93916	40	Pediatrics	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
247622	Fee-for-Service	1780608216	1780608216	1	1	LEGACY GOOD SAMARITAN	5/1/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSP & MED CTR	1015 NW 22ND AVE	None	PORTLAND	OR	97210	3025	00	None	45.53024175	-122.6966202	Multnomah County
247635	Fee-for-Service	1508807629	1508807629	1	1	LOPEZ, CAROLYN M PHD	10/29/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	35400 BOB HOPE DR	STE 113	RANCHO MIRAGE	CA	92270	1772	33	06065	33.7914	-116.4058625	Riverside County
247639	Fee-for-Service	1053315739	1053315739	1	2	LIVINGSTON MEMORIAL VNA	11/21/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1211 MARICOPA HIGHWAY	SUITE 264	VENTURA	CA	93023	5010	56	06111	34.44201622	-119.2632073	Ventura
247678	Fee-for-Service	1255402228	1255402228	1	1	LALEHZARIAN, MANOUCHEHR	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44686	34	Urology and Urological Surgery	0	In state provider	MD	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
247845	Fee-for-Service	1154432045	1154432045	1	1	LAM, OSAMA F MD	3/31/1992	207R00000X	NA	Other	026	PHYSICIANS	69482	41	Internal Medicine	0	In state provider	None	1625 THE ALAMEDA	STE 202	SAN JOSE	CA	95126	2223	43	06085	37.3357723	-121.9172682	Santa Clara County
247846	Fee-for-Service	1669795092	1669795092	1	1	LUU, HAI D DO	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	11000	05	Anesthesiology	0	In state provider	None	531 W COLLEGE STREET	None	LOS ANGELES	CA	90012	2315	19	06037	34.0645892	-118.2391033	Los Angeles County
247865	Fee-for-Service	1730131236	1730131236	1	1	LIN, SHAN C MD	1/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	83098	18	Ophthalmology	0	In state provider	None	1001 POTRERO AVE	RM 4M31	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
247874	Fee-for-Service	1669484127	1669484127	1	1	LINDE, RANDOLPH B MD	7/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	41234	67	Endocrinology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
247880	Fee-for-Service	1710929542	1710929542	2	1	LONGS DRUG STORES CA LLC	8/17/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	50 N ASHWOOD AVE	None	VENTURA	CA	93003	1810	56	06111	34.2753617	-119.2393488	Ventura County
247882	Fee-for-Service	1962498428	1962498428	1	1	LINDER, JEAN M MD	5/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	34722	41	Internal Medicine	0	In state provider	None	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	10	06019	36.84197867	-119.761714	Fresno County
247907	Fee-for-Service	1942866140	1942866140	1	1	LENDZION, LAUREN E MD	10/3/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	179563	None	None	0	In state provider	None	750 REDWOOD HWY	SUITE 1204	MILL VALLEY	CA	94941	2483	21	06041	37.89525674	-122.5158838	Marin County
247908	Fee-for-Service	1780608216	1780608216	1	1	LEGACY GOOD SAMARITAN	5/1/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSP & MED CTR	1015 NW 22ND AVE	None	PORTLAND	OR	97210	3025	00	None	45.53024175	-122.6966202	Multnomah County
247920	Fee-for-Service	1255833257	1255833257	1	1	LEE, TAI-WEI OT	4/10/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
247934	Fee-for-Service	1518586759	1518586759	1	1	LIN, JONATHAN B MD	5/9/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
247935	Fee-for-Service	1003367491	1003367491	1	1	LEGACY EMANUEL HOSPITAL & HE	3/28/2022	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	ALTH CENTER	1225 NE 2ND AVE	None	PORTLAND	OR	97232	2003	00	None	45.53179918	-122.6637358	Multnomah County
247965	Fee-for-Service	1255402228	1255402228	1	1	LALEHZARIAN, MANOUCHEHR	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44686	01	General Practice	0	In state provider	MD	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
247997	Fee-for-Service	1295726362	1295726362	1	1	LAKEWOOD HEALTH SYSTEM	8/31/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	49725 COUNTY 83	None	STAPLE	MN	56479	0000	00	None	46.351188	-94.7515995	Todd County
248016	Fee-for-Service	1942242755	1942242755	2	1	LONGS DRUG STORES CA LLC	12/8/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1350 FLORIN RD	None	SACRAMENTO	CA	95822	4202	34	06067	38.495232	-121.505409	Sacramento County
248023	Fee-for-Service	1982764189	1982764189	1	1	LEE, TONY B MD	8/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	60950	08	Family Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
248047	Fee-for-Service	1699353011	1699353011	1	1	LATSON, WILLIAM A MD	6/25/2024	207R00000X	NA	Other	026	PHYSICIANS	189163	41	Internal Medicine	0	In state provider	None	7202 MILLBROOK	105	FRESNO	CA	93720	3341	10	06019	36.83958089	-119.7645538	Fresno County
248053	Fee-for-Service	1003838012	1003838012	1	1	LEE, PAUL C MD	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75260	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	9896 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92844	1643	30	06059	33.77397653	-117.959571	Orange County
248083	Fee-for-Service	1669427449	1669427449	1	1	LILES,JEFFERY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	104 W 5TH AVE	None	SPOKANE	WA	99204	0000	00	None	47.651625	-117.4141485	Spokane County
248098	Fee-for-Service	1356552939	1356552939	1	1	LEVIT, NOAH MD	5/7/2008	146D00000X	NA	Other	026	PHYSICIANS	86439	66	Emergency Medicine (Urgent Care)	0	In state provider	None	825 N 10TH ST	None	SANTA PAULA	CA	93060	0270	56	06111	34.36574255	-119.0654422	Ventura County
248128	Fee-for-Service	1528032570	1528032570	1	1	LEE, MIKE H MD	6/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55051	30	Radiology	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
248130	Fee-for-Service	1467797365	1467797365	1	2	LARA, RAUL MD	3/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137807	40	Pediatrics	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
248137	Fee-for-Service	1588741417	1588741417	1	1	LEE, SUNHEE MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	70933	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
248172	Fee-for-Service	1104806421	1104806421	1	1	LEE, DON W	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	34051	None	None	0	In state provider	None	1510 S CENTRAL AVE	STE 150	GLENDALE	CA	91204	2541	19	06037	34.12709764	-118.2577911	Los Angeles County
248191	Fee-for-Service	1427340645	1427340645	1	1	LE, KAREN T MD	8/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120682	41	Internal Medicine	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
248223	Fee-for-Service	1003367491	1003367491	1	1	LEGACY EMANUEL HOSPITAL & HE	3/28/2022	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	ALTH CENTER	1225 NE 2ND AVE	None	PORTLAND	OR	97232	2003	00	None	45.53179918	-122.6637358	Multnomah County
248230	Fee-for-Service	1073546602	1073546602	1	1	LOSCO, JUDY A DO	3/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	7090	08	Family Practice	0	In state provider	None	2720 N HARBOR BLVD	None	FULLERTON	CA	92835	2609	30	06059	33.90126238	-117.9292154	Orange County
248248	Fee-for-Service	1760452593	1760452593	1	1	LEE, RACHEL U	7/3/2024	207K00000X	NA	Other	026	PHYSICIANS	99968	03	Allergy	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
248276	Fee-for-Service	1477556694	1477556694	1	1	LEVINE, MARK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
248285	Fee-for-Service	1356716138	1356716138	1	1	LU, YIXI K	4/7/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	795 E SECOND ST	SUITE 7	POMONA	CA	91766	2007	19	06037	34.05845654	-117.7423951	Los Angeles County
248309	Fee-for-Service	1306032495	1306032495	1	1	LANDER, MARLA R MD	5/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	73912	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
248342	Fee-for-Service	1003838012	1003838012	1	1	LEE, PAUL C MD	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75260	18	Ophthalmology	0	In state provider	None	9896 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92844	1643	30	06059	33.77397653	-117.959571	Orange County
248347	Fee-for-Service	1134418536	1134418536	1	1	LEONG, MADELINE LI MD	3/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144994	41	Internal Medicine	0	In state provider	None	26732 CROWN VALLEY PKWY	SUITE 151	MISSION VIEJO	CA	92691	6337	30	06059	33.56347704	-117.66546	Orange County
248373	Fee-for-Service	1396987228	1396987228	1	1	LAUREN TONEY MD	12/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 N DIVISION ST	None	AUBURN	WA	98001	0000	00	None	47.30904146	-122.2297239	King County
248393	Fee-for-Service	1881755437	1881755437	1	1	LEVIN, KERRY J S LCSW	12/8/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH RD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
248416	Fee-for-Service	1528032570	1528032570	1	1	LEE, MIKE H MD	6/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55051	01	General Practice	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
248425	Fee-for-Service	1841292182	1841292182	1	1	LOTZ, LAURENCE H MD	8/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	38426	08	Family Practice	0	In state provider	None	1250 PEACH ST	STE A	SAN LUIS OBISPO	CA	93401	2871	40	06079	35.28647825	-120.6599674	San Luis Obispo County
248446	Fee-for-Service	1801848270	1801848270	1	1	LUKE, ANTHONY C MD	5/16/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83194	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
248449	Fee-for-Service	1003435140	1003435140	1	1	LEYDEN, BRIANNA J MD	3/26/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	187824	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
248459	Fee-for-Service	1629661731	1629661731	1	1	LOPEZ, JESSICA CCC-SLP	4/18/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	707 15TH AVENUE	None	SAN FRANCISCO	CA	94118	3506	38	06075	37.77469812	-122.4735887	San Francisco County
248491	Fee-for-Service	1972997278	1972997278	1	1	LEUNG, ALINA A	1/4/2018	390200000X	NA	Other	026	PHYSICIANS	147682	40	Pediatrics	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
248499	Fee-for-Service	1831426642	1831426642	1	1	LAKESIDE MEDICAL	4/13/2010	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ORGANIZATION AMG INC	191 S BUENA VISTA STREET	SUITE 150	BURBANK	CA	91505	4522	19	06037	34.15872557	-118.3283863	Los Angeles County
248534	Fee-for-Service	1760452593	1760452593	1	1	LEE, RACHEL U	7/3/2024	207K00000X	NA	Other	026	PHYSICIANS	99968	41	Internal Medicine	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
248557	Fee-for-Service	1588712574	1588712574	1	1	LALICH, MICHAEL J MD	5/31/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55736	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
248565	Fee-for-Service	1821055922	1821055922	1	1	LAI, CINDY J MD	4/17/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78730	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
248567	Fee-for-Service	1891149043	1891149043	1	1	LEE, AUDREY MD	1/7/2020	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1200 N. BEAVER STREET	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
248614	Fee-for-Service	1578711958	1578711958	1	1	LIPSCOMB-HAMMOND, CECELIA N	12/29/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	P	5850 EL CAMINO REAL	None	ATASCADERO	CA	93422	3318	40	06079	35.48962035	-120.670989	San Luis Obispo County
248627	Fee-for-Service	1902812811	1902812811	1	1	LOVE, YVONNE R LP	4/21/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
248662	Fee-for-Service	1699110148	1699110148	1	1	LOPEZ-INAYAMA, MARIE J LCSW	6/13/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
248665	Fee-for-Service	1780338731	1780338731	1	1	LIAHONA HOME HEALTH SERVICES	9/10/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	155 N RIVERVIEW DRIVE	UNIT 121	ANAHEIM	CA	92808	1225	30	06059	33.86940474	-117.741772	Orange County
248673	Fee-for-Service	1518426667	1518426667	1	1	LEE, DANIEL S MD	4/3/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	180475	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
248691	Fee-for-Service	1952535221	1952535221	1	1	LADEN, MARIE-EVE R MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	113481	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
248715	Fee-for-Service	1699878991	1699878991	2	1	LE, JENNIFER N	8/27/1993	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	68 S PARK VICTORIA DR	None	MILPITAS	CA	95035	5723	43	06085	37.4344846	-121.8838689	Santa Clara County
248747	Fee-for-Service	1609221506	1609221506	1	1	LEE, CHIA-CHI J MD	9/20/2021	207R00000X	NA	Other	026	PHYSICIANS	153390	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
248796	Fee-for-Service	1184772097	1184772097	1	1	LENOIR, ZEMMAR III MD	11/27/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	35071	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
248810	Fee-for-Service	1326406745	1326406745	1	1	L&G HOME HEALTH, INC	11/11/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6850 VAN NUYS BLVD	SUITE 307	VAN NUYS	CA	91405	4640	19	06037	34.195401	-118.4487235	Los Angeles County
248820	Fee-for-Service	1366790610	1366790610	1	1	LAFLER, DOMINIC PSYD	9/26/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
248840	Fee-for-Service	1114556404	1114556404	1	1	LECKIE, AMBER L PHD	5/2/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
248860	Fee-for-Service	1053970855	1053970855	1	1	LATON UNIFIED SCHOOL	7/1/2019	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	6259 DE WOODY	None	LATON	CA	93242	0248	10	06019	36.43448499	-119.6855642	Fresno County
248891	Fee-for-Service	1477817211	1477817211	1	1	LAMARRE, AMANDA K PHD	7/17/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
248926	Fee-for-Service	1790195808	1790195808	1	1	LEE, DAVID MD	3/13/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186275	08	Family Practice	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
248939	Fee-for-Service	1518043116	1518043116	2	1	LINCARE INC	2/17/2021	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	901 HARKINS RD	SUITE E	SALINAS	CA	93901	0000	27	06053	36.6544621	-121.6258054	Monterey County
248948	Fee-for-Service	1427272756	1427272756	1	1	LEE, LAWRENCE J MD	6/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136812	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
248950	Fee-for-Service	1528120896	1528120896	1	1	LONGACRE, TERI A MD	9/30/1991	207ZP0102X	NA	Other	026	PHYSICIANS	69115	22	Pathology (M.D. only)	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
248968	Fee-for-Service	1073677811	1073677811	1	1	LA JOLLA SPINE INSTITUTE	9/5/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	MEDICAL GROUP INC	6719 ALVARDO RD	STE 308	SAN DIEGO	CA	92120	5268	37	06073	32.77684978	-117.055137	San Diego County
248983	Fee-for-Service	1255096426	1255096426	1	1	LIFESPAN: A CENTER FOR FAMIL	5/16/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	Y PSYCHOLOGICAL SERVICES	2801 TOWNSGATE ROAD	133	THOUSAND OAKS	CA	91361	5834	56	06111	34.15346648	-118.8246317	Ventura County
248992	Fee-for-Service	1497167985	1497167985	1	1	LEVYIM, DESIREE MD	3/8/2021	2084N0402X	NA	Neurology	026	PHYSICIANS	146350	None	None	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
249030	Fee-for-Service	1780642306	1780642306	1	1	LUNDQUIST, DAVIN R MD	7/12/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	79975	08	Family Practice	0	In state provider	None	5051 VERDUGO WAY	STE 100	CAMARILLO	CA	93012	8681	56	06111	34.21524684	-119.0033176	Ventura County
249069	Fee-for-Service	1376617688	1376617688	1	1	LIU, HAU MD	6/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79893	41	Internal Medicine	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
249071	Fee-for-Service	1720154339	1720154339	1	1	LARSEN, EDWIN K OD	6/14/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1737 1ST ST	None	NAPA	CA	94559	2437	28	06055	38.29736233	-122.2929399	Napa County
249081	Fee-for-Service	1477763829	1477763829	1	3	LEE, THOMAS T MD INC	10/31/1991	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4950 SAN BERNARDINO ST	STE 106	MONTCLAIR	CA	91763	2328	36	06071	34.07768363	-117.6968874	San Bernardino County
249121	Fee-for-Service	1710149869	1710149869	1	1	LEE, DWIGHT K	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124213	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
249159	Fee-for-Service	1952321309	1952321309	1	1	LESTER, JAMES W MD	9/3/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
249183	Fee-for-Service	1275504524	1275504524	1	1	LENSER, BRIAN A MD	8/1/2001	207W00000X	NA	Ophthalmology	026	PHYSICIANS	75079	18	Ophthalmology	0	In state provider	None	3109 COFFEE RD	STE C	MODESTO	CA	95355	1733	50	06099	37.68319185	-120.9760342	Stanislaus County
249189	Fee-for-Service	1043305782	1043305782	1	1	LONG BEACH CARE CTR, INC	10/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2615 GRAND AVE	None	LONG BEACH	CA	90815	1708	19	06037	33.80527565	-118.1470853	Los Angeles County
249217	Fee-for-Service	1528011806	1528011806	2	1	LUM, DARREN P MD	12/24/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
249222	Fee-for-Service	1902903875	1902903875	1	1	LAWSON, CANDACE M	9/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54581	08	Family Practice	0	In state provider	None	3950 V ST	None	SACRAMENTO	CA	95817	1439	34	06067	38.55697274	-121.4589106	Sacramento County
249252	Fee-for-Service	1124123609	1124123609	1	1	LAI, HOLLIE A MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62577	30	Radiology	0	In state provider	None	1201 W LA VETA AVENUE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
249265	Fee-for-Service	1699855841	1699855841	1	1	LIZOTTE, PAUL E DO	7/23/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	6147	42	Nuclear Medicine	0	In state provider	None	3531 FASHION WAY	None	TORRANCE	CA	90503	4807	19	06037	33.8352235	-118.348254	Los Angeles County
249273	Fee-for-Service	1699700518	1699700518	1	1	LEVY, LESLIE G DPM	1/1/1979	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	9535 RESEDA BLVD	STE 109	NORTHRIDGE	CA	91324	6022	19	06037	34.243128	-118.5361055	Los Angeles County
249277	Fee-for-Service	1780880153	1780880153	1	1	LEE, SCOTT S DO	10/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9531	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
249320	Fee-for-Service	1598092686	1598092686	1	1	LANDSMAN, ERIN LMFT	7/29/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
249352	Fee-for-Service	1518217744	1518217744	1	1	LCMS SOLUTIONS INC	6/14/2016	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	7301 GIRARD AVENUE	SUITE 100	LA JOLLA	CA	92037	5150	37	06073	32.83764565	-117.2715586	San Diego County
249387	Fee-for-Service	1497024061	1497024061	1	1	LUTFY, PATRICIA M MD	4/23/2018	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	133725	25	Physical Medicine and Rehabilitation	0	In state provider	None	7525 METROPOLITAN DR	302	SAN DIEGO	CA	92108	1161	37	06073	32.77677653	-117.1592911	San Diego County
249442	Fee-for-Service	1164532958	1164532958	1	1	LOREDO, SAMUEL MD INC	2/28/1990	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55263	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1190 W OLIVE AVE	STE F	MERCED	CA	95348	1960	24	06047	37.31910454	-120.4885665	Merced County
249443	Fee-for-Service	1851334601	1851334601	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5875 CALLE REAL	None	GOLETA	CA	93117	2313	42	06083	34.4414525	-119.827557	Santa Barbara County
249460	Fee-for-Service	1831278563	1831278563	1	2	LEWIS, DANIEL G MD	11/15/2022	2084P0802X	NA	Psychiatry	086	MEDICAL DIRECTORS	60814	-	NOT APPLICABLE	0	In state provider	None	3647 40TH ST	None	SACRAMENTO	CA	95817	3609	34	06067	38.541456	-121.4604765	Sacramento County
249468	Fee-for-Service	1023046141	1023046141	1	1	LIM, STEPHEN W MD	1/31/1994	174400000X	NA	Other	026	PHYSICIANS	70542	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
249481	Fee-for-Service	1336181155	1336181155	2	1	LONGS DRUG STORES CA LLC	11/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3619 W CALDWELL AVE.	None	VISALIA	CA	93277	7067	54	06107	36.297873	-119.33082	Tulare County
249527	Fee-for-Service	1609805209	1609805209	2	1	LI, YAOHUI MD	2/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87413	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
249535	Fee-for-Service	1154364941	1154364941	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	625 ELMIRA RD	None	VACAVILLE	CA	95687	4655	48	06095	38.35179979	-121.951024	Solano County
249553	Fee-for-Service	1699855841	1699855841	1	1	LIZOTTE, PAUL E DO	7/23/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	6147	30	Radiology	0	In state provider	None	3531 FASHION WAY	None	TORRANCE	CA	90503	4807	19	06037	33.8352235	-118.348254	Los Angeles County
249575	Fee-for-Service	1174064091	1174064091	1	1	LI, CONNIE J MD APC	9/5/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	87985	40	Pediatrics	0	In state provider	None	600 N GARFIELD AVE	SUITE 311	MONTEREY PARK	CA	91754	1171	19	06037	34.06820797	-118.1228835	Los Angeles County
249604	Fee-for-Service	1316110521	1316110521	1	1	LAU, STANLEY T MD	8/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103237	40	Pediatrics	0	In state provider	None	4733 WEST SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
249622	Fee-for-Service	1285890418	1285890418	1	1	LEE, DAVID P MD	11/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113133	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5427	19	06037	34.21980849	-118.4301135	Los Angeles County
249701	Fee-for-Service	1962109033	1962109033	1	13	LOS ANGELES COUNTY DEPARTMEN	2/8/2024	261QP0905X	NA	Other	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	711 DEL AMO BLVD	None	TORRANCE	CA	90502	1362	19	06037	33.84629878	-118.2862942	Los Angeles County
249760	Fee-for-Service	1275552556	1275552556	1	1	LEE, ERIC A MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	60208	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90095	0001	19	06037	34.03781261	-118.3755101	Los Angeles County
249771	Fee-for-Service	1699235762	1699235762	1	1	LEE, DANIEL H DO	7/21/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20827	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
249802	Fee-for-Service	1497778526	1497778526	1	1	LU, JIN-JOU MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	41229	41	Internal Medicine	0	In state provider	None	11190 WARNER AVENUE	SUITE 403	FOUNTAIN VALLEY	CA	92708	7505	30	06059	33.714	-117.9333585	Orange County
249845	Fee-for-Service	1174637276	1174637276	1	1	LIN, JOHN P MD	12/1/1994	2085B0100X	NA	MRI Provider	026	PHYSICIANS	70214	None	None	0	In state provider	None	443 S SOTO ST	None	LOS ANGELES	CA	90033	4315	19	06037	34.03962728	-118.2124322	Los Angeles County
249854	Fee-for-Service	1508809393	1508809393	2	1	LONGS DRUG STORES CA LLC	8/17/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2677 CLAYTON RD	None	CONCORD	CA	94519	2724	07	06013	37.97535075	-122.027832	Contra Costa County
249877	Fee-for-Service	1891724472	1891724472	1	1	LEE, GARRETT B MD	8/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	78487	66	Emergency Medicine (Urgent Care)	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
249928	Fee-for-Service	1649446675	1649446675	1	1	LEE, SANG W LAC	3/6/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	10933 VALLEY MALL	D7	EL MONTE	CA	91731	2606	19	06037	34.07556654	-118.03622	Los Angeles County
249963	Fee-for-Service	1639235849	1639235849	1	1	LANDIS, TOBY Y PHD	11/1/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	493 MAIN ST	STE. D	DIAMOND SPRINGS	CA	95619	9173	09	06017	38.694285	-120.8178945	El Dorado County
249970	Fee-for-Service	1538314141	1538314141	1	1	LERNER, MICHAEL R MD	12/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86296	07	Dermatology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
249973	Fee-for-Service	1225116965	1225116965	1	1	LLAGUNO, ALOYSIUS MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	43349	14	Neurological Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
249978	Fee-for-Service	1386738110	1386738110	1	1	LIU, TAYLOR I MD	7/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82429	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5 LOWER RAGSDALE DR	STE 102	MONTEREY	CA	93940	5817	27	06053	36.57544273	-121.8164209	Monterey County
249996	Fee-for-Service	1700964491	1700964491	1	1	LIU, DAVIS MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	66821	08	Family Practice	0	In state provider	None	1505 WILSON TER	STE 150	GLENDALE	CA	91206	4076	19	06037	34.14960934	-118.2313491	Los Angeles County
250043	Fee-for-Service	1770169583	1770169583	1	1	LAM, HAN MD	10/30/2024	208M00000X	NA	Other	026	PHYSICIANS	181205	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
250045	Fee-for-Service	1346810793	1346810793	1	1	LY, VI M CRNA	10/4/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
250064	Fee-for-Service	1750685277	1750685277	1	1	LE, AN K	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
250089	Fee-for-Service	1497778526	1497778526	1	1	LU, JIN-JOU MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	41229	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	11190 WARNER AVENUE	SUITE 403	FOUNTAIN VALLEY	CA	92708	7505	30	06059	33.714	-117.9333585	Orange County
250090	Fee-for-Service	1831219880	1831219880	1	1	LIN, MARGARET C MD	4/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	72970	30	Radiology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
250119	Fee-for-Service	1609846146	1609846146	1	1	LYONS, ROBERT	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42340	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 S FOREST RD	None	SONORA	CA	95370	4816	55	06109	37.98218745	-120.3911521	Tuolumne County
250144	Fee-for-Service	1851408009	1851408009	1	1	LIM, PING-SIM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	24845	41	Internal Medicine	0	In state provider	None	1433 W MERCED AVE	STE 206	WEST COVINA	CA	91790	3402	19	06037	34.06252177	-117.9477117	Los Angeles County
250156	Fee-for-Service	1629196977	1629196977	1	1	LEV-ER, DEBORAH LCSW	2/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3438 MENDOCINO AVE	B	SANTA ROSA	CA	95403	2275	49	06097	38.472282	-122.723991	Sonoma County
250158	Fee-for-Service	1497737696	1497737696	1	1	LEWIS, CLIFFORD E PHD	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2277 FAIR OAKS BLVD	STE 455	SACRAMENTO	CA	95825	5500	34	06067	38.575404	-121.4121195	Sacramento County
250256	Fee-for-Service	1447443270	1447443270	1	1	LUU, DOAN V MD	6/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94073	66	Emergency Medicine (Urgent Care)	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
250262	Fee-for-Service	1104983238	1104983238	1	1	LARKIN, CONRAD E LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	98 MAIN ST	# 444	TIBURON	CA	94920	2517	21	06041	37.87374706	-122.4582461	Marin County
250264	Fee-for-Service	1205011368	1205011368	1	1	LAVINA, JENNA M MD	3/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97377	41	Internal Medicine	0	In state provider	None	354 SANTA FE DRIVE	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
250274	Fee-for-Service	1023542529	1023542529	1	1	LOPEZ-NANDAM, ANEESH MD	3/26/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	157697	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
250333	Fee-for-Service	1154664597	1154664597	1	1	LING, JASON S MD	11/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156260	41	Internal Medicine	0	In state provider	None	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
250357	Fee-for-Service	1912403940	1912403940	1	1	LIN, ANDREW MD	12/28/2022	207P00000X	NA	Other	026	PHYSICIANS	180597	None	None	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
250372	Fee-for-Service	1386025773	1386025773	1	2	L A STAR MEDICAL GROUP, INC.	7/31/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	BELLFLOWER	9817 ARKANSAS STREET	None	BELLFLOWER	CA	90706	5913	19	06037	33.87937427	-118.1245762	Los Angeles County
250392	Fee-for-Service	1528433588	1528433588	1	1	LIVINGSTON COMMUNITY HEALTH	6/27/2017	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	12619 BENTLEY ST	None	WATERFORD	CA	95386	9011	50	06099	37.64073442	-120.7613165	Stanislaus County
250393	Fee-for-Service	1649358185	1649358185	1	1	LOU, ANNA MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50039	25	Physical Medicine and Rehabilitation	0	In state provider	None	2200 HAYES ST	None	SAN FRANCISCO	CA	94117	1013	38	06075	37.77302042	-122.45342	San Francisco County
250433	Fee-for-Service	1912534157	1912534157	1	1	LEE, KUN-UK DAVID MD	4/14/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176605	None	None	0	In state provider	None	2888 COCHRAN STREET	None	SIMI VALLEY	CA	93065	2782	56	06111	34.27898255	-118.7378325	Ventura County
250467	Fee-for-Service	1336106921	1336106921	1	1	LEE, WON T MD	7/2/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	34053	36	Psychiatry	0	In state provider	None	1745 PACIFIC AVE	None	LONG BEACH	CA	90813	1714	19	06037	33.788907	-118.1937575	Los Angeles County
250500	Fee-for-Service	1659505063	1659505063	1	1	LEE, DONG H MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113396	84	Surgery-Head and Neck	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
250520	Fee-for-Service	1487090049	1487090049	1	1	LAW, JESUA I MD	7/28/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	13918	20	Orthopedic Surgery	0	In state provider	None	609 E ORANGEBURG AVE	STE 201	MODESTO	CA	95350	5512	50	06099	37.66364947	-120.9857985	Stanislaus County
250522	Fee-for-Service	1477593366	1477593366	1	1	LESLIE, THEODORE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1615 DELAWARE ST	None	LONGVIEW	WA	98632	0000	00	None	46.1309207	-122.9408931	Cowlitz County
250543	Fee-for-Service	1396287710	1396287710	1	1	LEMON, MEGAN C CNP	9/7/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 220A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
250585	Fee-for-Service	1932121308	1932121308	1	1	LEE, MARSHA M MD	8/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78146	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
250590	Fee-for-Service	1861570640	1861570640	1	1	LEAVITT, RICHARD M MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	36239	36	Psychiatry	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
250620	Fee-for-Service	1154664597	1154664597	1	1	LING, JASON S MD	11/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156260	67	Endocrinology	0	In state provider	None	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
250624	Fee-for-Service	1609038215	1609038215	1	1	LEE, KATHERINE H MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119368	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
250625	Fee-for-Service	1295958312	1295958312	1	1	LISTER, DOUGLAS S DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	510 CYPRESS ST	STE E	FORT BRAGG	CA	95437	5411	23	06045	39.43260152	-123.798942	Mendocino County
250648	Fee-for-Service	1194966416	1194966416	1	1	LANG, PATRICK O MD	10/25/2021	2082S0105X	NA	General Surgery	026	PHYSICIANS	106890	None	None	0	In state provider	None	1 SHRADER ST	SUITE 650	SAN FRANCISCO	CA	94117	1036	38	06075	37.77467326	-122.4529451	San Francisco County
250680	Fee-for-Service	1528433588	1528433588	1	1	LIVINGSTON COMMUNITY HEALTH	9/2/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	12619 BENTLEY ST	None	WATERFORD	CA	95386	9011	50	06099	37.64073442	-120.7613165	Stanislaus County
250685	Fee-for-Service	1134137110	1134137110	1	1	LEE, BYRNE MD	8/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90704	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
250697	Fee-for-Service	1952746307	1952746307	1	1	LI, CARRIE J MD	6/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132819	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
250736	Fee-for-Service	1386655173	1386655173	1	1	LAWTON CONSULTING INC	10/5/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	EASYMEDONLINE	320 MAIN STREET	UNIT B	SEAL BEACH	CA	90740	6382	30	06059	33.74332176	-118.1033859	Orange County
250746	Fee-for-Service	1023046547	1023046547	1	1	LAWRENCE, TRACY D MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73940	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
250756	Fee-for-Service	1669580478	1669580478	1	1	LEE, JAE YOUNG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV OF IOWA HOSP & CLNS	200 HAWKINS DR	None	IOWA CITY	IA	52242	0000	00	None	41.659929	-91.548099	Johnson County
250775	Fee-for-Service	1639124514	1639124514	1	1	LIANG, SCOTT H MD	8/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86197	41	Internal Medicine	0	In state provider	None	147 W SIERRA AVE	None	SIERRA MADRE	CA	91024	0000	19	06037	34.15992167	-118.0498075	Los Angeles County
250803	Fee-for-Service	1528208907	1528208907	1	1	LINEBARGER, KEINA R LMFT	10/2/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	870 EMERALD BAY RD	SUITE 307	SOUTH LAKE TAHOE	CA	96150	9403	09	06017	38.91645023	-120.0084206	El Dorado County
250822	Fee-for-Service	1194863902	1194863902	1	1	LUBISICH, JOHN P MD	6/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77575	30	Radiology	0	In state provider	None	6386 ALVARADO CT	STE 121	SAN DIEGO	CA	92120	4906	37	06073	32.77666838	-117.0614255	San Diego County
250826	Fee-for-Service	1679112353	1679112353	1	1	LU, KRISTY A NP	11/25/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
250832	Fee-for-Service	1821192139	1821192139	1	1	LOTT, MARK MD	11/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85987	10	Gastroenterology (M.D. only)	0	In state provider	None	501 E HARDY ST	STE 430	INGLEWOOD	CA	90301	4069	19	06037	33.9491005	-118.348857	Los Angeles County
250855	Fee-for-Service	1235214081	1235214081	1	1	LING, SHIANG DO	11/25/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	10263	40	Pediatrics	0	In state provider	None	5051 VERDUGO WAY	SUITE 100	CAMARILLO	CA	93012	8681	56	06111	34.21524684	-119.0033176	Ventura County
250942	Fee-for-Service	1447293774	1447293774	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1074 ORO DAM BLVD EAST	None	OROVILLE	CA	95965	5834	04	06007	39.50067248	-121.562518	Butte County
250967	Fee-for-Service	1528433588	1528433588	1	1	LIVINGSTON COMMUNITY HEALTH	8/1/2017	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	12619 BENTLEY ST	None	WATERFORD	CA	95386	9011	50	06099	37.64073442	-120.7613165	Stanislaus County
250969	Fee-for-Service	1407904485	1407904485	1	1	LEE, GEORGE K OD	4/11/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
251007	Fee-for-Service	1396812111	1396812111	1	1	LUO, AMY M MD	7/1/1998	207L00000X	NA	Other	026	PHYSICIANS	65473	05	Anesthesiology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
251024	Fee-for-Service	1417416702	1417416702	1	1	LOBO, ANNA SUZETTE CNP	4/20/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2900 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2730	19	06037	33.896799	-118.3959415	Los Angeles County
251041	Fee-for-Service	1215126040	1215126040	1	1	LIU, HELEN L MD	2/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	92579	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
251067	Fee-for-Service	1659538486	1659538486	1	1	LAROSE, CONNOR R MD	10/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111430	20	Orthopedic Surgery	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
251076	Fee-for-Service	1033304050	1033304050	1	1	LOMIBAO, RICHARD M	11/19/2008	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
251097	Fee-for-Service	1871637579	1871637579	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5420 DEWEY DR	None	FAIR OAKS	CA	95628	3138	34	06067	38.664459	-121.3071795	Sacramento County
251105	Fee-for-Service	1790704344	1790704344	1	1	LITVAK, DONALD S MD	1/23/1973	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23815	30	Radiology	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
251120	Fee-for-Service	1437537065	1437537065	1	2	LAIRD, MEREDITH MD	5/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144237	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
251160	Fee-for-Service	1699093880	1699093880	1	1	LION, RICHARD P DO	8/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15698	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3899	36	06071	34.04824949	-117.2401425	San Bernardino County
251163	Fee-for-Service	1861422032	1861422032	1	1	LYNCH, TORREY MD	9/8/2020	207L00000X	NA	Other	026	PHYSICIANS	168942	05	Anesthesiology	0	In state provider	None	616 E CHAPEL ST	None	SANTA MARIA	CA	93454	4522	42	06083	34.95426953	-120.427596	Santa Barbara County
251171	Fee-for-Service	1437121225	1437121225	1	1	LATENDRESSE, THOMAS R MD	10/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	88529	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
251181	Fee-for-Service	1801833728	1801833728	2	1	LINCARE INC.	6/6/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2945 MCMILLAN AVE	STE 144	SAN LUIS OBISPO	CA	93401	6767	40	06079	35.263494	-120.648157	San Luis Obispo County
251201	Fee-for-Service	1558717199	1558717199	1	1	LIFESCRIPT PHARMACY	8/29/2016	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	39039 PASEO PADRE PKWY.	STE. 201	FREMONT	CA	94538	1620	01	06001	37.55409261	-121.9821804	Alameda County
251255	Fee-for-Service	1528433588	1528433588	1	1	LIVINGSTON COMMUNITY HEALTH	9/2/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	12619 BENTLEY ST	None	WATERFORD	CA	95386	9011	50	06099	37.64073442	-120.7613165	Stanislaus County
251302	Fee-for-Service	1457668311	1457668311	1	1	LAURON, MARK P MD INC	5/11/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61892	01	General Practice	0	In state provider	None	16024 KAMANA RD	None	APPLE VALLEY	CA	92307	1308	36	06071	34.54228943	-117.2719742	San Bernardino County
251327	Fee-for-Service	1861681439	1861681439	1	1	LANSDOWN, CHRISTINA L LMFT	8/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1060 EL CAMINO REAL	STE H	REDWOOD CITY	CA	94063	1645	41	06081	37.48361755	-122.2318706	San Mateo County
251346	Fee-for-Service	1346574183	1346574183	1	1	LIN, JENNIFER L MD	9/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115682	04	Otology, Laryngology, Rhinology	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
251362	Fee-for-Service	1336311646	1336311646	1	1	LINDER DUNKLE, DUSTA NOELLE	10/20/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	6101 1 / 2 W MANOR DR	None	LA MESA	CA	91942	3621	37	06073	32.78941836	-116.999075	San Diego County
251378	Fee-for-Service	1487624169	1487624169	1	1	LAO, MARICLEM P MD	7/16/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53653	08	Family Practice	0	In state provider	None	1700 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5115	36	06071	34.130214	-117.2788065	San Bernardino County
251391	Fee-for-Service	1790704344	1790704344	1	1	LITVAK, DONALD S MD	1/23/1973	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23815	01	General Practice	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
251411	Fee-for-Service	1134474760	1134474760	1	1	LOS ANGELES CENTERS FOR	8/30/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	ALCOHOL AND DRUG ABUSE	10400 S ORR AND DAY RD	ROOM F2	SANTE FE SPRINGS	CA	90670	4161	19	06037	33.94077362	-118.0904889	Los Angeles County
251531	Fee-for-Service	1427048081	1427048081	1	1	LUCARELLA, VANESSA J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	455 PINELLAS ST	STE 400	CLEARWATER	FL	33756	3356	00	None	27.95178047	-82.8005715	Pinellas County
251535	Fee-for-Service	1245230333	1245230333	1	1	LEE, KEVIN K MD	6/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73871	None	None	0	In state provider	None	5575 W LAS POSITAS BLVD	STE 130	PLEASANTON	CA	94588	5800	01	06001	37.69214859	-121.8796532	Alameda County
251552	Fee-for-Service	1285003467	1285003467	1	1	LEUNG, STEPHANIE K PT	11/17/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	601 VAN NESS AVE	None	SAN FRANCISCO	CA	94102	3200	38	06075	37.78149353	-122.4206703	San Francisco County
251575	Fee-for-Service	1417062431	1417062431	1	1	LOGERFO, SUNG EUN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	# 395110	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
251577	Fee-for-Service	1528329935	1528329935	1	1	LUDINGTON, JAMES S PT	8/16/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1630 W REDLANDS BLVD.	SUITE L	REDLANDS	CA	92373	8032	36	06071	34.06293049	-117.2104992	San Bernardino County
251579	Fee-for-Service	1255357968	1255357968	1	1	LYON, MICHAEL G MD	9/30/1987	207K00000X	NA	Other	026	PHYSICIANS	47269	83	Rheumatology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
251590	Fee-for-Service	1457668311	1457668311	1	1	LAURON, MARK P MD INC	5/11/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61892	41	Internal Medicine	0	In state provider	None	16024 KAMANA RD	None	APPLE VALLEY	CA	92307	1308	36	06071	34.54228943	-117.2719742	San Bernardino County
251620	Fee-for-Service	1366800385	1366800385	1	1	LINNARD, MADELEINE Y	5/2/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
251629	Fee-for-Service	1528528163	1528528163	1	1	LABORA, AMANDA MD	6/21/2023	390200000X	NA	Other	026	PHYSICIANS	183359	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
251634	Fee-for-Service	1346574183	1346574183	1	1	LIN, JENNIFER L MD	9/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115682	84	Surgery-Head and Neck	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
251637	Fee-for-Service	1386661288	1386661288	1	1	LAANE, CHRISTINA J MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68318	84	Surgery-Head and Neck	0	In state provider	None	40 N SAN MATEO DR	None	SAN MATEO	CA	94401	2824	41	06081	37.56752371	-122.3273214	San Mateo County
251648	Fee-for-Service	1336311646	1336311646	1	1	LINDER DUNKLE, DUSTA NOELLE	10/20/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	6101 1 / 2 W MANOR DR	None	LA MESA	CA	91942	3621	37	06073	32.78941836	-116.999075	San Diego County
251681	Fee-for-Service	1689106502	1689106502	1	1	LUDDER, SHAAN DO	8/4/2022	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	17220	None	None	0	In state provider	None	2800 L ST	STE 10	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
251694	Fee-for-Service	1699173310	1699173310	1	1	LOMA LINDA HOSPICE CARE, INC	9/28/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	STE 427	ENCINO	CA	91436	2204	19	06037	34.15682212	-118.4871886	Los Angeles County
251699	Fee-for-Service	1538166764	1538166764	1	1	LAMOTTE, ANGELA J MD	1/31/1991	207R00000X	NA	Other	026	PHYSICIANS	71109	41	Internal Medicine	0	In state provider	None	2683 PACIFIC AVE	None	LONG BEACH	CA	90806	2350	19	06037	33.805926	-118.193738	Los Angeles County
251752	Fee-for-Service	1457990327	1457990327	1	1	LI, JINGLAN CCC-SLP	11/18/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
251800	Fee-for-Service	1962553321	1962553321	1	1	LESTZ, RACHEL M MD	2/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114335	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
251869	Fee-for-Service	1255357968	1255357968	1	1	LYON, MICHAEL G MD	9/30/1987	207K00000X	NA	Other	026	PHYSICIANS	47269	41	Internal Medicine	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
251875	Fee-for-Service	1548790009	1548790009	1	1	LEMAS, BRYAN K LMFT	3/25/2022	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1103 BUTTE HOUSE RD	SUITE E	YUBA CITY	CA	95991	3109	51	06101	39.14536728	-121.6306637	Sutter County
251889	Fee-for-Service	1871749382	1871749382	1	1	LEE, LINDA S MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107543	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
251908	Fee-for-Service	1861745184	1861745184	1	1	LONG, MICHAEL T MD	6/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122497	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
251909	Fee-for-Service	1114556974	1114556974	1	1	LEE, BRIGETTE M MD	8/1/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	None	07	Dermatology	0	In state provider	None	11370 ANDERSON ST	# 2600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
251929	Fee-for-Service	1093179764	1093179764	1	1	LEVY, KIRA MD	8/28/2019	390200000X	NA	Other	026	PHYSICIANS	152139	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
251930	Fee-for-Service	1689617565	1689617565	1	1	LIN, ANDREW P MD	12/1/1997	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	80572	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
251953	Fee-for-Service	1457442410	1457442410	1	1	LEE, SHERYN S	11/30/1994	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9636 GARDEN GROVE BLVD	STE 5	GARDEN GROVE	CA	92844	1590	30	06059	33.77396648	-117.963882	Orange County
251979	Fee-for-Service	1164437661	1164437661	1	1	LUTSHEP, HELMI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAN JACKSON PK	RAOD	PORTLAND	OR	97239	0000	00	None	45.49936609	-122.6856232	Multnomah County
251981	Fee-for-Service	1699173310	1699173310	1	1	LOMA LINDA HOSPICE CARE, INC	9/28/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	STE 427	ENCINO	CA	91436	2204	19	06037	34.15682212	-118.4871886	Los Angeles County
251987	Fee-for-Service	1538166764	1538166764	1	1	LAMOTTE, ANGELA J MD	1/31/1991	207R00000X	NA	Other	026	PHYSICIANS	71109	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2683 PACIFIC AVE	None	LONG BEACH	CA	90806	2350	19	06037	33.805926	-118.193738	Los Angeles County
252088	Fee-for-Service	1962553321	1962553321	1	1	LESTZ, RACHEL M MD	2/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114335	79	Neurology-Child	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
252163	Fee-for-Service	1114975760	1114975760	1	1	LOGES, RICHARD J MD	4/15/2024	2085R0204X	NA	Other	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	6412 LAUREL AVE	None	MOUNTAIN MESA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
252191	Fee-for-Service	1356440507	1356440507	1	1	LOH, SAMUEL J MD INC	1/1/1979	207L00000X	NA	Other	026	PHYSICIANS	36150	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
252202	Fee-for-Service	1568633600	1568633600	1	1	LIU, EUGENE H MD	10/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144850	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
252220	Fee-for-Service	1194739797	1194739797	1	1	LIU, JOHN K MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	65778	01	General Practice	0	In state provider	None	1318 E FLORENCE AVE	None	LOS ANGELES	CA	90001	1935	19	06037	33.97472353	-118.251306	Los Angeles County
252224	Fee-for-Service	1467989061	1467989061	1	1	LASKY, ARIELLE K MD	11/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157229	01	General Practice	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94019	4364	41	06081	37.53039072	-122.2987772	San Mateo County
252232	Fee-for-Service	1013055433	1013055433	1	1	LAM, ALISON M MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97632	40	Pediatrics	0	In state provider	None	260 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
252243	Fee-for-Service	1144410051	1144410051	1	1	LUNGREN, MATTHEW P MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129680	30	Radiology	0	In state provider	None	300 PASTEUR DR	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
252246	Fee-for-Service	1518991108	1518991108	1	1	LEE, JIWON ESTHER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
252292	Fee-for-Service	1346805314	1346805314	1	1	LOPEZ, OFELIA LMFT	10/31/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
252355	Fee-for-Service	1760425094	1760425094	2	1	LONGS DRUG STORE CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	451 S REINO RD	None	NEWBURY PARK	CA	91320	0000	56	06111	34.17097058	-118.9551183	Ventura County
252369	Fee-for-Service	1013299825	1013299825	1	1	LEE, BRANDON Y CRNA	12/2/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
252392	Fee-for-Service	1457655946	1457655946	1	1	LESIGUES, JESSICA C OT	2/20/2024	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	805 E WALNUT AVE	None	LOMPOC	CA	93436	7027	42	06083	34.64061286	-120.4487303	Santa Barbara County
252441	Fee-for-Service	1346531225	1346531225	1	1	LI, MICHAEL MD	7/21/2023	208600000X	NA	General Surgery	026	PHYSICIANS	125430	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
252444	Fee-for-Service	1619055431	1619055431	1	1	LIBUIT, NOEL L MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	50003	22	Pathology (M.D. only)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
252445	Fee-for-Service	1043770977	1043770977	1	1	LIANG, ERIN MD	10/9/2023	207P00000X	NA	Other	026	PHYSICIANS	177106	None	None	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
252448	Fee-for-Service	1194820290	1194820290	1	1	LEE, KATIE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3901 HOYT AVE	None	EVERETT	WA	98201	4918	00	None	47.9655876	-122.2094249	Snohomish County
252493	Fee-for-Service	1932103827	1932103827	1	1	LIEM, LIONG B DO	1/1/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	5065	01	General Practice	0	In state provider	None	1174 CASTRO ST	STE 201	MOUNTAIN VIEW	CA	94040	2569	43	06085	37.3822628	-122.0861276	Santa Clara County
252494	Fee-for-Service	1700828779	1700828779	1	1	LUKE, HAROLD MD INC	1/13/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	24934	08	Family Practice	0	In state provider	None	137 E VINE ST	None	REDLANDS	CA	92373	4759	36	06071	34.05465946	-117.181026	San Bernardino County
252507	Fee-for-Service	1831245737	1831245737	1	2	LINDSEY, RHONDA PSYD	2/3/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1049 4TH STREET	SUITE G	SANTA ROSA	CA	95404	4354	49	06097	38.444508	-122.7060495	Sonoma County
252535	Fee-for-Service	1356983472	1356983472	1	1	LIFESTAR HOME HEALTH CARE	10/20/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	20501 VENTURA BLVD	STE 217	WOODLAND HILLS	CA	91364	6400	19	06037	34.16800818	-118.5797688	Los Angeles County
252603	Fee-for-Service	1336156363	1336156363	1	1	LAC RANCHO LOS AMIGOS	8/23/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	REHABILITATION CENTER	7601 E IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
252617	Fee-for-Service	1699094581	1699094581	1	1	LEWIS, ANDREA L LMFT	9/7/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
252704	Fee-for-Service	1568510535	1568510535	1	1	LI, MYHUE L MD	11/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83052	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
252711	Fee-for-Service	1548591373	1548591373	1	1	LI, JONATHAN MD	5/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109244	05	Anesthesiology	0	In state provider	None	101 THE CITY DRIVE S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
252717	Fee-for-Service	1811942378	1811942378	1	1	LEM, WILSON WONG MD	4/30/1991	207P00000X	NA	Other	026	PHYSICIANS	37299	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
252719	Fee-for-Service	1497768725	1497768725	1	1	LAW, MALENA S MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74010	41	Internal Medicine	0	In state provider	None	1131 WILSHIRE BLVD	# 100200	LOS ANGELES	CA	90017	1900	19	06037	34.05277469	-118.2641858	Los Angeles County
252739	Fee-for-Service	1033554480	1033554480	1	1	LOPEZ, MARYALICE MD	7/5/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	133468	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
252740	Fee-for-Service	1811351679	1811351679	1	1	LAI, ANDREW C MD	9/10/2020	207P00000X	NA	Other	026	PHYSICIANS	151421	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
252755	Fee-for-Service	1215015938	1215015938	1	1	LONDEREE, JASON J MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67890	02	General Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
252766	Fee-for-Service	1922021492	1922021492	1	1	LYONS, SAMUEL D MD	2/22/2023	208600000X	NA	General Surgery	026	PHYSICIANS	62858	None	None	0	In state provider	None	590 S INDIAN HILL BLVD	None	CLAREMONT	CA	91711	5212	19	06037	34.085313	-117.7191945	Los Angeles County
252780	Fee-for-Service	1932103827	1932103827	1	1	LIEM, LIONG B DO	1/1/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	5065	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1174 CASTRO ST	STE 201	MOUNTAIN VIEW	CA	94040	2569	43	06085	37.3822628	-122.0861276	Santa Clara County
252784	Fee-for-Service	1700828779	1700828779	1	1	LUKE, HAROLD MD INC	1/13/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	24934	01	General Practice	0	In state provider	None	137 E VINE ST	None	REDLANDS	CA	92373	4759	36	06071	34.05465946	-117.181026	San Bernardino County
252872	Fee-for-Service	1730685397	1730685397	2	1	LOW, OLIVIA G MD	11/30/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	164753	None	None	0	In state provider	None	1100 W GONZALES RD	None	OXNARD	CA	93036	3336	56	06111	34.21910048	-119.1907575	Ventura County
252890	Fee-for-Service	1528401742	1528401742	1	1	LINN, WUTT Y MD	7/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140020	None	None	0	In state provider	None	6555 COYLE AVE	STE 280	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
252892	Fee-for-Service	1336156363	1336156363	1	1	LAC RANCHO LOS AMIGOS	6/3/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	REHABILITATION CENTER	7601 E IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
252970	Fee-for-Service	1073694394	1073694394	1	1	LANG, YOSHADO K PHD	2/17/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8939 S SEPULVEDA BLVD	SUITE #200	LOS ANGELES	CA	90045	3631	19	06037	33.95485856	-118.3962461	Los Angeles County
252976	Fee-for-Service	1922066869	1922066869	1	1	LINDBERG, DANIEL M MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
253003	Fee-for-Service	1700175791	1700175791	1	1	LEE, JEANNE MD	8/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123946	41	Internal Medicine	0	In state provider	None	12 CAMINO ENCINAS	None	ORINDA	CA	94563	3304	07	06013	37.87679015	-122.1800856	Contra Costa County
253022	Fee-for-Service	1710115944	1710115944	1	1	LAW, JONATHAN MD	9/16/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	162967	04	Otology, Laryngology, Rhinology	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
253047	Fee-for-Service	1649464611	1649464611	1	1	LAKSHMINARAYANAN, SONALI MD	2/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106310	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
253061	Fee-for-Service	1669659033	1669659033	1	1	LEE, SUZEE E MD	8/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103301	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
253064	Fee-for-Service	1659806685	1659806685	1	1	LECLAIR, BRONSON	11/1/2024	207L00000X	NA	Other	026	PHYSICIANS	157217	05	Anesthesiology	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
253079	Fee-for-Service	1619224516	1619224516	1	1	LIMCHAIYAWAT, PAULINE MD	7/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129776	07	Dermatology	0	In state provider	None	200 MEDICAL PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
253150	Fee-for-Service	1750301065	1750301065	1	1	LEWIS, SUSAN L MD	5/30/2019	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	78780	20	Orthopedic Surgery	0	In state provider	None	401 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6387	43	06085	37.36777579	-122.0276404	Santa Clara County
253176	Fee-for-Service	1780760207	1780760207	1	1	LEE, HENRY MD	12/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92986	07	Dermatology	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
253196	Fee-for-Service	1962936930	1962936930	1	1	LOPEZ, NOE NP	1/16/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
253200	Fee-for-Service	1104827757	1104827757	1	1	LEE, THOMAS C MD	7/15/1996	207P00000X	NA	Other	026	PHYSICIANS	83231	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
253210	Fee-for-Service	1104214238	1104214238	1	1	LAN N NGUYEN DO PC	6/4/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	3750 CONVOY ST	SUITE 201	SAN DIEGO	CA	92111	3770	37	06073	32.81201122	-117.1531108	San Diego County
253275	Fee-for-Service	1588240519	1588240519	1	1	LEE, YONG MD	9/3/2023	207R00000X	NA	Other	026	PHYSICIANS	181877	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
253291	Fee-for-Service	1831456045	1831456045	1	1	LE, GIANG T MD	10/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142747	05	Anesthesiology	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
253292	Fee-for-Service	1316396351	1316396351	1	1	LOHARUKA, SHEILA DO	4/25/2024	207R00000X	NA	Other	026	PHYSICIANS	18117	41	Internal Medicine	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
253319	Fee-for-Service	1740290485	1740290485	1	1	LEVIN, JEFFREY R MD	10/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	46304	13	Neurology (M.D. only)	0	In state provider	None	1541 FLORIDA AVE	STE 300	MODESTO	CA	95350	4439	50	06099	37.666863	-120.9962775	Stanislaus County
253335	Fee-for-Service	1649464611	1649464611	1	1	LAKSHMINARAYANAN, SONALI MD	2/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106310	68	Hematology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
253336	Fee-for-Service	1376774521	1376774521	1	1	LEE, TEH L NP	8/30/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
253346	Fee-for-Service	1184799520	1184799520	1	1	LANDIS, KENNETH W MD AMC	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	29787	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4644 LINCOLN BLVD	SUITE 500	MARINA DEL REY	CA	90292	6391	19	06037	33.98210351	-118.4405172	Los Angeles County
253386	Fee-for-Service	1306855523	1306855523	1	1	LODI MEMORIAL HOSPITAL	8/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	MEDICAL GROUP	2415 W VINE ST	STE 105	LODI	CA	95242	3731	39	06077	38.1228953	-121.3052826	San Joaquin County
253422	Fee-for-Service	1992124333	1992124333	1	1	LIM, HANA MD	5/5/2017	390200000X	NA	Other	026	PHYSICIANS	140071	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
253468	Fee-for-Service	1891941282	1891941282	1	1	LEE, CHIA-WEN MD	6/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	117494	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
253488	Fee-for-Service	1104827757	1104827757	1	1	LEE, THOMAS C MD	7/15/1996	207P00000X	NA	Other	026	PHYSICIANS	83231	70	Clinic (mixed specialty)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
253509	Fee-for-Service	1669890554	1669890554	1	1	LIU, MENGYUAN MD	3/23/2020	208200000X	NA	General Surgery	026	PHYSICIANS	168101	24	Plastic Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 465	LOS ANGELES	CA	90095	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
253554	Fee-for-Service	1780877613	1780877613	2	1	LOS ANGELES COUNTY	5/23/2007	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	DEPARTMENT OF HEALTH	1670 E 120TH ST	None	LOS ANGELES	CA	90059	3029	19	06037	33.92456051	-118.2417525	Los Angeles County
253577	Fee-for-Service	1831456045	1831456045	1	1	LE, GIANG T MD	10/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142747	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
253585	Fee-for-Service	1154345536	1154345536	1	1	LE, JOE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	76940	08	Family Practice	0	In state provider	None	7807 LAGUNA BLVD	STE 440	ELK GROVE	CA	95758	7953	34	06067	38.423736	-121.410846	Sacramento County
253587	Fee-for-Service	1164443222	1164443222	1	1	LUCATORTO, RACHAEL MD	2/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92446	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
253625	Fee-for-Service	1649464611	1649464611	1	1	LAKSHMINARAYANAN, SONALI MD	2/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106310	78	Neoplastic Diseases/Oncology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
253634	Fee-for-Service	1184799520	1184799520	1	1	LANDIS, KENNETH W MD AMC	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	29787	41	Internal Medicine	0	In state provider	None	4644 LINCOLN BLVD	SUITE 500	MARINA DEL REY	CA	90292	6391	19	06037	33.98210351	-118.4405172	Los Angeles County
253637	Fee-for-Service	1902896541	1902896541	1	1	LODESPOTO, MARK J MD	4/27/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	89396	30	Radiology	0	In state provider	None	8717 LA TIJERA BLVD	None	LOS ANGELES	CA	90045	3906	19	06037	33.95788109	-118.3936725	Los Angeles County
253654	Fee-for-Service	1861579724	1861579724	1	1	LIN, JAMES S MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69313	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
253675	Fee-for-Service	1437207495	1437207495	1	1	LAMBERT, BRENT WALTER	5/30/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	73556	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1225 15TH ST	None	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
253695	Fee-for-Service	1467674705	1467674705	1	1	LOYDS LIBERTY HOMES INC	7/1/1991	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6520 N COLONIAL AVE	None	FRESNO	CA	93704	1102	10	06019	36.83227974	-119.8037413	Fresno County
253739	Fee-for-Service	1023309499	1023309499	1	1	LIU, WENJING MD	5/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126207	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	SUITE 1-340	LOS ANGELES	CA	90095	0001	19	06037	34.06482757	-118.4443441	Los Angeles County
253743	Fee-for-Service	1174522999	1174522999	1	1	LAREAU, LAWRENCE G MD	6/22/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	140207	30	Radiology	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
253751	Fee-for-Service	1962883124	1962883124	1	1	LOPEZ, JENNIFER L OD	4/2/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8120 TIMBERLAKE WAY	STE 211	SACRAMENTO	CA	95823	5414	34	06067	38.461023	-121.41414	Sacramento County
253782	Fee-for-Service	1093401002	1093401002	1	1	LEGUIE, EUNIQUE	1/5/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
253783	Fee-for-Service	1609336775	1609336775	1	1	LI, BECKY S MD	9/30/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	185450	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
253805	Fee-for-Service	1932589108	1932589108	1	1	LU, GLORIA MD	8/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144820	01	General Practice	0	In state provider	None	4900 BARRANCA PKWY	STE 103	IRVINE	CA	92604	8603	30	06059	33.67629075	-117.7956464	Orange County
253834	Fee-for-Service	1346283546	1346283546	1	1	LUI, ALFRED F MD	9/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	25015	22	Pathology (M.D. only)	0	In state provider	None	19951 MARINER AVE	STE 150	TORRANCE	CA	90503	1738	19	06037	33.85129396	-118.3504889	Los Angeles County
253835	Fee-for-Service	1669715694	1669715694	1	1	LI, LAN H DPM	8/25/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
253895	Fee-for-Service	1851896773	1851896773	1	1	LEONG, JOHN DO	5/20/2021	207R00000X	NA	Other	026	PHYSICIANS	18354	None	None	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
253896	Fee-for-Service	1982342432	1982342432	1	1	LEE, SERRA NP	2/13/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5814	19	06037	34.0981225	-118.2965085	Los Angeles County
253914	Fee-for-Service	1588604144	1588604144	1	2	LI, BING MD	4/30/2018	207L00000X	NA	Other	026	PHYSICIANS	74090	05	Anesthesiology	0	In state provider	None	100 S RAYMOND AVE	None	ALHAMBRA	CA	91801	3166	19	06037	34.09027878	-118.1450083	Los Angeles County
253916	Fee-for-Service	1679668032	1679668032	1	1	LI, JOAN Y MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	64554	41	Internal Medicine	0	In state provider	None	100 S ELLSWORTH AVE	STE 308	SAN MATEO	CA	94401	3931	41	06081	37.56665635	-122.3247743	San Mateo County
253955	Fee-for-Service	1285677062	1285677062	2	1	LONGS DRUG STORE CAL LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	218 E HIGHWAY 246	BLDG 3	BUELLTON	CA	93427	9654	42	06083	34.61133958	-120.1882009	Santa Barbara County
253960	Fee-for-Service	1467578609	1467578609	1	1	LEE, TARA K DPM	5/19/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
253962	Fee-for-Service	1326259763	1326259763	1	1	LINDEMAN, MICHAEL P	7/1/2008	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
253998	Fee-for-Service	1215161930	1215161930	1	1	LOS ANGELES CARDIOVASCULAR	3/12/2010	208G00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	AND THORACIC SURGERY GRP	201 S ALVARADO ST	STE 720	LOS ANGELES	CA	90057	2390	19	06037	34.06417777	-118.2719543	Los Angeles County
253999	Fee-for-Service	1205977345	1205977345	1	1	LIU, TERRENCE H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50912	89	Surgery-Traumatic	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
254024	Fee-for-Service	1760772628	1760772628	1	1	LO, AMANDA MD	4/25/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	127934	22	Pathology (M.D. only)	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
254028	Fee-for-Service	1831426642	1831426642	1	17	LAKESIDE MEDICAL	4/13/2010	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	12660 RIVERSIDE DRIVE	SUITE 225	NORTH HOLLYWOOD	CA	91201	3000	19	06037	34.1575795	-118.409499	Los Angeles County
254041	Fee-for-Service	1932140522	1932140522	1	1	LEE, CATHARINE OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1850 S AZUSA AVE	STE 107	HACIENDA HEIGHTS	CA	91745	6827	19	06037	33.98895597	-117.9322797	Los Angeles County
254054	Fee-for-Service	1821288952	1821288952	1	1	LIN, JAMES Y MD INC	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69813	41	Internal Medicine	0	In state provider	None	2224 S SANTA ANITA AVE	# 212	ARCADIA	CA	91006	3521	19	06037	34.11364869	-118.0308161	Los Angeles County
254060	Fee-for-Service	1245493428	1245493428	1	1	LIN, BEN A MD	9/11/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	103800	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
254068	Fee-for-Service	1356875116	1356875116	1	1	LIN, GEORGE PHD	2/21/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
254123	Fee-for-Service	1861540668	1861540668	1	1	LUKASIEWICZ, PAUL MD	4/30/1985	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	40697	08	Family Practice	0	In state provider	None	502 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3413	19	06037	33.83783749	-118.3832414	Los Angeles County
254160	Fee-for-Service	1912101619	1912101619	1	1	LIN, ALEX S MD	6/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93176	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
254187	Fee-for-Service	1174594394	1174594394	1	1	LIPTON, ANDREW B MD	2/8/2015	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	24252	01	General Practice	0	In state provider	None	2204 GRANT RD	STE 104	MOUNTAIN VIEW	CA	94040	3877	43	06085	37.37193085	-122.0779465	Santa Clara County
254194	Fee-for-Service	1700160892	1700160892	1	1	LIANG, HONG MD INC	10/16/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66820	41	Internal Medicine	0	In state provider	None	3105 DEL MAR AVE	None	ROSEMEAD	CA	91770	2366	19	06037	34.06460204	-118.0995274	Los Angeles County
254218	Fee-for-Service	1427286186	1427286186	1	1	LAGUNA, EMILY H	10/5/2009	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 WEST 6TH ST	SUITE 111	LOS ANGELES	CA	90017	1823	19	06037	34.05416748	-118.2622848	Los Angeles County
254242	Fee-for-Service	1801076625	1801076625	2	1	L&M HOME HEALTH CORPORATION	1/10/2011	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1101 W VALLEY BLVD	STE 207	ALHAMBRA	CA	91803	2473	19	06037	34.07797137	-118.1348562	Los Angeles County
254266	Fee-for-Service	1659502839	1659502839	1	1	LAM, ANTHONY P MD	3/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112245	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
254368	Fee-for-Service	1659536647	1659536647	2	1	LAGRANDEUR, ROBIN G MD	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124025	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
254372	Fee-for-Service	1881898658	1881898658	1	1	LEE, JASON E MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	99204	18	Ophthalmology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
254397	Fee-for-Service	1528102274	1528102274	1	1	LAM, MYLINH OD INC	9/1/1996	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10921 VALLEY MALL	None	EL MONTE	CA	91731	2615	19	06037	34.07564593	-118.0364912	Los Angeles County
254406	Fee-for-Service	1336252683	1336252683	1	1	LEE, MICHAEL Y MD	6/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81327	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
254423	Fee-for-Service	1326254137	1326254137	1	1	LEE, TIMOTHY T MD	8/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101050	36	Psychiatry	0	In state provider	None	1686 BARTON ROAD	None	REDLANDS	CA	92373	7761	36	06071	34.04833901	-117.2120103	San Bernardino County
254456	Fee-for-Service	1508151580	1508151580	1	1	LEACH, MATTHEW E MD	7/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141821	04	Otology, Laryngology, Rhinology	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
254460	Fee-for-Service	1174607162	1174607162	1	1	LOO, STEPHEN MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	5422	08	Family Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
254467	Fee-for-Service	1639224736	1639224736	1	1	LEE, SIDNEY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1319 PUNAHOU ST	None	HONOLULU	HI	96826	1001	00	None	21.30030321	-157.8342762	Honolulu County
254475	Fee-for-Service	1174594394	1174594394	1	1	LIPTON, ANDREW B MD	2/8/2015	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	24252	41	Internal Medicine	0	In state provider	None	2204 GRANT RD	STE 104	MOUNTAIN VIEW	CA	94040	3877	43	06085	37.37193085	-122.0779465	Santa Clara County
254558	Fee-for-Service	1609842517	1609842517	1	1	LOPRESTI, DAVID C MD	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	68116	30	Radiology	0	In state provider	None	300 LEWIS ST	None	SAN DIEGO	CA	92103	2108	37	06073	32.75191911	-117.1621589	San Diego County
254574	Fee-for-Service	1215469028	1215469028	1	1	LEE, TRACY DO	7/1/2020	207R00000X	NA	Other	026	PHYSICIANS	17140	41	Internal Medicine	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
254578	Fee-for-Service	1053302653	1053302653	1	1	LIMONADI, FARHAD M MD	8/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92257	14	Neurological Surgery	0	In state provider	FARHAD M LIMONADI MD INC	39000 BOB HOPE DR	STE W410	RANCHO MIRAGE	CA	92270	7087	33	06065	33.763572	-116.4056895	Riverside County
254579	Fee-for-Service	1598763682	1598763682	1	1	LEE, CHIHJEN MD	9/1/1998	207L00000X	NA	Other	026	PHYSICIANS	53123	05	Anesthesiology	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
254631	Fee-for-Service	1295809895	1295809895	1	1	LE, CHRISTINA A MD	12/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92222	41	Internal Medicine	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
254635	Fee-for-Service	1659776334	1659776334	1	1	LEE, NAKJU LMFT	5/30/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8 CORPORATE PARK	STE 220	IRVINE	CA	92606	3118	30	06059	33.69056625	-117.8286203	Orange County
254674	Fee-for-Service	1770964207	1770964207	1	1	LEE, DONG EUN LMFT	1/9/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
254696	Fee-for-Service	1487638730	1487638730	1	1	LANCE W JOBE MD	9/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1201 S MILLER ST	None	WENATCHEE	WA	98801	3201	00	None	47.406591	-120.3208875	Chelan County
254713	Fee-for-Service	1831245737	1831245737	1	1	LINDSEY, RHONDA PSYD	9/9/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3558 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
254720	Fee-for-Service	1639281322	1639281322	1	1	LOTFIPOUR, SHAHRAM MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62696	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
254731	Fee-for-Service	1780905695	1780905695	1	1	LAL, CHAN T MD	10/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112456	41	Internal Medicine	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
254779	Fee-for-Service	1255872677	1255872677	1	1	LIU, KEVIN MD	7/23/2021	207L00000X	NA	Other	026	PHYSICIANS	157221	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
254833	Fee-for-Service	1194751537	1194751537	1	1	LAUDER, PATRICIO L MD	2/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	64160	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3587	48	06095	38.26109552	-122.0470245	Solano County
254847	Fee-for-Service	1184988784	1184988784	1	1	LAWLOR, JACOB E	12/27/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
254892	Fee-for-Service	1629126404	1629126404	1	1	LEVIN, WAYNE I MD	1/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	64963	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
254900	Fee-for-Service	1710464607	1710464607	1	2	LCD INC	3/20/2022	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10572 CALLE LEE	STE 138	LOS ALAMITOS	CA	90720	8541	30	06059	33.80890075	-118.0573006	Orange County
254970	Fee-for-Service	1831426642	1831426642	1	8	LAKESIDE MEDICAL	4/13/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	24355 LYONS AVENUE	SUITE 210	SANTA CLARITA	CA	91321	2381	19	06037	34.37868281	-118.5605291	Los Angeles County
255001	Fee-for-Service	1154059657	1154059657	1	1	LOVE BEYOND WORDS LLC	2/18/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	14516 TACUBA DRIVE	None	LA MIRADA	CA	90638	2043	19	06037	33.91354414	-118.0218819	Los Angeles County
255002	Fee-for-Service	1285746420	1285746420	1	1	LIEN, BRENDA OD	9/14/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	477 E COLORADO BLVD	None	PASADENA	CA	91101	2024	19	06037	34.14587948	-118.140561	Los Angeles County
255012	Fee-for-Service	1588161210	1588161210	1	1	LIANG, AMY C MD	8/2/2021	207P00000X	NA	Other	026	PHYSICIANS	166818	None	None	0	In state provider	None	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	39	06077	38.12188356	-121.285872	San Joaquin County
255052	Fee-for-Service	1467496299	1467496299	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	525 W CAPITOL EXPY	None	SAN JOSE	CA	95136	3914	43	06085	37.27465146	-121.8523365	Santa Clara County
255069	Fee-for-Service	1114190626	1114190626	1	1	LEWIN, DAVID S LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD ROAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
255072	Fee-for-Service	1285273466	1285273466	1	1	LAWTON, LORI LMFT	8/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18672 FLORIDA ST	#100	HUNTINGTON BEACH	CA	92648	1917	30	06059	33.691185	-117.9910425	Orange County
255074	Fee-for-Service	1245556364	1245556364	1	1	LOCKWOOD, MICHAEL E MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118297	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5974 PENTZ ROAD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
255091	Fee-for-Service	1922685593	1922685593	1	1	LEBLANC, CHRISTOPHER	11/4/2024	390200000X	NA	Other	026	PHYSICIANS	188094	66	Emergency Medicine (Urgent Care)	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
255099	Fee-for-Service	1245939636	1245939636	1	1	LOVING HOME FOR SENIORS	7/5/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	9652 QUARTZ AVE	None	CHATSWORTH	CA	91311	3621	19	06037	34.24530615	-118.564416	Los Angeles County
255121	Fee-for-Service	1194751537	1194751537	1	1	LAUDER, PATRICIO L MD	2/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	64160	05	Anesthesiology	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3587	48	06095	38.26109552	-122.0470245	Solano County
255163	Fee-for-Service	1407837206	1407837206	2	1	LIBERTY MEDICAL LLC	10/5/2015	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	8883 LIBERTY LANE	SUITE 250	PORT ST. LUCIE	FL	34952	3477	00	None	27.2384955	-80.3797965	St. Lucie County
255175	Fee-for-Service	1922565506	1922565506	1	1	LIFESCAN LABS OF ILLINOIS, L	10/17/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	LC	5255 GOLF RD	None	SKOKIE	IL	60077	1106	00	None	42.05530881	-87.75857122	Cook County
255181	Fee-for-Service	1497135156	1497135156	1	1	LIU, XIONGFEI MD	7/12/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	144438	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
255185	Fee-for-Service	1043765977	1043765977	1	1	LAM, KENG MD	12/23/2019	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	164246	13	Neurology (M.D. only)	0	In state provider	None	4900 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5814	19	06037	34.0981225	-118.2965085	Los Angeles County
255237	Fee-for-Service	1073937710	1073937710	1	1	LOPEZ-LIZARRAGA, JOSE R MD	7/11/2017	2080P0006X	NA	Psychiatry	026	PHYSICIANS	144064	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
255238	Fee-for-Service	1205846763	1205846763	1	1	LIN, CYNTHIA S MD	11/1/1998	207R00000X	NA	Other	026	PHYSICIANS	62244	41	Internal Medicine	0	In state provider	None	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
255240	Fee-for-Service	1134290042	1134290042	1	1	LEE, SHERRI J MD	10/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82295	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
255254	Fee-for-Service	1063590719	1063590719	1	1	LEHRER, JAMES R MD	8/17/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76275	02	General Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
255259	Fee-for-Service	1730375502	1730375502	1	1	LEE, JENNIFER MD	10/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121701	41	Internal Medicine	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
255272	Fee-for-Service	1275731150	1275731150	1	1	LIPP, DIANNE B OT	6/22/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6596	19	06037	34.0981755	-118.295055	Los Angeles County
255300	Fee-for-Service	1053649640	1053649640	1	1	LAING, BRIAN Y MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110903	08	Family Practice	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
255378	Fee-for-Service	1831426642	1831426642	1	13	LAKESIDE MEDICAL	9/12/2022	225100000X	NA	Physical Therapist	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	101 S FIRST STREET	SUITE 1800	BURBANK	CA	91502	1959	19	06037	34.17942444	-118.3096895	Los Angeles County
255394	Fee-for-Service	1831426642	1831426642	1	18	LAKESIDE MEDICAL	4/13/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1500 W WEST COVINA PKWY	None	WEST COVINA	CA	91790	2703	19	06037	34.06953243	-117.9391587	Los Angeles County
255396	Fee-for-Service	1043439961	1043439961	1	1	LEWIS, SACHA T MD	1/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96222	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
255399	Fee-for-Service	1942220405	1942220405	1	1	LINGUA, ROBERT W MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	32910	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
255483	Fee-for-Service	1073785473	1073785473	1	1	LERNER, ALEXANDER MD	6/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97885	30	Radiology	0	In state provider	None	1500 SAN PABLO	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
255487	Fee-for-Service	1215061254	1215061254	1	1	LACEY, AUDRA K LMFT	10/14/2018	106H00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	680 OLD TELEGRAPH CANYON	202	CHULA VISTA	CA	91910	6552	37	06073	32.62559552	-117.0312122	San Diego County
255516	Fee-for-Service	1528151404	1528151404	1	1	LATY, MARK MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	85723	36	Psychiatry	0	In state provider	None	1080 EMELINE AVE	None	SANTA CRUZ	CA	95060	1966	44	06087	36.99191102	-122.0176744	Santa Cruz County
255541	Fee-for-Service	1194767913	1194767913	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2120 NEWBURY RD.	None	NEWBURY PARK	CA	91320	3363	56	06111	34.18200433	-118.9252874	Ventura County
255543	Fee-for-Service	1225138043	1225138043	1	1	LAM, HUNG DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9939 ARTESIA PL	None	BELLFLOWER	CA	90706	6757	19	06037	33.8748963	-118.1218785	Los Angeles County
255559	Fee-for-Service	1275531717	1275531717	1	1	LOUY, CHARLES MD	7/31/1995	207L00000X	NA	Other	026	PHYSICIANS	55264	05	Anesthesiology	0	In state provider	None	11601 SANTA MONICA BLVD	None	LOS ANGELES	CA	90025	2907	19	06037	34.04458879	-118.4542015	Los Angeles County
255581	Fee-for-Service	1245489434	1245489434	1	1	LUEBE, LINDSEY A LCSW	8/6/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
255596	Fee-for-Service	1871330019	1871330019	1	1	LIGHTHOUSE FAMILY THERAPY IN	7/31/2024	251S00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29995 TECHNOLOGY DR	STE 304	MURRIETA	CA	92563	2632	33	06065	33.56041691	-117.1370428	Riverside County
255613	Fee-for-Service	1700331410	1700331410	1	1	LEE, JONATHAN K CRNA	5/16/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
255644	Fee-for-Service	1164968848	1164968848	1	1	LOERA, TONI LCSW	5/9/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	822 G ST	STE 4	ARCATA	CA	95521	6247	12	06023	40.86821305	-124.0859305	Humboldt County
255661	Fee-for-Service	1164509683	1164509683	1	1	LAU, CHRISTOPHER Y MD	12/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137776	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
255664	Fee-for-Service	1831426642	1831426642	1	13	LAKESIDE MEDICAL	10/18/2023	225100000X	NA	Physical Therapist	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	101 S FIRST STREET	SUITE 1800	BURBANK	CA	91502	1959	19	06037	34.17942444	-118.3096895	Los Angeles County
255673	Fee-for-Service	1184821530	1184821530	1	1	LAPINE, ANNE L. MD	6/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
255680	Fee-for-Service	1942220405	1942220405	1	1	LINGUA, ROBERT W MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	32910	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
255685	Fee-for-Service	1831426642	1831426642	1	18	LAKESIDE MEDICAL	4/13/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1500 W WEST COVINA PKWY	None	WEST COVINA	CA	91790	2703	19	06037	34.06953243	-117.9391587	Los Angeles County
255712	Fee-for-Service	1033318605	1033318605	1	1	LEE, KEANE MD	1/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90369	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
255715	Fee-for-Service	1811424401	1811424401	1	1	LEE, JOHN MD	12/16/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181642	None	None	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
255724	Fee-for-Service	1568497238	1568497238	1	1	LAKE, JOHN R MD	10/3/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	14553	20	Orthopedic Surgery	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
255733	Fee-for-Service	1740668003	1740668003	1	1	LOWENTHAL, BRETT M MD	3/22/2017	207ZP0102X	NA	Other	026	PHYSICIANS	128364	22	Pathology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
255758	Fee-for-Service	1720066079	1720066079	1	1	LABORATORY CORPORATION	10/28/2005	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	OF AMERICA	2440 S SEPULVEDA BLVD	SUITE 181	LOS ANGELES	CA	90064	1784	19	06037	34.036488	-118.4323635	Los Angeles County
255766	Fee-for-Service	1295017895	1295017895	1	1	LEICHER, ADAM W MD	6/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118361	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23845 MCBEAN PARKWAY	None	VALENCIA	CA	91355	2083	19	06037	34.39696803	-118.5525278	Los Angeles County
255768	Fee-for-Service	1477855724	1477855724	1	1	LANGNER, MIKAEL D MD	11/20/2019	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	159095	01	General Practice	0	In state provider	None	124 WALNUT ST	None	WOODLAND	CA	95695	3137	57	06113	38.68160056	-121.7781391	Yolo County
255793	Fee-for-Service	1952620577	1952620577	1	1	LIU, CICI S MD	11/30/2022	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181570	None	None	0	In state provider	None	230 SAN JOSE STREET	None	SALINAS	CA	93901	3901	27	06053	36.65837657	-121.6469645	Monterey County
255863	Fee-for-Service	1457526451	1457526451	1	1	LIN, SHIN-E MD	10/8/2021	207L00000X	NA	Other	026	PHYSICIANS	103549	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
255887	Fee-for-Service	1578586764	1578586764	1	1	LIEBMAN, WAYNE P MD	7/1/1998	207L00000X	NA	Other	026	PHYSICIANS	29808	05	Anesthesiology	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
255891	Fee-for-Service	1912293267	1912293267	1	1	LAHIJI, PARSHAWN A DO	7/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154812	41	Internal Medicine	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
255906	Fee-for-Service	1831426642	1831426642	1	9	LAKESIDE MEDICAL	4/13/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	12660 RIVERSIDE DRIVE	SUITE 310-320	NORTH HOLLYWOOD	CA	91607	3431	19	06037	34.1575795	-118.409499	Los Angeles County
255922	Fee-for-Service	1376556555	1376556555	1	1	LOS ANGELES COUNTY	4/28/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	SAN FERNANDO FAM PLAN	1212 PICO ST	None	SAN FERNANDO	CA	91340	3503	19	06037	34.28357605	-118.4447788	Los Angeles County
255951	Fee-for-Service	1831426642	1831426642	1	13	LAKESIDE MEDICAL	4/13/2010	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	101 S FIRST STREET	SUITE 1800	BURBANK	CA	91502	1959	19	06037	34.17942444	-118.3096895	Los Angeles County
255965	Fee-for-Service	1053471045	1053471045	1	1	LALLANDE, ANDRE P MD	11/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	7021	83	Rheumatology	0	In state provider	None	4000 14TH ST	STE 511	RIVERSIDE	CA	92501	4019	33	06065	33.97771007	-117.3818381	Riverside County
255973	Fee-for-Service	1831426642	1831426642	1	18	LAKESIDE MEDICAL	4/13/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1500 W WEST COVINA PKWY	None	WEST COVINA	CA	91790	2703	19	06037	34.06953243	-117.9391587	Los Angeles County
255996	Fee-for-Service	1710912100	1710912100	1	1	LIN, HENRY MD	12/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103209	None	None	0	In state provider	None	2105 FOREST AVE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
256001	Fee-for-Service	1033318605	1033318605	1	1	LEE, KEANE MD	1/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90369	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
256003	Fee-for-Service	1649695248	1649695248	1	1	LEE, BRANDON T DO	5/13/2019	207P00000X	NA	Other	026	PHYSICIANS	16787	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
256012	Fee-for-Service	1568497238	1568497238	1	1	LAKE, JOHN R MD	10/3/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	14553	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
256016	Fee-for-Service	1801963194	1801963194	1	1	LAW, THOMAS B OD	10/1/2001	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	190 W H ST	STE 105	COLTON	CA	92324	2937	36	06071	34.06811341	-117.3252322	San Bernardino County
256074	Fee-for-Service	1649347857	1649347857	1	1	LEE, JAMES T MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62240	02	General Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
256106	Fee-for-Service	1447593637	1447593637	1	1	LEUNG, ALEXANDER H MD	9/1/2022	208G00000X	NA	General Surgery	026	PHYSICIANS	172869	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
256110	Fee-for-Service	1720021991	1720021991	2	1	LONGS DRUG STORES CA LLC	11/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	23791 WASHINGTON AVE	None	MURRIETA	CA	92562	2263	33	06065	33.5717611	-117.2338531	Riverside County
256162	Fee-for-Service	1962840157	1962840157	1	1	LE, ANDREW DO	10/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14806	41	Internal Medicine	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
256195	Fee-for-Service	1831426642	1831426642	1	9	LAKESIDE MEDICAL	4/13/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	12660 RIVERSIDE DRIVE	SUITE 310-320	NORTH HOLLYWOOD	CA	91607	3431	19	06037	34.1575795	-118.409499	Los Angeles County
256223	Fee-for-Service	1619339827	1619339827	1	1	LI, WENTAO	8/1/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	152218	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
256248	Fee-for-Service	1053471045	1053471045	1	1	LALLANDE, ANDRE P MD	11/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	7021	25	Physical Medicine and Rehabilitation	0	In state provider	None	4000 14TH ST	STE 511	RIVERSIDE	CA	92501	4019	33	06065	33.97771007	-117.3818381	Riverside County
256252	Fee-for-Service	1891739694	1891739694	1	1	LIN, HAICHI S MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64357	None	None	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
256260	Fee-for-Service	1831426642	1831426642	1	18	LAKESIDE MEDICAL	7/3/2013	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1500 W WEST COVINA PKWY	None	WEST COVINA	CA	91790	2703	19	06037	34.06953243	-117.9391587	Los Angeles County
256279	Fee-for-Service	1487719894	1487719894	1	1	LOMPOC VALLEY PEDIATRIC CARE	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	43842	None	None	0	In state provider	CENTER	1111 E OCEAN AVE	STE 6	LOMPOC	CA	93436	2500	42	06083	34.63889719	-120.4447732	Santa Barbara County
256321	Fee-for-Service	1811316284	1811316284	1	1	LE, SON HONG M D APC	7/1/2014	207R00000X	NA	Other	026	PHYSICIANS	42423	41	Internal Medicine	0	In state provider	None	9143 VALLEY BLVD	SUITE 101A	ROSEMEAD	CA	91770	1991	19	06037	34.08096534	-118.0700742	Los Angeles County
256370	Fee-for-Service	1932595642	1932595642	1	1	LIN, JIAHUI MD	11/12/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	167644	None	None	0	In state provider	None	20101 LAKE CHABOT RD	3RD FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
256391	Fee-for-Service	1164878633	1164878633	1	1	LI, HAN MD	12/16/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	151468	None	None	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
256394	Fee-for-Service	1134265309	1134265309	1	1	LAM, MICHAEL T	6/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99009	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
256397	Fee-for-Service	1699106120	1699106120	1	1	LUCKY PALLIATIVE SERVICES	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	20944 SHERMAN WAY	SUITE 204	CANOGA PARK	CA	91303	3661	19	06037	34.20095151	-118.5900435	Los Angeles County
256398	Fee-for-Service	1356415285	1356415285	1	1	LEVINE, MICHAEL S MD	5/9/1991	207RP1001X	NA	Pulmonology	026	PHYSICIANS	46153	41	Internal Medicine	0	In state provider	None	8536 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3153	19	06037	34.06550726	-118.3775199	Los Angeles County
256450	Fee-for-Service	1336251255	1336251255	2	1	LAPANSMART INC	9/28/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	115 N JACKSON AVE	STE - 103	SAN JOSE	CA	95116	1924	43	06085	37.36112479	-121.8461743	Santa Clara County
256455	Fee-for-Service	1871884130	1871884130	1	1	LEE, DAVID J MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124329	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
256512	Fee-for-Service	1962550939	1962550939	1	1	LOH, WELLINGTON (JR)	10/31/1990	2080P0207X	NA	Hematology	026	PHYSICIANS	41999	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
256538	Fee-for-Service	1053471045	1053471045	1	1	LALLANDE, ANDRE P MD	11/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	7021	08	Family Practice	0	In state provider	None	4000 14TH ST	STE 511	RIVERSIDE	CA	92501	4019	33	06065	33.97771007	-117.3818381	Riverside County
256574	Fee-for-Service	1184799520	1184799520	1	2	LANDIS, KENNETH W MD AMC	3/31/1989	207RP1001X	NA	Pulmonology	026	PHYSICIANS	29787	01	General Practice	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
256612	Fee-for-Service	1942787270	1942787270	1	1	LEGACY HOME HEALTH, LLC	3/18/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	146 N SAN FERNANDO BLVD	STE 220	BURBANK	CA	91502	1230	19	06037	34.18151411	-118.30954	Los Angeles County
256634	Fee-for-Service	1780752139	1780752139	1	1	LONES, MARK A MD	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	43615	22	Pathology (M.D. only)	0	In state provider	None	280 S MAIN ST	None	ORANGE	CA	92868	3852	30	06059	33.784695	-117.867327	Orange County
256641	Fee-for-Service	1013159466	1013159466	1	1	LEE, JULIANNE O MD INC	4/30/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	97817	40	Pediatrics	0	In state provider	None	711 N ALVARADO STREET	SUITE 106	LOS ANGELES	CA	90026	4016	19	06037	34.07424293	-118.2655575	Los Angeles County
256649	Fee-for-Service	1124176102	1124176102	1	1	LAMANTIA, MICHELE A MD	12/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71855	41	Internal Medicine	0	In state provider	LAKESIDE MEDICAL CLINIC	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
256672	Fee-for-Service	1689003568	1689003568	1	1	LOVEJOY, MERILEE CP	8/11/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	123 W PADRE ST	STE A	SANTA BARBARA	CA	93105	3960	42	06083	34.43007785	-119.7177802	Santa Barbara County
256684	Fee-for-Service	1356415285	1356415285	1	1	LEVINE, MICHAEL S MD	5/9/1991	207RP1001X	NA	Pulmonology	026	PHYSICIANS	46153	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	8536 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3153	19	06037	34.06550726	-118.3775199	Los Angeles County
256685	Fee-for-Service	1699106120	1699106120	1	1	LUCKY PALLIATIVE SERVICES	12/3/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	20944 SHERMAN WAY	SUITE 204	CANOGA PARK	CA	91303	3661	19	06037	34.20095151	-118.5900435	Los Angeles County
256690	Fee-for-Service	1699357186	1699357186	1	1	LOOP, JAMES	3/13/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
256699	Fee-for-Service	1902460447	1902460447	1	1	LAPWORTH, JESSICA R DO	12/10/2023	390200000X	NA	Other	026	PHYSICIANS	21251	None	None	0	In state provider	None	4560 ADMIRALTY WAY	SUITE 105	MARINA DEL REY	CA	90292	5423	19	06037	33.98364904	-118.4449069	Los Angeles County
256753	Fee-for-Service	1225071012	1225071012	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	187 NIBLICK RD	None	PASO ROBLES	CA	93446	4845	40	06079	35.61687	-120.681882	San Luis Obispo County
256763	Fee-for-Service	1154565828	1154565828	1	1	LAMSEN, RUTH VINNA R OT	10/22/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
256771	Fee-for-Service	1053499129	1053499129	1	1	LIKHACHEVA, OLGA P MD	11/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92444	41	Internal Medicine	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
256814	Fee-for-Service	1437398476	1437398476	1	1	LO, JOSEPH T K DO	8/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89015	5524	00	None	36.163269	-115.1654465	Clark County
256827	Fee-for-Service	1366081457	1366081457	1	1	LOPEZ, KAYLA E LCSW	8/27/2024	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	621 W MICHELTORENA ST	STE B	SANTA BARBARA	CA	93101	4195	42	06083	34.41914194	-119.7157341	Santa Barbara County
256829	Fee-for-Service	1811056435	1811056435	1	1	LAU, JAMES L MD	3/31/1989	208800000X	NA	Other	026	PHYSICIANS	45838	01	General Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
256834	Fee-for-Service	1013927136	1013927136	1	1	LING, RICHARD T MD	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	65452	18	Ophthalmology	0	In state provider	None	2325 17TH ST	None	BAKERSFIELD	CA	93301	3503	15	06029	35.37432252	-119.0289375	Kern County
256845	Fee-for-Service	1730653890	1730653890	1	1	LIVE LOVE SMILE HOME HEALTH	10/30/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	10545 BURBANK BLVD	SUITE 127	NORTH HOLLYWOOD	CA	91601	2249	19	06037	34.1721655	-118.3608315	Los Angeles County
256857	Fee-for-Service	1538838115	1538838115	1	1	LGAM HOME HEALTH CARE INC	12/8/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	15300 DEVONSHIRE ST	STE 204	MISSION HILLS	CA	91345	2781	19	06037	34.25726548	-118.465281	Los Angeles County
256861	Fee-for-Service	1184799520	1184799520	1	2	LANDIS, KENNETH W MD AMC	3/31/1989	207RP1001X	NA	Pulmonology	026	PHYSICIANS	29787	41	Internal Medicine	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
256864	Fee-for-Service	1962580555	1962580555	1	1	LETSINGER, GREG A MD	6/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75022	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
256873	Fee-for-Service	1881837433	1881837433	1	1	LUPERCIO, NADIA D MD	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122671	41	Internal Medicine	0	In state provider	None	400 W MINERAL KING	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
256895	Fee-for-Service	1821799164	1821799164	1	1	LIFE MEDICAL PRACTITIONERS	8/3/2023	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
256905	Fee-for-Service	1003159062	1003159062	1	1	LORENZE, ANDREA N MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132744	41	Internal Medicine	0	In state provider	None	1303 EAST HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
256908	Fee-for-Service	1952375966	1952375966	2	1	LEE, WILLIAM DO	10/1/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	5519	01	General Practice	0	In state provider	None	1085 N HARBOR BLVD	None	ANAHEIM	CA	92801	2417	30	06059	33.85017	-117.924238	Orange County
257031	Fee-for-Service	1124126487	1124126487	1	1	LEE, PETER J MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103851	34	Urology and Urological Surgery	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
257042	Fee-for-Service	1356366314	1356366314	1	1	LEXINGTON MEDICAL CENTER	9/15/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2720 SUNSET BLVD	None	WEST COLUMBIA	SC	29169	4810	00	None	34.00469285	-81.1156004	Lexington County
257073	Fee-for-Service	1639377310	1639377310	1	1	LIM, ANNIE K MD	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105718	18	Ophthalmology	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
257077	Fee-for-Service	1407442221	1407442221	1	1	LAMAS COUNSELING LICENSED CL	2/9/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	INICAL SOCIAL WORKER, IN	809 S ATLANTIC BLVD	203	MONTEREY PARK	CA	91754	4757	19	06037	34.05248855	-118.1371554	Los Angeles County
257080	Fee-for-Service	1568587236	1568587236	1	1	LEE, MARK C MD INC	5/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	68664	45	Nephrology (Renal-Kidney)	0	In state provider	None	15141 WHITTIER BLVD	STE 225	WHITTIER	CA	90603	2194	19	06037	33.94810044	-118.0039419	Los Angeles County
257109	Fee-for-Service	1437398476	1437398476	1	1	LO, JOSEPH T K DO	8/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89015	5524	00	None	36.163269	-115.1654465	Clark County
257146	Fee-for-Service	1912903071	1912903071	1	1	LONG, RICHARD J MD	5/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89306	34	Urology and Urological Surgery	0	In state provider	None	5201 NORRIS CANYON RD	None	SAN RAMON	CA	94583	5410	07	06013	37.77779028	-121.9600626	Contra Costa County
257148	Fee-for-Service	1477647931	1477647931	1	1	LUCAS-ROSS, HEATHER E MD	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94676	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300230	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
257150	Fee-for-Service	1023189214	1023189214	1	1	LINDER, BRUCE MD	6/29/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172125	None	None	0	In state provider	None	225 W HOSPITALITY LN	100	SAN BERNARDINO	CA	92408	3244	36	06071	34.06586109	-117.2884682	San Bernardino County
257194	Fee-for-Service	1356321988	1356321988	1	2	LICHT, JONATHAN MD	7/1/1995	2084N0400X	NA	Neurology	026	PHYSICIANS	43892	01	General Practice	0	In state provider	None	4033 3RD AVE	STE 206	SAN DIEGO	CA	92103	2137	37	06073	32.75053781	-117.1627168	San Diego County
257199	Fee-for-Service	1700380896	1700380896	1	1	LAU, CLAUDIA H MD	2/13/2021	390200000X	NA	Other	026	PHYSICIANS	164120	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90809	1701	19	06037	33.808185	-118.1850575	Los Angeles County
257212	Fee-for-Service	1366476970	1366476970	1	1	LEE, JAMES F MD	5/31/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	77416	08	Family Practice	0	In state provider	None	7248 S LAND PARK DR	STE 205	SACRAMENTO	CA	95831	3661	34	06067	38.494602	-121.513743	Sacramento County
257274	Fee-for-Service	1659716629	1659716629	1	1	LINDSEY A HANSON	10/26/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	112 SAINT OLAF AVE S	None	CANBY	MN	56220	1433	00	None	44.70763388	-96.27792114	Yellow Medicine County
257293	Fee-for-Service	1689672768	1689672768	1	1	LAI, ELLIS C MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77460	05	Anesthesiology	0	In state provider	None	3530 WILSHIRE BLVD	STE 350	LOS ANGELES	CA	90010	2335	19	06037	34.06171652	-118.301427	Los Angeles County
257300	Fee-for-Service	1134501828	1134501828	1	1	LLOYD, MICHAELA K PT	2/28/2025	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	28078 BAXTER RD	SUITE 330	MURRIETA	CA	92563	1404	33	06065	33.615	-117.1670265	Riverside County
257312	Fee-for-Service	1093824369	1093824369	1	1	LOMITA ADULT DAY HEALTH	2/25/2003	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	1234 LOMITA BLVD	STE E	HARBOR CITY	CA	90710	2147	19	06037	33.79770763	-118.2988643	Los Angeles County
257322	Fee-for-Service	1316268949	1316268949	1	1	LABUZETTA, JAMIE N MD	6/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130618	13	Neurology (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
257374	Fee-for-Service	1861405722	1861405722	1	1	LEE, EUNICE U MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65466	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4050 BARRANCA PKWY	STE 160	IRVINE	CA	92604	4785	30	06059	33.68293726	-117.8067799	Orange County
257412	Fee-for-Service	1871757294	1871757294	1	1	LIMMER, KARL K	12/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	99830	33	Thoracic Surgery	0	In state provider	None	7910 FROST STREET	SUITE 330	SAN DIEGO	CA	92123	2753	37	06073	32.80027449	-117.153846	San Diego County
257426	Fee-for-Service	1942352133	1942352133	1	1	LIPTON, GAIL A LMFT	7/2/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	330 FLUME ST	STE 100	CHICO	CA	95928	5400	04	06007	39.73048207	-121.8372333	Butte County
257427	Fee-for-Service	1053469015	1053469015	1	1	LEUNG, MONICA L MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39646	30	Radiology	0	In state provider	ATTN MGA OFFICE	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
257437	Fee-for-Service	1942349378	1942349378	1	1	LEE, JAE YONG MD	1/17/2022	207R00000X	NA	Other	026	PHYSICIANS	150254	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
257454	Fee-for-Service	1164059762	1164059762	1	1	LOTSHAW, ETHAN M MD	10/30/2023	207R00000X	NA	Other	026	PHYSICIANS	186404	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
257500	Fee-for-Service	1366476970	1366476970	1	1	LEE, JAMES F MD	5/31/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	77416	15	Obstetrics (D.O. only)	0	In state provider	None	7248 S LAND PARK DR	STE 205	SACRAMENTO	CA	95831	3661	34	06067	38.494602	-121.513743	Sacramento County
257527	Fee-for-Service	1467844456	1467844456	1	1	LEE, JENNY Y C	6/10/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
257569	Fee-for-Service	1669511408	1669511408	1	1	LEMAY, DANIEL R MD PHD INC	8/1/2001	207T00000X	NA	General Surgery	026	PHYSICIANS	74285	None	None	0	In state provider	None	8043 2ND ST	STE 105	DOWNEY	CA	90241	3621	19	06037	33.94296553	-118.1360957	Los Angeles County
257614	Fee-for-Service	1366090631	1366090631	1	1	LOMELI, HECTOR LMFT	3/12/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	415 KNOLLCREST DR	STE 101	REDDING	CA	96002	0181	45	06089	40.57267376	-122.3643496	Shasta County
257617	Fee-for-Service	1023450301	1023450301	1	1	LAU, JACKY K LMFT	12/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
257630	Fee-for-Service	1063669224	1063669224	1	1	LAM, WAI-HANG J MD	7/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104834	08	Family Practice	0	In state provider	None	1520 STOCKTON STREET	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
257674	Fee-for-Service	1689650145	1689650145	2	1	LE, THUAN D MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64908	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6250 CLAY ST	None	RIVERSIDE	CA	92509	6005	33	06065	33.974892	-117.462183	Riverside County
257683	Fee-for-Service	1487218640	1487218640	1	1	LE, ANNIE P MD	9/26/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176379	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
257710	Fee-for-Service	1922010081	1922010081	1	1	LARKS, MILCAH MD	3/7/2008	207R00000X	NA	Other	026	PHYSICIANS	99827	78	Neoplastic Diseases/Oncology	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
257803	Fee-for-Service	1205491172	1205491172	1	1	LEE, ERICA B MD	2/20/2025	207N00000X	NA	Dermatology	026	PHYSICIANS	None	07	Dermatology	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
257826	Fee-for-Service	1396227153	1396227153	1	1	LE, VU H MD	11/1/2019	207XX0004X	NA	Orthopedic Surgery	026	PHYSICIANS	158257	20	Orthopedic Surgery	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
257827	Fee-for-Service	1497706907	1497706907	1	1	LEVI, CAROL J MD	10/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
257872	Fee-for-Service	1952549180	1952549180	1	1	LUM, ERIK L MD	3/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102092	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
257881	Fee-for-Service	1144625096	1144625096	1	1	LEGAULT, AMBER N LMFT	7/30/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	133 E BONITA AVE	STE 205	SAN DIMAS	CA	91773	3098	19	06037	34.1067035	-117.806076	Los Angeles County
257893	Fee-for-Service	1295847077	1295847077	1	1	LIM, INGRID T MD	9/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83973	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
257913	Fee-for-Service	1659554103	1659554103	1	1	LAL, SATISH K MD APC	10/1/2008	174400000X	NA	Other	026	PHYSICIANS	34462	20	Orthopedic Surgery	0	In state provider	None	10841 WHITE OAK AVE	SUITE 100	RANCHO CUCAMONGA	CA	91730	3811	36	06071	34.10467596	-117.5661881	San Bernardino County
257932	Fee-for-Service	1750783726	1750783726	1	1	LAZARO, DEANNA S LCSW	8/18/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95186	-	NOT APPLICABLE	0	In state provider	None	855 3RD AVENUE	SUITE 2230	CHULA VISTA	CA	91911	1350	37	06073	32.62197574	-117.0723222	San Diego County
257944	Fee-for-Service	1891718565	1891718565	1	1	LAM, TRANG T MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66764	41	Internal Medicine	0	In state provider	None	7761 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92841	4200	30	06059	33.77387145	-117.9966555	Orange County
257967	Fee-for-Service	1851479422	1851479422	1	1	LIU, JEFFREY C MD	1/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94672	18	Ophthalmology	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
257995	Fee-for-Service	1962922690	1962922690	1	1	LYASHEVSKY, CLARA R DO	8/4/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17992	None	None	0	In state provider	None	2336 SANTA MONICA BLVD	301, 304	SANTA MONICA	CA	90404	2067	19	06037	34.03136627	-118.4766854	Los Angeles County
258000	Fee-for-Service	1922010081	1922010081	1	1	LARKS, MILCAH MD	3/7/2008	207R00000X	NA	Other	026	PHYSICIANS	99827	41	Internal Medicine	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
258023	Fee-for-Service	1609933563	1609933563	1	1	LEE, COREY M OD	3/31/1982	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1000 FRANKLIN PKWY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
258052	Fee-for-Service	1174941504	1174941504	1	1	LEONG, BEATRIZ V MD	8/3/2020	208600000X	NA	General Surgery	026	PHYSICIANS	129189	02	General Surgery	0	In state provider	None	197 E CAROLINE ST	None	SAN BERNARDINO	CA	92408	3731	36	06071	34.06143353	-117.2822085	San Bernardino County
258063	Fee-for-Service	1053942862	1053942862	1	1	LOUGHHEAD, ERIC M LMFT	10/9/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
258092	Fee-for-Service	1205491172	1205491172	1	1	LEE, ERICA B MD	2/20/2025	207N00000X	NA	Dermatology	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
258140	Fee-for-Service	1497771802	1497771802	1	1	LAGRAVE, MARK A MD	8/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92383	66	Emergency Medicine (Urgent Care)	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
258175	Fee-for-Service	1689972051	1689972051	1	1	LITTELL, BRENT M LMFT	11/24/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
258177	Fee-for-Service	1760412621	1760412621	1	1	LAMPEN, RHONDA R MD	2/20/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	54628	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
258224	Fee-for-Service	1205434180	1205434180	1	1	LEADING HOSPICE & PALLIATIVE	10/25/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE	16430 VENTURA BLVD	SUITE 304	ENCINO	CA	91436	2133	19	06037	34.15736278	-118.4911768	Los Angeles County
258246	Fee-for-Service	1578596201	1578596201	1	1	LAUX, ANN MARIE P MD	8/31/1989	207ZP0102X	NA	Other	026	PHYSICIANS	57463	22	Pathology (M.D. only)	0	In state provider	None	15615 POMERADO RD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
258379	Fee-for-Service	1134525512	1134525512	1	1	LEE, JANE NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
258397	Fee-for-Service	1588705750	1588705750	1	1	LE, THUY T MD	12/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62584	None	None	0	In state provider	None	11190 WARNER AVE	STE 408	FOUNTAIN VALLEY	CA	92708	4047	30	06059	33.714	-117.9333585	Orange County
258426	Fee-for-Service	1811930084	1811930084	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	855 EL CAMINO REAL	None	PALO ALTO	CA	94301	2305	43	06085	37.439424	-122.1586425	Santa Clara County
258463	Fee-for-Service	1790102192	1790102192	1	1	LI, JANET MD	3/1/2024	2086X0206X	NA	General Surgery	026	PHYSICIANS	192456	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
258475	Fee-for-Service	1184898397	1184898397	1	1	LEIBOVSKY, VLADIMIR M DO	11/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	13003	09	Gynecology (D.O. only)	0	In state provider	None	2545 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.0214303	-121.3461515	San Joaquin County
258510	Fee-for-Service	1477788354	1477788354	1	1	LEE, MICHAEL C MD	4/9/2021	207L00000X	NA	Other	026	PHYSICIANS	142065	None	None	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
258514	Fee-for-Service	1205434180	1205434180	1	1	LEADING HOSPICE & PALLIATIVE	10/25/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE	16430 VENTURA BLVD	SUITE 304	ENCINO	CA	91436	2133	19	06037	34.15736278	-118.4911768	Los Angeles County
258588	Fee-for-Service	1962079624	1962079624	1	1	LUDWICK, ANDREA NP	7/19/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	525 AUTO CENTER DR	None	WATSONVILLE	CA	95076	3745	44	06087	36.91959655	-121.7676826	Santa Cruz County
258590	Fee-for-Service	1154327138	1154327138	1	1	LIFELONG MEDICAL CARE	7/1/1997	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	EAST OAKLAND	10700 MACARTHUR BLVD	STE 14B	OAKLAND	CA	94605	5260	01	06001	37.74201242	-122.151048	Alameda County
258608	Fee-for-Service	1962071282	1962071282	1	1	LE, AN V MD	7/9/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
258644	Fee-for-Service	1699719039	1699719039	2	1	LONGS DRUG STORES CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2075 MENDOCINO AVE.	None	SANTA ROSA	CA	95401	3667	49	06097	38.460069	-122.7185055	Sonoma County
258660	Fee-for-Service	1659733194	1659733194	1	1	LEE, ANDREW M MD	12/2/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	151233	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
258681	Fee-for-Service	1396495958	1396495958	1	1	LI, ALVIN DO	6/17/2024	207P00000X	NA	Other	026	PHYSICIANS	21775	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
258686	Fee-for-Service	1366627168	1366627168	1	2	LUI, LINA C LAC	5/20/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	25691 ATLANTIC OCEAN DR	STE B11	LAKE FOREST	CA	92630	8839	30	06059	33.66663213	-117.6822119	Orange County
258689	Fee-for-Service	1922486893	1922486893	1	1	LUU, YING HUI MD	7/7/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	154486	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
258703	Fee-for-Service	1528121845	1528121845	1	1	LAM, ANSON C MD	9/15/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75187	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
258708	Fee-for-Service	1760564298	1760564298	1	1	LEWIS, DENNIS C PHD	6/3/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
258727	Fee-for-Service	1902357734	1902357734	1	1	LOPEZ, PAUL M	7/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	37210	41	Internal Medicine	0	In state provider	None	502 W VALLEY BLVD	None	COLTON	CA	92324	2249	36	06071	34.06784567	-117.3307387	San Bernardino County
258752	Fee-for-Service	1689712861	1689712861	1	1	LA MESA CARDIAC CTR MED	9/30/1991	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	OF SAN DIEGO	5565 GROSSMONT CENTER DR	STE 455	LA MESA	CA	91942	3073	37	06073	32.77978322	-117.0094766	San Diego County
258770	Fee-for-Service	1902338288	1902338288	1	1	LII, MARK OD	1/30/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
258802	Fee-for-Service	1902973845	1902973845	1	1	LI, DEREK J MD	10/26/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61662	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
258815	Fee-for-Service	1649384645	1649384645	1	1	LANIER, TIMOTHY DC	7/20/2017	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	23412 MOULTON PKWY	100	LAGUNA HILLS	CA	92653	1732	30	06059	33.62217163	-117.7312015	Orange County
258855	Fee-for-Service	1558996330	1558996330	1	1	LE, NADIA LCSW	3/20/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
258877	Fee-for-Service	1154327138	1154327138	1	1	LIFELONG MEDICAL CARE	8/3/2017	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	EAST OAKLAND	10700 MACARTHUR BLVD	STE 14B	OAKLAND	CA	94605	5260	01	06001	37.74201242	-122.151048	Alameda County
258885	Fee-for-Service	1982647715	1982647715	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	150 S 11TH AVE	None	HANFORD	CA	93230	5057	16	06031	36.322596	-119.6576055	Kings County
258886	Fee-for-Service	1952494585	1952494585	1	1	LEHNHERR, DAVID R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	320 ALPENGLOW LN	None	LINVINGSTON	MT	59047	8506	00	None	45.675135	-110.5268085	Park County
258887	Fee-for-Service	1700835162	1700835162	1	1	LIU, ANDREW T MD	6/23/2016	174400000X	NA	Other	026	PHYSICIANS	63332	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
258899	Fee-for-Service	1366525487	1366525487	1	5	LOS ANGELES RADIOLOGY	10/4/2018	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
258900	Fee-for-Service	1477005866	1477005866	1	1	LEE, KATY J CCC-SLP	5/18/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
258917	Fee-for-Service	1841428257	1841428257	1	1	LIVINGSTON, KRISTIN S MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135494	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
258920	Fee-for-Service	1326125287	1326125287	1	1	LAU, LAWNIE-LYN U MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67138	30	Radiology	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
258930	Fee-for-Service	1306865241	1306865241	1	1	LIAO, JOSEPH C MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68583	None	None	0	In state provider	None	10833 LECONTE AVE	None	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
258936	Fee-for-Service	1760666853	1760666853	1	1	LAU, EDWARD MD	12/23/2019	2084P0804X	NA	Psychiatry	086	MEDICAL DIRECTORS	102363	-	NOT APPLICABLE	0	In state provider	None	2335 COUNTRY HILLS DR	None	ANTIOCH	CA	94509	7319	07	06013	37.97021462	-121.7841321	Contra Costa County
258938	Fee-for-Service	1497489447	1497489447	1	1	LEO TANAKA MD INC	7/21/2022	207PE0005X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
258942	Fee-for-Service	1568587996	1568587996	1	1	LUNDAHL, JENNIFER F LMFT	11/16/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	47669	-	NOT APPLICABLE	0	In state provider	None	3125 E SEVENTH STREET	None	LONG BEACH	CA	90804	4932	19	06037	33.77538046	-118.155078	Los Angeles County
258946	Fee-for-Service	1013913698	1013913698	1	1	LECHTMAN, ALEX N MD	1/1/1993	208200000X	NA	General Surgery	026	PHYSICIANS	75188	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
258960	Fee-for-Service	1912180050	1912180050	1	1	LAURIN, ERIK G MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64389	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
258979	Fee-for-Service	1841256880	1841256880	1	1	LERMAN, JOEL A MD	6/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86330	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
258983	Fee-for-Service	1891061362	1891061362	1	1	LAM, CHUN M LCSW	6/18/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	320 S GARFIELD AVE	None	ALHAMBRA	CA	91801	3836	19	06037	34.09184212	-118.1245127	Los Angeles County
258984	Fee-for-Service	1922486893	1922486893	1	1	LUU, YING HUI MD	7/7/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	154486	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
258993	Fee-for-Service	1437379583	1437379583	1	1	LEVINE, BRUCE D DPM	3/31/1989	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1360 W 6TH ST	None	SAN PEDRO	CA	90732	3514	19	06037	33.73886546	-118.3075065	Los Angeles County
258995	Fee-for-Service	1306873070	1306873070	1	2	LITTEN, DANIEL MD	10/17/2019	174400000X	NA	Other	026	PHYSICIANS	85333	41	Internal Medicine	0	In state provider	None	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
259089	Fee-for-Service	1902973845	1902973845	1	1	LI, DEREK J MD	10/26/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61662	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
259091	Fee-for-Service	1174542088	1174542088	1	1	LOUIE, JAMES S MD	6/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	17767	83	Rheumatology	0	In state provider	None	200 MED PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
259098	Fee-for-Service	1922190719	1922190719	1	1	LIN,DON D MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66766	40	Pediatrics	0	In state provider	None	950 STOCKTON ST	STE 207	SAN FRANCISCO	CA	94108	1619	38	06075	37.79469747	-122.4079497	San Francisco County
259124	Fee-for-Service	1316002116	1316002116	1	1	LE, QUYNH-THU X MD	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79675	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
259140	Fee-for-Service	1932301397	1932301397	1	1	LEE, SUSAN E MD	11/24/2009	207L00000X	NA	Other	026	PHYSICIANS	82160	05	Anesthesiology	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
259148	Fee-for-Service	1346455938	1346455938	1	1	LUNDEBERG, JULIA LMFT	1/3/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	41084	-	NOT APPLICABLE	0	In state provider	None	844 PICO BLVD	None	SANTA MONICA	CA	90405	1325	19	06037	34.01263151	-118.4813759	Los Angeles County
259149	Fee-for-Service	1932297470	1932297470	1	1	LAGOMARSINO, MARGARET M NP	10/26/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	800 SERENO DRIVE	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
259165	Fee-for-Service	1154327138	1154327138	1	1	LIFELONG MEDICAL CARE	2/11/2009	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	EAST OAKLAND	10700 MACARTHUR BLVD	STE 14B	OAKLAND	CA	94605	5260	01	06001	37.74201242	-122.151048	Alameda County
259167	Fee-for-Service	1346312030	1346312030	1	2	LEY, ROBERT D MD	12/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	33075	24	Plastic Surgery	0	In state provider	None	3311 MISSION DR	None	SANTA CRUZ	CA	95065	1827	44	06087	36.99102829	-121.9802419	Santa Cruz County
259175	Fee-for-Service	1417907940	1417907940	1	7	LPCH MEDICAL GROUP DIV OF LU	6/23/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	3443 VILLA LANE	SUITE 2	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
259197	Fee-for-Service	1992877740	1992877740	1	1	LAU, KATHERINE MD	2/18/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73455	40	Pediatrics	0	In state provider	None	1505 W 17TH ST	None	SAN BERNARDINO	CA	92411	1202	36	06071	34.13045153	-117.31869	San Bernardino County
259219	Fee-for-Service	1659789196	1659789196	1	1	LORA L CORK	6/21/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2320 FREEWAY DR	None	MOUNT VERNON	WA	98273	5445	00	None	48.44169	-122.3431015	Skagit County
259261	Fee-for-Service	1205917879	1205917879	1	1	LEE, EUIHO H MD	6/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	31621	05	Anesthesiology	0	In state provider	None	1301 N ROSE DR	None	PLACENTIA	CA	92870	3802	30	06059	33.8868003	-117.8420447	Orange County
259266	Fee-for-Service	1396488060	1396488060	1	1	LARA BARTOLO, LAURA	6/5/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
259269	Fee-for-Service	1558705491	1558705491	1	1	LI, SHENG LAC	12/11/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
259275	Fee-for-Service	1477699155	1477699155	1	1	LATINO COMMISSION ON ALCOHOL	1/31/2017	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	AND DRUG ABUSE SERVICES	635 BRUNSWICK ST	None	SAN FRANCISCO	CA	94112	4202	38	06075	37.70954041	-122.4462271	San Francisco County
259308	Fee-for-Service	1265771380	1265771380	1	1	LINDSAY, JULIE L LMFT	4/11/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
259333	Fee-for-Service	1013920966	1013920966	1	2	LIAU, BERTY P	8/1/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	70626	40	Pediatrics	0	In state provider	None	402 8TH AVE	STE 202	SAN FRANCISCO	CA	94118	3057	38	06075	37.78061549	-122.4663704	San Francisco County
259344	Fee-for-Service	1972044295	1972044295	1	1	LU, KUANCHANG DO	9/23/2021	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	18431	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
259365	Fee-for-Service	1366869471	1366869471	1	1	LOEB, JENNIFER M MD	7/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148364	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
259367	Fee-for-Service	1417986019	1417986019	1	1	LOPEZ, ANTHONY C MD	6/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	57363	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	625 LINCOLN AVE	None	SAN JOSE	CA	95126	3518	43	06085	37.31809479	-121.9082315	Santa Clara County
259374	Fee-for-Service	1184890923	1184890923	1	1	LONGS DRUG STORES CA LLC	7/2/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1036 CASITAS PASS RD	None	CARPINTERIA	CA	93013	2109	42	06083	34.3960405	-119.5130178	Santa Barbara County
259376	Fee-for-Service	1174542088	1174542088	1	1	LOUIE, JAMES S MD	6/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	17767	01	General Practice	0	In state provider	None	200 MED PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
259395	Fee-for-Service	1760526842	1760526842	1	1	LE, KHANH VAN OD	6/23/2006	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	POMONA VALLEY OPTOMETRY	1900 ROYALTY DR	STE 100	POMONA	CA	91767	3048	19	06037	34.07754346	-117.7463466	Los Angeles County
259403	Fee-for-Service	1932635539	1932635539	1	1	LEUNG, BO C	3/1/2022	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	159636	None	None	0	In state provider	None	630 S RAYMOND AVE	STE 310	PASADENA	CA	91105	3278	19	06037	34.13505223	-118.1487761	Los Angeles County
259413	Fee-for-Service	1316002116	1316002116	1	1	LE, QUYNH-THU X MD	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79675	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
259432	Fee-for-Service	1104819119	1104819119	1	2	LINCOLN, ALAN J PHD	2/7/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10065 OLD GROVE RD	STE 103	SAN DIEGO	CA	92131	1664	37	06073	32.89886709	-117.1101984	San Diego County
259454	Fee-for-Service	1154327138	1154327138	1	1	LIFELONG MEDICAL CARE	7/1/1997	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	EAST OAKLAND	10700 MACARTHUR BLVD	STE 14B	OAKLAND	CA	94605	5260	01	06001	37.74201242	-122.151048	Alameda County
259460	Fee-for-Service	1922293935	1922293935	1	1	LIU, JENNIFER J MD	11/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	99211	02	General Surgery	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
259464	Fee-for-Service	1417907940	1417907940	1	7	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	3443 VILLA LANE	SUITE 2	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
259476	Fee-for-Service	1700018165	1700018165	1	1	LABANCA, VALERIE LCSW	4/21/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
259477	Fee-for-Service	1417907940	1417907940	1	14	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	4120 PRESCOTT ROAD	None	MODESTO	CA	95356	8418	50	06099	37.69891977	-121.0317078	Stanislaus County
259494	Fee-for-Service	1730122086	1730122086	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	32575 GOLDEN LANTERN ST	None	DANA POINT	CA	92629	3248	30	06059	33.48932682	-117.6980984	Orange County
259500	Fee-for-Service	1396804233	1396804233	1	1	LUNG, ANN Y PHD	1/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
259525	Fee-for-Service	1225129893	1225129893	1	1	LOURIE, LALEH K MD	10/31/1996	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	48901	None	None	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
259538	Fee-for-Service	1023435922	1023435922	1	1	LEE, DUSTIN T MD	9/8/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	155834	None	None	0	In state provider	None	300 STEIN PLZ	420	LOS ANGELES	CA	90095	0001	19	06037	34.06482846	-118.4443432	Los Angeles County
259551	Fee-for-Service	1316956360	1316956360	1	1	LINARES, DANIEL J MD	7/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	94119	08	Family Practice	0	In state provider	None	1499 W 1ST ST	None	SAN PEDRO	CA	90732	3255	19	06037	33.74333957	-118.3093406	Los Angeles County
259558	Fee-for-Service	1073653382	1073653382	1	1	LISTER, ZEPHON	9/24/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
259565	Fee-for-Service	1154337319	1154337319	1	2	LAU, KEI-CHUEN J MD	6/27/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	43229	36	Psychiatry	0	In state provider	None	10802 COLLEGE PLACE	None	CERRITOS	CA	90703	1579	19	06037	33.88484554	-118.102932	Los Angeles County
259584	Fee-for-Service	1609139310	1609139310	1	1	LOPEZ, WILLIAM M	7/30/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1340 LAKE BLVD	None	DAVIS	CA	95616	5673	57	06113	38.55491538	-121.7876886	Yolo County
259597	Fee-for-Service	1841825189	1841825189	1	1	LUMINERE HOSPICE INC	2/14/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7301 TOPANGA CANYON BLVD	STE 356	CANOGA PARK	CA	91303	3395	19	06037	34.203222	-118.605988	Los Angeles County
259663	Fee-for-Service	1104016567	1104016567	1	1	LOSEY, THEODORE J MD	2/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	310 SUNNYVIEW LN	None	KALISPELL	MT	59901	3129	00	None	48.214773	-114.3236925	Flathead County
259669	Fee-for-Service	1104278134	1104278134	1	1	LIN, ALYSON OD	1/10/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2656 W LA PALMA AVE	None	ANAHEIM	CA	92801	2601	30	06059	33.84680804	-117.9779497	Orange County
259679	Fee-for-Service	1205010030	1205010030	1	1	LERMAN, IMANUEL R MD	9/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122217	05	Anesthesiology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
259680	Fee-for-Service	1851952113	1851952113	1	1	LOS BANOS PRIMARY CARE, INC	10/24/2019	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1120 W I ST	SUITE B	LOS BANOS	CA	93635	3970	24	06047	37.06061305	-120.8634013	Merced County
259690	Fee-for-Service	1730576570	1730576570	1	1	LE, TRI T MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146295	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
259750	Fee-for-Service	1417907940	1417907940	1	7	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	3443 VILLA LANE	SUITE 2	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
259765	Fee-for-Service	1417907940	1417907940	1	14	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	4120 PRESCOTT ROAD	None	MODESTO	CA	95356	8418	50	06099	37.69891977	-121.0317078	Stanislaus County
259782	Fee-for-Service	1831419068	1831419068	1	1	LESSNER, ERIN B MD	6/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130474	18	Ophthalmology	0	In state provider	None	100 STEIN PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06489065	-118.4443287	Los Angeles County
259836	Fee-for-Service	1235546847	1235546847	1	1	LANE, AMANDA N	10/23/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
259837	Fee-for-Service	1225324759	1225324759	1	1	LIN, JENNIFER R DO	6/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14596	01	General Practice	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
259853	Fee-for-Service	1720480882	1720480882	1	1	LAWS, LAUREN J CNM	10/28/2024	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
259855	Fee-for-Service	1861540809	1861540809	1	1	LEE, MOON S MD	2/8/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	91262	41	Internal Medicine	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
259872	Fee-for-Service	1437179280	1437179280	1	1	LEANO, SHARON MD	2/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92008	05	Anesthesiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
259884	Fee-for-Service	1841825189	1841825189	1	1	LUMINERE HOSPICE INC	2/14/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7301 TOPANGA CANYON BLVD	STE 356	CANOGA PARK	CA	91303	3395	19	06037	34.203222	-118.605988	Los Angeles County
259887	Fee-for-Service	1245767854	1245767854	1	1	LADNA, MICHAEL MD	10/4/2023	207R00000X	NA	Other	026	PHYSICIANS	186204	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
259890	Fee-for-Service	1598341943	1598341943	1	1	LIU, DANIEL MD	7/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
259922	Fee-for-Service	1881777340	1881777340	1	1	LORICH, MICHAEL F. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	530 BOGACHIEL WAY	None	FORKS	WA	98331	9120	00	None	47.946141	-124.3931915	Clallam County
259928	Fee-for-Service	1104983238	1104983238	1	2	LARKIN, CONRAD E LCSW	4/16/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
259939	Fee-for-Service	1962554303	1962554303	1	1	LEONG, GRACE Y OD	4/2/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	395 HICKEY BLVD	5TH FLOOR	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
259984	Fee-for-Service	1669549234	1669549234	1	1	LANOFF, JULIE S PHD	1/23/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3710 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82467134	-122.2584144	Alameda County
259985	Fee-for-Service	1518047521	1518047521	1	1	LEE, JANE I MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	76206	41	Internal Medicine	0	In state provider	None	2500 HOSPITAL DR	STE 7	MOUNTAIN VIEW	CA	94040	4115	43	06085	37.36908	-122.081819	Santa Clara County
260004	Fee-for-Service	1164983342	1164983342	1	1	LAWANI, OSAYI	12/1/2023	208M00000X	NA	Other	026	PHYSICIANS	177997	None	None	0	In state provider	None	23625 WR HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
260019	Fee-for-Service	1831356799	1831356799	1	1	LIN, CHRISTIANE G MD	4/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104299	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
260040	Fee-for-Service	1417907940	1417907940	1	7	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	3443 VILLA LANE	SUITE 2	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
260053	Fee-for-Service	1417907940	1417907940	1	14	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	4120 PRESCOTT ROAD	None	MODESTO	CA	95356	8418	50	06099	37.69891977	-121.0317078	Stanislaus County
260063	Fee-for-Service	1427227685	1427227685	1	1	LANSIDEL, TIFFANY R	10/1/2002	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8050 SOQUEL DR	STE A	APTOS	CA	95003	3981	44	06087	36.97694316	-121.900446	Santa Cruz County
260083	Fee-for-Service	1982756797	1982756797	1	1	LAM, KAI KAI MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74806	40	Pediatrics	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
260084	Fee-for-Service	1669525945	1669525945	1	1	LEIDER, KAREN L MD	1/31/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53054	08	Family Practice	0	In state provider	None	2462 W 3RD ST	None	SANTA ROSA	CA	95401	6425	49	06097	38.437668	-122.769297	Sonoma County
260100	Fee-for-Service	1295722627	1295722627	1	1	LIU, LI MD	6/1/2001	193400000X	NA	Other	026	PHYSICIANS	74432	41	Internal Medicine	0	In state provider	None	210 N GARFIELD AVE	STE 203	MONTEREY PARK	CA	91754	1746	19	06037	34.064181	-118.122834	Los Angeles County
260128	Fee-for-Service	1225238801	1225238801	1	1	LAUX, JULIE P	2/8/2015	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1765 FORTUNA AVE	None	SAN DIEGO	CA	92109	6052	37	06073	32.79296689	-117.2356327	San Diego County
260143	Fee-for-Service	1801136213	1801136213	1	1	LHCG XXXVIII LLC	3/1/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	196 COHASSET RD	SUITE 200	CHICO	CA	95926	2287	04	06007	39.75171308	-121.8536013	Butte County
260148	Fee-for-Service	1447814439	1447814439	1	1	LUC, ANNA MD	10/28/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176149	None	None	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
260157	Fee-for-Service	1851419592	1851419592	1	1	LAITURI, STACEY L LMFT	7/11/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	51993	-	NOT APPLICABLE	0	In state provider	None	2000 W BRIGGSMORE AVE	SUITE I	MODESTO	CA	95350	3839	50	06099	37.67139252	-121.0281273	Stanislaus County
260169	Fee-for-Service	1578517280	1578517280	1	1	LEE, BRIAN MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	71489	05	Anesthesiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
260189	Fee-for-Service	1467487017	1467487017	1	1	LOCICERO, ALICE	4/12/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
260269	Fee-for-Service	1750660874	1750660874	1	1	LIM, KRISTIN A	10/6/2011	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
260300	Fee-for-Service	1851636641	1851636641	1	1	LAU, NICHOLAS P MD	6/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127634	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
260323	Fee-for-Service	1619373008	1619373008	1	1	LOPEZ, CORINA PHD	6/20/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
260329	Fee-for-Service	1417907940	1417907940	1	7	LPCH MEDICAL GROUP DIV OF LU	6/23/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	3443 VILLA LANE	SUITE 2	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
260341	Fee-for-Service	1417907940	1417907940	1	14	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	4120 PRESCOTT ROAD	None	MODESTO	CA	95356	8418	50	06099	37.69891977	-121.0317078	Stanislaus County
260353	Fee-for-Service	1093934036	1093934036	1	1	LEWIS, MICHAEL R MD	9/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103852	08	Family Practice	0	In state provider	None	501 N ORANGE AVE	STE 200	GLENDALE	CA	91203	1911	19	06037	34.15323119	-118.2565389	Los Angeles County
260366	Fee-for-Service	1417269747	1417269747	1	1	LAVALLEY WILLSEY, EVE A MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123871	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5821 JAMESON CT	None	CARMICHAEL	CA	95608	0820	34	06067	38.651409	-121.3290945	Sacramento County
260370	Fee-for-Service	1669525945	1669525945	1	1	LEIDER, KAREN L MD	1/31/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53054	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2462 W 3RD ST	None	SANTA ROSA	CA	95401	6425	49	06097	38.437668	-122.769297	Sonoma County
260375	Fee-for-Service	1457887556	1457887556	1	2	LEUNG, BOBBY DPM	12/11/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1580 VALENCIA STREET	109	SAN FRANCISCO	CA	94110	4420	38	06075	37.74746923	-122.4202583	San Francisco County
260384	Fee-for-Service	1932182276	1932182276	1	1	LUNA, CARLOS F MD	4/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	35	Pediatric Cardiology (M.D. only)	1	Border provider	None	3006 S MARYLAND PKWY	STE 690	LAS VEGAS	NV	89109	2297	00	None	36.135288	-115.1368705	Clark County
260385	Fee-for-Service	1275162745	1275162745	1	1	LE, TAMMY MD	12/13/2024	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	180649	38	Geriatrics	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
260386	Fee-for-Service	1700028354	1700028354	1	1	LO, DANIEL H MD	5/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114958	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5412	37	06073	33.03623896	-117.2837308	San Diego County
260419	Fee-for-Service	1992149231	1992149231	1	1	LEGESSE, ASHENAFI A MD	7/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138206	41	Internal Medicine	0	In state provider	None	1303 EAST HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
260427	Fee-for-Service	1700044815	1700044815	1	1	LOH, JEFFREY T MD	8/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115536	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
260451	Fee-for-Service	1255354700	1255354700	1	1	LEGACY MOUNT HOOD	5/1/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	24800 SE STARK ST	None	GRESHAM	OR	97030	3378	00	None	45.516762	-122.4070245	Multnomah County
260456	Fee-for-Service	1770696981	1770696981	1	1	LU, QUN MD	8/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85455	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
260458	Fee-for-Service	1780367862	1780367862	1	1	LOO, KAELANI LMFT	12/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
260460	Fee-for-Service	1831926104	1831926104	1	1	LOUKA, EMILY LMFT	12/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
260463	Fee-for-Service	1336439777	1336439777	1	1	LEE, JANET Y M MD	6/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136509	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
260466	Fee-for-Service	1396797049	1396797049	1	1	LEUNG, WINIFRED K MD	9/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113766	30	Radiology	0	In state provider	None	250 W PUEBLO STREET	None	SANTA BARBARA	CA	93105	3805	42	06083	34.43089516	-119.7216367	Santa Barbara County
260469	Fee-for-Service	1629608955	1629608955	1	1	LEE, TIFFANY L MD	7/23/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
260474	Fee-for-Service	1568721694	1568721694	1	1	LU, SHARON M MD	1/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128960	78	Neoplastic Diseases/Oncology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
260482	Fee-for-Service	1043223225	1043223225	1	1	LOGIE, BRENT A MD	1/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139036	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVENUE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
260483	Fee-for-Service	1902878036	1902878036	1	1	LAPPEN, RHONDA S MD	6/4/1984	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	52448	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1688 WILLOW ST	STE C	SAN JOSE	CA	95125	5109	43	06085	37.30345662	-121.9161453	Santa Clara County
260509	Fee-for-Service	1710727136	1710727136	1	1	LE BLANC, SILVIA DOULA	5/31/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	50	06099	0	0	None
260565	Fee-for-Service	1396876025	1396876025	1	1	LAWRENCE FAN M.D.	11/15/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3015 NE LOOP 286	None	PARIS	TX	75460	3433	00	None	33.67421469	-95.52145081	Lamar County
260573	Fee-for-Service	1003859356	1003859356	2	1	LONGS DRUG STORES CA LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	20475 YORBA LINDA BLVD	None	YORBA LINDA	CA	92886	3043	30	06059	33.893298	-117.774045	Orange County
260588	Fee-for-Service	1417907940	1417907940	1	10	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	5030 BUSINESS CENTER DR	SUITE 230	FAIRFIELD	CA	94533	6881	48	06095	38.21736891	-122.142579	Solano County
260603	Fee-for-Service	1801882261	1801882261	1	1	LAWTON, EDWARD S MD	1/31/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72781	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3404	30	06059	33.89344341	-117.9338865	Orange County
260616	Fee-for-Service	1417907940	1417907940	1	7	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	3443 VILLA LANE	SUITE 2	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
260625	Fee-for-Service	1033745906	1033745906	1	1	LIN, CHRISTINA F MD	9/18/2023	207R00000X	NA	Other	026	PHYSICIANS	182755	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
260631	Fee-for-Service	1417907940	1417907940	1	14	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	4120 PRESCOTT ROAD	None	MODESTO	CA	95356	8418	50	06099	37.69891977	-121.0317078	Stanislaus County
260650	Fee-for-Service	1336608652	1336608652	1	1	LEE, MONICA MD	6/15/2022	207R00000X	NA	Other	026	PHYSICIANS	176446	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
260679	Fee-for-Service	1396144747	1396144747	1	1	LOUIS, CAROLINA E LMFT	6/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15336 DEVONSHIRE	UNIT 6	MISSION HILLS	CA	91345	3205	19	06037	34.25726849	-118.4664285	Los Angeles County
260738	Fee-for-Service	1255354700	1255354700	1	1	LEGACY MOUNT HOOD	5/1/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	24800 SE STARK ST	None	GRESHAM	OR	97030	3378	00	None	45.516762	-122.4070245	Multnomah County
260740	Fee-for-Service	1447997309	1447997309	1	1	LACARE TRANSPORT INC	8/15/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	14726 RAMONA AVE	SUITE E3	CHINO	CA	91710	5730	36	06071	33.98583108	-117.7064762	San Bernardino County
260758	Fee-for-Service	1417907940	1417907940	1	2	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	1359 PARK AVE	None	ALAMEDA	CA	94501	4511	01	06001	37.76329307	-122.2420565	Alameda County
260764	Fee-for-Service	1568721694	1568721694	1	1	LU, SHARON M MD	1/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128960	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
260786	Fee-for-Service	1730267519	1730267519	1	1	LYNCH, MARGARET A MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	55025	30	Radiology	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
260801	Fee-for-Service	1962703454	1962703454	1	1	LAKE AVENUE MEDICAL SUPPLY	11/2/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC	467 NORTH LAKE AVE	None	PASADENA	CA	91101	1215	19	06037	34.1539512	-118.1325153	Los Angeles County
260830	Fee-for-Service	1285898056	1285898056	1	1	LATIF, WAHID MD	8/20/2009	207R00000X	NA	Other	026	PHYSICIANS	10449	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
260875	Fee-for-Service	1417907940	1417907940	1	10	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	5030 BUSINESS CENTER DR	SUITE 230	FAIRFIELD	CA	94533	6881	48	06095	38.21736891	-122.142579	Solano County
260888	Fee-for-Service	1376047407	1376047407	1	1	LWIN, PHYU W MD	10/28/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173736	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
260892	Fee-for-Service	1467568550	1467568550	1	1	LESTER, DON K MD INC	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	44984	20	Orthopedic Surgery	0	In state provider	None	6085 N 1ST ST	None	FRESNO	CA	93710	5465	10	06019	36.825282	-119.7747765	Fresno County
260905	Fee-for-Service	1417907940	1417907940	1	7	LPCH MEDICAL GROUP DIV OF LU	6/23/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	3443 VILLA LANE	SUITE 2	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
260912	Fee-for-Service	1205413895	1205413895	1	1	LAM, NATHAN MD	3/11/2025	390200000X	NA	Other	026	PHYSICIANS	181354	30	Radiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
260918	Fee-for-Service	1417907940	1417907940	1	14	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	4120 PRESCOTT ROAD	None	MODESTO	CA	95356	8418	50	06099	37.69891977	-121.0317078	Stanislaus County
260930	Fee-for-Service	1376164749	1376164749	1	1	LAST FRONTIER HEALTHCARE	7/1/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	670 COUNTY ROAD 83	None	CANBY	CA	96015	9722	25	06049	41.44344745	-120.8718025	Modoc County
260936	Fee-for-Service	1972597672	1972597672	1	1	LAI, EDWARD M MD AMC	7/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	33474	22	Pathology (M.D. only)	0	In state provider	None	5000 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
260961	Fee-for-Service	1821191750	1821191750	1	1	LEVY, JOSHUA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12758	41	Internal Medicine	0	In state provider	None	4910 VAN NUYS BLVD	STE 303	SHERMAN OAKS	CA	91403	1768	19	06037	34.15979697	-118.4486826	Los Angeles County
260968	Fee-for-Service	1982713814	1982713814	2	1	LAWSON, ERICA F MD	3/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108718	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
260980	Fee-for-Service	1497979702	1497979702	1	1	LOE, IRENE M MD	9/1/2000	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	67598	40	Pediatrics	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
260981	Fee-for-Service	1790882678	1790882678	1	1	LANG, DAVID J MD INC	6/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	50878	77	Infectious Disease	0	In state provider	None	999 N TUSTIN AVE	STE 103	SANTA ANA	CA	92705	6504	30	06059	33.754167	-117.834191	Orange County
260991	Fee-for-Service	1639883135	1639883135	1	1	LIFELONG SENIOR LIVING	4/24/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	16003 LUDLOW STREET	None	GRANADA HILLS	CA	91344	5330	19	06037	34.27101149	-118.48059	Los Angeles County
261000	Fee-for-Service	1669543542	1669543542	1	1	LOPEZ, GABRIEL E MD	10/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76488	08	Family Practice	0	In state provider	None	1701 CESAR CHAVEZ AVE	#354	LOS ANGELES	CA	90033	0000	19	06037	34.05112725	-118.2173921	Los Angeles County
261024	Fee-for-Service	1215293212	1215293212	1	1	LEE, NANCY MD	3/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149639	05	Anesthesiology	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
261028	Fee-for-Service	1649664632	1649664632	1	1	LOPEZ, DON VINCENT V MD	11/26/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151854	08	Family Practice	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
261029	Fee-for-Service	1821475013	1821475013	1	1	LUI, VALERIE T DO	9/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	100 HOSPITAL DR	STE 200	VALLEJO	CA	94589	2582	48	06095	38.13100118	-122.2403008	Solano County
261042	Fee-for-Service	1417907940	1417907940	1	2	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1359 PARK AVE	None	ALAMEDA	CA	94501	4511	01	06001	37.76329307	-122.2420565	Alameda County
261060	Fee-for-Service	1528014685	1528014685	1	1	LEVITAN, DEAN B MD	1/1/1982	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	47194	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1700 S COURT ST	STE B	VISALIA	CA	93277	4931	54	06107	36.315108	-119.2916925	Tulare County
261096	Fee-for-Service	1295913523	1295913523	1	1	LEE, SUN M MD	8/31/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	107464	40	Pediatrics	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
261101	Fee-for-Service	1811227523	1811227523	1	1	LIN, HENRY K MD	5/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109497	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
261105	Fee-for-Service	1568967776	1568967776	1	1	LEE, JIN SOL G MD	11/6/2021	208M00000X	NA	Other	026	PHYSICIANS	163864	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
261130	Fee-for-Service	1811910326	1811910326	1	1	LE, PHUONG LMFT	11/19/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
261157	Fee-for-Service	1982799375	1982799375	1	1	LOVELACE HEALTH SYSTEM INC	10/16/2018	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	4701 MONTGOMERY BLVD NE	None	ALBUQUERQUE	NM	87109	1219	00	None	35.13107363	-106.5908411	Bernalillo County
261162	Fee-for-Service	1417907940	1417907940	1	10	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	5030 BUSINESS CENTER DR	SUITE 230	FAIRFIELD	CA	94533	6881	48	06095	38.21736891	-122.142579	Solano County
261177	Fee-for-Service	1588833388	1588833388	1	1	LEE, DANIEL A MD	3/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101972	08	Family Practice	0	In state provider	None	595 CENTER AVE	SUITE 300	MARTINEZ	CA	94553	4634	07	06013	37.99313048	-122.1189497	Contra Costa County
261192	Fee-for-Service	1417907940	1417907940	1	7	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	3443 VILLA LANE	SUITE 2	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
261193	Fee-for-Service	1235424771	1235424771	1	1	LARA-MARQUEZ, MARIA L MD	4/4/2019	207K00000X	NA	Other	026	PHYSICIANS	145699	01	General Practice	0	In state provider	None	5671 BALBOA AVE	None	SAN DIEGO	CA	92111	2705	37	06073	32.82010691	-117.1788026	San Diego County
261206	Fee-for-Service	1417907940	1417907940	1	14	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	4120 PRESCOTT ROAD	None	MODESTO	CA	95356	8418	50	06099	37.69891977	-121.0317078	Stanislaus County
261216	Fee-for-Service	1760010532	1760010532	1	1	LIFTON, JACOB MD	7/11/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	190687	18	Ophthalmology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
261221	Fee-for-Service	1376164749	1376164749	1	1	LAST FRONTIER HEALTHCARE	7/1/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	670 COUNTY ROAD 83	None	CANBY	CA	96015	9722	25	06049	41.44344745	-120.8718025	Modoc County
261237	Fee-for-Service	1902680531	1902680531	1	1	LUCAS, IMANI BIRTH DOULA	5/8/2024	171M00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
261241	Fee-for-Service	1710955919	1710955919	1	1	LOCHNER, LESLIE T MD	4/1/1998	207R00000X	NA	Other	026	PHYSICIANS	66585	41	Internal Medicine	0	In state provider	None	1525 SUPERIOR AVE	SUITE 208	NEWPORT BEACH	CA	92663	3639	30	06059	33.6297071	-117.9300427	Orange County
261247	Fee-for-Service	1942413349	1942413349	1	1	LIU, LUKE D MD	6/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92987	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
261271	Fee-for-Service	1790882678	1790882678	1	1	LANG, DAVID J MD INC	6/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	50878	40	Pediatrics	0	In state provider	None	999 N TUSTIN AVE	STE 103	SANTA ANA	CA	92705	6504	30	06059	33.754167	-117.834191	Orange County
261303	Fee-for-Service	1215374699	1215374699	1	1	LEAMING, ROBERT DPM	5/9/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	23141 MOULTON PKWY	STE 109	LAGUNA HILLS	CA	92653	1241	30	06059	33.62613379	-117.7305831	Orange County
261304	Fee-for-Service	1043749526	1043749526	1	1	LOPEZ, ERIC CEASAR P CRNA	7/23/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
261309	Fee-for-Service	1841845138	1841845138	1	1	LAND OF PEACE 3	9/20/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	22600 KITTRIDGE ST	None	WEST HILLS	CA	91307	3608	19	06037	34.19147449	-118.6188255	Los Angeles County
261313	Fee-for-Service	1861744369	1861744369	1	1	LEONG, CELESTE L	6/22/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3440 E LA PALMA AVE	None	ANAHEIM	CA	92806	2020	30	06059	33.852105	-117.8444835	Orange County
261314	Fee-for-Service	1841211984	1841211984	1	1	LEELALUCKANAKUL-TRAN, S	1/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8790	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
261332	Fee-for-Service	1417907940	1417907940	1	2	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	1359 PARK AVE	None	ALAMEDA	CA	94501	4511	01	06001	37.76329307	-122.2420565	Alameda County
261348	Fee-for-Service	1871708180	1871708180	1	1	LADARYL LANKFORD	2/15/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 TOWSON AVE	None	FORT SMITH	AR	72901	4921	00	None	35.374455	-94.42107	Sebastian County
261358	Fee-for-Service	1386655918	1386655918	1	1	LOS ANGELES COUNTY	12/1/1977	282N00000X	NA	Hospitals	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	BUDGET FISCAL UNIT	2051 MARENGO ST	C2K100	LOS ANGELES	CA	90033	1352	19	06037	34.05627579	-118.2064774	Los Angeles County
261437	Fee-for-Service	1811632383	1811632383	1	1	LEAL, DESIREE	6/28/2022	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	4500 47TH AVE	STE 5	SACRAMENTO	CA	95824	3848	34	06067	38.509857	-121.4532495	Sacramento County
261445	Fee-for-Service	1982799375	1982799375	1	1	LOVELACE HEALTH SYSTEM INC	10/16/2018	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	4701 MONTGOMERY BLVD NE	None	ALBUQUERQUE	NM	87109	1219	00	None	35.13107363	-106.5908411	Bernalillo County
261451	Fee-for-Service	1417907940	1417907940	1	10	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	5030 BUSINESS CENTER DR	SUITE 230	FAIRFIELD	CA	94533	6881	48	06095	38.21736891	-122.142579	Solano County
261481	Fee-for-Service	1235424771	1235424771	1	1	LARA-MARQUEZ, MARIA L MD	4/4/2019	207K00000X	NA	Other	026	PHYSICIANS	145699	03	Allergy	0	In state provider	None	5671 BALBOA AVE	None	SAN DIEGO	CA	92111	2705	37	06073	32.82010691	-117.1788026	San Diego County
261484	Fee-for-Service	1316006067	1316006067	1	1	LIPIZ, JORGE P MD	12/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35759	13	Neurology (M.D. only)	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
261491	Fee-for-Service	1760019798	1760019798	1	1	LE, JOHN DO	7/5/2022	207R00000X	NA	Other	026	PHYSICIANS	19463	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
261494	Fee-for-Service	1417907940	1417907940	1	14	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	4120 PRESCOTT ROAD	None	MODESTO	CA	95356	8418	50	06099	37.69891977	-121.0317078	Stanislaus County
261505	Fee-for-Service	1407989858	1407989858	1	1	LEE, HSINYUEH LAC	2/28/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	770 MAGNOLIA AVE	1X	CORONA	CA	92879	3120	33	06065	33.85936872	-117.5534605	Riverside County
261506	Fee-for-Service	1376164749	1376164749	1	1	LAST FRONTIER HEALTHCARE	7/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	670 COUNTY ROAD 83	None	CANBY	CA	96015	9722	25	06049	41.44344745	-120.8718025	Modoc County
261519	Fee-for-Service	1154345023	1154345023	1	1	LEE, WOOJIN MD	1/26/1994	207P00000X	NA	Other	026	PHYSICIANS	78307	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
261523	Fee-for-Service	1831508761	1831508761	1	1	LIUZZI, MICHELLE D PSYD	5/16/2019	103TF0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2215 TRUXTUN AVE	STE 100	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
261524	Fee-for-Service	1497378129	1497378129	1	1	LODHIE, KAVAL K DO	4/3/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20567	None	None	0	In state provider	None	4560 ADMIRALTY WAY	STE 100	MARINA DEL REY	CA	90292	5424	19	06037	33.98364904	-118.4449069	Los Angeles County
261572	Fee-for-Service	1811124217	1811124217	1	1	LO, RONALD MD INC	7/21/2009	193400000X	NA	Other	026	PHYSICIANS	98161	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4000 14TH ST	STE 209	RIVERSIDE	CA	92501	4018	33	06065	33.97771007	-117.3818381	Riverside County
261595	Fee-for-Service	1720164775	1720164775	1	1	LOMBARD, CHARLES M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40301	22	Pathology (M.D. only)	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
261618	Fee-for-Service	1417907940	1417907940	1	2	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1359 PARK AVE	None	ALAMEDA	CA	94501	4511	01	06001	37.76329307	-122.2420565	Alameda County
261625	Fee-for-Service	1700383270	1700383270	1	1	LOS ANGELES CENTERS FOR ALCO	8/10/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	HOL AND DRUG ABUSE	5861 CHERRY AVE	None	LONG BEACH	CA	90805	4405	19	06037	33.86131627	-118.1686066	Los Angeles County
261634	Fee-for-Service	1679822506	1679822506	1	1	LEBLANC, TAMMIE	8/30/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	9625 MONTE VISTA AVE	SUITE 102	MONTCLAIR	CA	91763	2234	36	06071	34.08006762	-117.6982272	San Bernardino County
261677	Fee-for-Service	1558322479	1558322479	1	1	LEE, MARK C MD	5/1/2003	207R00000X	NA	Other	026	PHYSICIANS	68664	45	Nephrology (Renal-Kidney)	0	In state provider	None	15141 WHITTIER BLVD	STE 225	WHITTIER	CA	90603	2194	19	06037	33.94810044	-118.0039419	Los Angeles County
261680	Fee-for-Service	1861660045	1861660045	1	1	LR MEDICAL TRANSPORT INC	2/14/2007	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	27313 HONEY SCENTED ROAD	None	MORENO VALLEY	CA	92555	4752	33	06065	33.90878154	-117.1862055	Riverside County
261712	Fee-for-Service	1083077200	1083077200	1	1	LIU, CHARLES MD	12/3/2018	208600000X	NA	General Surgery	026	PHYSICIANS	150559	02	General Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
261738	Fee-for-Service	1417907940	1417907940	1	10	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	5030 BUSINESS CENTER DR	SUITE 230	FAIRFIELD	CA	94533	6881	48	06095	38.21736891	-122.142579	Solano County
261764	Fee-for-Service	1497795678	1497795678	1	1	LEWISON, JOHN F MD	8/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146742	41	Internal Medicine	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
261776	Fee-for-Service	1952823585	1952823585	1	1	LEGGINS, KAITLIN P	10/25/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
261801	Fee-for-Service	1831677145	1831677145	1	1	LEE, CAROLINE NP	1/22/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9090 WILSHIRE BLVD	STE 200	BEVERLY HILLS	CA	90211	1850	19	06037	34.06702873	-118.3894057	Los Angeles County
261805	Fee-for-Service	1154345023	1154345023	1	1	LEE, WOOJIN MD	1/26/1994	207P00000X	NA	Other	026	PHYSICIANS	78307	02	General Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
261813	Fee-for-Service	1952334047	1952334047	1	1	LINARES, HUMBERTO MD	11/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	93655	41	Internal Medicine	0	In state provider	None	5974 PENTZ ROAD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
261814	Fee-for-Service	1093172439	1093172439	1	1	LE, HOANGNAM M LMFT	7/21/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
261824	Fee-for-Service	1568993467	1568993467	1	1	LEE, CHRISTOPHER MD	9/26/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	159146	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
261868	Fee-for-Service	1467858571	1467858571	2	1	LILAONITKUL, MAYTINEE MD	9/26/2023	207L00000X	NA	Other	026	PHYSICIANS	167705	None	None	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
261877	Fee-for-Service	1568168672	1568168672	1	1	LEMELLE, TIFFANY CNP	2/26/2025	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
261885	Fee-for-Service	1659651974	1659651974	1	1	LWIN, KIKI Y H MD	12/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127424	08	Family Practice	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
261886	Fee-for-Service	1720164775	1720164775	1	1	LOMBARD, CHARLES M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40301	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
261907	Fee-for-Service	1417907940	1417907940	1	2	LPCH MEDICAL GROUP DIV OF LU	6/22/2021	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	1359 PARK AVE	None	ALAMEDA	CA	94501	4511	01	06001	37.76329307	-122.2420565	Alameda County
261910	Fee-for-Service	1841630266	1841630266	1	2	LEWIS, MARI MD	1/27/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	143654	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
261922	Fee-for-Service	1205632866	1205632866	1	1	LEBOW, OLIVIA LCSW	4/10/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
261928	Fee-for-Service	1003927195	1003927195	1	1	LEVINE, GLENN K MD	8/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71119	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
261953	Fee-for-Service	1386622025	1386622025	1	1	LAKES,MICHALE DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2222 PHILADELPHIA DR	None	DAYTON	OH	45406	1813	00	None	39.78749248	-84.23490647	Montgomery County
261959	Fee-for-Service	1417907940	1417907940	1	4	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	400 TAYLOR BLVD	SUITE 306	PLEASANT HILL	CA	94523	2160	07	06013	37.96132631	-122.0740275	Contra Costa County
261990	Fee-for-Service	1316008956	1316008956	1	1	LOPEZ, RHODORA D	2/28/1994	156FC0801X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	14449 ROSCOE BLVD	None	PANORAMA CITY	CA	91402	3012	19	06037	34.22156491	-118.4483229	Los Angeles County
261992	Fee-for-Service	1700172616	1700172616	1	1	LADWIG-SCOTT, EVE A MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123582	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1779 DOMINICAN WAY	STE B	SANTA CRUZ	CA	95065	1526	44	06087	36.9902958	-121.9808957	Santa Cruz County
261997	Fee-for-Service	1790773448	1790773448	1	1	LEE, ANITA T MD	2/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78299	78	Neoplastic Diseases/Oncology	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
262009	Fee-for-Service	1851585624	1851585624	1	1	LEONG, CLIFFORD J OD	6/21/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	39355 CALIFORNIA ST	SUITE 103	FREMONT	CA	94538	1447	01	06001	37.54733091	-121.9819574	Alameda County
262019	Fee-for-Service	1578925517	1578925517	1	1	LAM, ANGELA MD	9/9/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	161054	None	None	0	In state provider	None	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
262032	Fee-for-Service	1417907940	1417907940	1	10	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	5030 BUSINESS CENTER DR	SUITE 230	FAIRFIELD	CA	94533	6881	48	06095	38.21736891	-122.142579	Solano County
262048	Fee-for-Service	1568629707	1568629707	1	1	LEE, CURRIE MD	2/21/2013	207L00000X	NA	Other	026	PHYSICIANS	109468	None	None	0	In state provider	None	1205 E NORTH STREET	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
262049	Fee-for-Service	1831426642	1831426642	1	7	LAKESIDE MEDICAL	4/13/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4835 VAN NUYS BLVD	SUITE 114	SHERMAN OAKS	CA	91403	2137	19	06037	34.1587068	-118.4487394	Los Angeles County
262056	Fee-for-Service	1982652780	1982652780	1	1	LAUB, DAVID J MD	2/1/2000	208800000X	NA	Other	026	PHYSICIANS	62203	01	General Practice	0	In state provider	None	2323 DE LA VINA ST	STE 104	SANTA BARBARA	CA	93105	3878	42	06083	34.43202913	-119.7212339	Santa Barbara County
262063	Fee-for-Service	1235321316	1235321316	1	1	LEE, SUNGEUN MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100694	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
262081	Fee-for-Service	1255444014	1255444014	1	1	LLOYD, JOHN J MD	10/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	73073	01	General Practice	0	In state provider	None	1198 PACIFIC COAST HWY	STE I	SEAL BEACH	CA	90740	6278	30	06059	33.74325823	-118.1004531	Orange County
262101	Fee-for-Service	1609820901	1609820901	1	1	LEE, MICHALE HYUN-TAE MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86181	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5176 HILL RD E	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
262111	Fee-for-Service	1891985800	1891985800	1	1	LEWIS, MARK P MD	12/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96667	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
262118	Fee-for-Service	1730267568	1730267568	1	1	LIN, JIM MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84506	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
262128	Fee-for-Service	1467141234	1467141234	1	1	LAU, KIN H PSYD	7/8/2023	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
262134	Fee-for-Service	1851626014	1851626014	1	1	LU, JONG-PING MD	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98393	02	General Surgery	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
262161	Fee-for-Service	1972878361	1972878361	1	1	LOVELACE HEALTH SYSTEM	4/15/2013	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	117 E 19TH STREET	None	ROSWELL	NM	88201	5151	00	None	33.4159975	-104.521293	Chaves County
262165	Fee-for-Service	1417907940	1417907940	1	15	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	4598 SOUTH TRACY BLVD	SUITE 110	TRACY	CA	95377	8117	39	06077	37.699227	-121.4345335	San Joaquin County
262173	Fee-for-Service	1659651974	1659651974	1	1	LWIN, KIKI Y H MD	12/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127424	38	Geriatrics	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
262188	Fee-for-Service	1275659914	1275659914	1	1	LIN, SUSAN F MD	7/1/1993	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	77036	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
262196	Fee-for-Service	1417907940	1417907940	1	2	LPCH MEDICAL GROUP DIV OF LU	1/12/2018	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	LUCILE	1359 PARK AVE	None	ALAMEDA	CA	94501	4511	01	06001	37.76329307	-122.2420565	Alameda County
262199	Fee-for-Service	1477137669	1477137669	1	1	LIN, EMILY MD	9/6/2024	261QU0200X	NA	Other	026	PHYSICIANS	184413	08	Family Practice	0	In state provider	None	1450 TREAT BLVD	STE 160	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
262205	Fee-for-Service	1912085820	1912085820	1	1	LING, ZHONG MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70425	41	Internal Medicine	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
262214	Fee-for-Service	1043398688	1043398688	1	1	LIM, CHRISTINA K MD	10/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85331	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
262218	Fee-for-Service	1518362466	1518362466	1	1	LYND, KELSEY L NP	9/25/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
262243	Fee-for-Service	1447278098	1447278098	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1065 W MANNING AVE	None	REEDLEY	CA	93654	2446	10	06019	36.60329936	-119.4601523	Fresno County
262247	Fee-for-Service	1417907940	1417907940	1	4	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	400 TAYLOR BLVD	SUITE 306	PLEASANT HILL	CA	94523	2160	07	06013	37.96132631	-122.0740275	Contra Costa County
262305	Fee-for-Service	1659517852	1659517852	1	1	LEGER, CHRISTOPHER CRNA	8/2/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
262314	Fee-for-Service	1417907940	1417907940	1	10	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	5030 BUSINESS CENTER DR	SUITE 230	FAIRFIELD	CA	94533	6881	48	06095	38.21736891	-122.142579	Solano County
262329	Fee-for-Service	1447927249	1447927249	1	1	LOPEZ, ALYSSA-NICOLE T OT	9/11/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1020 TIERRA DEL REY	A1	CHULA VISTA	CA	91910	7886	37	06073	32.6377383	-117.0196092	San Diego County
262342	Fee-for-Service	1982652780	1982652780	1	1	LAUB, DAVID J MD	2/1/2000	208800000X	NA	Other	026	PHYSICIANS	62203	34	Urology and Urological Surgery	0	In state provider	None	2323 DE LA VINA ST	STE 104	SANTA BARBARA	CA	93105	3878	42	06083	34.43202913	-119.7212339	Santa Barbara County
262350	Fee-for-Service	1255750360	1255750360	1	1	LANDEO GUTIERREZ, JEREMY S M	7/28/2021	2080P0214X	NA	Pulmonology	026	PHYSICIANS	172945	None	None	0	In state provider	D	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
262364	Fee-for-Service	1922103282	1922103282	1	1	LOVELAND, CHERYL A	12/1/2005	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9280 W STOCKTON BLVD	STE 116	ELK GROVE	CA	95758	8073	34	06067	38.420235	-121.394961	Sacramento County
262411	Fee-for-Service	1306971387	1306971387	1	1	LAKOSKI, SUSAN G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
262427	Fee-for-Service	1750452447	1750452447	2	1	LAN, WEN-CHUN JIMMY MD	1/5/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	92292	None	None	0	In state provider	None	1400 CHURCH ST	BLDG 8	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
262439	Fee-for-Service	1487372579	1487372579	1	1	LARA, NICOLE	11/3/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
262452	Fee-for-Service	1972878361	1972878361	1	1	LOVELACE HEALTH SYSTEM	4/15/2013	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	117 E 19TH STREET	None	ROSWELL	NM	88201	5151	00	None	33.4159975	-104.521293	Chaves County
262454	Fee-for-Service	1417907940	1417907940	1	15	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	4598 SOUTH TRACY BLVD	SUITE 110	TRACY	CA	95377	8117	39	06077	37.699227	-121.4345335	San Joaquin County
262459	Fee-for-Service	1316628563	1316628563	1	1	LEOR, GUSTAVO CRNA	2/3/2025	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
262482	Fee-for-Service	1417907940	1417907940	1	2	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	1359 PARK AVE	None	ALAMEDA	CA	94501	4511	01	06001	37.76329307	-122.2420565	Alameda County
262485	Fee-for-Service	1023872256	1023872256	1	1	LORENZO, JOHN R OT	2/14/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2815 MAIN ST.,	SUITE 205	CORONA	CA	92882	0000	33	06065	33.84741266	-117.570694	Riverside County
262487	Fee-for-Service	1437562964	1437562964	1	1	LIM, CAITLIN F DO	7/31/2020	208800000X	NA	Other	026	PHYSICIANS	18235	34	Urology and Urological Surgery	0	In state provider	None	1667 DOMINICAN WAY	STE 234	SANTA CRUZ	CA	95065	1529	44	06087	36.99032635	-121.9811719	Santa Cruz County
262493	Fee-for-Service	1801199104	1801199104	1	1	LANG, MICHELLE LCSW	9/18/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
262495	Fee-for-Service	1740223098	1740223098	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1317 NORTH H ST	None	LOMPOC	CA	93436	3342	42	06083	34.66000293	-120.4576907	Santa Barbara County
262512	Fee-for-Service	1063871986	1063871986	1	2	LAKE HUGHES RECOVERY INC.	5/17/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1140 WEST LANCASTER BLVD	None	LANCASTER	CA	93534	2250	19	06037	34.69667251	-118.150794	Los Angeles County
262536	Fee-for-Service	1417907940	1417907940	1	4	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	400 TAYLOR BLVD	SUITE 306	PLEASANT HILL	CA	94523	2160	07	06013	37.96132631	-122.0740275	Contra Costa County
262537	Fee-for-Service	1477252583	1477252583	1	1	LAWLER, LAUREL LCSW	11/30/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
262538	Fee-for-Service	1750810487	1750810487	1	1	LANSKY, CHARLOTTE A MD	10/3/2019	207R00000X	NA	Other	026	PHYSICIANS	160864	30	Radiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
262542	Fee-for-Service	1194768937	1194768937	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1720 S BASCOM AVE	None	CAMPBELL	CA	95008	0608	43	06085	37.292472	-121.9315815	Santa Clara County
262554	Fee-for-Service	1962060269	1962060269	1	1	LUXURY HOME HEALTH INC	5/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	10012 COMMERCE AVE	STE C	TUJUNGA	CA	91042	2304	19	06037	34.25058808	-118.2886057	Los Angeles County
262572	Fee-for-Service	1700829751	1700829751	1	1	LOVELESS, BRIAN J DO	12/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8555	08	Family Practice	0	In state provider	None	9089 BASELINE RD	STE 100	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
262573	Fee-for-Service	1396035564	1396035564	1	1	LI, YANG MD	11/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124427	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
262586	Fee-for-Service	1417410374	1417410374	1	1	LY, AMANDA MD	10/30/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	190157	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
262602	Fee-for-Service	1417907940	1417907940	1	10	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	5030 BUSINESS CENTER DR	SUITE 230	FAIRFIELD	CA	94533	6881	48	06095	38.21736891	-122.142579	Solano County
262606	Fee-for-Service	1922262724	1922262724	1	1	LI, JANE MD	6/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104298	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
262630	Fee-for-Service	1194732008	1194732008	1	1	LOMA LINDA UNIVERSITY	1/16/1991	283Q00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	BEHAVIORAL MEDICINE CTR	1710 BARTON RD	None	REDLANDS	CA	92373	5304	36	06071	34.0483569	-117.2140061	San Bernardino County
262633	Fee-for-Service	1891893046	1891893046	1	1	LEE, KAI-MAN MD	2/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	45648	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
262689	Fee-for-Service	1548562150	1548562150	1	2	LITTLE HOUSE	2/19/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	9928 FLOWER ST.	STE. 101	BELLFLOWER	CA	90706	5453	19	06037	33.88207348	-118.1221515	Los Angeles County
262732	Fee-for-Service	1518901727	1518901727	1	1	LEACH, RICHARD D MD	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	62491	01	General Practice	0	In state provider	None	240 SPRUCE STREET	None	GRIDLEY	CA	95948	2216	04	06007	39.36701046	-121.6895355	Butte County
262737	Fee-for-Service	1063552024	1063552024	1	1	LEE, PEIYEE MD	8/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	90705	13	Neurology (M.D. only)	0	In state provider	None	30 MEDICAL PLAZA	SUITE B200	LOS ANGELES	CA	90095	0001	19	06037	34.0651473	-118.4458393	Los Angeles County
262743	Fee-for-Service	1417907940	1417907940	1	15	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	4598 SOUTH TRACY BLVD	SUITE 110	TRACY	CA	95377	8117	39	06077	37.699227	-121.4345335	San Joaquin County
262750	Fee-for-Service	1700497146	1700497146	1	1	LEWMAN, BRENNA C PT	6/18/2021	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
262762	Fee-for-Service	1154556348	1154556348	1	1	LOOMIS, JUDYTA M MD	5/17/2024	2085P0229X	NA	Other	026	PHYSICIANS	177686	30	Radiology	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
262770	Fee-for-Service	1417907940	1417907940	1	2	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1359 PARK AVE	None	ALAMEDA	CA	94501	4511	01	06001	37.76329307	-122.2420565	Alameda County
262772	Fee-for-Service	1053827097	1053827097	1	1	LAM NURSING HEALTHCARE	5/3/2023	No Taxonomy Provided	NA	None	093	CARE COORDINATOR AGENCIES (CCA)	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	14455 PARK AVE	SUITE E	VICTORVILLE	CA	92392	2344	36	06071	34.513515	-117.324891	San Bernardino County
262823	Fee-for-Service	1417907940	1417907940	1	4	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	400 TAYLOR BLVD	SUITE 306	PLEASANT HILL	CA	94523	2160	07	06013	37.96132631	-122.0740275	Contra Costa County
262834	Fee-for-Service	1144282484	1144282484	1	1	LAU, LISA M MD	11/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75103	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
262852	Fee-for-Service	1720209547	1720209547	1	1	LEGASPI, JOANNE B	5/27/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	43112 15TH STREET W	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
262861	Fee-for-Service	1497833065	1497833065	1	1	LIM, JOHN H DO	10/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9532	25	Physical Medicine and Rehabilitation	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
262862	Fee-for-Service	1669740544	1669740544	1	1	LARIOS, ROSA I LMFT	1/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
262877	Fee-for-Service	1093458846	1093458846	1	1	LO, JOCELYN CRNA	8/21/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
262913	Fee-for-Service	1295912277	1295912277	1	1	LIN, ERINA M MD	1/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77793	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
262956	Fee-for-Service	1124681986	1124681986	1	1	LIVESAY, GRAHAM LPCC	1/27/2024	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
262986	Fee-for-Service	1962579169	1962579169	1	1	LE, TUAN A	10/1/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4760 SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09811852	-118.293408	Los Angeles County
262987	Fee-for-Service	1770562316	1770562316	1	1	LIEU, TRACY	3/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	71439	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
263032	Fee-for-Service	1417907940	1417907940	1	15	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	4598 SOUTH TRACY BLVD	SUITE 110	TRACY	CA	95377	8117	39	06077	37.699227	-121.4345335	San Joaquin County
263051	Fee-for-Service	1114005295	1114005295	1	1	LANGKAMMER, DAVID P MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52778	01	General Practice	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
263059	Fee-for-Service	1417907940	1417907940	1	2	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	1359 PARK AVE	None	ALAMEDA	CA	94501	4511	01	06001	37.76329307	-122.2420565	Alameda County
263071	Fee-for-Service	1922293497	1922293497	1	1	LEPORE, JOSHUA D PSYD	11/5/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	147 NORTH BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
263110	Fee-for-Service	1417907940	1417907940	1	4	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	400 TAYLOR BLVD	SUITE 306	PLEASANT HILL	CA	94523	2160	07	06013	37.96132631	-122.0740275	Contra Costa County
263120	Fee-for-Service	1285715789	1285715789	2	1	LASHER, MARC D DO	10/13/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	7154	-	NOT APPLICABLE	0	In state provider	None	3707 E SHIELDS AVE	None	FRESNO	CA	93726	7029	10	06019	36.77969052	-119.7632025	Fresno County
263203	Fee-for-Service	1396847182	1396847182	1	1	LEPOSAVIC, ROBERT MD	11/1/1997	207ND0101X	NA	Dermatology	026	PHYSICIANS	63047	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
263214	Fee-for-Service	1710984091	1710984091	1	1	LOBAUGH, MARK L MD	3/31/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	61664	None	None	0	In state provider	None	1095 MARSHALL WAY	2N FL	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
263218	Fee-for-Service	1043381437	1043381437	1	1	LARRRABEE, HOLLYNN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 STADIUM DR	None	MORGANTOWN	WV	26506	7911	00	None	39.65345878	-79.95562791	Monongalia County
263233	Fee-for-Service	1619464799	1619464799	1	1	LIM, MICHAEL J OD	7/30/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
263239	Fee-for-Service	1528183928	1528183928	1	1	LARSON, CRAIG R DO	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11358	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
263243	Fee-for-Service	1760537682	1760537682	1	1	LEE, SUSAN K LCSW	4/1/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
263246	Fee-for-Service	1407219330	1407219330	1	1	LY, STANFORD MD	7/21/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	158084	None	None	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
263285	Fee-for-Service	1205111366	1205111366	1	1	LAM, CHRISTINE A MD	1/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122664	None	None	0	In state provider	None	200 ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.06481928	-118.3836235	Los Angeles County
263307	Fee-for-Service	1235700469	1235700469	1	1	LEE, JOSHUA DO	7/8/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22513	08	Family Practice	0	In state provider	None	1330 W COVINA BLVD	STE 201	SAN DIMAS	CA	91773	3200	19	06037	34.09894509	-117.8340464	Los Angeles County
263321	Fee-for-Service	1417907940	1417907940	1	15	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	4598 SOUTH TRACY BLVD	SUITE 110	TRACY	CA	95377	8117	39	06077	37.699227	-121.4345335	San Joaquin County
263336	Fee-for-Service	1114005295	1114005295	1	1	LANGKAMMER, DAVID P MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52778	41	Internal Medicine	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
263365	Fee-for-Service	1144233800	1144233800	1	1	LOS ANGELES COUNTY	7/1/2000	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HUDSON COMPREHENSIVE HLT	2829 S GRAND AVE	None	LOS ANGELES	CA	90007	3304	19	06037	34.02452751	-118.2735513	Los Angeles County
263377	Fee-for-Service	1861674244	1861674244	1	1	LOANZON, SHEILA L DO	11/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11761	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
263399	Fee-for-Service	1417907940	1417907940	1	4	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	400 TAYLOR BLVD	SUITE 306	PLEASANT HILL	CA	94523	2160	07	06013	37.96132631	-122.0740275	Contra Costa County
263401	Fee-for-Service	1417070566	1417070566	1	1	LE, RICHARD T DO	12/8/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	12033	None	None	0	In state provider	None	360 SAN MIGUEL DR	STE 309	NEWPORT BEACH	CA	92660	7836	30	06059	33.61321911	-117.8722084	Orange County
263431	Fee-for-Service	1073617262	1073617262	1	1	LUK, SELENE M DO	3/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	9643	36	Psychiatry	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
263461	Fee-for-Service	1942358916	1942358916	1	1	LIAO, EDWARD R	4/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77570	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
263463	Fee-for-Service	1407997836	1407997836	1	1	LEHMAN, TRANG	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117076	08	Family Practice	0	In state provider	None	2500 ALHAMBRA AVE	None	MARTINEZ	CA	94553	3156	07	06013	38.00658519	-122.1309063	Contra Costa County
263476	Fee-for-Service	1477608818	1477608818	1	1	LOWE, LINDSAY LCSW	12/12/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
263489	Fee-for-Service	1366547812	1366547812	1	1	LEONG, JANE MD	8/31/1984	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	42334	08	Family Practice	0	In state provider	HEALTH FOR ALL, INC	910 S ST	None	SACRAMENTO	CA	95814	7025	34	06067	38.570301	-121.4987355	Sacramento County
263499	Fee-for-Service	1982619680	1982619680	1	1	LONG BEACH RAD ONCOLOGY	1/31/1990	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP	2650 ELM AVE	STE 205	LONG BEACH	CA	90806	1600	19	06037	33.805521	-118.1882945	Los Angeles County
263523	Fee-for-Service	1477596583	1477596583	1	3	LONG BEACH MEMORIAL MEDICAL	10/26/2022	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	2701 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1552	19	06037	33.807735	-118.1850575	Los Angeles County
263558	Fee-for-Service	1538151964	1538151964	1	1	LOYA, ALTAF MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11920 ASTORIA BLVD	STE 110	HOUSTON	TX	77089	6155	00	None	29.583558	-95.2058655	Harris County
263568	Fee-for-Service	1710152509	1710152509	1	1	LUONG, KHOALINH T MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109896	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
263603	Fee-for-Service	1255340311	1255340311	1	1	LEE, ALICE N MD	1/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54000	07	Dermatology	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
263607	Fee-for-Service	1417907940	1417907940	1	15	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	4598 SOUTH TRACY BLVD	SUITE 110	TRACY	CA	95377	8117	39	06077	37.699227	-121.4345335	San Joaquin County
263608	Fee-for-Service	1548027683	1548027683	1	1	LMT PHARMACY	5/13/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9475 WARNER AVE	STE B	FOUNTAIN VALLEY	CA	92708	2814	30	06059	33.7161104	-117.9636946	Orange County
263624	Fee-for-Service	1679686554	1679686554	1	1	LYM, LAUREN T NP	5/9/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
263650	Fee-for-Service	1902886088	1902886088	1	1	LETAI, AGNES D MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	69484	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6405 DAY ST	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
263653	Fee-for-Service	1144233800	1144233800	1	1	LOS ANGELES COUNTY	6/18/2013	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	HUDSON COMPREHENSIVE HLT	2829 S GRAND AVE	None	LOS ANGELES	CA	90007	3304	19	06037	34.02452751	-118.2735513	Los Angeles County
263662	Fee-for-Service	1104876812	1104876812	1	1	LANZKOWSKY, LEORA MD	1/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87599	30	Radiology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
263663	Fee-for-Service	1457482424	1457482424	1	1	LEE, WILMA K MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	85782	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
263677	Fee-for-Service	1518348648	1518348648	1	1	LABROO, ESHAN	8/29/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	154886	08	Family Practice	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
263684	Fee-for-Service	1518900349	1518900349	2	1	LONGS DRUG STORES CA LLC	12/26/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3202 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	2333	19	06037	34.04034719	-118.4711691	Los Angeles County
263688	Fee-for-Service	1417907940	1417907940	1	4	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	400 TAYLOR BLVD	SUITE 306	PLEASANT HILL	CA	94523	2160	07	06013	37.96132631	-122.0740275	Contra Costa County
263729	Fee-for-Service	1689963118	1689963118	1	2	LESHER, JAMES D MD	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126205	02	General Surgery	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
263731	Fee-for-Service	1922146927	1922146927	1	1	LINDE, BRIAN K MD	1/22/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	70668	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
263748	Fee-for-Service	1407997836	1407997836	1	1	LEHMAN, TRANG	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117076	01	General Practice	0	In state provider	None	2500 ALHAMBRA AVE	None	MARTINEZ	CA	94553	3156	07	06013	38.00658519	-122.1309063	Contra Costa County
263758	Fee-for-Service	1780775528	1780775528	1	1	LAUGHLIN, COLBY L MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	590 EUREKA AVE	None	RENO	NV	89512	3425	00	None	39.53407902	-119.8048858	Washoe County
263819	Fee-for-Service	1730626797	1730626797	1	1	LE GRAND UNION HIGH SCHOOL	7/1/2016	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	12961 EAST LE GRAND ROAD	None	LE GRAND	CA	95333	9737	24	06047	37.226457	-120.2538195	Merced County
263848	Fee-for-Service	1225136435	1225136435	2	1	LEE, HWA M MD	6/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	33216	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3010 W ORANGE AVENUE	STE 103	ANAHEIM	CA	92804	3170	30	06059	33.82472315	-117.994133	Orange County
263857	Fee-for-Service	1710152509	1710152509	1	1	LUONG, KHOALINH T MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109896	15	Obstetrics (D.O. only)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
263859	Fee-for-Service	1912392655	1912392655	1	1	LITTLE-RICHARDSON, AMANDA M	12/16/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	163001	09	Gynecology (D.O. only)	0	In state provider	D	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
263876	Fee-for-Service	1013232917	1013232917	1	1	LIN, CHERYL MD	6/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	100010	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
263895	Fee-for-Service	1417907940	1417907940	1	15	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	4598 SOUTH TRACY BLVD	SUITE 110	TRACY	CA	95377	8117	39	06077	37.699227	-121.4345335	San Joaquin County
263898	Fee-for-Service	1225646045	1225646045	1	1	LIA HOSPICE CARE, INC	12/10/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 418	ENCINO	CA	91436	4709	19	06037	34.15524484	-118.4756687	Los Angeles County
263920	Fee-for-Service	1720136682	1720136682	1	1	LAVALLO, PATRICK MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	31327	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
263940	Fee-for-Service	1144233800	1144233800	1	1	LOS ANGELES COUNTY	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HUDSON COMPREHENSIVE HLT	2829 S GRAND AVE	None	LOS ANGELES	CA	90007	3304	19	06037	34.02452751	-118.2735513	Los Angeles County
263974	Fee-for-Service	1417907940	1417907940	1	4	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	400 TAYLOR BLVD	SUITE 306	PLEASANT HILL	CA	94523	2160	07	06013	37.96132631	-122.0740275	Contra Costa County
264022	Fee-for-Service	1932108263	1932108263	1	1	LEIBENHAUT, MARK H MD	11/30/1990	2085R0001X	NA	Other	026	PHYSICIANS	56255	30	Radiology	0	In state provider	None	5201 F ST	None	SACRAMENTO	CA	95819	3225	34	06067	38.570787	-121.4393895	Sacramento County
264037	Fee-for-Service	1063494920	1063494920	1	1	LUDLOW, KAREN MD	12/2/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	75270	08	Family Practice	0	In state provider	None	335 KATHERINE AVE	#1	SALINAS	CA	93901	3167	27	06053	36.65981144	-121.6491192	Monterey County
264066	Fee-for-Service	1417931965	1417931965	1	1	LEE, KWAN S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2800 E AJO WAY	None	TUCSON	AZ	85713	6204	00	None	32.175801	-110.9306925	Pima County
264074	Fee-for-Service	1447465729	1447465729	1	1	LAGNESE, MEENA E MD	10/5/2009	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	89823	41	Internal Medicine	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
264090	Fee-for-Service	1922738350	1922738350	1	1	LABORATORY SERVICE PARTNERS	10/17/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	LLC	3810 IRVING ST	STE B	DENVER	CO	80211	1956	00	None	39.769677	-105.0299225	Denver County
264115	Fee-for-Service	1174284277	1174284277	1	1	LEE, INGRID LCSW	2/12/2025	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	SUITE 465	ENCINO	CA	91436	4620	19	06037	34.15682212	-118.4871886	Los Angeles County
264138	Fee-for-Service	1225136435	1225136435	2	1	LEE, HWA M MD	6/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	33216	41	Internal Medicine	0	In state provider	None	3010 W ORANGE AVENUE	STE 103	ANAHEIM	CA	92804	3170	30	06059	33.82472315	-117.994133	Orange County
264139	Fee-for-Service	1154186872	1154186872	1	1	LABORATORY CORPORATION OF AM	5/7/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	ERICA	820 34TH ST STE 103	None	BAKERSFIELD	CA	93301	2268	15	06029	35.39053308	-119.0117133	Kern County
264167	Fee-for-Service	1639449929	1639449929	1	1	LABORATORY CORPORATION OF	1/9/2012	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	AMERICA	44725 10TH ST W	None	LANCASTER	CA	93534	3048	19	06037	34.695693	-118.1480965	Los Angeles County
264183	Fee-for-Service	1417907940	1417907940	1	15	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	4598 SOUTH TRACY BLVD	SUITE 110	TRACY	CA	95377	8117	39	06077	37.699227	-121.4345335	San Joaquin County
264188	Fee-for-Service	1225646045	1225646045	1	1	LIA HOSPICE CARE, INC	12/10/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 418	ENCINO	CA	91436	4709	19	06037	34.15524484	-118.4756687	Los Angeles County
264194	Fee-for-Service	1215952254	1215952254	1	1	LUCAS, SHAWN W MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69175	None	None	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
264196	Fee-for-Service	1740407618	1740407618	1	1	LYUDMILA MUINOV M.D.	7/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
264219	Fee-for-Service	1891256756	1891256756	1	1	LADBURY, COLTON J MD	3/6/2024	2085R0001X	NA	Other	026	PHYSICIANS	178093	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
264259	Fee-for-Service	1265514475	1265514475	1	1	LEONARD, WILLIAM D MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	98392	05	Anesthesiology	0	In state provider	None	354 SANTA FE DRIVE	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
264267	Fee-for-Service	1235363730	1235363730	1	1	LEE, YEEMAN SALLY	2/8/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	50 E FOOTHILL BLVD	STE 100	ARCADIA	CA	91006	2314	19	06037	34.15096965	-118.0295442	Los Angeles County
264294	Fee-for-Service	1992915433	1992915433	1	1	LEKKALA, MADHAVI MD	6/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100995	13	Neurology (M.D. only)	0	In state provider	None	11370 ANDERSON STREET	SUITE 2400	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
264330	Fee-for-Service	1437152063	1437152063	1	1	LOUBSER, PAUL G MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	40816	05	Anesthesiology	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
264363	Fee-for-Service	1215193503	1215193503	1	1	LUCIANO, WILLIAM N MD	10/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
264368	Fee-for-Service	1871754234	1871754234	1	1	LEHRMAN, EVAN D MD	6/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116174	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
264413	Fee-for-Service	1982782744	1982782744	1	1	LANDO, MATTHEW J MD	5/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	50425	04	Otology, Laryngology, Rhinology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
264440	Fee-for-Service	1386906311	1386906311	1	1	LEE, EVELYN G MD	12/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127150	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
264486	Fee-for-Service	1225219041	1225219041	1	1	LI, RAN	1/31/2008	163WC0400X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3273 BRIONES TERRACE	None	FREMONT	CA	94538	3083	01	06001	37.53610418	-121.9548791	Alameda County
264513	Fee-for-Service	1164438933	1164438933	1	1	LAU, CHU K MD	2/28/1991	207R00000X	NA	Other	026	PHYSICIANS	65881	None	None	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
264519	Fee-for-Service	1336428655	1336428655	1	1	LUU, TUYET N MD	2/6/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184020	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
264543	Fee-for-Service	1417907940	1417907940	1	23	LPCH MEDICAL GROUP DIV OF LU	6/10/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	1133 E STANLEY BLVD	SUITE 103	LIVERMORE	CA	94550	4270	01	06001	37.67914693	-121.7810206	Alameda County
264554	Fee-for-Service	1942410626	1942410626	1	1	LAFLEUR, SARA C MD	4/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	105246	05	Anesthesiology	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
264629	Fee-for-Service	1003378019	1003378019	1	1	LEMON, JACK D MD	7/24/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	187679	None	None	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
264652	Fee-for-Service	1215193503	1215193503	1	1	LUCIANO, WILLIAM N MD	10/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
264660	Fee-for-Service	1205444023	1205444023	1	1	LUCKY HOSPICE CARE, INC	12/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 222	ENCINO	CA	91436	2972	19	06037	34.15524484	-118.4756687	Los Angeles County
264696	Fee-for-Service	1114652617	1114652617	1	1	LAKE FOREST POST ACUTE LLC	8/16/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	25652 OLD TRABUCO RD	None	LAKE FOREST	CA	92630	2776	30	06059	33.64531866	-117.6831748	Orange County
264724	Fee-for-Service	1295886075	1295886075	1	1	LAXMIKANT, DIVYA MD	3/21/2008	207R00000X	NA	Other	026	PHYSICIANS	98506	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
264738	Fee-for-Service	1144496647	1144496647	1	1	LARSON, NANCY E LMFT	8/21/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	50483	-	NOT APPLICABLE	0	In state provider	None	801 WEST 70TH ST	None	LOS ANGELES	CA	90044	5218	19	06037	33.97640749	-118.2874275	Los Angeles County
264797	Fee-for-Service	1396040267	1396040267	1	1	LAUBER, AMANDA	4/1/2012	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	18700 BEACH BLVD	STE 120	HUNTINGTON BEACH	CA	92648	2089	30	06059	33.69070037	-117.9886896	Orange County
264829	Fee-for-Service	1417907940	1417907940	1	23	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1133 E STANLEY BLVD	SUITE 103	LIVERMORE	CA	94550	4270	01	06001	37.67914693	-121.7810206	Alameda County
264830	Fee-for-Service	1740523422	1740523422	1	1	LEE, BRIAN W DO	8/19/2019	390200000X	NA	Other	026	PHYSICIANS	17452	25	Physical Medicine and Rehabilitation	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
264864	Fee-for-Service	1518901966	1518901966	2	1	LONGS DRUG STORES CA LLC	12/24/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1800 SARATOGA AVE	None	SAN JOSE	CA	95129	5211	43	06085	37.2885718	-121.9953341	Santa Clara County
264866	Fee-for-Service	1902126873	1902126873	1	1	LAI, TONY YU-ZEN	8/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118858	08	Family Practice	0	In state provider	None	3201 DATA DRIVE	None	RANCHO CORDOVA	CA	95670	7374	34	06067	38.58561	-121.2838875	Sacramento County
264918	Fee-for-Service	1841579661	1841579661	1	1	LINDGREN, BRETT A DO	8/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14032	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
264940	Fee-for-Service	1326090192	1326090192	1	1	LEE, TED T H MD	4/30/1987	207R00000X	NA	Other	026	PHYSICIANS	55915	66	Emergency Medicine (Urgent Care)	0	In state provider	None	601 W KETTLEMAN LN	None	LODI	CA	95240	6006	39	06077	38.11544448	-121.2806385	San Joaquin County
264946	Fee-for-Service	1205444023	1205444023	1	1	LUCKY HOSPICE CARE, INC	12/14/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 222	ENCINO	CA	91436	2972	19	06037	34.15524484	-118.4756687	Los Angeles County
264956	Fee-for-Service	1477596583	1477596583	1	2	LONG BEACH MEMORIAL MEDICAL	2/23/2021	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2701 ATLANTIC AVE	None	LONG BEACH	CA	90806	2701	19	06037	33.807735	-118.1850575	Los Angeles County
264960	Fee-for-Service	1619340205	1619340205	1	2	LOPES, SHAWNE J LAC	2/27/2022	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	480 REDWOOD ST	SUITE 14	VALLEJO	CA	94590	2950	48	06095	38.12315545	-122.2597619	Solano County
264978	Fee-for-Service	1730121559	1730121559	2	1	LONGS DRUG STORES CA LLC	12/17/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1057 N 1ST ST	None	DIXON	CA	95620	2428	48	06095	38.45539647	-121.8224557	Solano County
264982	Fee-for-Service	1386624989	1386624989	1	1	LAWSON, ANGELA D MD	12/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	78740	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2915 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1816	44	06087	36.98821335	-121.978125	Santa Cruz County
264983	Fee-for-Service	1174948905	1174948905	1	1	LOCK, MARY ANGELI D MD	4/6/2020	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
265018	Fee-for-Service	1063590610	1063590610	1	1	LEE, PETER P MD	9/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78649	40	Pediatrics	0	In state provider	None	345 9TH ST	STE 204	OAKLAND	CA	94607	4206	01	06001	37.79975865	-122.2705956	Alameda County
265053	Fee-for-Service	1083716617	1083716617	1	1	LEAH KIVIAT MD	4/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1211 24TH ST	None	ANACORTES	WA	98221	2562	00	None	48.50285154	-122.615127	Skagit County
265063	Fee-for-Service	1639240690	1639240690	1	1	LEVY, LAWRENCE J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	22028	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
265106	Fee-for-Service	1346376837	1346376837	1	1	LEON, PATRICIA H LMFT	6/6/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5850 EL CAMINO REAL	None	ATASCADERO	CA	93422	3318	40	06079	35.48962035	-120.670989	San Luis Obispo County
265116	Fee-for-Service	1417907940	1417907940	1	23	LPCH MEDICAL GROUP DIV OF LU	6/10/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	1133 E STANLEY BLVD	SUITE 103	LIVERMORE	CA	94550	4270	01	06001	37.67914693	-121.7810206	Alameda County
265123	Fee-for-Service	1467659052	1467659052	1	1	LUDWIG, BETH A LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
265138	Fee-for-Service	1750674115	1750674115	1	1	LIU, JENNIFER C DO	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13203	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1250 EAST ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
265148	Fee-for-Service	1639845381	1639845381	1	1	LAWRENCE, ANNA E PT	5/14/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6387	43	06085	37.36777579	-122.0276404	Santa Clara County
265150	Fee-for-Service	1114559739	1114559739	1	1	LA PATIENT CARE HOSPICE	9/15/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	18570 SHERMAN WAY	STE 1	RESEDA	CA	91335	8639	19	06037	34.20101951	-118.538424	Los Angeles County
265151	Fee-for-Service	1902126873	1902126873	1	1	LAI, TONY YU-ZEN	8/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118858	01	General Practice	0	In state provider	None	3201 DATA DRIVE	None	RANCHO CORDOVA	CA	95670	7374	34	06067	38.58561	-121.2838875	Sacramento County
265163	Fee-for-Service	1093249872	1093249872	1	1	LEE, ARIEL E DO	2/24/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	18397	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
265204	Fee-for-Service	1497953442	1497953442	1	1	LEATH, JENNIFER M PSYD	5/12/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3152 RED HILL AVE	260	COSTA MESA	CA	92626	3436	30	06059	33.67898631	-117.8747698	Orange County
265213	Fee-for-Service	1053377580	1053377580	1	1	LAI, STEVE R MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77926	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
265226	Fee-for-Service	1326090192	1326090192	1	1	LEE, TED T H MD	4/30/1987	207R00000X	NA	Other	026	PHYSICIANS	55915	01	General Practice	0	In state provider	None	601 W KETTLEMAN LN	None	LODI	CA	95240	6006	39	06077	38.11544448	-121.2806385	San Joaquin County
265227	Fee-for-Service	1215189550	1215189550	1	1	LEE, EDWARD W MD	3/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97746	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	8344	19	06037	34.06373445	-118.443537	Los Angeles County
265235	Fee-for-Service	1558528711	1558528711	1	1	LIU, YI MD	6/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106287	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
265246	Fee-for-Service	1407289259	1407289259	1	1	LEE, SCOTT F OD	10/3/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	361 HOSPITAL RD	STE 425	NEWPORT BEACH	CA	92663	3525	30	06059	33.62579141	-117.9299554	Orange County
265249	Fee-for-Service	1992061113	1992061113	1	1	LAZO, ISABEL M MD	7/8/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	131473	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
265276	Fee-for-Service	1588190177	1588190177	1	1	LEE, JEAN Y MD	7/11/2024	2080P0214X	NA	Pulmonology	026	PHYSICIANS	173332	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
265349	Fee-for-Service	1104915065	1104915065	1	1	LAROSA, ERICA N	4/11/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	568 NORTH SUNRISE AVE	SUITE 100	ROSEVILLE	CA	95661	3097	31	06061	38.7576732	-121.2534645	Placer County
265359	Fee-for-Service	1720036270	1720036270	1	1	LUNDEEN, GREGORY A MD	6/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	555 N ARLINGTON AVE	None	RENO	NV	89503	4724	00	None	39.53124039	-119.8188498	Washoe County
265372	Fee-for-Service	1306403423	1306403423	1	1	LEWIS, BRITTANY B MD	8/23/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178773	None	None	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
265374	Fee-for-Service	1528024981	1528024981	1	1	LOUIS, ANNE A MD	10/31/1991	2084N0400X	NA	Neurology	026	PHYSICIANS	32064	13	Neurology (M.D. only)	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
265392	Fee-for-Service	1912999558	1912999558	1	1	LEE, LINDA H MD	4/19/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	184054	None	None	0	In state provider	None	2261 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3831	31	06061	38.74434897	-121.2413247	Placer County
265398	Fee-for-Service	1255447959	1255447959	1	1	LIM, BOON P MD	9/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	158566	41	Internal Medicine	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
265402	Fee-for-Service	1417907940	1417907940	1	23	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	1133 E STANLEY BLVD	SUITE 103	LIVERMORE	CA	94550	4270	01	06001	37.67914693	-121.7810206	Alameda County
265408	Fee-for-Service	1942458732	1942458732	1	1	LALITHA KAMESNARI DARBHA,MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7435 W TALCOTT AVE	None	CHICAGO	IL	60631	0000	00	None	41.98844808	-87.81251188	Cook County
265434	Fee-for-Service	1801818042	1801818042	1	1	LANGEE, HARVEY R JR MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56090	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
265439	Fee-for-Service	1114559739	1114559739	1	1	LA PATIENT CARE HOSPICE	9/15/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18570 SHERMAN WAY	STE 1	RESEDA	CA	91335	8639	19	06037	34.20101951	-118.538424	Los Angeles County
265466	Fee-for-Service	1811606536	1811606536	1	1	LEEB, GREGORY	7/31/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
265500	Fee-for-Service	1053377580	1053377580	1	1	LAI, STEVE R MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77926	38	Geriatrics	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
265506	Fee-for-Service	1235270836	1235270836	1	1	LAKIREDDY, VIKRAM MD	3/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106494	None	None	0	In state provider	None	388 E YOSEMITE AVENUE	STE 100	MERCED	CA	95340	8219	24	06047	37.33211447	-120.4641765	Merced County
265523	Fee-for-Service	1962448530	1962448530	1	1	LOWENBRAUN, NORMAN S	12/29/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	70729	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	173 N MORRISON AVE	STE D	SAN JOSE	CA	95126	2712	43	06085	37.33258801	-121.9084887	Santa Clara County
265533	Fee-for-Service	1710168372	1710168372	1	1	LEE, JAE-KYUNG	2/11/2008	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5842 E 2ND ST	None	LONG BEACH	CA	90803	5045	19	06037	33.75626418	-118.1203171	Los Angeles County
265541	Fee-for-Service	1194868232	1194868232	1	1	LAYTON, ESTHER O MD	8/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89869	05	Anesthesiology	0	In state provider	None	425 W JUNIPERO ST	STE 3	SANTA BARBARA	CA	93105	4294	42	06083	34.42973253	-119.7249544	Santa Barbara County
265546	Fee-for-Service	1821461492	1821461492	1	1	LOPEZ, YADIRA LMFT	6/3/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	150 N SANTA ANITA AVE	STE 300	ARCADIA	CA	91006	3116	19	06037	34.14186	-118.0314005	Los Angeles County
265548	Fee-for-Service	1144721416	1144721416	1	1	LO, PANHIA LMFT	7/8/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
265562	Fee-for-Service	1588190177	1588190177	1	1	LEE, JEAN Y MD	7/11/2024	2080P0214X	NA	Pulmonology	026	PHYSICIANS	173332	41	Internal Medicine	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
265658	Fee-for-Service	1417907940	1417907940	1	8	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1720 EL CAMINO REAL	SUITE 205	BURLINGAME	CA	94010	3226	41	06081	37.59341466	-122.381361	San Mateo County
265690	Fee-for-Service	1417907940	1417907940	1	23	LPCH MEDICAL GROUP DIV OF LU	6/10/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	1133 E STANLEY BLVD	SUITE 103	LIVERMORE	CA	94550	4270	01	06001	37.67914693	-121.7810206	Alameda County
265700	Fee-for-Service	1821001645	1821001645	1	1	LAU, KUEN CHINE OD	8/10/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	525 W MAIN ST	STE 2	EL CENTRO	CA	92243	7906	13	06025	32.79280049	-115.555473	Imperial County
265706	Fee-for-Service	1306889860	1306889860	1	1	LIU, STEPHEN KAO MD	7/1/2000	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	50939	30	Radiology	0	In state provider	None	1524 MCHENRY AVE	STE 100	MODESTO	CA	95350	4566	50	06099	37.666233	-120.993933	Stanislaus County
265755	Fee-for-Service	1346455938	1346455938	1	2	LUNDEBERG, JULIA LMFT	11/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
265760	Fee-for-Service	1851470611	1851470611	1	1	LI, TED MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	55348	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
265772	Fee-for-Service	1689774234	1689774234	1	1	LEAVITT, LISA A MD	2/21/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	80605	40	Pediatrics	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
265779	Fee-for-Service	1184682213	1184682213	1	1	LESSIN, MARC S MD	1/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	66405	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDREN PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
265836	Fee-for-Service	1326126806	1326126806	1	1	LI, ROBERT A MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53677	02	General Surgery	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
265865	Fee-for-Service	1588190177	1588190177	1	1	LEE, JEAN Y MD	7/11/2024	2080P0214X	NA	Pulmonology	026	PHYSICIANS	173332	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
265921	Fee-for-Service	1417907940	1417907940	1	11	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	5601 NORRIS CANYON ROAD	SUITE 230	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
265922	Fee-for-Service	1316981533	1316981533	1	1	LOCKSLEY, RICHARD M MD	3/31/1986	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	36241	77	Infectious Disease	0	In state provider	None	505 PARNASSUS AVE	# M997	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
265924	Fee-for-Service	1760946636	1760946636	1	1	LEGACY CARE HOME HEALTH INC	5/21/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1733 N PALM CANYON DR	SUITE C	PALM SPRINGS	CA	92262	2957	33	06065	33.845418	-116.546788	Riverside County
265927	Fee-for-Service	1336168616	1336168616	1	1	LEE, SONWOO MD	8/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78556	41	Internal Medicine	0	In state provider	None	200 MED PLAZA #365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
265928	Fee-for-Service	1831426642	1831426642	1	5	LAKESIDE MEDICAL	4/13/2010	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7345 MEDICAL CENTER DRIV	SUITE 500	WEST HILLS	CA	91307	1964	19	06037	34.20369349	-118.629837	Los Angeles County
265932	Fee-for-Service	1366687469	1366687469	1	1	LOVE, LESTER E	2/17/2017	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	70095	-	NOT APPLICABLE	0	In state provider	None	1055 W HENDERSON AVE	None	PORTERVILLE	CA	93257	1490	54	06107	36.08036906	-119.0410926	Tulare County
265943	Fee-for-Service	1417907940	1417907940	1	8	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1720 EL CAMINO REAL	SUITE 205	BURLINGAME	CA	94010	3226	41	06081	37.59341466	-122.381361	San Mateo County
265965	Fee-for-Service	1073264495	1073264495	1	1	LIU, KATHARINE CRNA	8/1/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
265975	Fee-for-Service	1417907940	1417907940	1	23	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1133 E STANLEY BLVD	SUITE 103	LIVERMORE	CA	94550	4270	01	06001	37.67914693	-121.7810206	Alameda County
265995	Fee-for-Service	1003132457	1003132457	1	1	LE, TUAN MD APC	8/31/2010	261Q00000X	NA	Other	026	PHYSICIANS	49909	41	Internal Medicine	0	In state provider	None	1569 LEXANN AVENUE	STE 122	SAN JOSE	CA	95121	1794	43	06085	37.30790568	-121.8141983	Santa Clara County
265999	Fee-for-Service	1316968571	1316968571	2	1	LUNA, EMMANUEL C MD	4/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	49643	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1500 S CENTRAL AVE	SUITE 321	GLENDALE	CA	91204	2581	19	06037	34.12736888	-118.257777	Los Angeles County
266002	Fee-for-Service	1952806523	1952806523	1	1	LAM, DANIEL J MD	7/22/2024	2080P0204X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
266005	Fee-for-Service	1265474084	1265474084	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11655 DUENDA RD	None	SAN DIEGO	CA	92127	1110	37	06073	33.03318967	-117.0792292	San Diego County
266032	Fee-for-Service	1578882833	1578882833	1	1	LORIAN HEALTH	2/7/2012	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7888 MISSION GROVE PKWY	SUITE 140	RIVERSIDE	CA	92508	5064	33	06065	33.90828955	-117.3269571	Riverside County
266035	Fee-for-Service	1598891368	1598891368	1	1	LEVIN, MICHELLE MD	2/12/2018	207RE0101X	NA	Endocrinology	026	PHYSICIANS	130179	67	Endocrinology	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
266050	Fee-for-Service	1275510927	1275510927	1	1	LE, DAVID Q OD	12/9/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1061 C ST	STE 140	GALT	CA	95632	1768	34	06067	38.25423	-121.2972705	Sacramento County
266067	Fee-for-Service	1326226002	1326226002	1	1	LIU, YUAN MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138703	24	Plastic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
266122	Fee-for-Service	1821393489	1821393489	1	4	LAGUNA HOME HEALTH SERVICES	12/28/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	24630 WASHINGTON AVE	STE 202 UNIT 109	MURRIETA	CA	92562	6177	33	06065	33.55565675	-117.2163131	Riverside County
266124	Fee-for-Service	1326126806	1326126806	1	1	LI, ROBERT A MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53677	66	Emergency Medicine (Urgent Care)	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
266144	Fee-for-Service	1831913292	1831913292	1	1	LANNY DAVID HAJDU, M.D. A ME	2/4/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	DICAL CORPORATION	8383 WILSHIRE BLVD	STE 800 OFFICE 889	BEVERLY HILLS	CA	90211	2440	19	06037	34.06457438	-118.3736146	Los Angeles County
266173	Fee-for-Service	1366607467	1366607467	1	1	LAM, LYDIA MD	5/6/2020	2086S0102X	NA	General Surgery	026	PHYSICIANS	85764	02	General Surgery	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
266174	Fee-for-Service	1184702292	1184702292	1	1	LUCAS, MICHAEL G DO	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	8090	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
266185	Fee-for-Service	1093742074	1093742074	1	1	LABORATORY DIAGNOSTICS	10/19/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	MEDICAL GROUP INC	9888 GENESEE AVE	LJ112	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
266191	Fee-for-Service	1659546596	1659546596	1	1	LU, LINDA C MD	3/4/2020	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	93691	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
266209	Fee-for-Service	1417907940	1417907940	1	11	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	5601 NORRIS CANYON ROAD	SUITE 230	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
266215	Fee-for-Service	1003964073	1003964073	1	1	LEVINE, DAVID M MD	12/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	50629	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
266223	Fee-for-Service	1598105611	1598105611	1	1	LEARNING TO COMMUNICATE	10/30/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	SPEECH THERAPY CORP	1921 N MANNING ST	None	BURBANK	CA	91505	1309	19	06037	34.18203248	-118.3585983	Los Angeles County
266225	Fee-for-Service	1336168616	1336168616	1	1	LEE, SONWOO MD	8/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78556	83	Rheumatology	0	In state provider	None	200 MED PLAZA #365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
266229	Fee-for-Service	1902961501	1902961501	1	1	LORBER, PETER MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	25377	13	Neurology (M.D. only)	0	In state provider	None	1245 WILSHIRE BLVD	STE 814	LOS ANGELES	CA	90017	4808	19	06037	34.05362775	-118.2661889	Los Angeles County
266231	Fee-for-Service	1417907940	1417907940	1	8	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	1720 EL CAMINO REAL	SUITE 205	BURLINGAME	CA	94010	3226	41	06081	37.59341466	-122.381361	San Mateo County
266250	Fee-for-Service	1497924377	1497924377	1	1	LIN, NAOMI K MD	3/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91445	13	Neurology (M.D. only)	0	In state provider	None	23430 HAWTHORNE BLVD	SUITE 105, BLG 3	TORRANCE	CA	90505	4777	19	06037	33.81316465	-118.3510077	Los Angeles County
266254	Fee-for-Service	1417032830	1417032830	1	1	LEE, ERNEST K MD	4/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88836	41	Internal Medicine	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
266261	Fee-for-Service	1417907940	1417907940	1	23	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	1133 E STANLEY BLVD	SUITE 103	LIVERMORE	CA	94550	4270	01	06001	37.67914693	-121.7810206	Alameda County
266286	Fee-for-Service	1629389853	1629389853	1	1	LESHIKAR, HOLLY B MD	5/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121112	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
266298	Fee-for-Service	1316992936	1316992936	1	1	LE, PHI-NGA MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	82140	40	Pediatrics	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
266301	Fee-for-Service	1811417553	1811417553	1	1	LUTHER, CHASE MD	1/27/2023	207P00000X	NA	Other	026	PHYSICIANS	180559	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
266313	Fee-for-Service	1154385938	1154385938	1	1	LEBOIT, PHILIP E MD	10/1/1995	207ZC0500X	NA	Other	026	PHYSICIANS	43513	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
266318	Fee-for-Service	1255526117	1255526117	1	1	LOCKLEAR, ERIN I LMFT	2/22/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
266333	Fee-for-Service	1396956694	1396956694	1	1	LEE, LISA MD	11/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112862	04	Otology, Laryngology, Rhinology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
266335	Fee-for-Service	1609306232	1609306232	1	1	LAGAFUAINA, KYM A NP	5/19/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4401 ATLANTIC AVE	STE 202	LONG BEACH	CA	90807	2252	19	06037	33.836976	-118.185096	Los Angeles County
266343	Fee-for-Service	1508091901	1508091901	1	1	LANGFORD, LARRY L LMFT	7/30/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	790 W SHAW AVE	STE 392	FRESNO	CA	93704	2303	10	06019	36.810441	-119.806416	Fresno County
266377	Fee-for-Service	1518908797	1518908797	1	1	LARRY L FONTANILLA, JR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	413 LILLY RD NE	None	OLYMPIA	WA	98506	5133	00	None	47.052801	-122.847462	Thurston County
266379	Fee-for-Service	1124155791	1124155791	1	1	LINDEMAN, KURTIS P MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	104052	36	Psychiatry	0	In state provider	None	617 E ALVARADO ST	None	FALLBROOK	CA	92028	2315	37	06073	33.38193948	-117.244989	San Diego County
266398	Fee-for-Service	1023247467	1023247467	1	1	LENEHAN. PATRICK J MD	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124959	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
266405	Fee-for-Service	1316913197	1316913197	1	1	LENNARD, COLLEEN M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	64328	04	Otology, Laryngology, Rhinology	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
266423	Fee-for-Service	1386611945	1386611945	1	1	LOW, JANICE S	2/1/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	55785	40	Pediatrics	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
266433	Fee-for-Service	1740361518	1740361518	1	1	LICATA, PAUL J MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	25662	08	Family Practice	0	In state provider	None	3356 W BALL RD	STE 109	ANAHEIM	CA	92804	3727	30	06059	33.81726453	-118.007451	Orange County
266440	Fee-for-Service	1255644845	1255644845	1	1	LATIF, MADIHA MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140054	83	Rheumatology	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
266478	Fee-for-Service	1710124573	1710124573	1	1	LAKE VISION OPTOMETRY	7/21/2009	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	25321 RAILROAD CANYON RD	SUITE 503	LAKE ELSINORE	CA	92532	2702	33	06065	33.66660166	-117.2650807	Riverside County
266497	Fee-for-Service	1417907940	1417907940	1	11	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	5601 NORRIS CANYON ROAD	SUITE 230	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
266507	Fee-for-Service	1366756892	1366756892	1	1	LO, EDWARD C MD	6/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134728	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
266516	Fee-for-Service	1396798484	1396798484	1	1	LERNER, LEONID E MD	6/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93312	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
266518	Fee-for-Service	1417907940	1417907940	1	8	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	1720 EL CAMINO REAL	SUITE 205	BURLINGAME	CA	94010	3226	41	06081	37.59341466	-122.381361	San Mateo County
266540	Fee-for-Service	1720104383	1720104383	1	1	LIN, HENRY MD	5/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106407	13	Neurology (M.D. only)	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
266543	Fee-for-Service	1780365098	1780365098	1	1	LIANG, GARRICK H CRNA	2/28/2025	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
266547	Fee-for-Service	1417907940	1417907940	1	23	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1133 E STANLEY BLVD	SUITE 103	LIVERMORE	CA	94550	4270	01	06001	37.67914693	-121.7810206	Alameda County
266566	Fee-for-Service	1942243795	1942243795	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	388 ELM AVE	None	AUBURN	CA	95603	4525	31	06061	38.90386468	-121.0746557	Placer County
266583	Fee-for-Service	1316992936	1316992936	1	1	LE, PHI-NGA MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	82140	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
266601	Fee-for-Service	1154385938	1154385938	1	1	LEBOIT, PHILIP E MD	10/1/1995	207ZC0500X	NA	Other	026	PHYSICIANS	43513	90	Pathology-Forensic	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
266624	Fee-for-Service	1679516405	1679516405	2	1	LONGS DRUG STORE CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	29412 AUBERRY RD	None	PRATHER	CA	93651	9719	10	06019	37.03843173	-119.5168292	Fresno County
266646	Fee-for-Service	1114330156	1114330156	1	1	LIAGHAT, ARASH J MD	8/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141641	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
266647	Fee-for-Service	1992994792	1992994792	1	1	LEE, HERBERT H MD MPH INC	5/18/2010	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	41465	10	Gastroenterology (M.D. only)	0	In state provider	None	113 WATERWORKS WAY	SUITE 315A	IRVINE	CA	92618	3174	30	06059	33.66497942	-117.7635578	Orange County
266655	Fee-for-Service	1609257864	1609257864	1	1	LEE, JAIMIE K MD	8/4/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	159233	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
266662	Fee-for-Service	1124155791	1124155791	1	1	LINDEMAN, KURTIS P MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	104052	08	Family Practice	0	In state provider	None	617 E ALVARADO ST	None	FALLBROOK	CA	92028	2315	37	06073	33.38193948	-117.244989	San Diego County
266675	Fee-for-Service	1477826683	1477826683	1	1	LEE, KELLEY B NP	12/6/2022	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
266719	Fee-for-Service	1669930533	1669930533	1	1	LA CASA HEALTH SERVICES INC	12/24/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	18321 VENTURA BLVD	SUITE 777	TARZANA	CA	91356	6440	19	06037	34.16710334	-118.5318618	Los Angeles County
266742	Fee-for-Service	1982629788	1982629788	1	1	LARRY REAVES	11/19/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
266747	Fee-for-Service	1063421410	1063421410	1	1	LAM, MICHAEL MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	38697	05	Anesthesiology	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
266750	Fee-for-Service	1154828465	1154828465	1	1	LA PENNA, JOSEPH T MD	10/31/2023	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	186935	None	None	0	In state provider	None	500 DOYLE PARK DR	STE 300	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
266767	Fee-for-Service	1720065121	1720065121	1	1	LOUSSARARIAN, ARTHUR MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	75082	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	24411 HEALTH CENTER DR	STE 550	LAGUNA HILLS	CA	92653	3687	30	06059	33.6087201	-117.7076948	Orange County
266775	Fee-for-Service	1538210182	1538210182	1	1	LUM, STEPHEN W OD	10/11/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1200 HIGHLAND AVE	None	NATIONAL CITY	CA	91950	3541	37	06073	32.67530709	-117.0977171	San Diego County
266779	Fee-for-Service	1417907940	1417907940	1	11	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	5601 NORRIS CANYON ROAD	SUITE 230	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
266800	Fee-for-Service	1396798484	1396798484	1	1	LERNER, LEONID E MD	6/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93312	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
266801	Fee-for-Service	1417907940	1417907940	1	8	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	1720 EL CAMINO REAL	SUITE 205	BURLINGAME	CA	94010	3226	41	06081	37.59341466	-122.381361	San Mateo County
266824	Fee-for-Service	1225022502	1225022502	1	1	LOTZOF, PIERRE R MD	7/3/1997	207L00000X	NA	Other	026	PHYSICIANS	50304	05	Anesthesiology	0	In state provider	None	230 E 4TH AVE	STE 100	ESCONDIDO	CA	92025	4946	37	06073	33.11993027	-117.0775662	San Diego County
266839	Fee-for-Service	1518650951	1518650951	1	1	LY, SPENCER OT	1/21/2025	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1561 ONTARIO	SUITE 101	CORONA	CA	92881	6662	33	06065	33.84257433	-117.5332788	Riverside County
266886	Fee-for-Service	1154385938	1154385938	1	1	LEBOIT, PHILIP E MD	10/1/1995	207ZC0500X	NA	Other	026	PHYSICIANS	43513	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
266902	Fee-for-Service	1376683052	1376683052	1	1	LABOVITZ, JONATHAN M DPM	1/19/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	309 E SECOND STREET	None	POMONA	CA	91766	1854	19	06037	34.05789396	-117.7476284	Los Angeles County
266909	Fee-for-Service	1467651877	1467651877	1	1	LUYIMBAZI, DAVID T MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120509	02	General Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
266952	Fee-for-Service	1366844862	1366844862	1	1	LUTHRA, NAVIN G MD	3/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133401	01	General Practice	0	In state provider	None	276 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
266953	Fee-for-Service	1417372897	1417372897	1	1	LEOS-GOMEZ, ANNEMARIE H LMFT	7/7/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
266959	Fee-for-Service	1164616702	1164616702	1	1	LINDEKEN, CHRISTOPHER M DO	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	10968	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11795 EDUCATION ST	STE 222	AUBURN	CA	95602	2469	31	06061	38.94433757	-121.098912	Placer County
266980	Fee-for-Service	1023618394	1023618394	1	1	LEE, KATHRINE NP	11/6/2020	363LN0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
266995	Fee-for-Service	1356753420	1356753420	1	2	LAAKSO, JEANETTE	12/15/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4211 B VALLEY VIEW AVE	None	NORCO	CA	92860	3502	33	06065	33.943446	-117.5498725	Riverside County
267032	Fee-for-Service	1114064367	1114064367	1	1	LEE-KOIDA, JANE OD	1/30/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
267037	Fee-for-Service	1366554289	1366554289	1	1	LOS OSOS RX DRUG STORE	3/9/1979	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	989 LOS OSOS VALLEY RD	None	LOS OSOS	CA	93402	3205	40	06079	35.31135164	-120.8338318	San Luis Obispo County
267042	Fee-for-Service	1902343361	1902343361	1	1	LEE, ENRIQUE CRNA	4/27/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
267063	Fee-for-Service	1417907940	1417907940	1	11	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	5601 NORRIS CANYON ROAD	SUITE 230	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
267070	Fee-for-Service	1982658407	1982658407	1	1	LEE MEMORIAL HEALTH SYSTEM	7/17/2017	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	13681 DOCTORS WAY	None	FORT MEYERS	FL	33912	4309	00	None	26.543916	-81.8501085	Lee County
267076	Fee-for-Service	1992056394	1992056394	1	1	LINDSAY-VASQUEZ, SUZANNE LM	3/15/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	1351 GEER RD	#107	TURLOCK	CA	95380	3269	50	06099	37.50571084	-120.8489913	Stanislaus County
267084	Fee-for-Service	1922258169	1922258169	1	1	LU, TIMOTHY T MD	5/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	95442	10	Gastroenterology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
267087	Fee-for-Service	1417907940	1417907940	1	8	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1720 EL CAMINO REAL	SUITE 205	BURLINGAME	CA	94010	3226	41	06081	37.59341466	-122.381361	San Mateo County
267108	Fee-for-Service	1023594892	1023594892	1	1	LEON, KIMBERLIN B LCSW	3/1/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
267110	Fee-for-Service	1063560001	1063560001	1	1	LU, JELYN W MD	5/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96481	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
267112	Fee-for-Service	1609106459	1609106459	1	1	LIU, TONY T DO	4/11/2018	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	12147	None	None	0	In state provider	None	830 S CITRUS AVE	SUITE 201	AZUSA	CA	91702	5942	19	06037	34.108074	-117.8902345	Los Angeles County
267153	Fee-for-Service	1205130036	1205130036	1	1	LIN, SHINKO MD	9/21/2023	207NS0135X	NA	Dermatology	026	PHYSICIANS	120354	None	None	0	In state provider	None	655 EUCLID AVE	SUITE 304	NATIONAL CITY	CA	91950	2978	37	06073	32.68353398	-117.082625	San Diego County
267169	Fee-for-Service	1992928733	1992928733	1	1	LEHMAN, LAWRENCE G PHD	4/7/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
267198	Fee-for-Service	1881985802	1881985802	1	1	LANGE, CHARLES E MD	8/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1775 THOMPSON ROAD	None	COOS BAY	OR	97420	2125	00	None	43.383456	-124.2330435	Coos County
267240	Fee-for-Service	1659735835	1659735835	1	1	LY, HUY Q MD	6/15/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	168363	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
267244	Fee-for-Service	1134371263	1134371263	1	1	LYONS, CHRISTOPHER MD	7/12/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
267259	Fee-for-Service	1992892962	1992892962	1	1	LANDA, HOWARD M MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	57063	34	Urology and Urological Surgery	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
267303	Fee-for-Service	1164658175	1164658175	1	1	LEE, LUIS MD	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118923	08	Family Practice	0	In state provider	None	5320 CARRINGTON CIRCLE	None	STOCKTON	CA	95210	3515	39	06077	38.00512188	-121.2937141	San Joaquin County
267339	Fee-for-Service	1134475023	1134475023	1	1	LEE, JESSIE K OD	9/20/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	350 N WIGET LANE	SUITE 200	WALNUT CREEK	CA	94598	3058	07	06013	37.92948925	-122.0275099	Contra Costa County
267346	Fee-for-Service	1417907940	1417907940	1	11	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	5601 NORRIS CANYON ROAD	SUITE 230	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
267351	Fee-for-Service	1982658407	1982658407	1	1	LEE MEMORIAL HEALTH SYSTEM	7/17/2017	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	13681 DOCTORS WAY	None	FORT MEYERS	FL	33912	4309	00	None	26.543916	-81.8501085	Lee County
267355	Fee-for-Service	1518902329	1518902329	1	2	LOS ALAMITOS IMAGING CENTER	11/20/2019	261QM1200X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER	3771 KATELLA AVE	SUITE 101	LOS ALAMITOS	CA	90720	3108	30	06059	33.80319153	-118.067274	Orange County
267363	Fee-for-Service	1265772537	1265772537	1	1	LEE, GEMAYEL A MD	10/3/2018	207LP2900X	NA	Other	026	PHYSICIANS	129129	05	Anesthesiology	0	In state provider	None	8901 ACTIVITY RD	100	SAN DIEGO	CA	92126	4432	37	06073	32.8960193	-117.1345934	San Diego County
267366	Fee-for-Service	1619936481	1619936481	1	1	LEHMANN, MARK M OD	4/27/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2074 LAKE TAHOE BLVD	STE 2	SOUTH LAKE TAHOE	CA	96150	6408	09	06017	38.91488542	-120.0019087	El Dorado County
267368	Fee-for-Service	1437292109	1437292109	1	1	LINK, JOSEPH L MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	42410	08	Family Practice	0	In state provider	None	6620 COYLE AVE	STE 310	CARMICHAEL	CA	95608	6337	34	06067	38.66751	-121.310028	Sacramento County
267369	Fee-for-Service	1417907940	1417907940	1	8	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	1720 EL CAMINO REAL	SUITE 205	BURLINGAME	CA	94010	3226	41	06081	37.59341466	-122.381361	San Mateo County
267383	Fee-for-Service	1912160383	1912160383	1	1	LATHAM, REBEKAH E DO	7/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12146	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
267396	Fee-for-Service	1174954366	1174954366	1	1	LANGAS, NEILVON B PT	6/20/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
267421	Fee-for-Service	1417907940	1417907940	1	25	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	282NC2000X	NA	Hospitals	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6121 HOLLIS STREET	SUITE 2	EMERYVILLE	CA	94608	2077	01	06001	37.84254056	-122.2901636	Alameda County
267434	Fee-for-Service	1467738229	1467738229	1	1	LOS ANGELES CENTERS FOR	8/30/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	ALCOHOL AND DRUG ABUSE	5777 LOCKHEED AVENUE	CLASSROOM 3	WHITTIER	CA	90606	1030	19	06037	33.99534358	-118.0647237	Los Angeles County
267517	Fee-for-Service	1992476550	1992476550	1	1	LEE, ALEXANDRA PT	2/9/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
267520	Fee-for-Service	1992228332	1992228332	1	1	LIU, YING MD	8/19/2024	207ZP0102X	NA	Other	026	PHYSICIANS	166478	22	Pathology (M.D. only)	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
267522	Fee-for-Service	1679816763	1679816763	1	1	LINGAD, MA JESUSA D MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142843	01	General Practice	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
267529	Fee-for-Service	1487709283	1487709283	1	1	LANGHAM, MARGARET A NP	5/30/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
267551	Fee-for-Service	1588607337	1588607337	2	1	LONGS DRUG STORES CA LLC	11/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	790 JAMACHA RD	None	EL CAJON	CA	92019	3201	37	06073	32.785695	-116.927956	San Diego County
267558	Fee-for-Service	1679002158	1679002158	1	1	LIN, SOPHIA D MD	9/6/2022	207L00000X	NA	Other	026	PHYSICIANS	173502	None	None	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
267564	Fee-for-Service	1013011345	1013011345	1	1	LOS ANGELES ORTHOPEDIC CENTE	8/21/2020	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ER	1245 WILSHIRE BLVD.	SUITE 400	LOS ANGELES	CA	90017	4814	19	06037	34.05362775	-118.2661889	Los Angeles County
267613	Fee-for-Service	1669502928	1669502928	1	1	LEMERT, REBECCA G LMFT	4/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
267627	Fee-for-Service	1962658344	1962658344	1	1	LOK, WARREN MD	1/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113540	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
267630	Fee-for-Service	1588690051	1588690051	1	1	LOUBE, DANIEL I MD	11/12/2010	207RP1001X	NA	Pulmonology	026	PHYSICIANS	78695	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
267634	Fee-for-Service	1417907940	1417907940	1	11	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	5601 NORRIS CANYON ROAD	SUITE 230	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
267651	Fee-for-Service	1417907940	1417907940	1	8	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	1720 EL CAMINO REAL	SUITE 205	BURLINGAME	CA	94010	3226	41	06081	37.59341466	-122.381361	San Mateo County
267664	Fee-for-Service	1902839863	1902839863	1	1	LAMPE, GREGORY W MD	12/31/1995	207P00000X	NA	Other	026	PHYSICIANS	55812	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
267671	Fee-for-Service	1184624025	1184624025	1	1	LOWE, ADAM B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 S DOBSON RD	BLDG A	CHANDLER	AZ	85224	5678	00	None	33.296121	-111.876705	Maricopa County
267679	Fee-for-Service	1235245275	1235245275	1	2	LA CLINICA DE LA RAZA	4/15/2013	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	16335 E 14TH ST	None	SAN LEANDRO	CA	94578	2322	01	06001	37.69576198	-122.1150647	Alameda County
267703	Fee-for-Service	1417907940	1417907940	1	25	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	282NC2000X	NA	Hospitals	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	6121 HOLLIS STREET	SUITE 2	EMERYVILLE	CA	94608	2077	01	06001	37.84254056	-122.2901636	Alameda County
267717	Fee-for-Service	1215416391	1215416391	1	1	LEWIS, SAMANTHA LMFT	1/19/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	413 W SAMPLE AVE	None	CLOVIS	CA	93612	1857	10	06019	36.82795999	-119.7190781	Fresno County
267724	Fee-for-Service	1952548612	1952548612	1	1	LEMOINE, MARSHALL R	4/12/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
267741	Fee-for-Service	1942500731	1942500731	1	1	LINNEA KRISTIN COOPER ARNP	4/4/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1415 E KINCAID ST	None	MOUNT VERNON	WA	98274	4126	00	None	48.41748257	-122.3241732	Skagit County
267768	Fee-for-Service	1720632862	1720632862	1	1	LEHTONEN, PAMELA LMFT	1/24/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17777 VENTURA BLVD	STE 105	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
267772	Fee-for-Service	1245849116	1245849116	1	1	LANDYMORE, ERICA L LMFT	6/7/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
267792	Fee-for-Service	1003028416	1003028416	1	1	LE, CRYSTAL N MD	6/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97634	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
267824	Fee-for-Service	1366467375	1366467375	1	1	LONG VALLEY HEALTH CTR	3/1/1994	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	PO BOX 870	50 BRANSCOMB RD	None	LAYTONVILLE	CA	95454	0870	23	06045	39.68781544	-123.4842982	Mendocino County
267912	Fee-for-Service	1588690051	1588690051	1	1	LOUBE, DANIEL I MD	11/12/2010	207RP1001X	NA	Pulmonology	026	PHYSICIANS	78695	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
267915	Fee-for-Service	1417907940	1417907940	1	11	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	5601 NORRIS CANYON ROAD	SUITE 230	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
267921	Fee-for-Service	1992919377	1992919377	1	1	LEE, KRISTINE L MD	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98784	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
267923	Fee-for-Service	1699198564	1699198564	1	2	LE, CAROLYN D MD	12/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140160	01	General Practice	0	In state provider	None	3100 TELEGRAPH AVE	STE 2102	OAKLAND	CA	94609	3210	01	06001	37.82037533	-122.2667839	Alameda County
267929	Fee-for-Service	1235155268	1235155268	1	1	LINDSAY, MICHAEL A PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4036 3RD AVE	None	SAN DIEGO	CA	92103	2102	37	06073	32.75065277	-117.1627724	San Diego County
267943	Fee-for-Service	1851326557	1851326557	1	1	LIN, DAVID S MD	5/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91627	30	Radiology	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
267962	Fee-for-Service	1306873070	1306873070	1	1	LITTEN, DANIEL MD	10/16/2012	174400000X	NA	Other	026	PHYSICIANS	85333	41	Internal Medicine	0	In state provider	None	351 S PATTERSON AVE	None	SANTA BARBARA	CA	93111	2403	42	06083	34.43295562	-119.8098287	Santa Barbara County
267963	Fee-for-Service	1235245275	1235245275	1	2	LA CLINICA DE LA RAZA	4/15/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	16335 E 14TH ST	None	SAN LEANDRO	CA	94578	2322	01	06001	37.69576198	-122.1150647	Alameda County
267972	Fee-for-Service	1265796437	1265796437	1	1	LEE, JASON S MD	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144215	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
267987	Fee-for-Service	1417907940	1417907940	1	25	LPCH MEDICAL GROUP DIV OF LU	11/17/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	None	6121 HOLLIS STREET	SUITE 2	EMERYVILLE	CA	94608	2077	01	06001	37.84254056	-122.2901636	Alameda County
268003	Fee-for-Service	1912224809	1912224809	1	1	LIN, CHRISTINE F MD	4/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119337	18	Ophthalmology	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
268016	Fee-for-Service	1386699635	1386699635	1	1	LIPTON,BRAIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3815 E BELL RD STE 2200	None	PHOENIX	AZ	85032	0000	00	None	33.638571	-111.9990015	Maricopa County
268023	Fee-for-Service	1457887606	1457887606	1	1	LEE, YURHEE MD	10/23/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	161799	41	Internal Medicine	0	In state provider	None	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	42	06083	34.42739162	-119.7253175	Santa Barbara County
268034	Fee-for-Service	1912393463	1912393463	1	1	LEMIEUX, LAUREN M MD	5/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148283	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
268042	Fee-for-Service	1821480542	1821480542	1	1	LBJ HEALTHCARE PARTNERS INC	2/2/2016	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	13749 CREWE ST	None	WHITTIER	CA	90605	4008	19	06037	33.92269451	-118.038321	Los Angeles County
268108	Fee-for-Service	1366467375	1366467375	1	1	LONG VALLEY HEALTH CTR	3/1/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	PO BOX 870	50 BRANSCOMB RD	None	LAYTONVILLE	CA	95454	0870	23	06045	39.68781544	-123.4842982	Mendocino County
268109	Fee-for-Service	1265494223	1265494223	1	1	LE, THANG Q MD	2/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	71456	05	Anesthesiology	0	In state provider	None	28062 BAXTER ROAD	None	MURRIETA	CA	92563	1400	33	06065	33.61350847	-117.1691225	Riverside County
268136	Fee-for-Service	1457437980	1457437980	1	1	LO, JOAN C MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	83200	67	Endocrinology	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
268160	Fee-for-Service	1730235334	1730235334	1	1	LEUNG, ROXANNE S MD	5/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103378	03	Allergy	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
268196	Fee-for-Service	1588690051	1588690051	1	1	LOUBE, DANIEL I MD	11/12/2010	207RP1001X	NA	Pulmonology	026	PHYSICIANS	78695	41	Internal Medicine	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
268204	Fee-for-Service	1518561919	1518561919	1	1	LUCAS HOSPICE INC	4/21/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	440 HUNTINGTON DR	SUITE 300	ARCADIA	CA	91006	3775	19	06037	34.14014147	-118.0220265	Los Angeles County
268222	Fee-for-Service	1003998030	1003998030	1	1	LEE, PETER L MD	11/27/1985	261QP2300X	NA	Other	026	PHYSICIANS	37381	41	Internal Medicine	0	In state provider	None	3801 SACRAMENTO ST	FL 3	SAN FRANCISCO	CA	94118	1625	38	06075	37.78707021	-122.4555217	San Francisco County
268226	Fee-for-Service	1811051246	1811051246	1	1	LEIBOVITCH, ERIC R MD	2/28/1996	207R00000X	NA	Other	026	PHYSICIANS	7762	None	None	0	In state provider	VENTURA COUNTY MED CTR	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
268243	Fee-for-Service	1043674096	1043674096	1	1	LANEY, JEREMY V MD	8/2/2021	207L00000X	NA	Other	026	PHYSICIANS	151991	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
268268	Fee-for-Service	1689659955	1689659955	1	1	LAI, WYMAN W MD	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	61378	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
268292	Fee-for-Service	1417907940	1417907940	1	25	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	282NC2000X	NA	Hospitals	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6121 HOLLIS STREET	SUITE 2	EMERYVILLE	CA	94608	2077	01	06001	37.84254056	-122.2901636	Alameda County
268308	Fee-for-Service	1457887606	1457887606	1	1	LEE, YURHEE MD	10/23/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	161799	68	Hematology	0	In state provider	None	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	42	06083	34.42739162	-119.7253175	Santa Barbara County
268320	Fee-for-Service	1750916789	1750916789	1	1	LLOYD, ROSEMARY PSYD	12/9/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
268341	Fee-for-Service	1023008075	1023008075	1	1	LIGHTFOOT, DAN R MD	1/22/1987	207W00000X	NA	Ophthalmology	026	PHYSICIANS	32243	18	Ophthalmology	0	In state provider	None	1120 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4815	49	06097	38.442708	-122.7009465	Sonoma County
268343	Fee-for-Service	1700854288	1700854288	1	1	LAMB HEALTH CENTER	8/29/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 S SUNSET AVE	None	LITTLEFIELD	TX	79339	4899	00	None	33.91175948	-102.3454369	Lamb County
268347	Fee-for-Service	1992908552	1992908552	1	1	LAURA K NASON MD	8/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1101 MADISON ST	STE 310	SEATTLE	WA	98104	1306	00	None	47.60953436	-122.3245882	King County
268361	Fee-for-Service	1497722292	1497722292	1	1	LANG, DEBORAH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	75 BEEKMAN ST	None	PLATTSBURGH	NY	12901	1438	00	None	44.701011	-73.4692635	Clinton County
268385	Fee-for-Service	1619537511	1619537511	1	1	LIU, JASON R MD	5/8/2024	2085R0001X	NA	Other	026	PHYSICIANS	176551	30	Radiology	0	In state provider	None	209 FAIR OAKS AVE	None	SOUTH PASADENA	CA	91030	1814	19	06037	34.12341	-118.1503065	Los Angeles County
268392	Fee-for-Service	1366467375	1366467375	1	1	LONG VALLEY HEALTH CTR	7/1/1994	261Q00000X	NA	Other	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	PO BOX 870	50 BRANSCOMB RD	None	LAYTONVILLE	CA	95454	0870	23	06045	39.68781544	-123.4842982	Mendocino County
268427	Fee-for-Service	1932528841	1932528841	1	1	LEE, GENE W MD	8/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154443	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
268432	Fee-for-Service	1649315193	1649315193	1	1	LWIN, WAI W MD	11/27/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53369	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
268438	Fee-for-Service	1417930140	1417930140	1	1	LEWINSKY, BERNARD S MD	5/20/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	23754	78	Neoplastic Diseases/Oncology	0	In state provider	None	1338 S HOPE ST	None	LOS ANGELES	CA	90015	2902	19	06037	34.03778533	-118.2667518	Los Angeles County
268450	Fee-for-Service	1184007874	1184007874	1	1	LEE KIT, CANDICE MD	3/15/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	154707	None	None	0	In state provider	None	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	19	06037	34.06704253	-118.3835029	Los Angeles County
268475	Fee-for-Service	1659566875	1659566875	1	1	LIVHITS, MASHA J MD	4/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	103993	67	Endocrinology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
268486	Fee-for-Service	1518561919	1518561919	1	1	LUCAS HOSPICE INC	4/21/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	440 HUNTINGTON DR	SUITE 300	ARCADIA	CA	91006	3775	19	06037	34.14014147	-118.0220265	Los Angeles County
268496	Fee-for-Service	1811550940	1811550940	1	1	LANG, PETER C DO	8/15/2023	207QA0401X	NA	Adult Primary Care	026	PHYSICIANS	20431	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
268511	Fee-for-Service	1679898175	1679898175	1	1	LEDGERWOOD, AMY L MD	6/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139586	36	Psychiatry	0	In state provider	None	1207 FAIRCHILD COURT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
268536	Fee-for-Service	1043473390	1043473390	1	1	LAKEWOOD EYE PHYSICIANS AND	3/30/2009	261QA1903X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	SURGEONS INC A MEDICAL	3300 E SOUTH ST	STE 107	LONG BEACH	CA	90805	4550	19	06037	33.86018093	-118.1537163	Los Angeles County
268538	Fee-for-Service	1114412608	1114412608	1	1	LIS, CLAIRE A MD	4/18/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	165329	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
268551	Fee-for-Service	1417907940	1417907940	1	25	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	282NC2000X	NA	Hospitals	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6121 HOLLIS STREET	SUITE 2	EMERYVILLE	CA	94608	2077	01	06001	37.84254056	-122.2901636	Alameda County
268556	Fee-for-Service	1750391231	1750391231	1	1	LOPEZ, ANN MD	3/31/1995	207W00000X	NA	Ophthalmology	026	PHYSICIANS	54323	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
268561	Fee-for-Service	1689659955	1689659955	1	1	LAI, WYMAN W MD	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	61378	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
268596	Fee-for-Service	1487882502	1487882502	1	1	LAM, BERNIE S L OD	5/11/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3300 E SOUTH ST	STE 105	LONG BEACH	CA	90805	4579	19	06037	33.86018093	-118.1537163	Los Angeles County
268610	Fee-for-Service	1104073550	1104073550	1	1	LAVINGHOUSEZ, PRESTON D MD	6/1/2023	2080P0203X	NA	Other	026	PHYSICIANS	102897	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
268675	Fee-for-Service	1366467375	1366467375	1	1	LONG VALLEY HEALTH CTR	3/1/1994	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	PO BOX 870	50 BRANSCOMB RD	None	LAYTONVILLE	CA	95454	0870	23	06045	39.68781544	-123.4842982	Mendocino County
268683	Fee-for-Service	1669768511	1669768511	1	1	LAU, JONATHAN T MD	2/7/2018	207P00000X	NA	Other	026	PHYSICIANS	122262	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
268695	Fee-for-Service	1982806170	1982806170	1	1	LEUNG, JENNIFER K MD	10/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131507	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
268699	Fee-for-Service	1699099242	1699099242	1	1	LIBBY, BRANDON MD	5/5/2023	207P00000X	NA	Other	026	PHYSICIANS	166621	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
268724	Fee-for-Service	1417930140	1417930140	1	1	LEWINSKY, BERNARD S MD	5/20/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	23754	30	Radiology	0	In state provider	None	1338 S HOPE ST	None	LOS ANGELES	CA	90015	2902	19	06037	34.03778533	-118.2667518	Los Angeles County
268747	Fee-for-Service	1417016155	1417016155	1	1	LAGUNDA, JOSE E MD	12/1/2002	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	51020	40	Pediatrics	0	In state provider	None	501 N BRIDGE ST	None	VISALIA	CA	93291	5014	54	06107	36.334107	-119.289186	Tulare County
268751	Fee-for-Service	1659566875	1659566875	1	1	LIVHITS, MASHA J MD	4/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	103993	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	SUITE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
268782	Fee-for-Service	1760579684	1760579684	1	1	LAWSON, MICHAEL R MD	6/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130599	41	Internal Medicine	0	In state provider	None	23625 WR HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
268792	Fee-for-Service	1437218260	1437218260	1	1	LANGFORD, LEIGH-ANN CRNA	1/22/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
268833	Fee-for-Service	1417907940	1417907940	1	25	LPCH MEDICAL GROUP DIV OF LU	11/17/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	6121 HOLLIS STREET	SUITE 2	EMERYVILLE	CA	94608	2077	01	06001	37.84254056	-122.2901636	Alameda County
268850	Fee-for-Service	1992726095	1992726095	1	1	LOVGREN-MORITZ, ARTHUR	12/10/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	73095	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
268868	Fee-for-Service	1265799530	1265799530	1	1	LI, XIAODONG CA	5/17/2018	390200000X	NA	Other	026	PHYSICIANS	None	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
268877	Fee-for-Service	1326663063	1326663063	1	1	LOYAL CARE AT HOME INC	5/27/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14546 HAMLIN ST	UNIT 150B	VAN NUYS	CA	91411	1629	19	06037	34.18866762	-118.4504031	Los Angeles County
268884	Fee-for-Service	1588007694	1588007694	1	1	LEE, CHARLIE C MD	8/16/2018	207K00000X	NA	Other	026	PHYSICIANS	153931	03	Allergy	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
268890	Fee-for-Service	1497754915	1497754915	1	1	LAWRENCE, ERIC U DPM	12/12/2019	213ES0131X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	12520 MAGNOLIA BLVD	#304	VALLEY VILLAGE	CA	91607	2355	19	06037	34.16485451	-118.406106	Los Angeles County
268930	Fee-for-Service	1922635960	1922635960	1	1	LAU, AMBER S DO	12/11/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20927	08	Family Practice	0	In state provider	None	3160 FOLSOM BLVD.	STE 1400	SACRAMENTO	CA	91816	5219	34	06067	38.568393	-121.4658585	Sacramento County
268932	Fee-for-Service	1811948094	1811948094	1	1	LESHCHINSKY, FELIX MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 17TH AVE	None	SEATTLE	WA	98122	5711	00	None	47.60689769	-122.3102467	King County
268971	Fee-for-Service	1689848848	1689848848	1	1	LIN, HENGLI MD	9/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102623	24	Plastic Surgery	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
268983	Fee-for-Service	1265816698	1265816698	1	1	LIU, ERIC MD	9/21/2020	207RR0500X	NA	Other	026	PHYSICIANS	155853	83	Rheumatology	0	In state provider	None	9675 BRIGHTON WAY	SUITE 100	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
268996	Fee-for-Service	1164510319	1164510319	1	1	LANDRUM, GEORGIA W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4729 E UNION HILLS DR	STE 111	PHOENIX	AZ	85050	3390	00	None	33.654672	-111.9804165	Maricopa County
269017	Fee-for-Service	1366896441	1366896441	1	1	LANDEFELD, JOHN C MD	10/1/2019	207R00000X	NA	Other	026	PHYSICIANS	153938	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
269026	Fee-for-Service	1104036128	1104036128	1	1	LISTON, SEAN M MD	7/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103802	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
269027	Fee-for-Service	1083024681	1083024681	1	1	LEDON, JENNIFER MD	8/13/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	155843	07	Dermatology	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
269043	Fee-for-Service	1932253077	1932253077	1	1	LAMPLAND, SARAH K LCSW	4/1/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PARKWAY	SUITE 370	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
269045	Fee-for-Service	1679916563	1679916563	1	1	LIM, MICHELLE K DO	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13727	01	General Practice	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
269061	Fee-for-Service	1265817605	1265817605	1	1	LOC, CHARLES C DPM	5/16/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
269064	Fee-for-Service	1518092683	1518092683	1	1	LIN, TED K MD	4/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92386	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
269074	Fee-for-Service	1932553377	1932553377	1	1	LYUBASYUK, VERA	11/13/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	153263	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
269088	Fee-for-Service	1366037632	1366037632	1	1	LOPEZ, ERIC A	9/29/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	740 S PLACENTIA AVE	STE 100	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
269094	Fee-for-Service	1699229484	1699229484	1	1	LONG BEACH CORNER CLINIC INC	5/15/2017	207R00000X	NA	Other	026	PHYSICIANS	34669	41	Internal Medicine	0	In state provider	None	1936 E ANAHEIM ST	None	LONG BEACH	CA	90813	3908	19	06037	33.78258554	-118.167831	Los Angeles County
269108	Fee-for-Service	1780238915	1780238915	1	1	LATTA, ANDREW B PT	7/26/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	735 W CHANNEL ISLANDS BL	None	PORT HUENEME	CA	93041	2130	56	06111	34.17613483	-119.2199788	Ventura County
269110	Fee-for-Service	1154386399	1154386399	1	1	LIMONADI, FARHAD M MD	4/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	92257	14	Neurological Surgery	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
269117	Fee-for-Service	1417907940	1417907940	1	25	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	282NC2000X	NA	Hospitals	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6121 HOLLIS STREET	SUITE 2	EMERYVILLE	CA	94608	2077	01	06001	37.84254056	-122.2901636	Alameda County
269130	Fee-for-Service	1699937250	1699937250	1	1	LEVY, MICHAEL MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112901	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
269133	Fee-for-Service	1992726095	1992726095	1	1	LOVGREN-MORITZ, ARTHUR	12/10/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	73095	41	Internal Medicine	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
269166	Fee-for-Service	1689210338	1689210338	1	1	LEE, MINA	11/7/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2315 CONEJO LANE	None	FULLERTON	CA	92833	1536	30	06059	33.89095698	-117.9666688	Orange County
269195	Fee-for-Service	1548595580	1548595580	1	1	LAU, KAREN K L MD	12/15/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	109171	08	Family Practice	0	In state provider	None	1310 W STEWART DR	STE 410	ORANGE	CA	92868	3855	30	06059	33.78236048	-117.8664975	Orange County
269206	Fee-for-Service	1205008588	1205008588	1	1	LEPERA, MICHAEL S	7/19/2021	207R00000X	NA	Other	026	PHYSICIANS	55520	None	None	0	In state provider	None	8648 WOODMAN AVE	106	ARLETA	CA	91331	6503	19	06037	34.22767939	-118.4340728	Los Angeles County
269219	Fee-for-Service	1548393747	1548393747	1	1	LIU, BENNY MD	3/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55306	None	None	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
269262	Fee-for-Service	1265816698	1265816698	1	1	LIU, ERIC MD	9/21/2020	207RR0500X	NA	Other	026	PHYSICIANS	155853	41	Internal Medicine	0	In state provider	None	9675 BRIGHTON WAY	SUITE 100	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
269275	Fee-for-Service	1366866345	1366866345	1	1	LOMA LINDA UNIVERSITY	11/21/2014	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CHILDREN'S HOSPITAL	11234 ANDERSON ST	SUITE A	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
269285	Fee-for-Service	1255408274	1255408274	1	1	LOO, DANA K MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78928	41	Internal Medicine	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
269297	Fee-for-Service	1588699656	1588699656	1	1	LARSON, CHRISTOPHER A MD	5/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	83358	18	Ophthalmology	0	In state provider	None	7202 N MILLBROOK AVE	STE 208	FRESNO	CA	93720	3341	10	06019	36.83958089	-119.7645538	Fresno County
269329	Fee-for-Service	1407057854	1407057854	1	1	LEUS, INE M MD	6/1/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	171601	None	None	0	In state provider	None	1332 PARK STREET	SUITE 202	ALAMEDA	CA	94501	4545	01	06001	37.76330843	-122.2435444	Alameda County
269338	Fee-for-Service	1225491590	1225491590	1	1	LEVI, AMIT MD	3/19/2019	390200000X	NA	Other	026	PHYSICIANS	153304	41	Internal Medicine	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
269352	Fee-for-Service	1063524122	1063524122	1	2	LIN, ROYCE C MD	11/13/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	79349	-	NOT APPLICABLE	0	In state provider	None	230 GOLDEN GATE AVE	None	SAN FRANCISCO	CA	94102	3706	38	06075	37.78184696	-122.4142203	San Francisco County
269394	Fee-for-Service	1417907940	1417907940	1	25	LPCH MEDICAL GROUP DIV OF LU	11/17/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	6121 HOLLIS STREET	SUITE 2	EMERYVILLE	CA	94608	2077	01	06001	37.84254056	-122.2901636	Alameda County
269416	Fee-for-Service	1114389491	1114389491	1	1	LYM, RYAN L MD	10/23/2019	390200000X	NA	Other	026	PHYSICIANS	152493	40	Pediatrics	0	In state provider	None	7300 GIRARD AVE	STE 106	LA JOLLA	CA	92037	5138	37	06073	32.83772948	-117.2716382	San Diego County
269429	Fee-for-Service	1598743585	1598743585	1	1	LEHIGH VALLEY HOSPITAL-	3/18/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MUHLENBERG	2545 SCHOENERSVILLE ROAD	None	BETHLEHEM	PA	18017	7300	00	None	40.644648	-75.40812	Lehigh County
269446	Fee-for-Service	1689210338	1689210338	1	1	LEE, MINA	11/7/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2315 CONEJO LANE	None	FULLERTON	CA	92833	1536	30	06059	33.89095698	-117.9666688	Orange County
269457	Fee-for-Service	1821393489	1821393489	1	1	LAGUNA HOME HEALTH SERVICES	7/3/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	25411 CABOT ROAD	SUITE 205	LAGUNA HILLS	CA	92653	5525	30	06059	33.59224599	-117.6746001	Orange County
269472	Fee-for-Service	1780915744	1780915744	1	1	LOS ANGELES ORTHOPEDIC	5/2/2011	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	5257 N PARAMOUNT BLVD	None	LAKEWOOD	CA	90712	2121	19	06037	33.852942	-118.1598865	Los Angeles County
269478	Fee-for-Service	1952498008	1952498008	1	1	LINDEQUE, BENNIE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
269486	Fee-for-Service	1912980913	1912980913	1	1	LEE, JANE S MD	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55264	None	None	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
269543	Fee-for-Service	1083886857	1083886857	1	1	LEUNG, ERIC H MD	6/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107780	18	Ophthalmology	0	In state provider	None	200 W ARBOR AVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
269554	Fee-for-Service	1366866345	1366866345	1	1	LOMA LINDA UNIVERSITY	11/21/2014	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CHILDREN'S HOSPITAL	11234 ANDERSON ST	SUITE A	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
269568	Fee-for-Service	1215370945	1215370945	1	1	LIBERSON, JENNIFER K	5/5/2014	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9333 E ROSECRANS AVE	None	LOS ANGELES	CA	90706	2141	19	06037	33.90413858	-118.1346616	Los Angeles
269572	Fee-for-Service	1992192421	1992192421	1	1	LOPEZ, ARISTEO MD	9/4/2018	208M00000X	NA	Other	026	PHYSICIANS	148502	41	Internal Medicine	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
269578	Fee-for-Service	1184684417	1184684417	1	1	LEE, BRIAN S LAC	10/5/2022	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	15785 LAGUNA CANYON RD	SUITE 330	IRVINE	CA	92618	3165	30	06059	33.66542536	-117.7615537	Orange County
269589	Fee-for-Service	1821202185	1821202185	1	1	LITTMAN,TRAVIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3355 RIVERBEND DRIVE	STE 300	SPRINGFIELD	OR	97477	0000	00	None	44.08239413	-123.0281717	Lane County
269590	Fee-for-Service	1144244898	1144244898	1	1	LAS TUNAS ANESTHESIA	6/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	MEDICAL GROUP	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
269615	Fee-for-Service	1295228062	1295228062	1	1	LI, WILLIAM MD	8/28/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	180074	13	Neurology (M.D. only)	0	In state provider	None	8635 W 3RD ST	STE 1190W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
269632	Fee-for-Service	1659430460	1659430460	2	1	LOPEZ, HORACIO G MD	2/13/2023	174400000X	NA	Other	026	PHYSICIANS	48199	40	Pediatrics	0	In state provider	None	2105 BEVERLY BLVD	STE 129	LOS ANGELES	CA	90057	2216	19	06037	34.06682861	-118.2706286	Los Angeles County
269658	Fee-for-Service	1548315104	1548315104	1	1	LOS ANGELES COUNTY CCS	2/24/1994	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	EL MONTE MTU	4544 MAXSON RD	None	EL MONTE	CA	91732	1757	19	06037	34.08361398	-118.0027322	Los Angeles County
269709	Fee-for-Service	1598743585	1598743585	1	1	LEHIGH VALLEY HOSPITAL-	3/18/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MUHLENBERG	2545 SCHOENERSVILLE ROAD	None	BETHLEHEM	PA	18017	7300	00	None	40.644648	-75.40812	Lehigh County
269711	Fee-for-Service	1114941671	1114941671	1	1	LIU, ARTHUR V MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	51042	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
269713	Fee-for-Service	1821141201	1821141201	1	1	LUNA, FABIAN I OD	2/4/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	440 4TH AVE	None	CHULA VISTA	CA	91910	4443	37	06073	32.63536228	-117.0821548	San Diego County
269732	Fee-for-Service	1508824012	1508824012	1	1	LOUIE, MAELAE OD	8/29/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	236 N MARKET ST	None	INGLEWOOD	CA	90301	1217	19	06037	33.96582518	-118.351974	Los Angeles County
269736	Fee-for-Service	1427195387	1427195387	1	1	LUNA, LELANIE M MD INC	10/1/1998	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1500 S CENTRAL AVE	STE 310	GLENDALE	CA	91204	2581	19	06037	34.12736888	-118.257777	Los Angeles County
269773	Fee-for-Service	1033221445	1033221445	1	1	LANGFORD, GREGORY A MD	1/31/1988	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	59011	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	488 E VALLEY PKWY	STE 107	ESCONDIDO	CA	92025	3363	37	06073	33.12523814	-117.0769715	San Diego County
269777	Fee-for-Service	1306845888	1306845888	1	1	LONGORIA, JAMES MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	74139	33	Thoracic Surgery	0	In state provider	None	5301 F ST	STE 312	SACRAMENTO	CA	95819	3222	34	06067	38.571354	-121.4368695	Sacramento County
269785	Fee-for-Service	1467411702	1467411702	1	1	LAJIN, MICHAEL MD	11/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	53475	None	None	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
269794	Fee-for-Service	1760645444	1760645444	1	1	LEA, ETHAN S MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126669	20	Orthopedic Surgery	0	In state provider	None	6620 COYLE AVE	STE 212	CARMICHAEL	CA	95608	6337	34	06067	38.66751	-121.310028	Sacramento County
269814	Fee-for-Service	1891224168	1891224168	1	1	LEE, YVONNE MD	7/1/2022	207RR0500X	NA	Other	026	PHYSICIANS	157219	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
269819	Fee-for-Service	1831426642	1831426642	1	14	LAKESIDE MEDICAL	4/13/2010	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	191 S BUENA VISTA STREET	SUITE 200-240	BURBANK	CA	91505	4542	19	06037	34.15872557	-118.3283863	Los Angeles County
269825	Fee-for-Service	1245273572	1245273572	2	1	LONGS DRUG STORE CAL LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1324 SAN CARLOS AVE	None	SAN CARLOS	CA	94070	2318	41	06081	37.50553234	-122.2626279	San Mateo County
269850	Fee-for-Service	1265632020	1265632020	1	1	LANDRENEAU, NASON E CRNA	12/30/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
269861	Fee-for-Service	1306982855	1306982855	1	21	LA LASER CENTER, PC, A PROFE	10/18/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	CANCER	3150 G. ST.,	STE. D	MERCED	CA	95340	1346	24	06047	37.32054811	-120.4691942	Merced County
269883	Fee-for-Service	1326305707	1326305707	1	1	LIN, MICHAEL Y H MD	7/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126712	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
269897	Fee-for-Service	1063431435	1063431435	1	1	LEE, WILLIAM V PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LEE PSYCHOLOGICAL SVCS	760 MARKET ST	SUITE 520	SAN FRANCISCO	CA	94102	2406	38	06075	37.78624708	-122.4052592	San Francisco County
269910	Fee-for-Service	1235238130	1235238130	2	1	LAWLER, MARK S MD	7/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	69218	01	General Practice	0	In state provider	None	18 BON AIR RD	None	LARKSPUR	CA	94939	1123	21	06041	37.94413684	-122.5391261	Marin County
269911	Fee-for-Service	1659430460	1659430460	2	1	LOPEZ, HORACIO G MD	2/13/2023	174400000X	NA	Other	026	PHYSICIANS	48199	03	Allergy	0	In state provider	None	2105 BEVERLY BLVD	STE 129	LOS ANGELES	CA	90057	2216	19	06037	34.06682861	-118.2706286	Los Angeles County
269915	Fee-for-Service	1720664899	1720664899	1	1	LEE, JUHYE M MD	8/13/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
269925	Fee-for-Service	1689648412	1689648412	1	1	LEBNAN SAAD	4/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4003 KRESGE WAY	STE 312	LOUISVILLE	KY	40207	4652	00	None	38.23910403	-85.63971444	Jefferson County
269930	Fee-for-Service	1568734754	1568734754	1	1	LANGNESS, SIMONE M MD	1/7/2019	390200000X	NA	Other	026	PHYSICIANS	123349	02	General Surgery	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
269990	Fee-for-Service	1932841368	1932841368	1	1	LIPINSKI, PATRICIA	4/13/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
269993	Fee-for-Service	1376917146	1376917146	1	1	LEVANTA COUNSELING SERVICES	1/14/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	LLC	433 N KENMORE AVE	None	LOS ANGELES	CA	90004	3336	19	06037	34.078779	-118.296987	Los Angeles County
270052	Fee-for-Service	1033221445	1033221445	1	1	LANGFORD, GREGORY A MD	1/31/1988	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	59011	01	General Practice	0	In state provider	None	488 E VALLEY PKWY	STE 107	ESCONDIDO	CA	92025	3363	37	06073	33.12523814	-117.0769715	San Diego County
270057	Fee-for-Service	1245402999	1245402999	1	1	LAUGHLIN, MARY H MD	4/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110580	05	Anesthesiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
270070	Fee-for-Service	1942477641	1942477641	1	1	LIM, FRANCES	7/5/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3700 TACHEVAH DR	105-107	PALM SPRINGS	CA	92262	7401	33	06065	33.8376885	-116.505378	Riverside County
270085	Fee-for-Service	1255374005	1255374005	1	1	LIPMAN, GRANT S MD	1/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89056	None	None	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
270087	Fee-for-Service	1831426642	1831426642	1	14	LAKESIDE MEDICAL	9/13/2022	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	191 S BUENA VISTA STREET	SUITE 200-240	BURBANK	CA	91505	4542	19	06037	34.15872557	-118.3283863	Los Angeles County
270106	Fee-for-Service	1952456378	1952456378	1	1	LOS ANGELES COUNTY CCS	7/15/2005	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	SANTA CLARITA MTU	19420 SIERRA ESTATES DR	None	SANTA CLARITA	CA	91321	2128	19	06037	34.39782763	-118.4752058	Los Angeles County
270153	Fee-for-Service	1306982855	1306982855	1	21	LA LASER CENTER, PC, A PROFE	10/18/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	CANCER	3150 G. ST.,	STE. D	MERCED	CA	95340	1346	24	06047	37.32054811	-120.4691942	Merced County
270160	Fee-for-Service	1326305707	1326305707	1	1	LIN, MICHAEL Y H MD	7/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126712	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
270170	Fee-for-Service	1982662946	1982662946	1	1	LEUNG, ANGELA M MD	2/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112665	67	Endocrinology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
270179	Fee-for-Service	1851895122	1851895122	1	1	LEUCHTER, RICHARD K MD	5/4/2022	207R00000X	NA	Other	026	PHYSICIANS	164294	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
270183	Fee-for-Service	1083828263	1083828263	1	1	LEVY AND ANDIMAN MD INC	1/1/1979	193400000X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	8631 W 3RD ST	STE 531E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
270189	Fee-for-Service	1235238130	1235238130	2	1	LAWLER, MARK S MD	7/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	69218	20	Orthopedic Surgery	0	In state provider	None	18 BON AIR RD	None	LARKSPUR	CA	94939	1123	21	06041	37.94413684	-122.5391261	Marin County
270239	Fee-for-Service	1396991253	1396991253	1	1	LANGILLE, MEGAN M MD	11/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110485	13	Neurology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
270274	Fee-for-Service	1902272644	1902272644	1	1	LINGANNAN, ARCHANA MD	4/16/2021	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	171378	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
270279	Fee-for-Service	1851632590	1851632590	1	1	LEE, JACINDA H LCSW	11/26/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
270281	Fee-for-Service	1316989528	1316989528	1	3	LINCARE, INC	7/26/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	200 MASON CIR	STE A	CONCORD	CA	94520	1249	07	06013	38.00933453	-122.0399865	Contra Costa County
270304	Fee-for-Service	1306031059	1306031059	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	850 CALIFORNIA ST	None	MOUNTAIN VIEW	CA	94041	1270	43	06085	37.39170031	-122.0813113	Santa Clara County
270316	Fee-for-Service	1306439955	1306439955	1	1	LA CANADA HOSPICE CARE, INC.	9/12/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2930 HONOLULU AVE	STE 201	GLENDALE	CA	91214	3978	19	06037	34.21321777	-118.2428641	Los Angeles County
270350	Fee-for-Service	1811123441	1811123441	1	1	LEVIN, MARC H MD	8/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125779	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
270364	Fee-for-Service	1831426642	1831426642	1	14	LAKESIDE MEDICAL	4/13/2010	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	191 S BUENA VISTA STREET	SUITE 200-240	BURBANK	CA	91505	4542	19	06037	34.15872557	-118.3283863	Los Angeles County
270393	Fee-for-Service	1811543887	1811543887	1	1	LIN, STACY PHD	12/12/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
270397	Fee-for-Service	1033341672	1033341672	1	1	LADHA, ABDULLAH MD	8/20/2020	207RH0000X	NA	Hematology	026	PHYSICIANS	159118	68	Hematology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
270410	Fee-for-Service	1407007594	1407007594	1	1	LEE, YONG H	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10549	08	Family Practice	0	In state provider	None	9089 BASELINE ROAD	SUITE 100	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
270411	Fee-for-Service	1326205154	1326205154	1	1	LAU, JASON A MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133909	05	Anesthesiology	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
270417	Fee-for-Service	1306982855	1306982855	1	21	LA LASER CENTER, PC, A PROFE	10/18/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	CANCER	3150 G. ST.,	STE. D	MERCED	CA	95340	1346	24	06047	37.32054811	-120.4691942	Merced County
270422	Fee-for-Service	1609864545	1609864545	1	1	LEE, JI SUN MD	11/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121120	08	Family Practice	0	In state provider	None	2175 ROSALINE AVENUE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
270455	Fee-for-Service	1932694452	1932694452	1	1	LIN, LUKE M MD	11/13/2021	207P00000X	NA	Other	026	PHYSICIANS	174917	None	None	0	In state provider	None	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1819	36	06071	34.073505	-117.3505995	San Bernardino County
270461	Fee-for-Service	1679536130	1679536130	1	1	LIN, J F H MD	9/30/1980	2084N0400X	NA	Neurology	026	PHYSICIANS	41717	None	None	0	In state provider	None	130 LA CASA VIA	BLDG 2	WALNUT CREEK	CA	94598	3045	07	06013	37.91175467	-122.0414101	Contra Costa County
270479	Fee-for-Service	1073645339	1073645339	1	1	LUCIA MAR UNIFIED SD	3/31/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	227 BRIDGE STREET	None	ARROYO GRANDE	CA	93420	3311	40	06079	35.120988	-120.577362	San Luis Obispo County
270482	Fee-for-Service	1760979108	1760979108	1	1	LEE, ANDREW J MD	1/15/2025	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
270509	Fee-for-Service	1538681390	1538681390	1	1	LECLAIRE, MADELEINE S LMFT	4/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
270529	Fee-for-Service	1790768877	1790768877	1	1	LEE,JOEL H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2700 STEWART PARKWAY	None	ROSEBURG	OR	97470	0000	00	None	43.2399838	-123.3665048	Douglas County
270557	Fee-for-Service	1437219615	1437219615	1	1	LEE, GREGORY P MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74649	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
270571	Fee-for-Service	1699174466	1699174466	1	1	LARSEN, KIRSTEN S LMFT	8/5/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	44444 20TH ST W	None	LANCASTER	CA	93534	2714	19	06037	34.69063406	-118.1656452	Los Angeles County
270585	Fee-for-Service	1992058655	1992058655	1	1	LEVIN, JESSICA M CNM	3/5/2019	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
270593	Fee-for-Service	1306439955	1306439955	1	1	LA CANADA HOSPICE CARE, INC.	9/12/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2930 HONOLULU AVE	STE 201	GLENDALE	CA	91214	3978	19	06037	34.21321777	-118.2428641	Los Angeles County
270606	Fee-for-Service	1992741813	1992741813	1	1	LUBLIN, MATTHEW A MD	2/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	82116	02	General Surgery	0	In state provider	None	1920 COLORADO BLVD	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
270622	Fee-for-Service	1467512624	1467512624	1	1	LEE, BRYAN X MD	9/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91137	05	Anesthesiology	0	In state provider	None	160 E ARTESIA ST	STE 360	POMONA	CA	91767	2927	19	06037	34.07556833	-117.7507835	Los Angeles County
270637	Fee-for-Service	1821393489	1821393489	1	3	LAGUNA HOME HEALTH SERVICES	1/11/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	1370 VALLEY VISTA DR	SUITE 201	DIAMOND BAR	CA	91765	3921	19	06037	33.99742278	-117.8381087	Los Angeles County
270644	Fee-for-Service	1831426642	1831426642	1	14	LAKESIDE MEDICAL	10/18/2023	207RR0500X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	191 S BUENA VISTA STREET	SUITE 200-240	BURBANK	CA	91505	4542	19	06037	34.15872557	-118.3283863	Los Angeles County
270683	Fee-for-Service	1568751576	1568751576	1	1	LIN, PATRICK S MD	1/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128176	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
270803	Fee-for-Service	1447257688	1447257688	1	1	LEIDL, PETER J MD	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	41675	41	Internal Medicine	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
270826	Fee-for-Service	1154805992	1154805992	1	1	LOPEZ, DIANE C LCSW	8/7/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
270838	Fee-for-Service	1023233707	1023233707	1	1	LUTT, JOSEPH R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1551 PROFESSIONAL LN	UNIT 235	LONGMONT	CO	80501	6967	00	None	40.13906531	-105.1007425	Boulder County
270854	Fee-for-Service	1467485649	1467485649	1	1	LOVETT, PARIS B MD	4/3/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	70	Clinic (mixed specialty)	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
270864	Fee-for-Service	1033752365	1033752365	1	1	LEGRAND, MATTHIEU MD	3/16/2020	207LC0200X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
270924	Fee-for-Service	1831426642	1831426642	1	14	LAKESIDE MEDICAL	4/13/2010	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	191 S BUENA VISTA STREET	SUITE 200-240	BURBANK	CA	91505	4542	19	06037	34.15872557	-118.3283863	Los Angeles County
270944	Fee-for-Service	1649086968	1649086968	1	1	LEWIS, SARAH CCC-SLP	12/19/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2262 N. 1ST ST	None	SAN JOSE	CA	95131	2022	43	06085	37.37772646	-121.921374	Santa Clara County
270977	Fee-for-Service	1871625830	1871625830	1	1	LYNN, LILIANA D LMFT	6/23/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
270986	Fee-for-Service	1033151659	1033151659	1	1	LINDA V CABRERA INC	11/30/2011	246XS1301X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	8402 CAROB STREET	None	CYPRESS	CA	90630	2061	30	06059	33.840594	-118.0568335	Orange County
271005	Fee-for-Service	1881603009	1881603009	1	1	LODI MEMORIAL HOSPITAL	8/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL GROUP	845 S FAIRMONT AVE	STE 8	LODI	CA	95240	5113	39	06077	38.123217	-121.285878	San Joaquin County
271036	Fee-for-Service	1720035686	1720035686	1	1	LOS ALAMITOS INTERNAL MEDICA	1/1/1979	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5300 KATELLA AVE	None	LOS ALAMITOS	CA	90720	2808	30	06059	33.80291117	-118.0403489	Orange County
271040	Fee-for-Service	1245281211	1245281211	1	1	LINK, JOHN S MD	6/16/1988	174400000X	NA	Other	026	PHYSICIANS	25774	None	None	0	In state provider	None	2840 LONG BEACH BLVD	STE 130	LONG BEACH	CA	90806	1516	19	06037	33.808743	-118.189341	Los Angeles County
271049	Fee-for-Service	1427483908	1427483908	1	1	LEE, JENIE C OD	9/11/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
271053	Fee-for-Service	1508058058	1508058058	1	1	LEE, ALEXANDER J MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
271058	Fee-for-Service	1184782229	1184782229	1	1	LEVINE, VLADIMIR MD	8/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68957	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
271060	Fee-for-Service	1538501721	1538501721	1	1	LARA LLERENA, ARTURO MD	11/19/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
271063	Fee-for-Service	1306889662	1306889662	2	1	LONGS DRUG STORES CA LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3625 MT DIABLO BLVD	None	LAFAYETTE	CA	94549	3711	07	06013	37.89110549	-122.1251394	Contra Costa County
271077	Fee-for-Service	1467499582	1467499582	1	1	LINDBERG, FREDERICK S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52787	08	Family Practice	0	In state provider	None	2125 THOUSAND OAKS BLVD	None	THOUSAND OAKS	CA	91362	2942	56	06111	34.17525064	-118.8467186	Ventura County
271097	Fee-for-Service	1801943279	1801943279	1	1	LEE, JEFFREY	6/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97291	18	Ophthalmology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
271105	Fee-for-Service	1225108269	1225108269	1	1	LUU, DANIEL Q DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4427 EUCLID AVE	None	SAN DIEGO	CA	92115	4523	37	06073	32.7570336	-117.0921463	San Diego County
271107	Fee-for-Service	1417907940	1417907940	1	26	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	282NC2000X	NA	Hospitals	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	258 SAN JOSE STREET	SUITE A	SALINAS	CA	93901	3934	27	06053	36.65808239	-121.6456689	Monterey County
271114	Fee-for-Service	1245310200	1245310200	1	1	LUDWIG, DERON J MD,	6/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52097	02	General Surgery	0	In state provider	None	251 COHASSET RD	STE 120	CHICO	CA	95926	2274	04	06007	39.75090044	-121.8522609	Butte County
271129	Fee-for-Service	1306982855	1306982855	1	22	LA LASER CENTER, PC, A PROFE	10/22/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	CANCER CENTER	276 S MILL ST	STE C	TEHACHAPI	CA	93561	1678	15	06029	35.13089495	-118.4526363	Kern County
271133	Fee-for-Service	1467485649	1467485649	1	1	LOVETT, PARIS B MD	4/3/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
271144	Fee-for-Service	1679860142	1679860142	1	1	LEWIS, NICOLE L MD	5/10/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159091	None	None	0	In state provider	None	8170 LAGUNA BLVD	STE 210	ELK GROVE	CA	95758	7902	34	06067	38.421054	-121.405365	Sacramento County
271151	Fee-for-Service	1144667353	1144667353	1	1	LIN, YI-JU LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
271155	Fee-for-Service	1750068177	1750068177	1	1	LIFE CARE SENIOR MANOR LLC	10/4/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	10415 AZALEA CIRCLE	None	GARDEN GROVE	CA	92840	2007	30	06059	33.79024515	-117.9513358	Orange County
271159	Fee-for-Service	1689826752	1689826752	1	1	LEE, CHRISTINE H MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106046	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	1778	19	06037	34.06373445	-118.443537	Los Angeles County
271165	Fee-for-Service	1326255498	1326255498	1	1	LOYDS LIBERTY HOMES INC	3/11/1997	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	304 JOELYLE ST	None	BAKERSFIELD	CA	93314	3872	15	06029	35.35213659	-119.1482589	Kern County
271170	Fee-for-Service	1942613575	1942613575	1	1	LAM, DAVID V OD	11/1/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
271211	Fee-for-Service	1376984864	1376984864	1	1	LEINWEBER, ANDREW L MD	2/1/2018	207L00000X	NA	Other	026	PHYSICIANS	153660	05	Anesthesiology	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
271246	Fee-for-Service	1790725364	1790725364	1	1	LIU, JASON Y S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	48180	30	Radiology	0	In state provider	None	1025 S ANAHEIM BLVD	None	ANAHEIM	CA	92805	5806	30	06059	33.81994338	-117.9087416	Orange County
271249	Fee-for-Service	1083932198	1083932198	1	1	LE, STEVEN H MD	11/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119572	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
271254	Fee-for-Service	1861597528	1861597528	1	1	LIMANON, CHAINARONK MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42678	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	SUITE 103	7248 S LAND PARK DR	None	SACRAMENTO	CA	95831	3660	34	06067	38.494602	-121.513743	Sacramento County
271256	Fee-for-Service	1861473480	1861473480	1	1	LABORATORY CORPORATION	2/29/2004	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	OF AMERICA	10930 BIGGE ST	None	SAN LEANDRO	CA	94577	1121	01	06001	37.72586136	-122.1862649	Alameda County
271295	Fee-for-Service	1164788634	1164788634	1	1	LIU, BRIDGET Q MD	6/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149024	66	Emergency Medicine (Urgent Care)	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	3204	41	06081	37.53039072	-122.2987772	San Mateo County
271315	Fee-for-Service	1255423299	1255423299	1	1	LU, SHANHONG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	61944	41	Internal Medicine	0	In state provider	None	830 PINE ST	None	MOUNT SHASTA	CA	96067	2137	47	06093	41.31730651	-122.3208659	Siskiyou County
271335	Fee-for-Service	1184782229	1184782229	1	1	LEVINE, VLADIMIR MD	8/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68957	40	Pediatrics	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
271337	Fee-for-Service	1174936116	1174936116	1	1	LUU, VINH Q MD	10/20/2020	207R00000X	NA	Other	026	PHYSICIANS	161944	41	Internal Medicine	0	In state provider	None	8110 LAGUNA BLVD	None	ELK GROVE	CA	95758	7904	34	06067	38.421306	-121.408173	Sacramento County
271346	Fee-for-Service	1487627410	1487627410	1	1	LY, HAN V MD	5/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90712	05	Anesthesiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
271362	Fee-for-Service	1649340555	1649340555	3	1	LEVITT, MARC A MD	2/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	85	Surgery-Pediatric	2	Out of state provider	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
271384	Fee-for-Service	1417907940	1417907940	1	26	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	282NC2000X	NA	Hospitals	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	258 SAN JOSE STREET	SUITE A	SALINAS	CA	93901	3934	27	06053	36.65808239	-121.6456689	Monterey County
271389	Fee-for-Service	1417907940	1417907940	1	27	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5720 STONERIDGE MALL RD	#240	PLEASANTON	CA	94588	2830	01	06001	37.69247085	-121.9301884	Alameda County
271406	Fee-for-Service	1306982855	1306982855	1	22	LA LASER CENTER, PC, A PROFE	10/22/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	CANCER CENTER	276 S MILL ST	STE C	TEHACHAPI	CA	93561	1678	15	06029	35.13089495	-118.4526363	Kern County
271415	Fee-for-Service	1831278563	1831278563	1	1	LEWIS, DANIEL G MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	60814	01	General Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
271420	Fee-for-Service	1417907940	1417907940	1	31	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1900 GARDEN RD	STE 110	MONTEREY	CA	93940	5334	27	06053	36.58681385	-121.8623548	Monterey County
271449	Fee-for-Service	1609302397	1609302397	2	1	LUXOR PHARMACY CORP	3/22/2024	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10465 ARLINGTON AVE.	STE. 300	RIVERSIDE	CA	92505	3210	33	06065	33.94652661	-117.4828792	Riverside County
271466	Fee-for-Service	1205080520	1205080520	1	1	LANCASTER, JENNIFER A DO	1/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10614	36	Psychiatry	0	In state provider	None	4785 N FIRST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
271471	Fee-for-Service	1851649271	1851649271	1	1	LAACK, CARLOS M LMFT	9/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14500 ROSCOE BLVD	STE 400	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
271496	Fee-for-Service	1811083389	1811083389	1	1	LEMBERSKY, MARK DPM	3/1/2000	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	A PROFESSIONAL CORP	11300 MAGNOLIA BLVD	UNIT 5	NORTH HOLLYWOOD	CA	91601	3772	19	06037	34.16491154	-118.3776525	Los Angeles County
271527	Fee-for-Service	1194737908	1194737908	1	1	LONG, STEVEN R MD	8/2/1995	207ZP0102X	NA	Other	026	PHYSICIANS	79234	22	Pathology (M.D. only)	0	In state provider	None	3301 C ST	STE 103C	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
271536	Fee-for-Service	1609845627	1609845627	1	1	LOZANO, MARTHA E MD	7/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	48551	66	Emergency Medicine (Urgent Care)	0	In state provider	None	841 KUHN DR	STE 200	CHULA VISTA	CA	91914	3552	37	06073	32.65289649	-116.9665862	San Diego County
271567	Fee-for-Service	1023227154	1023227154	1	1	LIM, PHILLIP H	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	9128	05	Anesthesiology	0	In state provider	None	5742 BEACH BLVD	STE G	BUENA PARK	CA	90621	2043	30	06059	33.876423	-117.9981635	Orange County
271646	Fee-for-Service	1689950297	1689950297	1	1	LIKHACHEVA, ANNA O MD	2/7/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	159080	30	Radiology	0	In state provider	None	2825 CAPITOL AVE	None	SACRAMENTO	CA	95816	6039	34	06067	38.570805	-121.4696385	Sacramento County
271654	Fee-for-Service	1295887966	1295887966	1	1	LONGAR, SUSAN M MD APC	6/27/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1850 SULLIVAN AVE	STE 500	DALY CITY	CA	94015	2215	41	06081	37.68085904	-122.4728842	San Mateo County
271660	Fee-for-Service	1417907940	1417907940	1	26	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	282NC2000X	NA	Hospitals	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	258 SAN JOSE STREET	SUITE A	SALINAS	CA	93901	3934	27	06053	36.65808239	-121.6456689	Monterey County
271666	Fee-for-Service	1417907940	1417907940	1	27	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5720 STONERIDGE MALL RD	#240	PLEASANTON	CA	94588	2830	01	06001	37.69247085	-121.9301884	Alameda County
271667	Fee-for-Service	1922645365	1922645365	1	1	LEUNG, VICTORIA LAC	8/20/2021	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
271691	Fee-for-Service	1083896229	1083896229	1	1	LEE, CONNIE J MD	11/20/2008	207R00000X	NA	Other	026	PHYSICIANS	97435	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
271697	Fee-for-Service	1417907940	1417907940	1	31	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1900 GARDEN RD	STE 110	MONTEREY	CA	93940	5334	27	06053	36.58681385	-121.8623548	Monterey County
271747	Fee-for-Service	1225618689	1225618689	1	1	LEE, MATTHEW DO	8/1/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20680	08	Family Practice	0	In state provider	None	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	33	06065	33.49890392	-117.1612965	Riverside County
271768	Fee-for-Service	1801259320	1801259320	1	1	LI, LINDA MD	4/24/2020	207L00000X	NA	Other	026	PHYSICIANS	168280	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
271812	Fee-for-Service	1609845627	1609845627	1	1	LOZANO, MARTHA E MD	7/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	48551	41	Internal Medicine	0	In state provider	None	841 KUHN DR	STE 200	CHULA VISTA	CA	91914	3552	37	06073	32.65289649	-116.9665862	San Diego County
271832	Fee-for-Service	1053064493	1053064493	1	1	LILY HOME HEALTH SERVICES	2/2/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	121 W LEXINGTON DR	STE B180C	GLENDALE	CA	91203	2203	19	06037	34.1517575	-118.2560706	Los Angeles County
271846	Fee-for-Service	1942445374	1942445374	1	1	LU, FRANCES MD	4/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101544	10	Gastroenterology (M.D. only)	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
271856	Fee-for-Service	1356384523	1356384523	2	1	LONGS DRUG STORE CAL LLC	5/6/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4100 REDWOOD RD	None	OAKLAND	CA	94619	2363	01	06001	37.79783782	-122.1832794	Alameda County
271894	Fee-for-Service	1023323573	1023323573	1	1	LANZMAN, BRYAN A MD	5/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135612	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
271920	Fee-for-Service	1689950297	1689950297	1	1	LIKHACHEVA, ANNA O MD	2/7/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	159080	78	Neoplastic Diseases/Oncology	0	In state provider	None	2825 CAPITOL AVE	None	SACRAMENTO	CA	95816	6039	34	06067	38.570805	-121.4696385	Sacramento County
271936	Fee-for-Service	1417907940	1417907940	1	26	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	282NC2000X	NA	Hospitals	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	258 SAN JOSE STREET	SUITE A	SALINAS	CA	93901	3934	27	06053	36.65808239	-121.6456689	Monterey County
271942	Fee-for-Service	1417907940	1417907940	1	27	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5720 STONERIDGE MALL RD	#240	PLEASANTON	CA	94588	2830	01	06001	37.69247085	-121.9301884	Alameda County
271971	Fee-for-Service	1417907940	1417907940	1	31	LPCH MEDICAL GROUP DIV OF LU	3/6/2015	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	None	1900 GARDEN RD	STE 110	MONTEREY	CA	93940	5334	27	06053	36.58681385	-121.8623548	Monterey County
272004	Fee-for-Service	1437573615	1437573615	1	1	LOPEZ, CIARA	2/21/2023	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	222 WEST HENDERSON AVE	None	PORTERVILLE	CA	93257	1731	54	06107	36.0804034	-119.0217006	Tulare County
272044	Fee-for-Service	1124441852	1124441852	1	1	LAGUNA SC	10/26/2015	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	150 LAGUNA RD	STE B	FULLERTON	CA	92835	3614	30	06059	33.89367364	-117.9302191	Orange County
272089	Fee-for-Service	1922721489	1922721489	1	1	LUCAS, MELANIE PHD	10/24/2022	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
272117	Fee-for-Service	1003967621	1003967621	1	1	LIU, RICHARD C DO	4/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8312	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
272125	Fee-for-Service	1154859072	1154859072	1	1	LAM, BRYAN A MD	12/17/2018	207R00000X	NA	Other	026	PHYSICIANS	157227	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
272146	Fee-for-Service	1205047644	1205047644	1	1	LEE, ANYORK	11/20/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1050 E YORBA LINDA BLVD	#101	PLACENTIA	CA	92870	3730	30	06059	33.88824259	-117.8446439	Orange County
272194	Fee-for-Service	1154560019	1154560019	1	1	LANE, PRISCILLA S LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
272205	Fee-for-Service	1437607447	1437607447	1	1	LINDBERG, SARAH	1/10/2024	174400000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2262 N. 1ST ST	None	SAN JOSE	CA	95131	2022	43	06085	37.37772646	-121.921374	Santa Clara County
272209	Fee-for-Service	1417907940	1417907940	1	26	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	282NC2000X	NA	Hospitals	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	258 SAN JOSE STREET	SUITE A	SALINAS	CA	93901	3934	27	06053	36.65808239	-121.6456689	Monterey County
272214	Fee-for-Service	1417907940	1417907940	1	27	LPCH MEDICAL GROUP DIV OF LU	11/17/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	None	5720 STONERIDGE MALL RD	#240	PLEASANTON	CA	94588	2830	01	06001	37.69247085	-121.9301884	Alameda County
272227	Fee-for-Service	1326432758	1326432758	1	1	LYDY, KRISTINA M	5/22/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVENUE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
272244	Fee-for-Service	1417907940	1417907940	1	31	LPCH MEDICAL GROUP DIV OF LU	3/6/2015	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1900 GARDEN RD	STE 110	MONTEREY	CA	93940	5334	27	06053	36.58681385	-121.8623548	Monterey County
272311	Fee-for-Service	1215299490	1215299490	1	1	LARSEN, JORDAN R DO	8/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
272325	Fee-for-Service	1235148495	1235148495	1	1	LEE, VINCENT J MD	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54309	30	Radiology	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
272390	Fee-for-Service	1578762704	1578762704	1	1	LI, ZIZHUANG MD	4/5/2020	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	1251 W REDONDO BEACH BLV	STE 101	GARDENA	CA	90247	3456	19	06037	33.89233033	-118.2974415	Los Angeles County
272436	Fee-for-Service	1083817779	1083817779	1	1	LU, STEVEN S MD	7/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80286	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
272463	Fee-for-Service	1255543831	1255543831	1	1	LABIB, WESSAM K MD	9/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102223	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
272479	Fee-for-Service	1417907940	1417907940	1	26	LPCH MEDICAL GROUP DIV OF LU	11/17/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	258 SAN JOSE STREET	SUITE A	SALINAS	CA	93901	3934	27	06053	36.65808239	-121.6456689	Monterey County
272487	Fee-for-Service	1417907940	1417907940	1	27	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5720 STONERIDGE MALL RD	#240	PLEASANTON	CA	94588	2830	01	06001	37.69247085	-121.9301884	Alameda County
272489	Fee-for-Service	1265728430	1265728430	1	1	LEE, JENNIFER Y MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141262	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
272505	Fee-for-Service	1669841151	1669841151	1	1	LINDSEY, CARYN LCSW	12/20/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8700 BEVERLY BLVD	# 3611	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
272512	Fee-for-Service	1851529564	1851529564	1	1	LONG, ANDREA M MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143241	89	Surgery-Traumatic	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
272518	Fee-for-Service	1417907940	1417907940	1	31	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1900 GARDEN RD	STE 110	MONTEREY	CA	93940	5334	27	06053	36.58681385	-121.8623548	Monterey County
272526	Fee-for-Service	1326356106	1326356106	1	1	LUU, LOI MD INC	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	56092	01	General Practice	0	In state provider	None	14501 MAGNOLIA ST	STE 108	WESTMINSTER	CA	92683	1307	30	06059	33.75188963	-117.9723601	Orange County
272531	Fee-for-Service	1245211895	1245211895	1	1	LEONARD, ELLEN I. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5101 MEDICAL DR	None	SAN ANTONIO	TX	78229	4801	00	None	29.514015	-98.5868955	Bexar County
272547	Fee-for-Service	1134159775	1134159775	1	1	LIEBMAN, HOWARD A MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	28178	41	Internal Medicine	0	In state provider	None	1510 SAN PABLO ST	STE 451	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
272550	Fee-for-Service	1982877445	1982877445	1	1	LEE, JULIANN K MD	2/8/2015	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	102596	20	Orthopedic Surgery	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
272579	Fee-for-Service	1225665789	1225665789	1	1	LUU, TYLER MD	4/17/2025	207R00000X	NA	Other	026	PHYSICIANS	None	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
272586	Fee-for-Service	1932181575	1932181575	1	1	LIPSON, SCOTT A MD	7/1/1996	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	70627	30	Radiology	0	In state provider	None	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
272593	Fee-for-Service	1003859851	1003859851	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1165 W EL CAMINO REAL	None	SUNNYVALE	CA	94087	1026	43	06085	37.3734494	-122.0544775	Santa Clara County
272594	Fee-for-Service	1235148495	1235148495	1	1	LEE, VINCENT J MD	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54309	78	Neoplastic Diseases/Oncology	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
272599	Fee-for-Service	1013442672	1013442672	1	1	LOERA, SANDRA CCC-SLP	4/11/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11870 PIERCE STREET	SUITE 150	RIVERSIDE	CA	92505	4402	33	06065	33.90095662	-117.4936969	Riverside County
272605	Fee-for-Service	1144245143	1144245143	1	1	LANGFORD, PAUL M CRNA	3/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	None	None	0	In state provider	None	6602 WHITE FEATHER ROAD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13293186	-116.2767585	San Bernardino County
272650	Fee-for-Service	1720159791	1720159791	1	1	LUBKA, RHONDA MD	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	50217	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
272742	Fee-for-Service	1346283132	1346283132	2	1	LONGS DRUG STORE CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5800 SANTA ROSA RD	None	CAMARILLO	CA	93012	7056	56	06111	34.226169	-118.9882109	Ventura County
272749	Fee-for-Service	1417907940	1417907940	1	26	LPCH MEDICAL GROUP DIV OF LU	11/17/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	None	258 SAN JOSE STREET	SUITE A	SALINAS	CA	93901	3934	27	06053	36.65808239	-121.6456689	Monterey County
272753	Fee-for-Service	1417907940	1417907940	1	27	LPCH MEDICAL GROUP DIV OF LU	11/17/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	5720 STONERIDGE MALL RD	#240	PLEASANTON	CA	94588	2830	01	06001	37.69247085	-121.9301884	Alameda County
272764	Fee-for-Service	1952497521	1952497521	1	1	LEE, JOSEPH I MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69253	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	416 W LAS TUNAS DR	STE 205	SAN GABRIEL	CA	91776	1236	19	06037	34.10243845	-118.1046106	Los Angeles County
272786	Fee-for-Service	1417907940	1417907940	1	31	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1900 GARDEN RD	STE 110	MONTEREY	CA	93940	5334	27	06053	36.58681385	-121.8623548	Monterey County
272855	Fee-for-Service	1396129896	1396129896	1	1	LEWIS, NEGIN S MD	9/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151824	41	Internal Medicine	0	In state provider	None	1020 29TH ST	STE 120	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
272917	Fee-for-Service	1720159791	1720159791	1	1	LUBKA, RHONDA MD	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	50217	84	Surgery-Head and Neck	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
272934	Fee-for-Service	1295706919	1295706919	1	1	LEYVA, FERNANDO F MD	9/20/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	148208	08	Family Practice	0	In state provider	None	525 3RD AVE	None	CHULA VISTA	CA	91910	5696	37	06073	32.63367609	-117.0769202	San Diego County
272945	Fee-for-Service	1104990381	1104990381	1	1	LEU, LIANGHUEY MD	8/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98061	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
272954	Fee-for-Service	1326396664	1326396664	1	1	LEONG, NATHANIEL Y MD	10/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122322	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
273004	Fee-for-Service	1366604126	1366604126	1	1	LEONG, ERICA J MD	9/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107779	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
273006	Fee-for-Service	1669567541	1669567541	1	1	LY, TRUNG H MD	3/3/2020	207R00000X	NA	Other	026	PHYSICIANS	94616	41	Internal Medicine	0	In state provider	None	10362 BOLSA AVE	STE 110	WESTMINSTER	CA	92683	6763	30	06059	33.74488248	-117.94806	Orange County
273018	Fee-for-Service	1417907940	1417907940	1	26	LPCH MEDICAL GROUP DIV OF LU	11/17/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	258 SAN JOSE STREET	SUITE A	SALINAS	CA	93901	3934	27	06053	36.65808239	-121.6456689	Monterey County
273019	Fee-for-Service	1306801477	1306801477	1	1	LIVINGSTON, CAROL MD	4/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	62605	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7601 HOSPITAL DR	STE 220	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
273021	Fee-for-Service	1750401055	1750401055	1	1	LAURENCIN, MERCEDES G MD	3/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	51038	01	General Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
273023	Fee-for-Service	1417907940	1417907940	1	27	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5720 STONERIDGE MALL RD	#240	PLEASANTON	CA	94588	2830	01	06001	37.69247085	-121.9301884	Alameda County
273034	Fee-for-Service	1952497521	1952497521	1	1	LEE, JOSEPH I MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69253	41	Internal Medicine	0	In state provider	None	416 W LAS TUNAS DR	STE 205	SAN GABRIEL	CA	91776	1236	19	06037	34.10243845	-118.1046106	Los Angeles County
273044	Fee-for-Service	1821079393	1821079393	1	1	LOCK, ROBERT J MD	1/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	51176	41	Internal Medicine	0	In state provider	None	2535 HARRISON AVE	None	EUREKA	CA	95501	3220	12	06023	40.7844301	-124.1396251	Humboldt County
273048	Fee-for-Service	1346942844	1346942844	1	1	LOVE YOUR BEST LIFE LLC	3/24/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
273053	Fee-for-Service	1306982855	1306982855	1	5	LA LASER CENTER, PC, A PROFE	2/14/2024	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	CANCER	1467 LIVE OAK BLVD	None	YUBA CITY	CA	95991	2920	51	06101	39.151206	-121.620634	Sutter County
273054	Fee-for-Service	1417907940	1417907940	1	31	LPCH MEDICAL GROUP DIV OF LU	3/6/2015	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1900 GARDEN RD	STE 110	MONTEREY	CA	93940	5334	27	06053	36.58681385	-121.8623548	Monterey County
273091	Fee-for-Service	1396962213	1396962213	1	1	LECHPAMMER, MIRNA MD	10/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121336	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
273093	Fee-for-Service	1053512558	1053512558	1	1	LEE, CHRISTOPHER S MD	8/2/2010	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	112769	20	Orthopedic Surgery	0	In state provider	None	6719 ALVARADO RD	STE 200	SAN DIEGO	CA	92120	5256	37	06073	32.77684978	-117.055137	San Diego County
273098	Fee-for-Service	1003955758	1003955758	1	1	LASSEN MEDICAL GROUP INC	4/17/2007	207Q00000X	NA	Adult Primary Care	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	RED BLUFF	2450 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	52	06103	40.14921426	-122.2216794	Tehama County
273115	Fee-for-Service	1316018237	1316018237	1	1	LAU, JAMES HK MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	45546	20	Orthopedic Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
273118	Fee-for-Service	1336230572	1336230572	1	1	LYNCH, MAURICE A OD	1/10/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 WILSHIRE BLVD.	SUITE 1275	LOS ANGELES	CA	90025	7143	19	06037	34.04370122	-118.4678993	Los Angeles County
273128	Fee-for-Service	1295894889	1295894889	1	1	LIM, DEE WEE MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31587	01	General Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
273139	Fee-for-Service	1952385403	1952385403	1	1	LIN, TERENCE MD	11/10/2010	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	88330	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	5409	01	06001	37.54866156	-121.9750739	Alameda County
273151	Fee-for-Service	1932775251	1932775251	1	1	LUONG, JENNIFER H MD	4/28/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
273176	Fee-for-Service	1326369349	1326369349	1	1	LEUNG, JENNIFER T MD	6/23/2015	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	117653	None	None	0	In state provider	None	2333 BUCHANAN STREET	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
273182	Fee-for-Service	1033410303	1033410303	1	1	LUNG, CARMEN Y CNM	10/18/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
273195	Fee-for-Service	1275641821	1275641821	1	1	LEBARON, ELIZABETH J	4/1/1996	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
273226	Fee-for-Service	1790856557	1790856557	1	1	LOVEJOY, AMY E MD	5/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75176	78	Neoplastic Diseases/Oncology	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
273256	Fee-for-Service	1235142761	1235142761	1	1	LI, EVELYN E MD	4/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	48660	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	27206 CALAROGA AVE	STE 205	HAYWARD	CA	94545	4300	01	06001	37.632357	-122.0868765	Alameda County
273288	Fee-for-Service	1417907940	1417907940	1	27	LPCH MEDICAL GROUP DIV OF LU	11/17/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	5720 STONERIDGE MALL RD	#240	PLEASANTON	CA	94588	2830	01	06001	37.69247085	-121.9301884	Alameda County
273293	Fee-for-Service	1124736061	1124736061	1	1	LEWIS, BRIA	1/28/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6800 INDIANA AVE STE 130	None	RIVERSIDE	CA	92506	4266	33	06065	33.94303679	-117.391856	Riverside County
273316	Fee-for-Service	1649665795	1649665795	1	1	LIU, JOSHUA J MD	11/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153863	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
273324	Fee-for-Service	1417907940	1417907940	1	31	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1900 GARDEN RD	STE 110	MONTEREY	CA	93940	5334	27	06053	36.58681385	-121.8623548	Monterey County
273327	Fee-for-Service	1437318474	1437318474	1	1	LUO, MINGFEI MD	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122016	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
273349	Fee-for-Service	1235699414	1235699414	1	1	LI, KATHERINE T MD	6/11/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	178610	77	Infectious Disease	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
273366	Fee-for-Service	1760707830	1760707830	1	1	LAJOIE, ALEXANDRA MD	2/3/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	125777	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4640 ADMIRALTY WAY	9TH FL	MARINA DEL REY	CA	90292	6630	19	06037	33.98120707	-118.4409729	Los Angeles County
273373	Fee-for-Service	1821393489	1821393489	1	2	LAGUNA HOME HEALTH SERVICES	12/28/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1902 WRIGHT PL	SUITE 254	CARLSBAD	CA	92008	6583	37	06073	33.12126581	-117.2883907	San Diego County
273381	Fee-for-Service	1255771747	1255771747	1	1	LIM, PHILIP K MD	8/2/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	131638	20	Orthopedic Surgery	0	In state provider	None	101 CITY DR S	# B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
273409	Fee-for-Service	1093891517	1093891517	1	1	LE, TINH-UYEN H MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75398	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
273413	Fee-for-Service	1114975646	1114975646	1	1	LI, D YUNG-NING	2/8/2015	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	5312	30	Radiology	0	In state provider	None	830 SCENIC DR	None	MODESTO	CA	95350	6131	50	06099	37.64720049	-120.982338	Stanislaus County
273420	Fee-for-Service	1720234701	1720234701	1	1	LEE, CHANG L MD INC	10/14/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	99010	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	399 E HIGHLAND AVE	SUITE 223	SAN BERNARDINO	CA	92404	3864	36	06071	34.1358627	-117.2757898	San Bernardino County
273484	Fee-for-Service	1932375649	1932375649	1	1	LITWILLER, JONATHAN P MD	3/14/2022	207L00000X	NA	Other	026	PHYSICIANS	174030	None	None	0	In state provider	None	2425 SAMARITAN DRIVE	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
273497	Fee-for-Service	1790856557	1790856557	1	1	LOVEJOY, AMY E MD	5/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75176	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
273513	Fee-for-Service	1689099293	1689099293	1	1	LIEVANO, KANGMEI DO	5/28/2024	207P00000X	NA	Other	026	PHYSICIANS	21593	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23625 HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
273528	Fee-for-Service	1063931616	1063931616	1	1	LINDNER, DANIELLE J	12/11/2017	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	4482 BARRANCA	STE 175	IRVINE	CA	92604	1746	30	06059	33.68008811	-117.8015383	Orange County
273545	Fee-for-Service	1942304373	1942304373	3	1	LEE, THOMAS T MD	9/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	37294	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4950 SAN BERNARDINO ST	STE 106	MONTCLAIR	CA	91763	2328	36	06071	34.07768363	-117.6968874	San Bernardino County
273567	Fee-for-Service	1033506175	1033506175	1	1	LIN, ANDREW DO	11/1/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	17256	13	Neurology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
273578	Fee-for-Service	1073722005	1073722005	1	1	LANDMARK MEDICAL SERVICES	7/28/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	2030 N GAREY AVENUE	None	POMONA	CA	91767	2722	19	06037	34.08361398	-117.7525657	Los Angeles County
273628	Fee-for-Service	1144494659	1144494659	1	1	LAM, JULIE	10/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	109728	None	None	0	In state provider	None	8841 GARVEY AVE	None	ROSEMEAD	CA	91770	3358	19	06037	34.06276591	-118.07587	Los Angeles County
273639	Fee-for-Service	1578596292	1578596292	1	1	LIPTON, STUART A MD	1/1/2000	2084N0400X	NA	Neurology	026	PHYSICIANS	85439	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
273655	Fee-for-Service	1790946440	1790946440	1	1	LOUIS, ANKMALIKA A G MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116893	40	Pediatrics	0	In state provider	None	27871 MEDICAL CENTER RD	SUITE 200	MISSION VIEJO	CA	92691	6406	30	06059	33.558534	-117.6641255	Orange County
273657	Fee-for-Service	1245817196	1245817196	1	1	LENTZ, SARAH MD	3/12/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
273669	Fee-for-Service	1740691427	1740691427	1	1	LEUNG, TIFFANY K MD	6/4/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	142357	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
273693	Fee-for-Service	1285385740	1285385740	1	1	LEWIS, SHANDA	11/20/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23181 VERDUGO DR	STE 103A	LAGUNA HILLS	CA	92653	1313	30	06059	33.62609529	-117.7293191	Orange County
273701	Fee-for-Service	1295148773	1295148773	1	1	LESTER, JENNA C MD	7/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139821	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
273762	Fee-for-Service	1871190249	1871190249	1	1	LOZADA, JANICE P RCP	8/11/2023	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
273765	Fee-for-Service	1790856557	1790856557	1	1	LOVEJOY, AMY E MD	5/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75176	68	Hematology	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
273770	Fee-for-Service	1285845982	1285845982	1	1	LOS ANGELES COUNTY	5/23/2007	No Taxonomy Provided	NA	None	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	DEPT OF HEALTH SERVICES	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	19	06037	34.32450186	-118.4456317	Los Angeles County
273781	Fee-for-Service	1346420437	1346420437	1	1	LU, STEPHANIE Y MD	4/15/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	93439	18	Ophthalmology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
273782	Fee-for-Service	1740500800	1740500800	1	1	LIZARO, SANTIAGO R MD	12/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54073	40	Pediatrics	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
273785	Fee-for-Service	1245724541	1245724541	1	1	LIN, VICKI CRNA	11/6/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
273793	Fee-for-Service	1487221628	1487221628	1	1	LIFELINC ANESTHESIA VI PC	11/9/2021	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	75 NIELSON	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
273848	Fee-for-Service	1447214432	1447214432	1	1	LEUNG, JESSICA W MD	10/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81266	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
273850	Fee-for-Service	1518013580	1518013580	1	1	LOMPOC VALLEY ANESTHESIA	11/1/1993	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	ASSOCIATES	1515 E OCEAN AVE.	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
273866	Fee-for-Service	1619388378	1619388378	1	1	LAWHN HEATH, COURTNEY MD	6/28/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	141735	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
273872	Fee-for-Service	1760809859	1760809859	1	1	LEE, STEPHANIE C MD	7/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150024	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
273880	Fee-for-Service	1114454600	1114454600	1	1	LAM, CHRISTINA K DO	3/28/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	18864	None	None	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
273916	Fee-for-Service	1477583656	1477583656	1	1	LE, HOANG TRAN MD	9/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67079	41	Internal Medicine	0	In state provider	None	10221 SLATER AVE	STE 102	FOUNTAIN VALLEY	CA	92708	4743	30	06059	33.70910146	-117.950427	Orange County
273948	Fee-for-Service	1417907940	1417907940	1	29	LPCH MEDICAL GROUP DIV OF LU	4/1/2015	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE PACKARD CHILDRENS	824 BAY AVE	STE 70	CAPITOLA	CA	95010	2104	44	06087	36.98166938	-121.9559707	Santa Cruz County
273974	Fee-for-Service	1457599631	1457599631	1	2	LOS ANGELES CHRISTIAN	6/16/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	545 S SAN PEDRO ST	RM 237, 268-274,NURSING	LOS ANGELES	CA	90013	2101	19	06037	34.04312264	-118.2446664	Los Angeles County
273978	Fee-for-Service	1528146305	1528146305	1	1	LAZO, IRENEO B	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49328	08	Family Practice	0	In state provider	None	2585 SAMARITAN DR	None	SAN JOSE	CA	95124	4107	43	06085	37.25083752	-121.9503884	Santa Clara County
274001	Fee-for-Service	1710066147	1710066147	1	2	LEDUC, XUANTO MD	1/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	39058	01	General Practice	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
274018	Fee-for-Service	1174566343	1174566343	2	1	LONGS DRUG STORES CA LLC	12/8/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1550 E 14TH ST	None	SAN LEANDRO	CA	94577	4807	01	06001	37.72316567	-122.1533351	Alameda County
274059	Fee-for-Service	1487221628	1487221628	1	1	LIFELINC ANESTHESIA VI PC	11/9/2021	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	75 NIELSON	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
274086	Fee-for-Service	1598898330	1598898330	1	1	LI, EVELYN E MD INC	1/25/2000	193200000X	NA	Other	026	PHYSICIANS	48660	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	27206 CALAROGA AVE	STE 205	HAYWARD	CA	94545	4300	01	06001	37.632357	-122.0868765	Alameda County
274108	Fee-for-Service	1851668255	1851668255	1	1	LIN, STEVEN Y MD	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118924	08	Family Practice	0	In state provider	None	300 PASTEUR DR	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
274114	Fee-for-Service	1518013580	1518013580	1	1	LOMPOC VALLEY ANESTHESIA	6/13/2024	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	ASSOCIATES	1515 E OCEAN AVE.	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
274180	Fee-for-Service	1306864756	1306864756	1	1	LOOSE, MICHAEL S MD	3/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84055	36	Psychiatry	0	In state provider	None	3273 CLAREMONT WAY	STE 201	NAPA	CA	94558	3329	28	06055	38.32062499	-122.3012501	Napa County
274181	Fee-for-Service	1477583656	1477583656	1	1	LE, HOANG TRAN MD	9/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67079	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	10221 SLATER AVE	STE 102	FOUNTAIN VALLEY	CA	92708	4743	30	06059	33.70910146	-117.950427	Orange County
274210	Fee-for-Service	1174955728	1174955728	1	1	LEFKOWITZ, MELISSA H	12/24/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	116 E WALNUT AVE	None	MONROVIA	CA	91016	3431	19	06037	34.14367921	-118.0000903	Los Angeles County
274213	Fee-for-Service	1417907940	1417907940	1	29	LPCH MEDICAL GROUP DIV OF LU	4/1/2015	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE PACKARD CHILDRENS	824 BAY AVE	STE 70	CAPITOLA	CA	95010	2104	44	06087	36.98166938	-121.9559707	Santa Cruz County
274226	Fee-for-Service	1053503599	1053503599	1	1	LISA L SCHLITZKUS	7/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
274227	Fee-for-Service	1073010740	1073010740	1	1	LUCERNE VALLEY HEALTHCARE IN	4/18/2019	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	32770 OLD WOMAN SPRINGS	UNIT A	LUCERNE VALLEY	CA	92356	7012	36	06071	34.44391545	-116.948943	San Bernardino County
274238	Fee-for-Service	1457599631	1457599631	1	2	LOS ANGELES CHRISTIAN	6/16/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	545 S SAN PEDRO ST	RM 237, 268-274,NURSING	LOS ANGELES	CA	90013	2101	19	06037	34.04312264	-118.2446664	Los Angeles County
274259	Fee-for-Service	1336148832	1336148832	1	1	LEIBOLD, JOHN L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10500 MONTGOMERY RD	None	CINCINNATI	OH	45242	0000	00	None	39.252267	-84.3413535	Hamilton County
274262	Fee-for-Service	1710077961	1710077961	2	1	L AND P MEDICAL GROUP INC	10/31/1994	193400000X	NA	Other	026	PHYSICIANS	46128	01	General Practice	0	In state provider	None	1107 S ALVARADO ST	None	LOS ANGELES	CA	90006	4184	19	06037	34.04997092	-118.2810099	Los Angeles County
274294	Fee-for-Service	1144336355	1144336355	1	1	LANDMAN, PETRA F MD	4/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	60639	40	Pediatrics	0	In state provider	None	2320 WOOLSEY ST	301	BERKELEY	CA	94705	1976	01	06001	37.85282167	-122.2609028	Alameda County
274347	Fee-for-Service	1174739544	1174739544	1	1	LOYDS LIBERTY HOMES INC	3/11/1997	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	9605 HOLLY OAK DR	None	BAKERSFIELD	CA	93311	1712	15	06029	35.33251965	-119.1093013	Kern County
274383	Fee-for-Service	1972745123	1972745123	1	1	LI, WENDIE S MD	4/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	103706	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
274429	Fee-for-Service	1386759272	1386759272	1	1	LOWRY, JENNIFER L DO	12/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10583	36	Psychiatry	0	In state provider	None	11770 BERNARDO PLAZA CT	STE 370	SAN DIEGO	CA	92128	2426	37	06073	33.02003995	-117.0767619	San Diego County
274431	Fee-for-Service	1467468488	1467468488	1	1	LEE, STEPHEN B MD	1/29/2008	174400000X	NA	Other	026	PHYSICIANS	65674	08	Family Practice	0	In state provider	None	1617 E. FIRST ST	STE A	SANTA ANA	CA	92701	6385	30	06059	33.74616534	-117.8462414	Orange County
274437	Fee-for-Service	1245226190	1245226190	1	1	LEESBURG REGIONAL MEDICAL	3/20/2010	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	600 E DIXIE AVE	None	LEESBURG	FL	34748	5925	00	None	28.808244	-81.868338	Lake County
274445	Fee-for-Service	1306864756	1306864756	1	1	LOOSE, MICHAEL S MD	3/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84055	26	Psychiatry (child)	0	In state provider	None	3273 CLAREMONT WAY	STE 201	NAPA	CA	94558	3329	28	06055	38.32062499	-122.3012501	Napa County
274452	Fee-for-Service	1942910724	1942910724	1	2	LEGACY THERAPEUTIC SERVICES,	4/3/2024	225X00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	18270 SISKIYOU RD	SUITE B	APPLE VALLEY	CA	92307	1413	36	06071	34.54450348	-117.265221	San Bernardino County
274468	Fee-for-Service	1285121335	1285121335	1	1	LECH, REBECCA M DO	12/12/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17598	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
274472	Fee-for-Service	1366525487	1366525487	1	3	LOS ANGELES RADIOLOGY	10/4/2018	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	115 MALL DR	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
274478	Fee-for-Service	1417907940	1417907940	1	29	LPCH MEDICAL GROUP DIV OF LU	4/1/2015	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	LUCILE PACKARD CHILDRENS	824 BAY AVE	STE 70	CAPITOLA	CA	95010	2104	44	06087	36.98166938	-121.9559707	Santa Cruz County
274484	Fee-for-Service	1902860513	1902860513	1	1	LABUGUEN, MELINDA D MD	11/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	52770	22	Pathology (M.D. only)	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
274505	Fee-for-Service	1801001466	1801001466	1	1	LEE, ROGER P MD	4/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101973	30	Radiology	0	In state provider	None	2800 L STREET	STE 610	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
274516	Fee-for-Service	1215973920	1215973920	1	1	LE, HOANG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 NE MOTHER JOSEPH PL	None	VANCOUVER	WA	98664	3299	00	None	45.624096	-122.580144	Clark County
274533	Fee-for-Service	1417054321	1417054321	1	1	LOPRESTI, ANTHONY DO	9/23/2015	207K00000X	NA	Other	026	PHYSICIANS	6194	08	Family Practice	0	In state provider	None	325 N WIGET LN	STE 130	WALNUT CREEK	CA	94598	2435	07	06013	37.92849285	-122.0266387	Contra Costa County
274557	Fee-for-Service	1093580268	1093580268	1	1	LEBLANC, ASHLEY PT	2/5/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
274585	Fee-for-Service	1114131489	1114131489	1	1	LYON, KRISTOPHER L MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100746	None	None	0	In state provider	None	1911 JOHNSON AVENUE	None	SAN LUIS OBISPO	CA	93401	4131	40	06079	35.27851417	-120.6501092	San Luis Obispo County
274606	Fee-for-Service	1801384045	1801384045	1	1	LAMPLEY, ANDREW MD	7/27/2020	2084B0040X	NA	Neurology	026	PHYSICIANS	164903	None	None	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
274702	Fee-for-Service	1245226190	1245226190	1	1	LEESBURG REGIONAL MEDICAL	3/20/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	600 E DIXIE AVE	None	LEESBURG	FL	34748	5925	00	None	28.808244	-81.868338	Lake County
274712	Fee-for-Service	1417907940	1417907940	1	9	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 100	WALNUT CREEK	CA	94598	3084	07	06013	37.91255783	-122.0428047	Contra Costa County
274716	Fee-for-Service	1942910724	1942910724	1	2	LEGACY THERAPEUTIC SERVICES,	4/3/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	18270 SISKIYOU RD	SUITE B	APPLE VALLEY	CA	92307	1413	36	06071	34.54450348	-117.265221	San Bernardino County
274741	Fee-for-Service	1417907940	1417907940	1	29	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE PACKARD CHILDRENS	824 BAY AVE	STE 70	CAPITOLA	CA	95010	2104	44	06087	36.98166938	-121.9559707	Santa Cruz County
274785	Fee-for-Service	1174601793	1174601793	1	1	LAWRY, TODD B MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	83453	07	Dermatology	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
274797	Fee-for-Service	1417054321	1417054321	1	1	LOPRESTI, ANTHONY DO	9/23/2015	207K00000X	NA	Other	026	PHYSICIANS	6194	01	General Practice	0	In state provider	None	325 N WIGET LN	STE 130	WALNUT CREEK	CA	94598	2435	07	06013	37.92849285	-122.0266387	Contra Costa County
274836	Fee-for-Service	1265461644	1265461644	1	1	LUI, FRED Y MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	44819	01	General Practice	0	In state provider	None	1750 EL CAMINO REAL	STE 15	BURLINGAME	CA	94010	3208	41	06081	37.59392355	-122.3819595	San Mateo County
274838	Fee-for-Service	1093165987	1093165987	1	1	LI, YUN R MD	10/25/2021	2085R0001X	NA	Other	026	PHYSICIANS	152614	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
274858	Fee-for-Service	1578947271	1578947271	1	1	LESLIE, ERIC A MD	12/24/2021	207P00000X	NA	Other	026	PHYSICIANS	143816	None	None	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
274870	Fee-for-Service	1619522992	1619522992	1	1	LAND OF PEACE 1	9/20/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6624 SALE AVE	None	WEST HILLS	CA	91307	3628	19	06037	34.19111954	-118.6185969	Los Angeles County
274877	Fee-for-Service	1780702654	1780702654	1	1	LUONG, CHERYL A	5/25/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 CALIFORNIA STREET	None	REDLANDS	CA	92374	2910	36	06071	34.07159807	-117.2263378	San Bernardino County
274888	Fee-for-Service	1528486602	1528486602	1	1	LI, YI MD	10/28/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	152249	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
274892	Fee-for-Service	1285964577	1285964577	1	1	LING, DANIEL E MD	8/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125178	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1801	19	06037	34.07671715	-118.3799413	Los Angeles County
274897	Fee-for-Service	1114414331	1114414331	1	1	LA SPADA, PAIGE MD	2/19/2020	390200000X	NA	Other	026	PHYSICIANS	164952	08	Family Practice	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
274948	Fee-for-Service	1194735886	1194735886	1	1	LODI MEMORIAL HOSPITAL	8/1/1999	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	MEDICAL GROUP	1235 W VINE ST	# 20	LODI	CA	95240	5109	39	06077	38.12279179	-121.2879362	San Joaquin County
274973	Fee-for-Service	1417907940	1417907940	1	9	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 100	WALNUT CREEK	CA	94598	3084	07	06013	37.91255783	-122.0428047	Contra Costa County
274999	Fee-for-Service	1548511033	1548511033	1	1	LOGHMANI, NORMA L LCSW	2/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
275003	Fee-for-Service	1417907940	1417907940	1	29	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE PACKARD CHILDRENS	824 BAY AVE	STE 70	CAPITOLA	CA	95010	2104	44	06087	36.98166938	-121.9559707	Santa Cruz County
275013	Fee-for-Service	1275532145	1275532145	1	1	LEE, SIMON K MD	10/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83169	41	Internal Medicine	0	In state provider	None	950 STOCKTON ST	STE 202	SAN FRANCISCO	CA	94108	1676	38	06075	37.79469747	-122.4079497	San Francisco County
275031	Fee-for-Service	1538190749	1538190749	1	1	LERNER, HILARY J MD	2/8/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	40939	18	Ophthalmology	0	In state provider	None	2260 GLADSTONE DR	STE 4	PITTSBURG	CA	94565	5125	07	06013	38.00615824	-121.8668668	Contra Costa County
275068	Fee-for-Service	1306982855	1306982855	1	6	LA LASER CENTER, PC, A PROFE	5/21/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	CANCER	400 N IRWIN ST	None	HANFORD	CA	93230	4426	16	06031	36.32926961	-119.6477031	Kings County
275083	Fee-for-Service	1336815612	1336815612	1	1	LINCARE INC	2/1/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	405 W COLLEGE AVE	SUITE A	SANTA ROSA	CA	95401	6506	49	06097	38.446245	-122.73237	Sonoma County
275096	Fee-for-Service	1558920843	1558920843	1	1	LIBERTYMED HEALTH GROUP INC	9/18/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	900 GLENOAKS BLVD	D	GLENDALE	CA	91202	2664	19	06037	34.16091126	-118.2752474	Los Angeles County
275098	Fee-for-Service	1265461644	1265461644	1	1	LUI, FRED Y MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	44819	45	Nephrology (Renal-Kidney)	0	In state provider	None	1750 EL CAMINO REAL	STE 15	BURLINGAME	CA	94010	3208	41	06081	37.59392355	-122.3819595	San Mateo County
275135	Fee-for-Service	1831455575	1831455575	1	1	LEE, AARON D MD	9/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124768	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
275158	Fee-for-Service	1457914954	1457914954	1	1	LUONG, SERENA S DO	7/1/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	19646	None	None	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
275165	Fee-for-Service	1942337985	1942337985	1	1	LEE, EUGENE	6/14/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
275209	Fee-for-Service	1194735886	1194735886	1	1	LODI MEMORIAL HOSPITAL	8/1/1999	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	MEDICAL GROUP	1235 W VINE ST	# 20	LODI	CA	95240	5109	39	06077	38.12279179	-121.2879362	San Joaquin County
275223	Fee-for-Service	1275858102	1275858102	1	1	LEE, ADAM K MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151013	20	Orthopedic Surgery	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
275232	Fee-for-Service	1417907940	1417907940	1	9	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 100	WALNUT CREEK	CA	94598	3084	07	06013	37.91255783	-122.0428047	Contra Costa County
275239	Fee-for-Service	1871661793	1871661793	1	1	LERTWONGKANAKOOL, SUVEPA	8/31/1989	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	726 SANTA MONICA BLVD	STE 204	SANTA MONICA	CA	90401	2626	19	06037	34.01925137	-118.4916438	Los Angeles County
275264	Fee-for-Service	1417907940	1417907940	1	29	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE PACKARD CHILDRENS	824 BAY AVE	STE 70	CAPITOLA	CA	95010	2104	44	06087	36.98166938	-121.9559707	Santa Cruz County
275281	Fee-for-Service	1790312189	1790312189	1	1	LIAO, PETER L MD	6/30/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	178622	36	Psychiatry	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
275315	Fee-for-Service	1730178807	1730178807	1	1	LEVIN, DESMOND D MD	11/19/1996	174400000X	NA	Other	026	PHYSICIANS	46414	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	361 HOSPITAL RD	STE 227	NEWPORT BEACH	CA	92663	3523	30	06059	33.62579141	-117.9299554	Orange County
275317	Fee-for-Service	1164059911	1164059911	1	1	LEE, KELSEY DO	8/17/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20302	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
275328	Fee-for-Service	1679899694	1679899694	1	1	LEE, JEDIAH J MD	9/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135858	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
275329	Fee-for-Service	1306982855	1306982855	1	6	LA LASER CENTER, PC, A PROFE	5/21/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	CANCER	400 N IRWIN ST	None	HANFORD	CA	93230	4426	16	06031	36.32926961	-119.6477031	Kings County
275354	Fee-for-Service	1265461644	1265461644	1	1	LUI, FRED Y MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	44819	41	Internal Medicine	0	In state provider	None	1750 EL CAMINO REAL	STE 15	BURLINGAME	CA	94010	3208	41	06081	37.59392355	-122.3819595	San Mateo County
275377	Fee-for-Service	1659675015	1659675015	1	1	LAU, ELISA H.Y DO	7/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
275397	Fee-for-Service	1942650627	1942650627	1	1	LOPEZ, REBECCA M MD	1/30/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151344	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
275421	Fee-for-Service	1770632051	1770632051	1	1	LE, TUAN MD	3/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	55456	45	Nephrology (Renal-Kidney)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
275442	Fee-for-Service	1578038790	1578038790	1	1	LAUZON, SYLVIE R CNM	2/12/2024	171M00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
275464	Fee-for-Service	1881071215	1881071215	1	1	LOPEZ, ASHLEY E CRNA	9/10/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
275483	Fee-for-Service	1487893301	1487893301	1	1	LEE, JANE V LMFT	10/7/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	401 SPRING ST	STE 203	NEVADA CITY	CA	95959	2448	29	06057	39.26236961	-121.0205076	Nevada County
275489	Fee-for-Service	1417907940	1417907940	1	9	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 100	WALNUT CREEK	CA	94598	3084	07	06013	37.91255783	-122.0428047	Contra Costa County
275503	Fee-for-Service	1295883080	1295883080	1	1	LIM, RENEE MD	3/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	84314	08	Family Practice	0	In state provider	None	1042 N EL CAMINO REAL	STE B170	ENCINITAS	CA	92024	1322	37	06073	33.066063	-117.26559	San Diego County
275522	Fee-for-Service	1417907940	1417907940	1	29	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE PACKARD CHILDRENS	824 BAY AVE	STE 70	CAPITOLA	CA	95010	2104	44	06087	36.98166938	-121.9559707	Santa Cruz County
275607	Fee-for-Service	1417907940	1417907940	1	21	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	2160 APPIAN WAY	SUITE 100	PINOLE	CA	94564	2524	07	06013	37.99585174	-122.3021549	Contra Costa County
275609	Fee-for-Service	1740863273	1740863273	1	1	LONG, MATTHEW T DO	7/2/2024	207R00000X	NA	Other	026	PHYSICIANS	22404	41	Internal Medicine	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
275636	Fee-for-Service	1750375440	1750375440	1	1	LARSSON, KATHRYN L	10/29/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	HARDER OPTOMETRY	1150 W ORANGEBURG AVE	None	MODESTO	CA	95350	4042	50	06099	37.66396236	-121.0095829	Stanislaus County
275669	Fee-for-Service	1285398552	1285398552	1	1	LOPEZ, RAMON R CRNA	4/19/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
275697	Fee-for-Service	1083023030	1083023030	1	1	LOPEZ, GLADYS LPCC	3/11/2025	No Taxonomy Provided	NA	None	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
275731	Fee-for-Service	1467407973	1467407973	1	1	LIM-KYO, SHIELA-LYN M NP	2/16/2022	2279P3900X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
275743	Fee-for-Service	1003231283	1003231283	1	1	LEWIS, WENDY M PHD	5/27/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
275748	Fee-for-Service	1417907940	1417907940	1	9	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 100	WALNUT CREEK	CA	94598	3084	07	06013	37.91255783	-122.0428047	Contra Costa County
275779	Fee-for-Service	1417907940	1417907940	1	29	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE PACKARD CHILDRENS	824 BAY AVE	STE 70	CAPITOLA	CA	95010	2104	44	06087	36.98166938	-121.9559707	Santa Cruz County
275784	Fee-for-Service	1699954644	1699954644	1	1	LUKAC, JAN S MD	9/6/2010	207W00000X	NA	Ophthalmology	026	PHYSICIANS	32888	18	Ophthalmology	0	In state provider	None	410 W CENTRAL AVE	STE 109	BREA	CA	92821	3009	30	06059	33.93194416	-117.9031642	Orange County
275827	Fee-for-Service	1659350718	1659350718	1	1	LIEBROSS, BURTON A MD	3/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	32169	45	Nephrology (Renal-Kidney)	0	In state provider	None	5525 ETIWANDA AVE	STE 320	TARZANA	CA	91356	6130	19	06037	34.17046451	-118.5308463	Los Angeles County
275831	Fee-for-Service	1225108533	1225108533	1	1	LUCCHESI, ARCHANA C MD	8/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84084	None	None	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
275838	Fee-for-Service	1861750507	1861750507	1	1	LI, DAVID Z H DO	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14459	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
275861	Fee-for-Service	1912334202	1912334202	1	1	LAFAMILIA PHARMACY INC	6/10/2014	332B00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14359 PIONEER BLVD	STE B	NORWALK	CA	90650	4870	19	06037	33.90057	-118.0826075	Los Angeles County
275862	Fee-for-Service	1902617210	1902617210	1	1	LEE, SHANNON NP	3/28/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
275863	Fee-for-Service	1417907940	1417907940	1	21	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	2160 APPIAN WAY	SUITE 100	PINOLE	CA	94564	2524	07	06013	37.99585174	-122.3021549	Contra Costa County
275868	Fee-for-Service	1548774714	1548774714	1	1	LEGER, MICHELLE J PSYD	2/24/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
275870	Fee-for-Service	1245262013	1245262013	1	1	LEE, YU-HSIANG S DO	8/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12321	01	General Practice	0	In state provider	None	600 N GARFIELD AVE	STE 100	MONTEREY PARK	CA	91754	1167	19	06037	34.06820797	-118.1228835	Los Angeles County
275899	Fee-for-Service	1376575910	1376575910	1	1	LARA, OLEGARIO J DO	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	6671	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
275925	Fee-for-Service	1194772418	1194772418	1	1	LEE, SAMUEL S MD	3/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	49819	34	Urology and Urological Surgery	0	In state provider	None	16850 BEAR VALLEY ROAD	None	VICTORVILLE	CA	92395	5795	36	06071	34.47092468	-117.2977236	San Bernardino County
275929	Fee-for-Service	1114109279	1114109279	1	1	LUCKIE, DEBORAH K DO	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
275974	Fee-for-Service	1255353694	1255353694	1	1	LEE, JOSEPH DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2085 RICE ST	None	ROSEVILLE	MN	55113	6807	00	None	45.004023	-93.10596601	Ramsey County
275977	Fee-for-Service	1417907940	1417907940	1	19	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	3100 TELEGRAPH AVE	SUITE 2103	OAKLAND	CA	94609	3239	01	06001	37.82037533	-122.2667839	Alameda County
275983	Fee-for-Service	1497381354	1497381354	1	1	LEE, EUN JEE MD	7/1/2023	208M00000X	NA	Other	026	PHYSICIANS	176495	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
275986	Fee-for-Service	1710392204	1710392204	1	1	LAI, SIMON OD	12/15/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	781 VALLEJO ST	None	SAN FRANCISCO	CA	94133	3834	38	06075	37.79840018	-122.4100366	San Francisco County
275989	Fee-for-Service	1194266130	1194266130	1	1	LOERA, ALEXANDER LMFT	10/13/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	32 S RAYMOND AVE	3	PASADENA	CA	91105	1961	19	06037	34.145172	-118.1488625	Los Angeles County
276001	Fee-for-Service	1417907940	1417907940	1	9	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 100	WALNUT CREEK	CA	94598	3084	07	06013	37.91255783	-122.0428047	Contra Costa County
276017	Fee-for-Service	1629296140	1629296140	1	1	LONDON, MICHELE L LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
276022	Fee-for-Service	1730268483	1730268483	1	1	LE, HIEN D MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93825	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
276024	Fee-for-Service	1861868267	1861868267	1	1	LIZANO, CHRISTA N LCSW	8/9/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	26585 W AGOURA ROAD	330	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
276032	Fee-for-Service	1760447031	1760447031	1	1	LE, LONG X MD	1/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	79487	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3200 WALFORD AVENUE	STE A	EUREKA	CA	95503	4828	12	06023	40.77887445	-124.1378239	Humboldt County
276077	Fee-for-Service	1033153754	1033153754	1	1	L'ARCHEVEQUE, DEE M MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	78038	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
276082	Fee-for-Service	1659350718	1659350718	1	1	LIEBROSS, BURTON A MD	3/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	32169	41	Internal Medicine	0	In state provider	None	5525 ETIWANDA AVE	STE 320	TARZANA	CA	91356	6130	19	06037	34.17046451	-118.5308463	Los Angeles County
276103	Fee-for-Service	1265937049	1265937049	1	1	LEE, CHRISTOPHER	7/30/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	165127	30	Radiology	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
276113	Fee-for-Service	1326004789	1326004789	1	1	LASK, DAVID C MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	36939	30	Radiology	0	In state provider	None	44105 15TH ST W	None	LANCASTER	CA	93534	4088	19	06037	34.684218	-118.1568465	Los Angeles County
276114	Fee-for-Service	1417907940	1417907940	1	21	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	2160 APPIAN WAY	SUITE 100	PINOLE	CA	94564	2524	07	06013	37.99585174	-122.3021549	Contra Costa County
276194	Fee-for-Service	1871536532	1871536532	1	1	LIU, YI HUI MD	9/5/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75175	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
276199	Fee-for-Service	1740369883	1740369883	1	1	LEU, JASON T MD	2/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88628	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
276201	Fee-for-Service	1083656862	1083656862	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	260 SPRUCE ST	None	GRIDLEY	CA	95948	2216	04	06007	39.36699649	-121.690458	Butte County
276218	Fee-for-Service	1437444916	1437444916	1	1	LA, QUAN M MD	4/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143240	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
276229	Fee-for-Service	1417907940	1417907940	1	19	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	3100 TELEGRAPH AVE	SUITE 2103	OAKLAND	CA	94609	3239	01	06001	37.82037533	-122.2667839	Alameda County
276249	Fee-for-Service	1790941078	1790941078	1	1	LAURIE, TIMOTHY DO	6/1/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	22195	10	Gastroenterology (M.D. only)	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
276250	Fee-for-Service	1255364055	1255364055	1	1	LAU, NANCY C MD	10/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90951	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
276254	Fee-for-Service	1417907940	1417907940	1	9	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 100	WALNUT CREEK	CA	94598	3084	07	06013	37.91255783	-122.0428047	Contra Costa County
276259	Fee-for-Service	1790701514	1790701514	1	1	LATINO HEALTH SERVICES MEDIC	12/1/2003	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ANTA ANA	517 N MAIN ST	STE 100	SANTA ANA	CA	92701	4619	30	06059	33.74951945	-117.8675809	Orange County
276262	Fee-for-Service	1275761470	1275761470	1	1	LUDWIG, GAIL A	7/9/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9466 BLACK MTN RD	STE 100	SAN DIEGO	CA	92126	4550	37	06073	32.89448076	-117.123457	San Diego County
276269	Fee-for-Service	1831426642	1831426642	1	2	LAKESIDE MEDICAL	4/13/2010	208800000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	24355 LYONS AVE	STE 222	SANTA CLARITA	CA	91321	2386	19	06037	34.37868281	-118.5605291	Los Angeles County
276271	Fee-for-Service	1568473965	1568473965	1	1	LEVY, ROBERT L MD	12/11/2002	207RH0003X	NA	Oncology	026	PHYSICIANS	39275	78	Neoplastic Diseases/Oncology	0	In state provider	None	1401 SPANOS CAT	STE 134	MODESTO	CA	95355	0000	50	06099	37.66975543	-120.9724048	Stanislaus County
276275	Fee-for-Service	1164506382	1164506382	1	1	LEE, DAVIS Y MD	4/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88870	40	Pediatrics	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
276289	Fee-for-Service	1962908111	1962908111	1	1	LOPEZ, BLAKE E MD	5/1/2022	207P00000X	NA	Other	026	PHYSICIANS	177065	None	None	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
276303	Fee-for-Service	1134166333	1134166333	1	1	LY, KELLY L MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91551	05	Anesthesiology	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
276330	Fee-for-Service	1033153754	1033153754	1	1	L'ARCHEVEQUE, DEE M MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	78038	01	General Practice	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
276331	Fee-for-Service	1457599631	1457599631	1	1	LOS ANGELES CHRISTIAN	7/1/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1625 E 4TH ST	None	LOS ANGELES	CA	90033	4201	19	06037	34.04297786	-118.2220181	Los Angeles County
276366	Fee-for-Service	1417907940	1417907940	1	21	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	2160 APPIAN WAY	SUITE 100	PINOLE	CA	94564	2524	07	06013	37.99585174	-122.3021549	Contra Costa County
276406	Fee-for-Service	1275566267	1275566267	1	1	LOS ANGELES VISION CTR	1/9/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	9808 VENICE BLVD	STE 400	CULVER CITY	CA	90232	6800	19	06037	34.0236396	-118.3980847	Los Angeles County
276410	Fee-for-Service	1326154360	1326154360	1	1	LA CLINICA DE LA RAZA	4/1/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3050 E 16TH ST	None	OAKLAND	CA	94601	2319	01	06001	37.77994268	-122.2250102	Alameda County
276419	Fee-for-Service	1487116208	1487116208	1	1	LIN, JEFFREY M DO	6/29/2022	207P00000X	NA	Other	026	PHYSICIANS	19814	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
276445	Fee-for-Service	1407332273	1407332273	1	1	LIU-CHEN, ANDREW MD	7/8/2023	208800000X	NA	Other	026	PHYSICIANS	165611	None	None	0	In state provider	None	1520 SAN PABLO ST	STE 1300	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
276451	Fee-for-Service	1336593912	1336593912	1	1	LOU, LINDA W MD	11/17/2019	207P00000X	NA	Other	026	PHYSICIANS	158254	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
276464	Fee-for-Service	1508866740	1508866740	1	1	LOUIE, JOHN G MD	6/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	48591	41	Internal Medicine	0	In state provider	None	5575 W LAS POSITAS BLVD	STE 130	PLEASANTON	CA	94588	5800	01	06001	37.69214859	-121.8796532	Alameda County
276471	Fee-for-Service	1437207354	1437207354	1	1	LEE, SOONHAE L MD	1/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	36262	30	Radiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
276479	Fee-for-Service	1568783736	1568783736	1	1	LIN, STEVE DO	12/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12964	41	Internal Medicine	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
276480	Fee-for-Service	1417907940	1417907940	1	19	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	3100 TELEGRAPH AVE	SUITE 2103	OAKLAND	CA	94609	3239	01	06001	37.82037533	-122.2667839	Alameda County
276505	Fee-for-Service	1417907940	1417907940	1	9	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 100	WALNUT CREEK	CA	94598	3084	07	06013	37.91255783	-122.0428047	Contra Costa County
276523	Fee-for-Service	1568473965	1568473965	1	1	LEVY, ROBERT L MD	12/11/2002	207RH0003X	NA	Oncology	026	PHYSICIANS	39275	68	Hematology	0	In state provider	None	1401 SPANOS CAT	STE 134	MODESTO	CA	95355	0000	50	06099	37.66975543	-120.9724048	Stanislaus County
276538	Fee-for-Service	1669758264	1669758264	1	1	LEEGANT, GABRIELLE A LMFT	1/28/2019	390200000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
276578	Fee-for-Service	1457599631	1457599631	1	1	LOS ANGELES CHRISTIAN	7/1/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1625 E 4TH ST	None	LOS ANGELES	CA	90033	4201	19	06037	34.04297786	-118.2220181	Los Angeles County
276613	Fee-for-Service	1689358947	1689358947	1	1	LUCV MEDICAL TRANSPORTATION	8/18/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	CORP	416 2ND. STREET	STE. 105	CALEXICO	CA	92231	9222	13	06025	32.66665368	-115.4926807	Imperial County
276615	Fee-for-Service	1417907940	1417907940	1	21	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	2160 APPIAN WAY	SUITE 100	PINOLE	CA	94564	2524	07	06013	37.99585174	-122.3021549	Contra Costa County
276642	Fee-for-Service	1568415255	1568415255	1	1	LEMUS, JULIO F MD INC	1/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	44494	66	Emergency Medicine (Urgent Care)	0	In state provider	A MEDICAL CORP	120 S MONTEBELLO BLVD	None	MONTEBELLO	CA	90640	4730	19	06037	34.00902509	-118.1084052	Los Angeles County
276648	Fee-for-Service	1851785109	1851785109	1	1	LAI, GRACE Y MD	6/13/2022	207T00000X	NA	General Surgery	026	PHYSICIANS	176698	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
276658	Fee-for-Service	1013267087	1013267087	1	1	LUSK, WILLIAM A LAC	11/26/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
276659	Fee-for-Service	1326154360	1326154360	1	1	LA CLINICA DE LA RAZA	4/1/1992	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3050 E 16TH ST	None	OAKLAND	CA	94601	2319	01	06001	37.77994268	-122.2250102	Alameda County
276681	Fee-for-Service	1942437017	1942437017	1	1	LOBO, VIVETA E MD	8/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120884	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DRIVE	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
276707	Fee-for-Service	1205247376	1205247376	1	1	LEE, JAI H MD A PROFESSIONAL	11/20/2014	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	38492	20	Orthopedic Surgery	0	In state provider	CORPORATION	520 S VIRGIL AVE	STE 103	LOS ANGELES	CA	90020	1425	19	06037	34.064487	-118.2870305	Los Angeles County
276714	Fee-for-Service	1720615032	1720615032	1	1	LA, KEVIN T	9/13/2022	390200000X	NA	Other	026	PHYSICIANS	179813	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
276719	Fee-for-Service	1730374802	1730374802	1	1	LEUNG, CHRISTINA D OD	5/27/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	25252 MCINTYRE STREET	STE D	LAGUNA HILLS	CA	92653	5448	30	06059	33.59484852	-117.679188	Orange County
276728	Fee-for-Service	1417907940	1417907940	1	19	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	3100 TELEGRAPH AVE	SUITE 2103	OAKLAND	CA	94609	3239	01	06001	37.82037533	-122.2667839	Alameda County
276747	Fee-for-Service	1265827554	1265827554	1	1	LI, ALLEN MD	8/27/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	152883	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
276772	Fee-for-Service	1568473965	1568473965	1	1	LEVY, ROBERT L MD	12/11/2002	207RH0003X	NA	Oncology	026	PHYSICIANS	39275	01	General Practice	0	In state provider	None	1401 SPANOS CAT	STE 134	MODESTO	CA	95355	0000	50	06099	37.66975543	-120.9724048	Stanislaus County
276789	Fee-for-Service	1508278714	1508278714	1	2	LEE, SKY MD	1/5/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	139443	-	NOT APPLICABLE	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
276792	Fee-for-Service	1295059871	1295059871	1	1	LEIKAUF, JOHN MD	9/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130939	36	Psychiatry	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
276798	Fee-for-Service	1598078883	1598078883	1	1	LUNA, JENNIE MD	12/24/2020	207RE0101X	NA	Endocrinology	026	PHYSICIANS	168717	None	None	0	In state provider	None	6109 W RAMSEY ST	None	BANNING	CA	92220	3051	33	06065	33.92940576	-116.9437965	Riverside County
276814	Fee-for-Service	1043326853	1043326853	1	1	LIU, ERIC MD	1/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89668	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
276828	Fee-for-Service	1457599631	1457599631	1	1	LOS ANGELES CHRISTIAN	4/24/2023	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1625 E 4TH ST	None	LOS ANGELES	CA	90033	4201	19	06037	34.04297786	-118.2220181	Los Angeles County
276831	Fee-for-Service	1154676112	1154676112	1	1	LOPEZ, EDGAR	5/15/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3392 SPRUCE STREET	None	LAKE ELSINORE	CA	92530	1882	33	06065	33.69535337	-117.3851308	Riverside County
276845	Fee-for-Service	1780183335	1780183335	1	1	LA DOWNTOWN MEDICAL CENTER	3/1/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	LLC	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
276864	Fee-for-Service	1417907940	1417907940	1	21	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	2160 APPIAN WAY	SUITE 100	PINOLE	CA	94564	2524	07	06013	37.99585174	-122.3021549	Contra Costa County
276891	Fee-for-Service	1568415255	1568415255	1	1	LEMUS, JULIO F MD INC	1/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	44494	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	A MEDICAL CORP	120 S MONTEBELLO BLVD	None	MONTEBELLO	CA	90640	4730	19	06037	34.00902509	-118.1084052	Los Angeles County
276974	Fee-for-Service	1467511279	1467511279	1	1	LEE, JULIA Y	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
276976	Fee-for-Service	1417907940	1417907940	1	19	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	3100 TELEGRAPH AVE	SUITE 2103	OAKLAND	CA	94609	3239	01	06001	37.82037533	-122.2667839	Alameda County
277003	Fee-for-Service	1083476139	1083476139	1	1	LO, PAJ KOU CCC-SLP	5/24/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
277015	Fee-for-Service	1366874422	1366874422	1	1	LAU, CLIFFORD S MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126564	01	General Practice	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
277028	Fee-for-Service	1578503132	1578503132	1	1	LEE, DANIEL E MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68580	40	Pediatrics	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
277040	Fee-for-Service	1750879755	1750879755	1	1	LEE, JOHN M MD	5/24/2022	208M00000X	NA	Other	026	PHYSICIANS	176924	None	None	0	In state provider	None	444 BRUCE ST	None	YREKA	CA	96097	3450	47	06093	41.71863548	-122.6458755	Siskiyou County
277046	Fee-for-Service	1043356819	1043356819	1	1	LARSON, AMY J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11714 N CREEK PKWY N	STE 100	BOTHELL	WA	98011	8250	00	None	47.77467892	-122.1838257	King County
277050	Fee-for-Service	1831426642	1831426642	1	19	LAKESIDE MEDICAL	4/13/2010	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	191 S BUENA VISTA STREET	SUITE 420-440	BURBANK	CA	91505	4551	19	06037	34.15872557	-118.3283863	Los Angeles County
277071	Fee-for-Service	1417907940	1417907940	1	17	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1688 WILLOW ST	SUITES B & C	SAN JOSE	CA	95125	5109	43	06085	37.30345662	-121.9161453	Santa Clara County
277074	Fee-for-Service	1467833129	1467833129	1	1	LAKHANI, YASMEEN OD	3/9/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2333 W WHITENDALE AVE	None	VISALIA	CA	93277	8701	54	06107	36.305514	-119.316546	Tulare County
277081	Fee-for-Service	1154676112	1154676112	1	1	LOPEZ, EDGAR	5/15/2015	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3392 SPRUCE STREET	None	LAKE ELSINORE	CA	92530	1882	33	06065	33.69535337	-117.3851308	Riverside County
277084	Fee-for-Service	1417041153	1417041153	1	1	LINDAUER, KELLY R MD	3/25/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	89371	30	Radiology	0	In state provider	None	180 ROWLAND WAY	None	NOVATO	CA	94945	5009	21	06041	38.09825699	-122.5598561	Marin County
277094	Fee-for-Service	1780183335	1780183335	1	1	LA DOWNTOWN MEDICAL CENTER	3/1/2019	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	LLC	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
277105	Fee-for-Service	1508940578	1508940578	1	1	LEE, GARY MD	1/30/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	59012	05	Anesthesiology	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
277111	Fee-for-Service	1417907940	1417907940	1	21	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	2160 APPIAN WAY	SUITE 100	PINOLE	CA	94564	2524	07	06013	37.99585174	-122.3021549	Contra Costa County
277158	Fee-for-Service	1740676014	1740676014	1	1	LEE, JEAN W MD	10/29/2018	208M00000X	NA	Other	026	PHYSICIANS	153363	41	Internal Medicine	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
277164	Fee-for-Service	1477501203	1477501203	1	1	LEVENTIS, LYNN L MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	88421	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	153 PIONEER LANE	STE C	BISHOP	CA	93514	2563	14	06027	37.3624356	-118.4073711	Inyo County
277176	Fee-for-Service	1477085728	1477085728	1	1	LIU, DANIEL MD	6/20/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1 CHILDREN'S WAY	SLOT 653	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
277187	Fee-for-Service	1518007590	1518007590	1	1	LEMON, STEPHEN K MD	12/10/1998	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	27000	41	Internal Medicine	0	In state provider	None	601 E ARRELLAGA ST	STE 102	SANTA BARBARA	CA	93103	4233	42	06083	34.43383593	-119.7024663	Santa Barbara County
277207	Fee-for-Service	1306982855	1306982855	1	17	LA LASER CENTER, PC, A PROFE	7/18/2024	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	OF BAKERSFIELD II	300 OLD RIVER RD.,	STE. 120	BAKERSFIELD	CA	93311	9512	15	06029	35.352648	-119.1122505	Kern County
277210	Fee-for-Service	1154428324	1154428324	1	1	LAPSIWALA, ARVIND C MD	5/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35704	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	409 E MERCED AVE	STE C	WEST COVINA	CA	91790	5061	19	06037	34.05501985	-117.9380648	Los Angeles County
277212	Fee-for-Service	1790131381	1790131381	1	1	LI, VIRGINIA Y MD	2/19/2020	208800000X	NA	Other	026	PHYSICIANS	155966	34	Urology and Urological Surgery	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
277220	Fee-for-Service	1750487591	1750487591	1	1	LUTHER, JEFFREY S MD	8/7/1989	207QA0000X	NA	Pediatric Primary Care	026	PHYSICIANS	66587	08	Family Practice	0	In state provider	None	2705 LOMA VISTA RD	None	VENTURA	CA	93003	1581	56	06111	34.27504051	-119.2600018	Ventura County
277223	Fee-for-Service	1417907940	1417907940	1	19	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	3100 TELEGRAPH AVE	SUITE 2103	OAKLAND	CA	94609	3239	01	06001	37.82037533	-122.2667839	Alameda County
277236	Fee-for-Service	1477511947	1477511947	1	1	LAM, HIU FUNG S MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134238	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 CAMPUS POINT DR	None	LA JOLLA	CA	92037	1300	37	06073	32.877999	-117.225891	San Diego County
277246	Fee-for-Service	1073559233	1073559233	1	1	LEE, BETTY WAI-HAN OD	8/6/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	330 N BRAND BLVD	STE 110	GLENDALE	CA	91203	2308	19	06037	34.15116156	-118.2549512	Los Angeles County
277275	Fee-for-Service	1578503132	1578503132	1	1	LEE, DANIEL E MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68580	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
277284	Fee-for-Service	1598787061	1598787061	1	1	LI, TINA G MD	5/4/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71525	18	Ophthalmology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
277287	Fee-for-Service	1801286828	1801286828	1	1	LINARES, CINDY LCSW	3/13/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4835 VAN NUYS BLVD	1-200	SHERMAN OAKS	CA	91403	2139	19	06037	34.1587068	-118.4487394	Los Angeles County
277298	Fee-for-Service	1831426642	1831426642	1	19	LAKESIDE MEDICAL	4/13/2010	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	191 S BUENA VISTA STREET	SUITE 420-440	BURBANK	CA	91505	4551	19	06037	34.15872557	-118.3283863	Los Angeles County
277302	Fee-for-Service	1285633081	1285633081	1	1	LEVIN, NEIL A MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71159	41	Internal Medicine	0	In state provider	None	4702 HOEN AVE	None	SANTA ROSA	CA	95405	7824	49	06097	38.441016	-122.664483	Sonoma County
277320	Fee-for-Service	1417907940	1417907940	1	17	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1688 WILLOW ST	SUITES B & C	SAN JOSE	CA	95125	5109	43	06085	37.30345662	-121.9161453	Santa Clara County
277336	Fee-for-Service	1780183335	1780183335	1	1	LA DOWNTOWN MEDICAL CENTER	3/4/2019	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	LLC	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
277358	Fee-for-Service	1417907940	1417907940	1	21	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	2160 APPIAN WAY	SUITE 100	PINOLE	CA	94564	2524	07	06013	37.99585174	-122.3021549	Contra Costa County
277367	Fee-for-Service	1093031155	1093031155	1	1	LAI, JENNIFER HL MD	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	119776	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
277402	Fee-for-Service	1962914739	1962914739	1	1	LANSANG, CHERYL N CRNA	12/15/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
277406	Fee-for-Service	1770750218	1770750218	1	1	LOO, RAY MUN MD	3/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101118	40	Pediatrics	0	In state provider	None	702 WAKE AVENUE	None	EL CENTRO	CA	92243	7502	13	06025	32.77066047	-115.560144	Imperial County
277407	Fee-for-Service	1417907940	1417907940	1	32	LPCH MEDICAL GROUP DIV OF LU	7/8/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	ALLIANCE, LPCH STANFORD	2495 HOSPITAL DR	625	MOUNTAIN VIEW	CA	94040	4119	43	06085	37.369341	-122.0817635	Santa Clara County
277419	Fee-for-Service	1760951958	1760951958	1	1	LOLONG, RENATTA A NP	12/18/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
277432	Fee-for-Service	1518007590	1518007590	1	1	LEMON, STEPHEN K MD	12/10/1998	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	27000	10	Gastroenterology (M.D. only)	0	In state provider	None	601 E ARRELLAGA ST	STE 102	SANTA BARBARA	CA	93103	4233	42	06083	34.43383593	-119.7024663	Santa Barbara County
277446	Fee-for-Service	1962525667	1962525667	1	1	LEVINE, ERIC S MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	83283	18	Ophthalmology	0	In state provider	None	2045 ROYAL AVE	STE 221	SIMI VALLEY	CA	93065	4600	56	06111	34.26117469	-118.7579108	Ventura County
277456	Fee-for-Service	1306982855	1306982855	1	17	LA LASER CENTER, PC, A PROFE	7/18/2024	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	OF BAKERSFIELD II	300 OLD RIVER RD.,	STE. 120	BAKERSFIELD	CA	93311	9512	15	06029	35.352648	-119.1122505	Kern County
277459	Fee-for-Service	1154428324	1154428324	1	1	LAPSIWALA, ARVIND C MD	5/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35704	02	General Surgery	0	In state provider	None	409 E MERCED AVE	STE C	WEST COVINA	CA	91790	5061	19	06037	34.05501985	-117.9380648	Los Angeles County
277463	Fee-for-Service	1720147440	1720147440	1	1	LALIMAR, MONETTE L NP	10/18/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
277470	Fee-for-Service	1417907940	1417907940	1	19	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	3100 TELEGRAPH AVE	SUITE 2103	OAKLAND	CA	94609	3239	01	06001	37.82037533	-122.2667839	Alameda County
277477	Fee-for-Service	1053445098	1053445098	1	1	LORENZO, MAYRA E LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
277483	Fee-for-Service	1962813519	1962813519	1	1	LIFEGUARD HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6700 KOLL CENTER PKWY	115	PLEASANTON	CA	94566	7032	01	06001	37.65861609	-121.9008715	Alameda County
277490	Fee-for-Service	1770526030	1770526030	2	1	LONGS DRUG STORES CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	728 W SHAW AVE	None	FRESNO	CA	93704	2301	10	06019	36.810441	-119.806416	Fresno County
277545	Fee-for-Service	1831426642	1831426642	1	19	LAKESIDE MEDICAL	4/13/2010	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	None	191 S BUENA VISTA STREET	SUITE 420-440	BURBANK	CA	91505	4551	19	06037	34.15872557	-118.3283863	Los Angeles County
277557	Fee-for-Service	1023303922	1023303922	1	1	LYLES-MCKELVY, STARLA N DO	10/19/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	14833	None	None	0	In state provider	None	24785 STEWART ST	STE 111	LOMA LINDA	CA	92350	1721	36	06071	34.0538151	-117.2632755	San Bernardino County
277563	Fee-for-Service	1417907940	1417907940	1	17	LPCH MEDICAL GROUP DIV OF LU	9/24/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	1688 WILLOW ST	SUITES B & C	SAN JOSE	CA	95125	5109	43	06085	37.30345662	-121.9161453	Santa Clara County
277565	Fee-for-Service	1316969462	1316969462	1	1	LE, BRIAN B MD	7/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	84977	18	Ophthalmology	0	In state provider	None	2020 CAMINO DEL RIO N	STE 808	SAN DIEGO	CA	92108	1546	37	06073	32.77020579	-117.1423463	San Diego County
277576	Fee-for-Service	1134254345	1134254345	1	1	LEUNG, CYRIL Y MD FACC	4/14/2021	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	45066	None	None	0	In state provider	None	1974 SANTA FE AVE.	None	LONG BEACH	CA	90810	4064	19	06037	33.793137	-118.2153705	Los Angeles County
277579	Fee-for-Service	1376671768	1376671768	1	1	LIN, MARTIN Y MD	9/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85862	45	Nephrology (Renal-Kidney)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
277581	Fee-for-Service	1508850637	1508850637	1	1	LAUNIUS, BRIAN W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3390 N CAMPBELL AVE	STE 110	TUCSON	AZ	85719	2380	00	None	32.26833	-110.94327	Pima County
277592	Fee-for-Service	1700818861	1700818861	1	1	LAROCCA, BRAD M MD	4/30/1988	207P00000X	NA	Other	026	PHYSICIANS	30067	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
277607	Fee-for-Service	1871138990	1871138990	1	1	LAI, GLORIA Y CRNA	3/16/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
277623	Fee-for-Service	1720241300	1720241300	1	1	LEMOS, JOHN P MD	9/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125176	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
277634	Fee-for-Service	1215085162	1215085162	1	1	LEUNG, MILLIE M MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61489	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
277646	Fee-for-Service	1497960769	1497960769	1	1	LOYDS LIBERTY HOMES INC	4/22/1993	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4508 IRONWOOD WAY	None	BAKERSFIELD	CA	93306	1320	15	06029	35.40847199	-118.9429964	Kern County
277652	Fee-for-Service	1417907940	1417907940	1	32	LPCH MEDICAL GROUP DIV OF LU	7/8/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	ALLIANCE, LPCH STANFORD	2495 HOSPITAL DR	625	MOUNTAIN VIEW	CA	94040	4119	43	06085	37.369341	-122.0817635	Santa Clara County
277664	Fee-for-Service	1073545216	1073545216	1	1	LEE, BRIAN S MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69591	66	Emergency Medicine (Urgent Care)	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
277679	Fee-for-Service	1780697607	1780697607	1	1	LUPEIKA, DEBRA L MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70796	08	Family Practice	0	In state provider	None	3184 CHURN CREEK RD	None	REDDING	CA	96002	2122	45	06089	40.56138796	-122.3531253	Shasta County
277695	Fee-for-Service	1396139556	1396139556	1	1	LE, BUU-DIEN NP	2/21/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15272 SUMMIT AVE	None	FONTANA	CA	92336	0231	36	06071	34.152624	-117.4724415	San Bernardino County
277716	Fee-for-Service	1417907940	1417907940	1	19	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	3100 TELEGRAPH AVE	SUITE 2103	OAKLAND	CA	94609	3239	01	06001	37.82037533	-122.2667839	Alameda County
277724	Fee-for-Service	1306982855	1306982855	1	8	LA LASER CENTER, PC, A PROFE	5/22/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	CANCER	3105 MCHENRY AVE.	STE. 101	MODESTO	CA	95350	1439	50	06099	37.68348404	-120.994242	Stanislaus County
277726	Fee-for-Service	1134641509	1134641509	1	1	LEE, SANG HEON LAC	11/19/2020	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	339 S MAGNOLIA AVE	None	ANAHEIM	CA	92804	2115	30	06059	33.8275947	-117.9759841	Orange County
277728	Fee-for-Service	1962813519	1962813519	1	1	LIFEGUARD HOSPICE CARE INC	4/29/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6700 KOLL CENTER PKWY	115	PLEASANTON	CA	94566	7032	01	06001	37.65861609	-121.9008715	Alameda County
277778	Fee-for-Service	1699188292	1699188292	1	1	LINDSAY MICHELLE DAVIS	8/19/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 1ST AVE	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
277790	Fee-for-Service	1962437210	1962437210	1	1	LIM, EDUARDO MED CORP	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49674	68	Hematology	0	In state provider	None	201 S ALVARADO ST	STE 505	LOS ANGELES	CA	90057	2385	19	06037	34.06417777	-118.2719543	Los Angeles County
277793	Fee-for-Service	1326283946	1326283946	1	1	LIBURD, NIKKI A MD	8/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112381	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
277794	Fee-for-Service	1619078979	1619078979	1	1	LUCAS, JENNIFER B MD	6/1/1998	174400000X	NA	Other	026	PHYSICIANS	62799	41	Internal Medicine	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
277807	Fee-for-Service	1417907940	1417907940	1	17	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	1688 WILLOW ST	SUITES B & C	SAN JOSE	CA	95125	5109	43	06085	37.30345662	-121.9161453	Santa Clara County
277822	Fee-for-Service	1215972740	1215972740	1	1	LEVINE, SAUL D MD	10/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85453	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
277832	Fee-for-Service	1114913563	1114913563	1	1	LOCKETT, MARK D MD	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2735 SILVER CREEK RD	None	BULLHEAD CITY	AZ	86442	7924	00	None	35.110926	-114.5552445	Mohave County
277839	Fee-for-Service	1720044183	1720044183	1	1	LOH, CHRISTOPHER T MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82141	30	Radiology	0	In state provider	None	675 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1932	43	06085	37.34275712	-121.8768207	Santa Clara County
277848	Fee-for-Service	1588832968	1588832968	1	1	LONGS DRUG STORES CA LLC	11/14/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	75 PRINGLE WAY	STE 102	RENO	NV	89502	8424	00	None	39.52621891	-119.7944075	Washoe County
277866	Fee-for-Service	1508589854	1508589854	1	1	LEANO, MARY C CNP	12/16/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1401 S BALDWIN AVE	None	ARCADIA	CA	91007	7922	19	06037	34.12357479	-118.0551359	Los Angeles County
277892	Fee-for-Service	1366881674	1366881674	1	1	LUGO, GIANCARLO J MD	7/14/2020	2084N0402X	NA	Neurology	026	PHYSICIANS	166670	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
277896	Fee-for-Service	1417907940	1417907940	1	32	LPCH MEDICAL GROUP DIV OF LU	7/8/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	ALLIANCE, LPCH STANFORD	2495 HOSPITAL DR	625	MOUNTAIN VIEW	CA	94040	4119	43	06085	37.369341	-122.0817635	Santa Clara County
277911	Fee-for-Service	1528593159	1528593159	1	1	LINARES, ANTHONY J MD	3/8/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	157815	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
277920	Fee-for-Service	1609954437	1609954437	1	1	LAM, THOMAS T MD	10/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82883	01	General Practice	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
277942	Fee-for-Service	1194917294	1194917294	1	1	LEE, SOHYUN MD	6/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102302	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
277966	Fee-for-Service	1306982855	1306982855	1	8	LA LASER CENTER, PC, A PROFE	5/22/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	CANCER	3105 MCHENRY AVE.	STE. 101	MODESTO	CA	95350	1439	50	06099	37.68348404	-120.994242	Stanislaus County
277968	Fee-for-Service	1336174101	1336174101	1	1	LIAO, MICHAEL M MD	3/10/2023	207P00000X	NA	Other	026	PHYSICIANS	184853	None	None	0	In state provider	None	5555 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	4000	01	06001	37.69212528	-121.8803442	Alameda County
277971	Fee-for-Service	1689944407	1689944407	1	1	LEE-CHANG, ALFREDO MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142854	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
277975	Fee-for-Service	1326563529	1326563529	1	1	LIVELY COOKSON, LYNETTE PSY	11/1/2024	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	D	11230 SORRENTO VALLEY RD	STE 220	SAN DIEGO	CA	92121	1300	37	06073	32.90734306	-117.2281918	San Diego County
277989	Fee-for-Service	1982238267	1982238267	1	1	LI, JENNIFER MD	10/1/2020	208600000X	NA	General Surgery	026	PHYSICIANS	168677	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
277995	Fee-for-Service	1518920701	1518920701	1	1	LIPSKY, CAREN L MD	4/30/1995	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	83464	40	Pediatrics	0	In state provider	None	147 BRUNO ST	None	LOS ANGELES	CA	90012	1814	19	06037	34.06252051	-118.2354654	Los Angeles County
278000	Fee-for-Service	1578622213	1578622213	1	1	LEE, MICHELLE G MD	12/31/2007	207R00000X	NA	Other	026	PHYSICIANS	95002	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
278005	Fee-for-Service	1689854028	1689854028	1	1	LIAO, JUDY C OD INC	4/1/2005	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	631 N BROADWAY	None	LOS ANGELES	CA	90012	2801	19	06037	34.05932442	-118.2399343	Los Angeles County
278006	Fee-for-Service	1376586990	1376586990	1	1	LEE, MARC J MD	6/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94566	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
278020	Fee-for-Service	1346754538	1346754538	1	1	LIN, ANDREW D MD	7/1/2021	390200000X	NA	Other	026	PHYSICIANS	158548	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
278034	Fee-for-Service	1962437210	1962437210	1	1	LIM, EDUARDO MED CORP	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49674	78	Neoplastic Diseases/Oncology	0	In state provider	None	201 S ALVARADO ST	STE 505	LOS ANGELES	CA	90057	2385	19	06037	34.06417777	-118.2719543	Los Angeles County
278053	Fee-for-Service	1417907940	1417907940	1	17	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	1688 WILLOW ST	SUITES B & C	SAN JOSE	CA	95125	5109	43	06085	37.30345662	-121.9161453	Santa Clara County
278059	Fee-for-Service	1003846858	1003846858	1	1	LODI MEMORIAL HOSPITAL ASSOC	3/15/1998	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	AL PHARMACY WEST	2415 W VINE ST	STE 104B	LODI	CA	95242	2008	39	06077	38.1228953	-121.3052826	San Joaquin County
278065	Fee-for-Service	1831390723	1831390723	1	1	LEWIS, SHERALYN H	12/24/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	15446 S WESTERN AVE	None	GARDENA	CA	90249	4319	19	06037	33.89042107	-118.3091303	Los Angeles County
278092	Fee-for-Service	1932541760	1932541760	1	1	LAMERSON LANDY CARE	7/31/2013	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1976 CORDELIA DR	None	ATWATER	CA	95301	0000	24	06047	37.34172748	-120.5734213	Merced County
278122	Fee-for-Service	1922509082	1922509082	1	1	LETTINI, CAMILLA A LCSW	1/17/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
278141	Fee-for-Service	1417907940	1417907940	1	32	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ALLIANCE, LPCH STANFORD	2495 HOSPITAL DR	625	MOUNTAIN VIEW	CA	94040	4119	43	06085	37.369341	-122.0817635	Santa Clara County
278194	Fee-for-Service	1043448236	1043448236	1	1	LONG, STEPHANIE B MD	5/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128190	01	General Practice	0	In state provider	None	225 SAN ANTONIO RD	None	MOUNTAIN VIEW	CA	94040	1209	43	06085	37.40620433	-122.110589	Santa Clara County
278208	Fee-for-Service	1649537838	1649537838	1	1	LIN, DAVID Y MD	6/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140253	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
278265	Fee-for-Service	1831426642	1831426642	1	11	LAKESIDE MEDICAL	4/13/2010	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1500 S CENTRAL AVE	STE 200	GLENDALE	CA	91204	2851	19	06037	34.12736888	-118.257777	Los Angeles County
278267	Fee-for-Service	1902813751	1902813751	1	1	LIWANAG, EUGENIA S MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71346	08	Family Practice	0	In state provider	None	800 3RD ST	None	MARYSVILLE	CA	95901	5831	58	06115	39.13757487	-121.5949642	Yuba County
278268	Fee-for-Service	1942347067	1942347067	1	1	LINIGER, RICHARD BRUCE	8/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89220	05	Anesthesiology	0	In state provider	WILSON MD	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
278296	Fee-for-Service	1417907940	1417907940	1	17	LPCH MEDICAL GROUP DIV OF LU	9/24/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	1688 WILLOW ST	SUITES B & C	SAN JOSE	CA	95125	5109	43	06085	37.30345662	-121.9161453	Santa Clara County
278304	Fee-for-Service	1912533159	1912533159	1	1	LA BARAKA 1188, INC	9/21/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	655 W AVENUE Q	SUITE E	PALMDALE	CA	93551	3894	19	06037	34.58715647	-118.1417372	Los Angeles County
278382	Fee-for-Service	1417907940	1417907940	1	32	LPCH MEDICAL GROUP DIV OF LU	7/8/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	ALLIANCE, LPCH STANFORD	2495 HOSPITAL DR	625	MOUNTAIN VIEW	CA	94040	4119	43	06085	37.369341	-122.0817635	Santa Clara County
278414	Fee-for-Service	1003002718	1003002718	1	1	LA, TRANG H MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	96662	30	Radiology	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
278418	Fee-for-Service	1285845982	1285845982	1	2	LOS ANGELES COUNTY	6/12/2020	No Taxonomy Provided	NA	None	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	DEPT OF HEALTH SERVICES	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	19	06037	34.32450186	-118.4456317	Los Angeles County
278421	Fee-for-Service	1710527692	1710527692	1	1	LULL, KELLI LMFT	10/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1742 OREGON STREET	None	REDDING	CA	96001	1717	45	06089	40.5808265	-122.3932989	Shasta County
278422	Fee-for-Service	1659614055	1659614055	1	1	LAI, SAMUEL Y MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136171	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
278423	Fee-for-Service	1275257636	1275257636	1	1	LARGO TRANSPORTATION	11/15/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	510 STEWART ST	None	FORT BRAGG	CA	95437	3018	23	06045	39.44701993	-123.8072921	Mendocino County
278464	Fee-for-Service	1104306968	1104306968	1	1	LIM, ANGELA NP	2/18/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
278472	Fee-for-Service	1083073415	1083073415	1	1	LEE, PAUL S MD	9/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138756	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	SUITE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
278499	Fee-for-Service	1639378714	1639378714	1	1	LIANG, JUNE PHD	3/6/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BOULEVARD	SUITE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
278504	Fee-for-Service	1720378573	1720378573	1	1	LAMAS, PATRICIA LMFT	8/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
278508	Fee-for-Service	1831426642	1831426642	1	11	LAKESIDE MEDICAL	7/3/2013	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1500 S CENTRAL AVE	STE 200	GLENDALE	CA	91204	2851	19	06037	34.12736888	-118.257777	Los Angeles County
278522	Fee-for-Service	1881114742	1881114742	1	1	LEUNG, ANDREA J MD	8/11/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	178565	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
278526	Fee-for-Service	1912574203	1912574203	1	1	LEE, JEREMIAH MD	10/29/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
278527	Fee-for-Service	1013179126	1013179126	1	1	LI, MINGQING MD	6/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102539	78	Neoplastic Diseases/Oncology	0	In state provider	None	6555 COYLE AVE	STE 301	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
278536	Fee-for-Service	1417907940	1417907940	1	17	LPCH MEDICAL GROUP DIV OF LU	9/24/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	1688 WILLOW ST	SUITES B & C	SAN JOSE	CA	95125	5109	43	06085	37.30345662	-121.9161453	Santa Clara County
278537	Fee-for-Service	1619014479	1619014479	1	1	LI, JINGHONG MD	10/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107000	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
278565	Fee-for-Service	1790079176	1790079176	1	1	LI, YI MD	6/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	125590	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
278585	Fee-for-Service	1285965038	1285965038	1	1	LIU, CHUN-YING CNP	10/29/2019	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
278586	Fee-for-Service	1598185399	1598185399	1	1	LEUNG, CRYSTAL MD	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140419	40	Pediatrics	0	In state provider	None	17100 EUCLID	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
278606	Fee-for-Service	1922110717	1922110717	1	1	LISA B. ARIAN MD	5/22/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	41690	67	Endocrinology	0	In state provider	None	3830 VALLEY CENTRE DR	STE 705381	SAN DIEGO	CA	92130	3319	37	06073	32.93777252	-117.2318423	San Diego County
278620	Fee-for-Service	1154735082	1154735082	1	1	LUONG, RICHARD Y K	7/29/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1340 LAKE BLVD	None	DAVIS	CA	95616	2619	57	06113	38.55491538	-121.7876886	Yolo County
278621	Fee-for-Service	1417907940	1417907940	1	32	LPCH MEDICAL GROUP DIV OF LU	1/6/2021	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ALLIANCE, LPCH STANFORD	2495 HOSPITAL DR	625	MOUNTAIN VIEW	CA	94040	4119	43	06085	37.369341	-122.0817635	Santa Clara County
278649	Fee-for-Service	1629361860	1629361860	1	1	LIDSTONE, LYNN K LCSW	11/17/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD ROAD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
278651	Fee-for-Service	1386752475	1386752475	1	1	LI, SAMUEL T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	81427	05	Anesthesiology	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
278655	Fee-for-Service	1124153655	1124153655	1	1	LAING, CHRISTOPHER J MD	6/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104050	30	Radiology	0	In state provider	None	3161 L STREET	None	SACRAMENTO	CA	95816	0000	34	06067	38.570958	-121.4642295	Sacramento County
278677	Fee-for-Service	1366525487	1366525487	1	4	LOS ANGELES RADIOLOGY	10/4/2018	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
278745	Fee-for-Service	1831426642	1831426642	1	11	LAKESIDE MEDICAL	10/18/2023	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1500 S CENTRAL AVE	STE 200	GLENDALE	CA	91204	2851	19	06037	34.12736888	-118.257777	Los Angeles County
278766	Fee-for-Service	1013179126	1013179126	1	1	LI, MINGQING MD	6/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102539	68	Hematology	0	In state provider	None	6555 COYLE AVE	STE 301	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
278772	Fee-for-Service	1174612287	1174612287	1	1	LOEBEL, HANAN MD	2/28/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	32683	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	14649 VICTORY BLVD	STE 10	VAN NUYS	CA	91411	4101	19	06037	34.18669152	-118.452393	Los Angeles County
278775	Fee-for-Service	1417907940	1417907940	1	17	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1688 WILLOW ST	SUITES B & C	SAN JOSE	CA	95125	5109	43	06085	37.30345662	-121.9161453	Santa Clara County
278778	Fee-for-Service	1760453922	1760453922	1	1	LO, LARRY J MD, INC	12/31/1984	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	54156	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	632 W 11TH STREET	SUITE 119	TRACY	CA	95376	3861	39	06077	37.73965648	-121.4352045	San Joaquin County
278788	Fee-for-Service	1215196217	1215196217	1	1	LUNA, J JAVIER PHD	11/8/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	23 MAIN STREET	None	WINTERS	CA	95694	0674	57	06113	38.52163272	-121.9695765	Yolo County
278791	Fee-for-Service	1841562048	1841562048	1	1	LOCKIE, AMANDA L LCSW	3/5/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
278842	Fee-for-Service	1598991283	1598991283	1	1	LEE, TRACY J MD	4/16/2020	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	122079	39	Preventive (M.D. only)	0	In state provider	None	15751 ROCKFIELD BLVD	None	IRVINE	CA	92618	2842	30	06059	33.63421195	-117.7205486	Orange County
278850	Fee-for-Service	1598718926	1598718926	1	1	LIZERBRAM, ERIC K MD	1/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	74959	30	Radiology	0	In state provider	None	12620 MONTE VISTA RD	STE A	POWAY	CA	92064	2531	37	06073	32.99536145	-117.056826	San Diego County
278857	Fee-for-Service	1417907940	1417907940	1	32	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ALLIANCE, LPCH STANFORD	2495 HOSPITAL DR	625	MOUNTAIN VIEW	CA	94040	4119	43	06085	37.369341	-122.0817635	Santa Clara County
278866	Fee-for-Service	1780721209	1780721209	1	1	LIN, TZU-HUNG CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	807 E GARVEY AVE	None	MONTEREY PARK	CA	91755	3026	19	06037	34.0626543	-118.1116155	Los Angeles County
278883	Fee-for-Service	1669697892	1669697892	1	1	LIU, HENRY C MD	12/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91763	05	Anesthesiology	0	In state provider	None	3687 MT DIABLO BLVD	STE 200	LAFAYETTE	CA	94549	3717	07	06013	37.8898926	-122.1304235	Contra Costa County
278884	Fee-for-Service	1659324531	1659324531	1	1	LAZARUS, STEPHEN C MD	7/31/1982	207RP1001X	NA	Pulmonology	026	PHYSICIANS	25354	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	# 997M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
278899	Fee-for-Service	1417907940	1417907940	1	24	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	1181 CENTRAL BOULEVARD	SUITE B	BRENTWOOD	CA	94513	2278	07	06013	37.93768751	-121.6999428	Contra Costa County
278902	Fee-for-Service	1346401031	1346401031	1	1	LIBER DIAGNOSTICS INC	6/30/2008	293D00000X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1400 S HAYWORTH AVE	SUITE 200	LOS ANGELES	CA	90035	4814	19	06037	34.05143357	-118.3675495	Los Angeles County
278912	Fee-for-Service	1154361814	1154361814	1	1	LCHD#1/MORTON GENERAL HO	3/29/2006	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	521 ADAMS	None	MORTON	WA	98356	0000	00	None	46.55593249	-122.2798365	Lewis County
278925	Fee-for-Service	1396099081	1396099081	1	1	LOZANO, HEIDI A LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
278926	Fee-for-Service	1841354784	1841354784	1	1	LEE, LANCE	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
278936	Fee-for-Service	1326176405	1326176405	1	1	LEE, ISABEL DEMOS MD	10/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93882	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	BLD 80 W83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
278937	Fee-for-Service	1962481036	1962481036	1	1	LUU, A-T JESSICA DPM INC	11/3/2008	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	15038 IMPERIAL HWY	None	LA MIRADA	CA	90638	1301	19	06037	33.91707319	-118.009999	Los Angeles County
278982	Fee-for-Service	1831426642	1831426642	1	11	LAKESIDE MEDICAL	4/13/2010	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1500 S CENTRAL AVE	STE 200	GLENDALE	CA	91204	2851	19	06037	34.12736888	-118.257777	Los Angeles County
278984	Fee-for-Service	1144635210	1144635210	1	1	LEONARD, PAUL M MD	11/5/2019	207P00000X	NA	Other	086	MEDICAL DIRECTORS	166431	-	NOT APPLICABLE	0	In state provider	None	2001 F ST	STE 102	BAKERSFIELD	CA	93301	4237	15	06029	35.377398	-119.0235085	Kern County
278997	Fee-for-Service	1912731886	1912731886	1	1	LIANG, VICTOR	10/9/2024	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
279003	Fee-for-Service	1437659497	1437659497	1	1	LUX, EILEEN LCSW	9/23/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
279004	Fee-for-Service	1427533454	1427533454	1	1	LAI, SONIA NP	6/7/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
279007	Fee-for-Service	1174612287	1174612287	1	1	LOEBEL, HANAN MD	2/28/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	32683	41	Internal Medicine	0	In state provider	None	14649 VICTORY BLVD	STE 10	VAN NUYS	CA	91411	4101	19	06037	34.18669152	-118.452393	Los Angeles County
279009	Fee-for-Service	1760453922	1760453922	1	1	LO, LARRY J MD, INC	12/31/1984	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	54156	01	General Practice	0	In state provider	None	632 W 11TH STREET	SUITE 119	TRACY	CA	95376	3861	39	06077	37.73965648	-121.4352045	San Joaquin County
279017	Fee-for-Service	1003074469	1003074469	1	1	LEONARD, STEPHANIE A MD	8/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117476	03	Allergy	0	In state provider	None	3020 CHILDREN'S WY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
279023	Fee-for-Service	1275066896	1275066896	1	1	LIU, HENRY MD	4/3/2022	208M00000X	NA	Other	026	PHYSICIANS	159025	None	None	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
279024	Fee-for-Service	1932239019	1932239019	1	1	LINDSAY M GOULD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PEDIATRIC ACADEMIC ASSOC	555 S 18TH STREET	None	COLUMBUS	OH	43205	0000	00	None	39.95323846	-82.9765048	Franklin County
279055	Fee-for-Service	1659345726	1659345726	1	1	LOPEZ, CECILIO D L C MD	8/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156131	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
279077	Fee-for-Service	1811026982	1811026982	1	1	LIU, MICO K OD	1/25/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8500 WASHINGTON BLVD	None	PICO RIVERA	CA	90660	3788	19	06037	33.985017	-118.1050785	Los Angeles County
279080	Fee-for-Service	1538105077	1538105077	1	1	LANGLOTZ, CURTIS P MD	9/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132013	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
279094	Fee-for-Service	1417907940	1417907940	1	32	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ALLIANCE, LPCH STANFORD	2495 HOSPITAL DR	625	MOUNTAIN VIEW	CA	94040	4119	43	06085	37.369341	-122.0817635	Santa Clara County
279100	Fee-for-Service	1528132511	1528132511	1	1	LAM, SIHAO MD	1/18/1988	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	42164	40	Pediatrics	0	In state provider	None	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
279119	Fee-for-Service	1336503416	1336503416	1	1	LONGBERG, AUSTIN DO	9/3/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	18173	07	Dermatology	0	In state provider	None	26800 CROWN VALLEY PKWY	STE 305, 315, 325, 330	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
279126	Fee-for-Service	1609057694	1609057694	1	1	LIN, AMY Y MD	6/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85602	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
279134	Fee-for-Service	1417907940	1417907940	1	24	LPCH MEDICAL GROUP DIV OF LU	6/10/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	1181 CENTRAL BOULEVARD	SUITE B	BRENTWOOD	CA	94513	2278	07	06013	37.93768751	-121.6999428	Contra Costa County
279147	Fee-for-Service	1154361814	1154361814	1	1	LCHD#1/MORTON GENERAL HO	7/1/1998	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	521 ADAMS	None	MORTON	WA	98356	0000	00	None	46.55593249	-122.2798365	Lewis County
279176	Fee-for-Service	1053334292	1053334292	1	1	LEFF, MICHELLE L	12/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89956	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
279188	Fee-for-Service	1366587321	1366587321	1	1	LU, LE N MD	6/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104777	None	None	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
279195	Fee-for-Service	1164788725	1164788725	1	1	LEONG, KENNETH T DO	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12507	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
279250	Fee-for-Service	1003074469	1003074469	1	1	LEONARD, STEPHANIE A MD	8/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117476	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
279296	Fee-for-Service	1801554035	1801554035	1	1	LA PALMA ADULT DAY HEALTH	12/6/2024	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	1901 NEWPORT BLVD	STE 180	COSTA MESA	CA	92627	2286	30	06059	33.64361308	-117.9164802	Orange County
279309	Fee-for-Service	1356639694	1356639694	2	1	LUCERO-MARTINEZ, KARIN LMFT	6/2/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	950 COUNTY SQUARE DR	SUITE 112	VENTURA	CA	93003	5410	56	06111	34.26650142	-119.2145321	Ventura County
279324	Fee-for-Service	1407957350	1407957350	1	1	LAI, STEVEN S OD	1/31/1989	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	BRIGTH EYE CARE OPT CTR	419 N ATLANTIC BLVD	STE 104	MONTEREY PARK	CA	91754	7702	19	06037	34.06716498	-118.1344137	Los Angeles County
279359	Fee-for-Service	1609057694	1609057694	1	1	LIN, AMY Y MD	6/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85602	68	Hematology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
279366	Fee-for-Service	1417907940	1417907940	1	24	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1181 CENTRAL BOULEVARD	SUITE B	BRENTWOOD	CA	94513	2278	07	06013	37.93768751	-121.6999428	Contra Costa County
279416	Fee-for-Service	1629005434	1629005434	1	1	LEE COLLIN D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300F E JEFFERSON ST	STE 101	BOISE	ID	83712	6230	00	None	43.61245599	-116.190299	Ada County
279420	Fee-for-Service	1831277748	1831277748	1	1	LEE, BRUCE D MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	67908	40	Pediatrics	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
279421	Fee-for-Service	1235910530	1235910530	1	1	LEE, FELICIA	6/17/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
279431	Fee-for-Service	1700375961	1700375961	1	1	LOSSO, VERONICA M MD	5/24/2023	1835P1300X	NA	Other	026	PHYSICIANS	166168	None	None	0	In state provider	None	601 DUBOCE AVE	STE 250	SAN FRANCISCO	CA	94117	3389	38	06075	37.7691148	-122.4344597	San Francisco County
279434	Fee-for-Service	1538387741	1538387741	1	1	LANGLEY, CYNTHIA G LCSW	11/4/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
279439	Fee-for-Service	1144484551	1144484551	1	1	LONG, CYNTHIA A LCSW	12/13/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD RD	SUITE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
279445	Fee-for-Service	1033288006	1033288006	1	1	LEBLEU, GREGORY E MD	9/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53588	25	Physical Medicine and Rehabilitation	0	In state provider	None	6 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76683038	-121.2481833	Placer County
279452	Fee-for-Service	1508810185	1508810185	1	1	LEISTIKO, LAURA L MD	5/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90865	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
279485	Fee-for-Service	1982170437	1982170437	1	1	LIBERTY TRANSIT INC	12/10/2018	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	289 5TH STREET	None	VALLEJO	CA	94590	6905	48	06095	38.09309323	-122.2457529	Solano County
279543	Fee-for-Service	1629126503	1629126503	1	1	LAM, RAYMOND T MD	5/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72650	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
279550	Fee-for-Service	1801874797	1801874797	1	1	LINDER, MARTIN MD	10/1/1983	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	50590	08	Family Practice	0	In state provider	None	336 OXFORD ST	STE 102	CHULA VISTA	CA	91911	3121	37	06073	32.60988116	-117.0691213	San Diego County
279558	Fee-for-Service	1194385328	1194385328	1	1	LUSARETA, CHRISTINE A LMFT	6/15/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
279564	Fee-for-Service	1396327649	1396327649	1	1	LIN, EVAN DO	10/3/2024	208M00000X	NA	Other	026	PHYSICIANS	22589	41	Internal Medicine	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
279587	Fee-for-Service	1225318660	1225318660	1	1	LEE, JI HYUN MD	5/2/2022	207L00000X	NA	Other	026	PHYSICIANS	172786	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
279597	Fee-for-Service	1255656963	1255656963	1	1	LE, BILLY T DO	7/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	11949	41	Internal Medicine	0	In state provider	None	24411 HEALTH CENTER DR	STE 680	LAGUNA HILLS	CA	92653	3692	30	06059	33.6087201	-117.7076948	Orange County
279598	Fee-for-Service	1417907940	1417907940	1	24	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1181 CENTRAL BOULEVARD	SUITE B	BRENTWOOD	CA	94513	2278	07	06013	37.93768751	-121.6999428	Contra Costa County
279621	Fee-for-Service	1528233582	1528233582	1	1	LUCAS, CHRISTOPHER L MD	9/22/2021	208M00000X	NA	Other	026	PHYSICIANS	149360	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
279629	Fee-for-Service	1316383938	1316383938	1	1	LAU, MARGARET L MD	11/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136675	40	Pediatrics	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
279635	Fee-for-Service	1760488621	1760488621	1	1	LYNCH, MARC E DO	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	6261	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13193 CENTRAL AVE	STE 220	CHINO	CA	91710	4179	36	06071	34.01406506	-117.6891684	San Bernardino County
279657	Fee-for-Service	1427480185	1427480185	1	1	LALLY, PATRICK J MD	4/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126768	None	None	0	In state provider	None	141 LYNCH CREEK WAY	SUITE C	PETALUMA	CA	94954	2390	49	06097	38.25192092	-122.6341929	Sonoma County
279660	Fee-for-Service	1942308192	1942308192	1	1	LEW, CHERYL MD	4/28/1999	2080P0214X	NA	Pulmonology	026	PHYSICIANS	25609	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
279671	Fee-for-Service	1871098988	1871098988	1	1	LAM, VINCENTE P MD	7/13/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165849	None	None	0	In state provider	None	11420 WARNER AVE.	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
279678	Fee-for-Service	1396034781	1396034781	1	1	LISA M FORBECK	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1305 W 18TH ST	None	SIOUX FALLS	SD	57105	0401	00	None	43.535484	-96.7428585	Minnehaha County
279720	Fee-for-Service	1376639054	1376639054	1	1	LIBERMAN, HAVA MD	12/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81032	22	Pathology (M.D. only)	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
279739	Fee-for-Service	1467694000	1467694000	1	1	LEE, RENEE W DO	8/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11451	40	Pediatrics	0	In state provider	None	8235 ROCHESTER AVE	SUITE 110	RANCHO CUCAMONGA	CA	91730	0719	36	06071	34.103952	-117.5456935	San Bernardino County
279753	Fee-for-Service	1215137104	1215137104	1	1	LEE, ALVIN Y MD	7/1/2010	207L00000X	NA	Other	026	PHYSICIANS	92293	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
279784	Fee-for-Service	1801874797	1801874797	1	1	LINDER, MARTIN MD	10/1/1983	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	50590	01	General Practice	0	In state provider	None	336 OXFORD ST	STE 102	CHULA VISTA	CA	91911	3121	37	06073	32.60988116	-117.0691213	San Diego County
279817	Fee-for-Service	1548561558	1548561558	1	1	LARRAZOLO, OSCAR G MD	9/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116028	None	None	0	In state provider	None	44215 NORTH 15TH ST WEST	SUITE 115	LANCASTER	CA	93534	5503	19	06037	34.68666415	-118.1568572	Los Angeles County
279820	Fee-for-Service	1750342234	1750342234	1	1	LEPINE, LISA A MD	8/2/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	71806	None	None	0	In state provider	None	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93102	0689	42	06083	34.42887662	-119.7237878	Santa Barbara County
279830	Fee-for-Service	1417907940	1417907940	1	24	LPCH MEDICAL GROUP DIV OF LU	6/10/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	1181 CENTRAL BOULEVARD	SUITE B	BRENTWOOD	CA	94513	2278	07	06013	37.93768751	-121.6999428	Contra Costa County
279841	Fee-for-Service	1124115654	1124115654	1	1	LEE, JAUMAAN MD INC	5/1/2001	193200000X	NA	Other	026	PHYSICIANS	69090	25	Physical Medicine and Rehabilitation	0	In state provider	None	223 N GARFIELD AVE	STE 105	MONTEREY PARK	CA	91754	1700	19	06037	34.0646166	-118.1228948	Los Angeles County
279867	Fee-for-Service	1760488621	1760488621	1	1	LYNCH, MARC E DO	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	6261	05	Anesthesiology	0	In state provider	None	13193 CENTRAL AVE	STE 220	CHINO	CA	91710	4179	36	06071	34.01406506	-117.6891684	San Bernardino County
279882	Fee-for-Service	1184873606	1184873606	1	1	LEM, LANA L DPM	4/2/2009	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
279914	Fee-for-Service	1790754067	1790754067	1	1	LIU, SHUGUANG MD	11/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84179	None	None	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
279938	Fee-for-Service	1750548814	1750548814	1	1	LOW, KENNETH T MD	8/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	35264	41	Internal Medicine	0	In state provider	None	6339 MACK RD	None	SACRAMENTO	CA	95823	4655	34	06067	38.475585	-121.4285265	Sacramento County
279941	Fee-for-Service	1487670907	1487670907	1	1	LAI, CHRISTOPHER S MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92005	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
279948	Fee-for-Service	1417251133	1417251133	1	1	LANDA, MARIA C LMFT	1/26/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6340 IRVINE BLVD	None	IRVINE	CA	92620	2102	30	06059	33.69980974	-117.7402998	Orange County
279962	Fee-for-Service	1164593927	1164593927	1	1	LEVY, MICHAEL L MD	2/1/1993	207T00000X	NA	General Surgery	026	PHYSICIANS	62556	None	None	0	In state provider	None	8010 FROST ST	STE 502	SAN DIEGO	CA	92123	4222	37	06073	32.80026879	-117.1520059	San Diego County
279972	Fee-for-Service	1417907940	1417907940	1	16	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	50 S SAN MATEO DR	SUITE 180	SAN MATEO	CA	94401	3859	41	06081	37.56634141	-122.3261145	San Mateo County
279973	Fee-for-Service	1154649010	1154649010	1	1	LIM, GEESNELL B MD	9/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110905	08	Family Practice	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
279979	Fee-for-Service	1033190491	1033190491	1	1	LIM, ANDREW R OD	8/28/1987	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PARAMOUNT FAM VISION CTR	14905 PARAMOUNT BLVD	STE E	PARAMOUNT	CA	90723	3440	19	06037	33.89776247	-118.1602406	Los Angeles County
280006	Fee-for-Service	1831173970	1831173970	1	1	LIM, RUSSELL F MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	72427	36	Psychiatry	0	In state provider	None	2252 45TH ST	None	SACRAMENTO	CA	95817	1514	34	06067	38.55487602	-121.4529879	Sacramento County
280034	Fee-for-Service	1447612932	1447612932	1	1	LIU, ELIZABETH H	12/3/2020	207L00000X	NA	Other	026	PHYSICIANS	155085	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
280044	Fee-for-Service	1215537923	1215537923	1	1	LAHLOU, SARAH LMFT	2/11/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
280047	Fee-for-Service	1982752853	1982752853	1	1	LUM, SOPHIA F MD	12/1/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61366	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
280059	Fee-for-Service	1417907940	1417907940	1	24	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1181 CENTRAL BOULEVARD	SUITE B	BRENTWOOD	CA	94513	2278	07	06013	37.93768751	-121.6999428	Contra Costa County
280065	Fee-for-Service	1750343158	1750343158	1	1	LANIER, ANDREA B MD	10/31/1986	207W00000X	NA	Ophthalmology	026	PHYSICIANS	51172	18	Ophthalmology	0	In state provider	None	1817 SHAW AVE	STE 104	CLOVIS	CA	93611	4069	10	06019	36.8086995	-119.681613	Fresno County
280069	Fee-for-Service	1942200746	1942200746	1	1	LOUIE, STANLEY Y DO INC	12/1/1997	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	LOGAN STREET MEDICAL GRP	2511 LOGAN ST	None	SELMA	CA	93662	3012	10	06019	36.570951	-119.613866	Fresno County
280070	Fee-for-Service	1508975665	1508975665	1	1	LEIBOWITZ, DAVID MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84443	68	Hematology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
280087	Fee-for-Service	1902986664	1902986664	1	1	LE, HUAN MD	8/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	59923	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
280093	Fee-for-Service	1508841990	1508841990	1	1	LABORATORY CORPORATION	12/27/1996	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	1	Border provider	OF AMERICA	1015 TELEGRAPH STREET	STE B	RENO	NV	89502	2227	00	None	39.516273	-119.773509	Washoe County
280094	Fee-for-Service	1871503706	1871503706	1	1	LOPEZ, ELVA MD	7/1/2000	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	73158	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	815 DR MARTIN LUTHER KIN	None	BAKERSFIELD	CA	93307	1365	15	06029	35.3655	-118.985202	Kern County
280126	Fee-for-Service	1306982855	1306982855	1	13	LA LASER CENTER, PC, A PROFE	6/18/2024	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	OF BAKERSFIELD IV	4805 CENTENNIAL PLAZA WA	None	BAKERSFIELD	CA	93312	1905	15	06029	35.40329695	-119.0934977	Kern County
280136	Fee-for-Service	1053466656	1053466656	1	1	LIT, WENDY W OD	9/27/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6700 FALLBROOK AVE	STE 190	WEST HILLS	CA	91307	3583	19	06037	34.192332	-118.623381	Los Angeles County
280138	Fee-for-Service	1629001524	1629001524	1	1	LOGUE, DREW H MD	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	25519	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1329 SPANOS CT	STE C3	MODESTO	CA	95355	2806	50	06099	37.66976149	-120.9731145	Stanislaus County
280164	Fee-for-Service	1750548814	1750548814	1	1	LOW, KENNETH T MD	8/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	35264	01	General Practice	0	In state provider	None	6339 MACK RD	None	SACRAMENTO	CA	95823	4655	34	06067	38.475585	-121.4285265	Sacramento County
280184	Fee-for-Service	1457439135	1457439135	1	1	LIVERMORE, BARBARA M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29813	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
280188	Fee-for-Service	1366525487	1366525487	1	6	LOS ANGELES RADIOLOGY	10/4/2018	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5974 PENTZ RD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
280195	Fee-for-Service	1417907940	1417907940	1	16	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	50 S SAN MATEO DR	SUITE 180	SAN MATEO	CA	94401	3859	41	06081	37.56634141	-122.3261145	San Mateo County
280196	Fee-for-Service	1558789537	1558789537	1	1	LAMBOVA, YORDANKA CRNA	2/6/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
280206	Fee-for-Service	1295197028	1295197028	1	1	LEATHAM, HAYLEY W MD	8/11/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	151279	07	Dermatology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
280234	Fee-for-Service	1740700392	1740700392	1	1	LANTER, PATRICK W MD	8/13/2021	207P00000X	NA	Other	026	PHYSICIANS	172009	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
280248	Fee-for-Service	1780032243	1780032243	1	1	LE, TUAN MD	8/13/2019	207P00000X	NA	Other	026	PHYSICIANS	151124	66	Emergency Medicine (Urgent Care)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
280258	Fee-for-Service	1659430379	1659430379	1	1	LIAO, DAVID W MD	3/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81269	41	Internal Medicine	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
280266	Fee-for-Service	1417907940	1417907940	1	33	LPCH MEDICAL GROUP DIV OF LU	12/4/2023	208000000X	NA	Pediatric Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	EN'S HOSPITAL AT STANFOR	1195 WEST FREMONT AVE	None	SUNNYVALE	CA	94087	3832	43	06085	37.35222787	-122.0618134	Santa Clara County
280287	Fee-for-Service	1417907940	1417907940	1	24	LPCH MEDICAL GROUP DIV OF LU	6/10/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	1181 CENTRAL BOULEVARD	SUITE B	BRENTWOOD	CA	94513	2278	07	06013	37.93768751	-121.6999428	Contra Costa County
280289	Fee-for-Service	1376930941	1376930941	1	1	LEUNG, ANDREW K MD	6/30/2020	208800000X	NA	Other	026	PHYSICIANS	168675	34	Urology and Urological Surgery	0	In state provider	None	4000 DUBLIN BLVD	None	DUBLIN	CA	94568	3113	01	06001	37.70553949	-121.872609	Alameda County
280296	Fee-for-Service	1508975665	1508975665	1	1	LEIBOWITZ, DAVID MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84443	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
280299	Fee-for-Service	1154855971	1154855971	1	1	LARIVIERE, ALEJANDRO A MD	8/20/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	162747	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
280319	Fee-for-Service	1265929855	1265929855	1	1	LIU, EMILY Y MD	6/26/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	177798	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
280353	Fee-for-Service	1306982855	1306982855	1	13	LA LASER CENTER, PC, A PROFE	6/18/2024	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	OF BAKERSFIELD IV	4805 CENTENNIAL PLAZA WA	None	BAKERSFIELD	CA	93312	1905	15	06029	35.40329695	-119.0934977	Kern County
280421	Fee-for-Service	1417907940	1417907940	1	16	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	50 S SAN MATEO DR	SUITE 180	SAN MATEO	CA	94401	3859	41	06081	37.56634141	-122.3261145	San Mateo County
280439	Fee-for-Service	1417907940	1417907940	1	12	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	11030 BOLLINGER CANYON	SUITE 220 A B	SAN RAMON	CA	94582	4862	07	06013	37.77383963	-121.9239786	Contra Costa County
280475	Fee-for-Service	1336819564	1336819564	1	1	LA TANYA TAKLA PSYCHOLOGIST	8/1/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PY	1651 RESPONSE RD	STE 111	SACRAMENTO	CA	95815	5254	34	06067	38.596932	-121.428018	Sacramento County
280488	Fee-for-Service	1417907940	1417907940	1	33	LPCH MEDICAL GROUP DIV OF LU	1/25/2024	208000000X	NA	Pediatric Primary Care	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	EN'S HOSPITAL AT STANFOR	1195 WEST FREMONT AVE	None	SUNNYVALE	CA	94087	3832	43	06085	37.35222787	-122.0618134	Santa Clara County
280507	Fee-for-Service	1649489071	1649489071	1	1	LEAHY, MAUREEN A LCSW	8/3/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	330 FLUME STREET	SUITE #100	CHICO	CA	95928	5400	04	06007	39.73048207	-121.8372333	Butte County
280509	Fee-for-Service	1417907940	1417907940	1	24	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	1181 CENTRAL BOULEVARD	SUITE B	BRENTWOOD	CA	94513	2278	07	06013	37.93768751	-121.6999428	Contra Costa County
280527	Fee-for-Service	1508949645	1508949645	1	1	LA MAESTRA FAMILY CLINIC INC	9/27/2005	261QC1500X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CLINIC-NATIONAL CITY	217 HIGHLAND AVE	None	NATIONAL CITY	CA	91950	1518	37	06073	32.68298968	-117.1005464	San Diego County
280530	Fee-for-Service	1467989483	1467989483	1	1	LYMAN, TRAVIS P OD	9/7/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10 BRYSON DR	None	SUTTER CREEK	CA	95685	9633	03	06005	38.38296339	-120.8055258	Amador County
280553	Fee-for-Service	1316143902	1316143902	1	1	LA, HANH H MD	10/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113651	41	Internal Medicine	0	In state provider	None	1000 NUT TREE RD	None	VACAVILLE	CA	95687	4100	48	06095	38.35581953	-121.9530257	Solano County
280569	Fee-for-Service	1700131240	1700131240	1	1	LOS ANGELES CENTERS FOR	8/30/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	ALCOHOL AND DRUG ABUSE	12417 PHILADELPHIA ST	CLASSROOM D101	WHITTIER	CA	90601	3933	19	06037	33.9791415	-118.0441035	Los Angeles County
280576	Fee-for-Service	1306982855	1306982855	1	13	LA LASER CENTER, PC, A PROFE	6/18/2024	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	OF BAKERSFIELD IV	4805 CENTENNIAL PLAZA WA	None	BAKERSFIELD	CA	93312	1905	15	06029	35.40329695	-119.0934977	Kern County
280581	Fee-for-Service	1710050307	1710050307	1	1	LIFE CARE HOME HEALTH &	2/14/2003	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	MEDICAL SUPPLIES INC	11843 WILSHIRE BLVD	None	WEST LOS ANGELES	CA	90025	6601	19	06037	34.04742839	-118.4634812	Los Angeles County
280600	Fee-for-Service	1013580513	1013580513	1	1	LLG HOSPICE, INC	1/25/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	719 S VICTORY BLVD	UNIT B	BURBANK	CA	91502	2426	19	06037	34.16843415	-118.3102541	Los Angeles County
280644	Fee-for-Service	1417907940	1417907940	1	16	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	50 S SAN MATEO DR	SUITE 180	SAN MATEO	CA	94401	3859	41	06081	37.56634141	-122.3261145	San Mateo County
280661	Fee-for-Service	1417907940	1417907940	1	12	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	11030 BOLLINGER CANYON	SUITE 220 A B	SAN RAMON	CA	94582	4862	07	06013	37.77383963	-121.9239786	Contra Costa County
280693	Fee-for-Service	1912258369	1912258369	1	1	LONG TERM CARE PSYCHIATRY	1/16/2015	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	NURSING CORPORATION	99 ESCUELA DR	None	DALY CITY	CA	94015	4003	41	06081	37.67441047	-122.4762435	San Mateo County
280697	Fee-for-Service	1336819564	1336819564	1	1	LA TANYA TAKLA PSYCHOLOGIST	8/1/2023	103TC0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	PY	1651 RESPONSE RD	STE 111	SACRAMENTO	CA	95815	5254	34	06067	38.596932	-121.428018	Sacramento County
280712	Fee-for-Service	1417907940	1417907940	1	33	LPCH MEDICAL GROUP DIV OF LU	6/7/2023	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	EN'S HOSPITAL AT STANFOR	1195 WEST FREMONT AVE	None	SUNNYVALE	CA	94087	3832	43	06085	37.35222787	-122.0618134	Santa Clara County
280713	Fee-for-Service	1942526918	1942526918	1	1	LUNG, VICTORIA L MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119952	41	Internal Medicine	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
280733	Fee-for-Service	1417907940	1417907940	1	22	LPCH MEDICAL GROUP DIV OF LU	6/10/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	1100 LARKSPUR LANDING CI	SUITE 150	LARKSPUR	CA	94939	1868	21	06041	37.94817177	-122.5100062	Marin County
280747	Fee-for-Service	1679612436	1679612436	1	1	LYNCH, MICHAEL W MD	10/25/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	48359	41	Internal Medicine	0	In state provider	None	5151 N PALM AVE	STE 200	FRESNO	CA	93704	2221	10	06019	36.81119879	-119.808555	Fresno County
280749	Fee-for-Service	1508949645	1508949645	1	1	LA MAESTRA FAMILY CLINIC INC	9/27/2005	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CLINIC-NATIONAL CITY	217 HIGHLAND AVE	None	NATIONAL CITY	CA	91950	1518	37	06073	32.68298968	-117.1005464	San Diego County
280761	Fee-for-Service	1568798338	1568798338	2	1	LINDHURST PHARMACY SERVICES	10/7/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5991 LINDHURST AVE	None	MARYSVILLE	CA	95901	6100	58	06115	39.12367449	-121.5685452	Yuba County
280775	Fee-for-Service	1427634526	1427634526	1	1	LEE, CHIH-YING MD	8/7/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191977	08	Family Practice	0	In state provider	None	11420 WARNER AVE.	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
280815	Fee-for-Service	1174934566	1174934566	1	1	LU, CHEN-YUAN MD	6/1/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	141244	08	Family Practice	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
280823	Fee-for-Service	1013580513	1013580513	1	1	LLG HOSPICE, INC	1/25/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	719 S VICTORY BLVD	UNIT B	BURBANK	CA	91502	2426	19	06037	34.16843415	-118.3102541	Los Angeles County
280835	Fee-for-Service	1588639231	1588639231	1	1	LUI, GEORGE K MD	3/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123877	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
280858	Fee-for-Service	1275639486	1275639486	1	1	LAVEY, ELLIOTT B MD	1/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	36751	24	Plastic Surgery	0	In state provider	None	913 SAN RAMON VALLEY BLV	STE 288	DANVILLE	CA	94526	4031	07	06013	37.80763097	-121.9919049	Contra Costa County
280865	Fee-for-Service	1417907940	1417907940	1	16	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	50 S SAN MATEO DR	SUITE 180	SAN MATEO	CA	94401	3859	41	06081	37.56634141	-122.3261145	San Mateo County
280871	Fee-for-Service	1073504262	1073504262	1	1	LIM, DERRICK G OD	12/1/1995	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	477 E COLORADO BLVD	None	PASADENA	CA	91101	2024	19	06037	34.14587948	-118.140561	Los Angeles County
280872	Fee-for-Service	1235580697	1235580697	1	1	LUMICERA HEALTH SERVICES	9/18/2018	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	LLC	9185 EAST PIMA CENTER PK	SUITE 200	SCOTTSDALE	AZ	85258	4644	00	None	33.557049	-111.883419	Maricopa County
280875	Fee-for-Service	1477250850	1477250850	1	1	LOPEZ RAMOS, CORINA	3/7/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
280887	Fee-for-Service	1417907940	1417907940	1	12	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	11030 BOLLINGER CANYON	SUITE 220 A B	SAN RAMON	CA	94582	4862	07	06013	37.77383963	-121.9239786	Contra Costa County
280915	Fee-for-Service	1306857024	1306857024	1	1	LUNDY, JAMES H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49493	05	Anesthesiology	0	In state provider	None	15630 18TH AVE	None	CLEARLAKE	CA	95422	0000	17	06033	38.93612361	-122.6201499	Lake County
280929	Fee-for-Service	1851310684	1851310684	1	1	LI, ZHAOPING MD	8/7/1995	207R00000X	NA	Other	026	PHYSICIANS	55523	41	Internal Medicine	0	In state provider	None	17821 PIONEER BLVD	None	ARTESIA	CA	90701	3901	19	06037	33.8691791	-118.0823685	Los Angeles County
280934	Fee-for-Service	1417907940	1417907940	1	33	LPCH MEDICAL GROUP DIV OF LU	9/7/2023	208000000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	EN'S HOSPITAL AT STANFOR	1195 WEST FREMONT AVE	None	SUNNYVALE	CA	94087	3832	43	06085	37.35222787	-122.0618134	Santa Clara County
280951	Fee-for-Service	1417907940	1417907940	1	22	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1100 LARKSPUR LANDING CI	SUITE 150	LARKSPUR	CA	94939	1868	21	06041	37.94817177	-122.5100062	Marin County
280967	Fee-for-Service	1356663553	1356663553	1	1	LIM, GRACE E LAC	2/27/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	15501 SAN FERNANDO MISSI	SUITE 311	MISSION HILLS	CA	91345	1359	19	06037	34.27189979	-118.4695266	Los Angeles County
281000	Fee-for-Service	1982602496	1982602496	1	1	LOS ROBLES HOMECARE SERVICES	4/9/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	1	Border provider	None	1881 TRAVERSE PARKWAY	SUITE E 112	LEHI	UT	84043	5986	00	None	40.43229342	-111.8768292	Utah County
281027	Fee-for-Service	1437304797	1437304797	1	1	LI, ROBIN T MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120427	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
281032	Fee-for-Service	1639514987	1639514987	1	1	LIN, CONNIE MD	4/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132249	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
281037	Fee-for-Service	1780618322	1780618322	1	1	LIANG, JAMES Z DO	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7592	08	Family Practice	0	In state provider	None	1450 TREAT BLVD	STE 160	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
281056	Fee-for-Service	1588639231	1588639231	1	1	LUI, GEORGE K MD	3/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123877	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
281065	Fee-for-Service	1528412103	1528412103	1	1	LEE, CAMERON M MD	8/10/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153235	08	Family Practice	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
281085	Fee-for-Service	1417907940	1417907940	1	16	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	50 S SAN MATEO DR	SUITE 180	SAN MATEO	CA	94401	3859	41	06081	37.56634141	-122.3261145	San Mateo County
281092	Fee-for-Service	1346864709	1346864709	1	1	LU, SONGCHI MD	9/13/2023	208M00000X	NA	Other	026	PHYSICIANS	185942	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
281104	Fee-for-Service	1417907940	1417907940	1	12	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	11030 BOLLINGER CANYON	SUITE 220 A B	SAN RAMON	CA	94582	4862	07	06013	37.77383963	-121.9239786	Contra Costa County
281134	Fee-for-Service	1629284088	1629284088	1	1	LOYDS LIBERTY HOMES INC	7/1/1991	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2518 NEWPORT LN	None	BAKERSFIELD	CA	93309	4357	15	06029	35.33176284	-119.0802512	Kern County
281144	Fee-for-Service	1417907940	1417907940	1	18	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 240	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
281171	Fee-for-Service	1417907940	1417907940	1	22	LPCH MEDICAL GROUP DIV OF LU	6/10/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	1100 LARKSPUR LANDING CI	SUITE 150	LARKSPUR	CA	94939	1868	21	06041	37.94817177	-122.5100062	Marin County
281180	Fee-for-Service	1912588567	1912588567	1	1	LOPEZ-ACERO, KAREN J CNM	6/8/2021	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
281195	Fee-for-Service	1558457143	1558457143	1	1	LEE, HAN NE MD	8/15/2002	207N00000X	NA	Dermatology	026	PHYSICIANS	80177	07	Dermatology	0	In state provider	None	1355 SAN PABLO ST	None	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
281234	Fee-for-Service	1245625888	1245625888	1	1	LINGENFELTER, DAVID MD	10/17/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	148772	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
281248	Fee-for-Service	1255534129	1255534129	1	1	LITTLE, SARAH J	6/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102541	None	None	0	In state provider	None	2420 CAMINO RAMON	None	SAN RAMON	CA	94583	4319	07	06013	37.77229042	-121.9634581	Contra Costa County
281303	Fee-for-Service	1417907940	1417907940	1	16	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	50 S SAN MATEO DR	SUITE 180	SAN MATEO	CA	94401	3859	41	06081	37.56634141	-122.3261145	San Mateo County
281304	Fee-for-Service	1720402522	1720402522	1	1	LUCAS, JOSHUA W MD	8/16/2018	207T00000X	NA	General Surgery	026	PHYSICIANS	126012	14	Neurological Surgery	0	In state provider	None	6555 COYLE AVE	STE 260	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
281322	Fee-for-Service	1417907940	1417907940	1	12	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	11030 BOLLINGER CANYON	SUITE 220 A B	SAN RAMON	CA	94582	4862	07	06013	37.77383963	-121.9239786	Contra Costa County
281331	Fee-for-Service	1306982855	1306982855	1	7	LA LASER CENTER, PC, A PROFE	5/17/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	CANCER	30589 TEMECULA PKWY	None	TEMECULA	CA	92592	2840	33	06065	33.47579179	-117.127031	Riverside County
281334	Fee-for-Service	1316958440	1316958440	1	1	LEUNG, L ERIC MD	7/14/2010	207W00000X	NA	Ophthalmology	026	PHYSICIANS	35631	18	Ophthalmology	0	In state provider	None	929 CLAY ST	STE 503	SAN FRANCISCO	CA	94108	1500	38	06075	37.79398652	-122.4083496	San Francisco County
281359	Fee-for-Service	1417907940	1417907940	1	18	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 240	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
281387	Fee-for-Service	1417907940	1417907940	1	22	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	1100 LARKSPUR LANDING CI	SUITE 150	LARKSPUR	CA	94939	1868	21	06041	37.94817177	-122.5100062	Marin County
281395	Fee-for-Service	1851657001	1851657001	1	1	LI, XIANGLI MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132485	01	General Practice	0	In state provider	None	9133 TRUMAN STREET	None	SAN DIEGO	CA	92129	3631	37	06073	32.94382613	-117.1317445	San Diego County
281405	Fee-for-Service	1033615968	1033615968	1	1	LANZAFAME, JAIMIE C MD	9/15/2021	390200000X	NA	Other	026	PHYSICIANS	164787	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
281408	Fee-for-Service	1801968623	1801968623	1	1	LAM,LYNDA L MD	5/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85326	13	Neurology (M.D. only)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
281422	Fee-for-Service	1053354316	1053354316	2	1	LONGS DRUG STORES CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6 THE CROSSROADS	None	CARMEL	CA	93923	8610	27	06053	36.53659115	-121.9104489	Monterey County
281452	Fee-for-Service	1902984016	1902984016	1	1	LEE, NINA Y MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71881	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
281459	Fee-for-Service	1760550735	1760550735	1	1	LITTLE, DAVID G DPM INC	8/8/2000	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	8540 S SEPULVEDA BLVD	STE 106	LOS ANGELES	CA	90045	3811	19	06037	33.96022076	-118.3961982	Los Angeles County
281480	Fee-for-Service	1043518665	1043518665	1	1	LWIN, KYAW K MD	7/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116283	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
281516	Fee-for-Service	1417907940	1417907940	1	16	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	50 S SAN MATEO DR	SUITE 180	SAN MATEO	CA	94401	3859	41	06081	37.56634141	-122.3261145	San Mateo County
281527	Fee-for-Service	1093201568	1093201568	1	1	LECOMTE, TRINH N NP	1/27/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2825 CAPITOL AVENUE	None	SACRAMENTO	CA	95816	6039	34	06067	38.570805	-121.4696385	Sacramento County
281538	Fee-for-Service	1417907940	1417907940	1	12	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	11030 BOLLINGER CANYON	SUITE 220 A B	SAN RAMON	CA	94582	4862	07	06013	37.77383963	-121.9239786	Contra Costa County
281547	Fee-for-Service	1306982855	1306982855	1	7	LA LASER CENTER, PC, A PROFE	5/17/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	CANCER	30589 TEMECULA PKWY	None	TEMECULA	CA	92592	2840	33	06065	33.47579179	-117.127031	Riverside County
281558	Fee-for-Service	1306982855	1306982855	1	4	LA LASER CENTER, PC, A PROFE	9/5/2023	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	N CANCER	155 MAIN ST	None	WOODLAND	CA	95695	3125	57	06113	38.67751848	-121.7808405	Yolo County
281573	Fee-for-Service	1417907940	1417907940	1	1	LPCH MEDICAL GROUP DIV OF LU	10/4/2022	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	EN'S HOSPITAL AT STANFOR	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
281599	Fee-for-Service	1417907940	1417907940	1	22	LPCH MEDICAL GROUP DIV OF LU	6/10/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	1100 LARKSPUR LANDING CI	SUITE 150	LARKSPUR	CA	94939	1868	21	06041	37.94817177	-122.5100062	Marin County
281606	Fee-for-Service	1205443272	1205443272	1	1	LIFE BRIDGE HOSPICE CARE,	10/26/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	6454 VAN NUYS BLVD	STE 110/9	VAN NUYS	CA	91401	1445	19	06037	34.187886	-118.448714	Los Angeles County
281644	Fee-for-Service	1265522684	1265522684	1	1	LAUERMANN, MICHAEL W MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	25668	41	Internal Medicine	0	In state provider	None	2865 ATLANTIC AVE	STE 150	LONG BEACH	CA	90806	7413	19	06037	33.809418	-118.185058	Los Angeles County
281695	Fee-for-Service	1164719993	1164719993	1	1	LEWIS, NICHOLAS A MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142218	30	Radiology	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
281697	Fee-for-Service	1629542949	1629542949	1	1	LEONID BASOVICH DO INC	6/28/2019	207QA0401X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	7777 GREENBACK LANE	SUITE 103	CITRUS HEIGHTS	CA	95610	5800	34	06067	38.678868	-121.2777135	Sacramento County
281711	Fee-for-Service	1871507814	1871507814	1	1	LIU, JIANGHUA	11/29/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	680 BREA CANYON RD,	SUITE 158	DIAMOND BAR	CA	91789	3005	19	06037	34.006824	-117.8465105	Los Angeles County
281718	Fee-for-Service	1770506537	1770506537	1	1	LAU, DIANA W MD	2/28/1993	207R00000X	NA	Other	026	PHYSICIANS	77103	41	Internal Medicine	0	In state provider	None	800 3RD ST	None	MARYSVILLE	CA	95901	5831	58	06115	39.13757487	-121.5949642	Yuba County
281746	Fee-for-Service	1992780225	1992780225	1	1	LEE, WONIL MD	2/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54116	83	Rheumatology	0	In state provider	None	12660 RIVERSIDE	SUITE 200	NORTH HOLLYWOOD	CA	91607	3430	19	06037	34.1575795	-118.409499	Los Angeles County
281748	Fee-for-Service	1417907940	1417907940	1	12	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	11030 BOLLINGER CANYON	SUITE 220 A B	SAN RAMON	CA	94582	4862	07	06013	37.77383963	-121.9239786	Contra Costa County
281785	Fee-for-Service	1417907940	1417907940	1	18	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 240	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
281792	Fee-for-Service	1730399932	1730399932	1	1	LOPEZ, YAMIL MD	4/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114680	None	None	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
281795	Fee-for-Service	1457879959	1457879959	1	1	LACABANNE, SHANNON	2/23/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 E GARVEY AVE N	B2	WEST COVINA	CA	91791	1544	19	06037	34.07280989	-117.8995249	Los Angeles County
281811	Fee-for-Service	1417907940	1417907940	1	22	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1100 LARKSPUR LANDING CI	SUITE 150	LARKSPUR	CA	94939	1868	21	06041	37.94817177	-122.5100062	Marin County
281818	Fee-for-Service	1205443272	1205443272	1	1	LIFE BRIDGE HOSPICE CARE,	10/26/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	6454 VAN NUYS BLVD	STE 110/9	VAN NUYS	CA	91401	1445	19	06037	34.187886	-118.448714	Los Angeles County
281821	Fee-for-Service	1205153939	1205153939	1	1	LIN, KEN Y MD	6/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120946	18	Ophthalmology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
281825	Fee-for-Service	1275571523	1275571523	1	1	LENTZ, DANIEL MD	9/30/1992	2085B0100X	NA	MRI Provider	026	PHYSICIANS	71025	30	Radiology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
281870	Fee-for-Service	1417907940	1417907940	1	3	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	1134 MURRIETA BLVD	SUITES A B C	LIVERMORE	CA	94550	4113	01	06001	37.6759635	-121.781043	Alameda County
281909	Fee-for-Service	1629542949	1629542949	1	1	LEONID BASOVICH DO INC	6/28/2019	207QA0401X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	7777 GREENBACK LANE	SUITE 103	CITRUS HEIGHTS	CA	95610	5800	34	06067	38.678868	-121.2777135	Sacramento County
281910	Fee-for-Service	1487122305	1487122305	1	1	LEBLEUCHATEAU, INC	8/21/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1900 GRISMER AVE	None	BURBANK	CA	91504	3623	19	06037	34.19546517	-118.3255668	Los Angeles County
281913	Fee-for-Service	1245426295	1245426295	1	1	LONG, ELIZA E MD	4/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	96480	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
281924	Fee-for-Service	1922628023	1922628023	1	1	LI, JUNWEI MD	6/22/2023	207P00000X	NA	Other	026	PHYSICIANS	178745	None	None	0	In state provider	None	1025 S ANAHEIM BLVD	None	ANAHEIM	CA	92805	5806	30	06059	33.81994338	-117.9087416	Orange County
281926	Fee-for-Service	1609971183	1609971183	1	1	LONDON, ERIC T MD	2/1/2000	208600000X	NA	General Surgery	026	PHYSICIANS	55814	02	General Surgery	0	In state provider	None	2800 L ST	# 260	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
281931	Fee-for-Service	1144744053	1144744053	1	1	LOVE, FANYA N LCSW	4/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	231 N EUCLID AVE	None	UPLAND	CA	91786	4359	36	06071	34.096779	-117.6513275	San Bernardino County
281933	Fee-for-Service	1770506537	1770506537	1	1	LAU, DIANA W MD	2/28/1993	207R00000X	NA	Other	026	PHYSICIANS	77103	83	Rheumatology	0	In state provider	None	800 3RD ST	None	MARYSVILLE	CA	95901	5831	58	06115	39.13757487	-121.5949642	Yuba County
281935	Fee-for-Service	1215390638	1215390638	1	1	LI, XI MD	7/19/2023	207L00000X	NA	Other	026	PHYSICIANS	151996	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
281962	Fee-for-Service	1417907940	1417907940	1	12	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	11030 BOLLINGER CANYON	SUITE 220 A B	SAN RAMON	CA	94582	4862	07	06013	37.77383963	-121.9239786	Contra Costa County
281994	Fee-for-Service	1417907940	1417907940	1	1	LPCH MEDICAL GROUP DIV OF LU	5/4/2017	282NC2000X	NA	Hospitals	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	EN'S HOSPITAL AT STANFOR	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
282007	Fee-for-Service	1417907940	1417907940	1	30	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE PACKARD CHILDRENS	100 CORTONA WAY	STE 230	BRENTWOOD	CA	94513	7160	07	06013	37.92663446	-121.7366493	Contra Costa County
282017	Fee-for-Service	1609070721	1609070721	1	1	LISLE, DARREN G LAC	10/26/2007	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	133 E HALEY ST	None	SANTA BARBARA	CA	93102	2330	42	06083	34.41883725	-119.6933889	Santa Barbara County
282021	Fee-for-Service	1417907940	1417907940	1	22	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1100 LARKSPUR LANDING CI	SUITE 150	LARKSPUR	CA	94939	1868	21	06041	37.94817177	-122.5100062	Marin County
282022	Fee-for-Service	1083118442	1083118442	1	1	LEVINE, JACLYNN N DO	5/1/2020	207R00000X	NA	Other	026	PHYSICIANS	17819	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
282072	Fee-for-Service	1780183335	1780183335	1	2	LA DOWNTOWN MEDICAL CENTER	3/1/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	LLC	7500 HELLMAN AVE	None	ROSEMEAD	CA	91770	2216	19	06037	34.06982751	-118.1056459	Los Angeles County
282077	Fee-for-Service	1417907940	1417907940	1	3	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	1134 MURRIETA BLVD	SUITES A B C	LIVERMORE	CA	94550	4113	01	06001	37.6759635	-121.781043	Alameda County
282089	Fee-for-Service	1326377698	1326377698	1	1	LEUNG, STEPHANIE K MD	7/27/2023	2080P0204X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
282098	Fee-for-Service	1194870709	1194870709	1	1	LOS ANGELES COUNTY CCS	8/23/1993	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	CLAREMONT MTU	1745 LYNOAK DR	None	CLAREMONT	CA	91711	2421	19	06037	34.11601566	-117.7400159	Los Angeles County
282099	Fee-for-Service	1215971650	1215971650	2	1	LONGS DRUG STORE CA LLC	12/2/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	576 E EL CAMINO REAL	None	SUNNYVALE	CA	94087	1940	43	06085	37.36249974	-122.0260401	Santa Clara County
282102	Fee-for-Service	1568981264	1568981264	1	1	LEE, BITNA J	8/17/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
282118	Fee-for-Service	1285197368	1285197368	1	1	LIAO, JENNIFER L MD	9/1/2022	207P00000X	NA	Other	026	PHYSICIANS	181661	None	None	0	In state provider	None	4001 J STREET	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
282122	Fee-for-Service	1689952277	1689952277	1	1	LEE, LILY YEUK YING NP	5/22/2023	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
282138	Fee-for-Service	1205878865	1205878865	1	1	LIPAROTO, BLAYNE R	4/18/2005	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ADVANTAGE PHYSICAL THRPY	4572 TELEPHONE RD	STE 903	VENTURA	CA	93003	5663	56	06111	34.25635267	-119.2348313	Ventura County
282150	Fee-for-Service	1861692964	1861692964	1	1	LAM, LOI MD	11/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99203	41	Internal Medicine	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
282178	Fee-for-Service	1922427186	1922427186	1	1	LEE, JONATHAN Y MD	8/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137567	36	Psychiatry	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
282179	Fee-for-Service	1366650889	1366650889	1	1	LIN, SERENA P MD	2/11/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	89736	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
282184	Fee-for-Service	1659877850	1659877850	1	1	LEE, SCOTT MD	1/27/2022	208M00000X	NA	Other	026	PHYSICIANS	173478	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
282195	Fee-for-Service	1306982855	1306982855	1	1	LA LASER CENTER, PC, A PROFE	10/1/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	A PROFESSIONAL MEDICAL	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	15	06029	35.356203	-119.0612695	Kern County
282204	Fee-for-Service	1417907940	1417907940	1	1	LPCH MEDICAL GROUP DIV OF LU	9/19/2016	282NC2000X	NA	Hospitals	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	EN'S HOSPITAL AT STANFOR	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
282207	Fee-for-Service	1548308109	1548308109	1	1	LE, NGUYEN L MD	10/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83309	40	Pediatrics	0	In state provider	INTELLIGENT CARE MED CLI	5507 EL CAJON BLVD	STE B	SAN DIEGO	CA	92115	3624	37	06073	32.75824665	-117.0763619	San Diego County
282212	Fee-for-Service	1417907940	1417907940	1	30	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE PACKARD CHILDRENS	100 CORTONA WAY	STE 230	BRENTWOOD	CA	94513	7160	07	06013	37.92663446	-121.7366493	Contra Costa County
282216	Fee-for-Service	1629085527	1629085527	1	1	LUO, HONG MD	5/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	61057	None	None	0	In state provider	None	400 MORRIS ST	STE H	SEBASTOPOL	CA	95472	3830	49	06097	38.40685624	-122.8200572	Sonoma County
282227	Fee-for-Service	1417907940	1417907940	1	22	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	1100 LARKSPUR LANDING CI	SUITE 150	LARKSPUR	CA	94939	1868	21	06041	37.94817177	-122.5100062	Marin County
282238	Fee-for-Service	1154485597	1154485597	1	1	LEVIN, ROBERT M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33278	77	Infectious Disease	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
282240	Fee-for-Service	1770767071	1770767071	1	1	LEE, MIMI Y MD	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102225	08	Family Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
282246	Fee-for-Service	1528203312	1528203312	2	1	LIGHT DAYS HOSPICE INC	12/12/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	225 EAST BROADWAY	SUITE 204	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
282277	Fee-for-Service	1780183335	1780183335	1	2	LA DOWNTOWN MEDICAL CENTER	3/4/2019	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	LLC	7500 HELLMAN AVE	None	ROSEMEAD	CA	91770	2216	19	06037	34.06982751	-118.1056459	Los Angeles County
282283	Fee-for-Service	1417907940	1417907940	1	3	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	1134 MURRIETA BLVD	SUITES A B C	LIVERMORE	CA	94550	4113	01	06001	37.6759635	-121.781043	Alameda County
282293	Fee-for-Service	1326377698	1326377698	1	1	LEUNG, STEPHANIE K MD	7/27/2023	2080P0204X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
282294	Fee-for-Service	1821183252	1821183252	1	1	LIM,JOHN TAEK MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69386	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
282391	Fee-for-Service	1750366712	1750366712	2	1	LUM LUNG, MICHAEL P MD	12/10/2019	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
282399	Fee-for-Service	1982716221	1982716221	1	1	LOGAN, SUSAN C MD	1/31/2001	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	69486	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 DOYLE PARK DR	STE 103	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
282404	Fee-for-Service	1417907940	1417907940	1	1	LPCH MEDICAL GROUP DIV OF LU	11/15/2005	282NC2000X	NA	Hospitals	031	PSYCHOLOGISTS	-	None	None	0	In state provider	EN'S HOSPITAL AT STANFOR	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
282415	Fee-for-Service	1417907940	1417907940	1	30	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE PACKARD CHILDRENS	100 CORTONA WAY	STE 230	BRENTWOOD	CA	94513	7160	07	06013	37.92663446	-121.7366493	Contra Costa County
282424	Fee-for-Service	1487283206	1487283206	1	1	LIAO, ERIKA MD	1/29/2025	207L00000X	NA	Other	026	PHYSICIANS	190765	05	Anesthesiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
282445	Fee-for-Service	1770767071	1770767071	1	1	LEE, MIMI Y MD	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102225	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
282448	Fee-for-Service	1528203312	1528203312	2	1	LIGHT DAYS HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	225 EAST BROADWAY	SUITE 204	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
282457	Fee-for-Service	1366866345	1366866345	1	2	LOMA LINDA UNIVERSITY	7/10/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	11370 ANDERSON ST	ST B800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
282487	Fee-for-Service	1417907940	1417907940	1	3	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	1134 MURRIETA BLVD	SUITES A B C	LIVERMORE	CA	94550	4113	01	06001	37.6759635	-121.781043	Alameda County
282501	Fee-for-Service	1396809406	1396809406	1	1	LIU, REBECCA C PHD	11/8/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	820 LAS GALLINAS AVENUE	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
282512	Fee-for-Service	1033282223	1033282223	1	1	LOFFLER, CHRISTINE MD	4/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62590	40	Pediatrics	0	In state provider	LOFFLER-BARRY MD & MORGE	2160 JEFFERSON ST	STE 260	NAPA	CA	94559	1252	28	06055	38.30647594	-122.2951788	Napa County
282545	Fee-for-Service	1336670413	1336670413	1	1	LI, XIA MD	7/1/2021	364SP0809X	NA	Other	026	PHYSICIANS	163344	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
282556	Fee-for-Service	1447889993	1447889993	1	1	LAU, JEFFREY PT	2/23/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
282606	Fee-for-Service	1417907940	1417907940	1	1	LPCH MEDICAL GROUP DIV OF LU	4/19/2019	282NC2000X	NA	Hospitals	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	EN'S HOSPITAL AT STANFOR	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
282610	Fee-for-Service	1831231190	1831231190	1	1	LEON-MONDRAGON, MICHELLE MD	1/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	85023	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
282618	Fee-for-Service	1417907940	1417907940	1	30	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE PACKARD CHILDRENS	100 CORTONA WAY	STE 230	BRENTWOOD	CA	94513	7160	07	06013	37.92663446	-121.7366493	Contra Costa County
282627	Fee-for-Service	1780117077	1780117077	1	1	LIN, WEI-CHEN MD	10/18/2022	207LP2900X	NA	Other	026	PHYSICIANS	159164	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
282646	Fee-for-Service	1770767071	1770767071	1	1	LEE, MIMI Y MD	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102225	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
282685	Fee-for-Service	1871757153	1871757153	1	1	LI, DAN MD	8/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93986	10	Gastroenterology (M.D. only)	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
282686	Fee-for-Service	1417907940	1417907940	1	3	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1134 MURRIETA BLVD	SUITES A B C	LIVERMORE	CA	94550	4113	01	06001	37.6759635	-121.781043	Alameda County
282716	Fee-for-Service	1265553994	1265553994	1	1	LEE, CAROLYN S MD	11/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101049	07	Dermatology	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
282717	Fee-for-Service	1740498294	1740498294	1	1	LEACH, MARISELA L LMFT	9/6/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
282730	Fee-for-Service	1245671726	1245671726	1	1	LA CLINICA DE LA RAZA INC	9/16/2013	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1390 66TH AVE	None	OAKLAND	CA	94621	3506	01	06001	37.7620165	-122.1932801	Alameda County
282731	Fee-for-Service	1871794404	1871794404	1	1	LAKE, JAMES H MD	10/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77237	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
282733	Fee-for-Service	1801902622	1801902622	1	1	LANNER-CUSIN, KATARINA	5/31/1985	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	50153	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MD	2915 TELEGRAPH AVE	STE 200	BERKELEY	CA	94705	2030	01	06001	37.85719633	-122.2595246	Alameda County
282737	Fee-for-Service	1992746481	1992746481	1	1	LAUTERBACH, STEWART MD	5/31/1982	207P00000X	NA	Other	026	PHYSICIANS	48147	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
282739	Fee-for-Service	1831279231	1831279231	1	1	LIN, CAROLE MD	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	72099	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
282743	Fee-for-Service	1417907940	1417907940	1	20	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	1776 YGNACIO VALLEY ROAD	STE 100	WALNUT CREEK	CA	94598	3100	07	06013	37.91657746	-122.0403263	Contra Costa County
282778	Fee-for-Service	1023515947	1023515947	1	1	LIU, YUFEI MD	7/20/2023	2085R0001X	NA	Other	026	PHYSICIANS	186580	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
282792	Fee-for-Service	1730124793	1730124793	1	1	LEE, MICHAEL SUNG MD	6/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84978	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
282800	Fee-for-Service	1417907940	1417907940	1	18	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 240	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
282814	Fee-for-Service	1417907940	1417907940	1	30	LPCH MEDICAL GROUP DIV OF LU	4/1/2015	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE PACKARD CHILDRENS	100 CORTONA WAY	STE 230	BRENTWOOD	CA	94513	7160	07	06013	37.92663446	-121.7366493	Contra Costa County
282821	Fee-for-Service	1699878553	1699878553	1	1	LEE, JAMES MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	48902	41	Internal Medicine	0	In state provider	None	2650 GRIFFITH PARK BLVD	None	LOS ANGELES	CA	90039	2520	19	06037	34.10637377	-118.2719754	Los Angeles County
282847	Fee-for-Service	1346341260	1346341260	1	1	LAMAR, MARLENE A OT	5/15/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1085 W EL CAMINO REAL	None	SUNNYVALE	CA	94087	1030	43	06085	37.37270741	-122.0517412	Santa Clara County
282848	Fee-for-Service	1487628871	1487628871	1	1	LONGIN, HELENA A MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54528	07	Dermatology	0	In state provider	None	3883 AIRWAY DR	#203	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
282850	Fee-for-Service	1669985909	1669985909	1	1	LOWREY, HEATHER M CNP	10/18/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2791 AGOURA RD	None	THOUSAND OAKS	CA	91361	3101	56	06111	34.15068671	-118.8255597	Ventura County
282858	Fee-for-Service	1629466537	1629466537	1	1	LIVE-WELL ICF, INC	7/21/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	11053 SHARP AVE	None	MISSION HILLS	CA	91345	1740	19	06037	34.27082483	-118.4501052	Los Angeles County
282866	Fee-for-Service	1952595092	1952595092	1	1	LARSEN, ALYS LCSW	6/4/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
282884	Fee-for-Service	1417907940	1417907940	1	3	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1134 MURRIETA BLVD	SUITES A B C	LIVERMORE	CA	94550	4113	01	06001	37.6759635	-121.781043	Alameda County
282925	Fee-for-Service	1245671726	1245671726	1	1	LA CLINICA DE LA RAZA INC	9/16/2013	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1390 66TH AVE	None	OAKLAND	CA	94621	3506	01	06001	37.7620165	-122.1932801	Alameda County
282937	Fee-for-Service	1417907940	1417907940	1	20	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1776 YGNACIO VALLEY ROAD	STE 100	WALNUT CREEK	CA	94598	3100	07	06013	37.91657746	-122.0403263	Contra Costa County
282938	Fee-for-Service	1740368844	1740368844	1	1	LEVY, DAVID H MD	2/28/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	49945	None	None	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
282956	Fee-for-Service	1205903028	1205903028	1	1	LEE-SHIN, CATHERINE A MD	4/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74475	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
282997	Fee-for-Service	1417907940	1417907940	1	1	LPCH MEDICAL GROUP DIV OF LU	3/13/2018	282NC2000X	NA	Hospitals	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	EN'S HOSPITAL AT STANFOR	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
283012	Fee-for-Service	1417907940	1417907940	1	30	LPCH MEDICAL GROUP DIV OF LU	4/1/2015	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE PACKARD CHILDRENS	100 CORTONA WAY	STE 230	BRENTWOOD	CA	94513	7160	07	06013	37.92663446	-121.7366493	Contra Costa County
283016	Fee-for-Service	1891954772	1891954772	1	1	LUM, BRENT L MD	8/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116550	18	Ophthalmology	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
283021	Fee-for-Service	1154314409	1154314409	1	1	LEXINGTON COUNTY EMS	12/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5005 SUNSET BLVD	None	LEXINGTON	SC	29072	0000	00	None	34.0103993	-81.18859242	Lexington County
283067	Fee-for-Service	1114001500	1114001500	1	1	LAI, EN MING DO INC	8/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6144	08	Family Practice	0	In state provider	None	616 N GARFIELD AVE	STE 300	MONTEREY PARK	CA	91754	1101	19	06037	34.06916465	-118.1229039	Los Angeles County
283069	Fee-for-Service	1306014238	1306014238	1	1	LIBERTY DIALYSIS	4/2/2009	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	None	601 SIERRA ROSE DRIVE	STE 201	RENO	NV	89511	4027	00	None	39.47338868	-119.7957435	Washoe County
283079	Fee-for-Service	1417907940	1417907940	1	3	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1134 MURRIETA BLVD	SUITES A B C	LIVERMORE	CA	94550	4113	01	06001	37.6759635	-121.781043	Alameda County
283084	Fee-for-Service	1417311325	1417311325	1	1	LAM, KENTSON MD	8/22/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	152497	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
283101	Fee-for-Service	1417901067	1417901067	1	1	LISH, BENJAMIN T MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	67012	08	Family Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
283119	Fee-for-Service	1245671726	1245671726	1	1	LA CLINICA DE LA RAZA INC	9/16/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1390 66TH AVE	None	OAKLAND	CA	94621	3506	01	06001	37.7620165	-122.1932801	Alameda County
283137	Fee-for-Service	1417907940	1417907940	1	20	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1776 YGNACIO VALLEY ROAD	STE 100	WALNUT CREEK	CA	94598	3100	07	06013	37.91657746	-122.0403263	Contra Costa County
283167	Fee-for-Service	1255653879	1255653879	1	1	LIFE PRACTICE COUNSELING GRO	9/30/2019	251S00000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	UP, INC	3820 AUBURN BLVD	STE 100	SACRAMENTO	CA	95821	2124	34	06067	38.639583	-121.3754985	Sacramento County
283183	Fee-for-Service	1528053303	1528053303	1	1	LLOYD, FREDERICK J	4/30/1993	207W00000X	NA	Ophthalmology	026	PHYSICIANS	40145	None	None	0	In state provider	None	25333 BARTON RD	None	LOMA LINDA	CA	92354	3123	36	06071	34.04801656	-117.251334	San Bernardino County
283190	Fee-for-Service	1417907940	1417907940	1	1	LPCH MEDICAL GROUP DIV OF LU	11/10/2016	282NC2000X	NA	Hospitals	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	EN'S HOSPITAL AT STANFOR	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
283204	Fee-for-Service	1417907940	1417907940	1	30	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE PACKARD CHILDRENS	100 CORTONA WAY	STE 230	BRENTWOOD	CA	94513	7160	07	06013	37.92663446	-121.7366493	Contra Costa County
283262	Fee-for-Service	1114001500	1114001500	1	1	LAI, EN MING DO INC	8/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6144	01	General Practice	0	In state provider	None	616 N GARFIELD AVE	STE 300	MONTEREY PARK	CA	91754	1101	19	06037	34.06916465	-118.1229039	Los Angeles County
283270	Fee-for-Service	1417907940	1417907940	1	3	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	1134 MURRIETA BLVD	SUITES A B C	LIVERMORE	CA	94550	4113	01	06001	37.6759635	-121.781043	Alameda County
283307	Fee-for-Service	1942372602	1942372602	1	1	LAW COURTER, JOANNA C MD	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92255	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
283325	Fee-for-Service	1417907940	1417907940	1	20	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	1776 YGNACIO VALLEY ROAD	STE 100	WALNUT CREEK	CA	94598	3100	07	06013	37.91657746	-122.0403263	Contra Costa County
283329	Fee-for-Service	1063590651	1063590651	1	1	LEUNG, SUN MD	12/14/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	51511	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
283353	Fee-for-Service	1427138015	1427138015	1	1	LANDREVILLE, WENDY MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74353	08	Family Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
283376	Fee-for-Service	1134394364	1134394364	1	1	LOBATO, ROBERT L MD	7/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112931	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
283377	Fee-for-Service	1417907940	1417907940	1	18	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 240	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
283392	Fee-for-Service	1417907940	1417907940	1	30	LPCH MEDICAL GROUP DIV OF LU	4/1/2015	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	LUCILE PACKARD CHILDRENS	100 CORTONA WAY	STE 230	BRENTWOOD	CA	94513	7160	07	06013	37.92663446	-121.7366493	Contra Costa County
283397	Fee-for-Service	1730476110	1730476110	1	1	LA CLINICA DE LA RAZA, INC	4/27/2018	261QF0400X	NA	Federally Qualified Health Center	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1030 INTERNATIONAL BLVD	None	OAKLAND	CA	94606	3730	01	06001	37.7917365	-122.2492617	Alameda County
283412	Fee-for-Service	1922599539	1922599539	1	1	LEE, SUN YONG MD	7/9/2021	390200000X	NA	Other	026	PHYSICIANS	173322	None	None	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
283423	Fee-for-Service	1710411459	1710411459	1	1	LIBBY, CHRISTOPHER MD	9/22/2020	207P00000X	NA	Other	026	PHYSICIANS	164790	66	Emergency Medicine (Urgent Care)	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
283430	Fee-for-Service	1679730956	1679730956	1	1	LIVONI, RAQUEL R MD	3/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106921	08	Family Practice	0	In state provider	None	7551 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
283435	Fee-for-Service	1699311464	1699311464	1	1	LIVERPOOL HOME CARE SERVICES	11/17/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2828 E FOOTHILL BLVD	STE 2028	PASADENA	CA	91107	2828	19	06037	34.14990147	-118.0924785	Los Angeles County
283474	Fee-for-Service	1316070204	1316070204	1	1	LUND, KATE PSYD	12/3/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
283495	Fee-for-Service	1447487863	1447487863	1	1	LY, VIETNAM OD	11/17/2010	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9449 IMPERIAL HWY	None	DOWNEY	CA	90242	2814	19	06037	33.91714048	-118.1262915	Los Angeles County
283502	Fee-for-Service	1063477743	1063477743	1	1	LAWLER, CHRISTOPHER M MD	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	55969	25	Physical Medicine and Rehabilitation	0	In state provider	None	25982 PALA	STE 170	MISSION VIEJO	CA	92691	6724	30	06059	33.61983904	-117.6772494	Orange County
283507	Fee-for-Service	1447294897	1447294897	2	1	LONGS DRUG STORES CA LLC	12/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	352 UNIVERSITY AVE	None	PALO ALTO	CA	94301	1715	43	06085	37.44665081	-122.1608377	Santa Clara County
283511	Fee-for-Service	1083786321	1083786321	1	1	LEE, MYUNG-MOO MD	11/30/1995	207N00000X	NA	Dermatology	026	PHYSICIANS	76180	07	Dermatology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
283513	Fee-for-Service	1417907940	1417907940	1	20	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	1776 YGNACIO VALLEY ROAD	STE 100	WALNUT CREEK	CA	94598	3100	07	06013	37.91657746	-122.0403263	Contra Costa County
283530	Fee-for-Service	1366459422	1366459422	1	1	LEARD, LORRIANA E MD	3/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79692	41	Internal Medicine	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
283568	Fee-for-Service	1417907940	1417907940	1	18	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 240	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
283632	Fee-for-Service	1699863225	1699863225	1	1	LAL, RAJESH MD	12/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40353	02	General Surgery	0	In state provider	LAL MEDICAL CORPORATION	17822 BEACH BLVD	STE 400	HUNTINGTON BEACH	CA	92647	7510	30	06059	33.70331388	-117.9890471	Orange County
283643	Fee-for-Service	1548421886	1548421886	1	1	LEE, VINCENT G MD	11/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86132	33	Thoracic Surgery	0	In state provider	None	901 SAN BERNARDINO ROAD	SUITE 102	UPLAND	CA	91786	4988	36	06071	34.10050176	-117.6382066	San Bernardino County
283667	Fee-for-Service	1508278714	1508278714	1	1	LEE, SKY W MD	9/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139443	01	General Practice	0	In state provider	None	10 WOODLAND ROAD	None	SAINT HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
283697	Fee-for-Service	1588078224	1588078224	1	1	LUGO, RICARDO MD	8/16/2021	204E00000X	NA	Dental Provider	026	PHYSICIANS	158305	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
283699	Fee-for-Service	1417907940	1417907940	1	20	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	1776 YGNACIO VALLEY ROAD	STE 100	WALNUT CREEK	CA	94598	3100	07	06013	37.91657746	-122.0403263	Contra Costa County
283705	Fee-for-Service	1649624800	1649624800	1	1	LIU, MARISA C MD	5/31/2020	390200000X	NA	Other	026	PHYSICIANS	153303	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
283709	Fee-for-Service	1417085853	1417085853	1	1	LA VOY, TINA M LCSW	10/6/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
283710	Fee-for-Service	1740231927	1740231927	1	1	LILLIE, MICHAEL J MD	1/1/1995	207L00000X	NA	Other	026	PHYSICIANS	63391	05	Anesthesiology	0	In state provider	None	12373 LEWIS ST	STE 102	GARDEN GROVE	CA	92840	4676	30	06059	33.78307435	-117.8981519	Orange County
283725	Fee-for-Service	1821319187	1821319187	1	1	LITVINOFF, JEROME S MD AMC	1/1/1979	207T00000X	NA	General Surgery	026	PHYSICIANS	20193	14	Neurological Surgery	0	In state provider	None	6536 CRYSTALAIRE DRIVE	None	SAN DIEGO	CA	92120	3902	37	06073	32.78902098	-117.0562752	San Diego County
283741	Fee-for-Service	1902238272	1902238272	1	1	LEBRUN COLLIER, ARIANA OT	11/29/2022	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7812 EDINGER AVE STE	400	HUNTINGTON BEACH	CA	92647	3727	30	06059	33.73009047	-117.992493	Orange County
283749	Fee-for-Service	1417907940	1417907940	1	18	LPCH MEDICAL GROUP DIV OF LU	4/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 240	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
283777	Fee-for-Service	1316175805	1316175805	1	1	LINCOLN HEALTH DME &	4/2/2012	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	SUPPLIES	1430 THIRD STREET	SUITE 6	RIVERSIDE	CA	98250	7345	33	06065	33.98298096	-117.3432357	Riverside County
283799	Fee-for-Service	1366525487	1366525487	1	2	LOS ANGELES RADIOLOGY	10/19/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL ASSOCIATES, INC	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
283831	Fee-for-Service	1144370453	1144370453	1	1	LILLYWHITE, MARGARET R LCSW	7/6/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	27449	-	NOT APPLICABLE	0	In state provider	None	1212 SOUTH 43RD STREET	SUITES C, D, E	SAN DIEGO	CA	92113	3434	37	06073	32.69386652	-117.1024299	San Diego County
283834	Fee-for-Service	1407044639	1407044639	1	1	LEEPER, NICHOLAS J MD	4/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90602	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
283838	Fee-for-Service	1366842114	1366842114	1	1	LEBOEUF, CHIEN-YU L LMFT	10/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
283851	Fee-for-Service	1417907940	1417907940	1	34	LPCH MEDICAL GROUP DIV OF LU	12/4/2023	208000000X	NA	Pediatric Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	EN'S HOSPITAL AT STANFOR	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
283883	Fee-for-Service	1417907940	1417907940	1	20	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	1776 YGNACIO VALLEY ROAD	STE 100	WALNUT CREEK	CA	94598	3100	07	06013	37.91657746	-122.0403263	Contra Costa County
283898	Fee-for-Service	1447641345	1447641345	1	1	L A URGENT CARE MEDICAL CENT	8/29/2024	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	ER	401 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	3620	19	06037	34.01634247	-118.1020649	Los Angeles County
283899	Fee-for-Service	1255321568	1255321568	1	2	LUTMAN, CHRISTOPHER V MD	1/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140803	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1325 E CHURCH ST	STE 202	SANTA MARIA	CA	93454	5915	42	06083	34.95209265	-120.4147348	Santa Barbara County
283900	Fee-for-Service	1952343113	1952343113	1	1	LEAVITT, ANDREW D MD	6/30/1993	207R00000X	NA	Other	026	PHYSICIANS	65749	68	Hematology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
283906	Fee-for-Service	1942562590	1942562590	1	1	LUKAC, PAUL J MD	10/14/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	158276	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
283920	Fee-for-Service	1114196003	1114196003	1	1	LIPA, JOAN E MD	3/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53095	24	Plastic Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 465	LOS ANGELES	CA	90024	7002	19	06037	34.06527974	-118.4462792	Los Angeles County
283933	Fee-for-Service	1417907940	1417907940	1	1	LPCH MEDICAL GROUP DIV OF LU	7/5/2005	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	EN'S HOSPITAL AT STANFOR	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
283934	Fee-for-Service	1346455961	1346455961	1	1	LOVING CARE, LLC	1/12/2000	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	LOVING CARE ADHC	2565 CAMINO DEL RIO S	STE 201	SAN DIEGO	CA	92108	3789	37	06073	32.76942874	-117.1370277	San Diego County
283956	Fee-for-Service	1437104478	1437104478	1	1	LE, ANH X MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	79842	20	Orthopedic Surgery	0	In state provider	None	333 E ALPINE AVE	None	STOCKTON	CA	95204	3407	39	06077	37.98100681	-121.2957195	San Joaquin County
283960	Fee-for-Service	1922147727	1922147727	1	1	LAM, DUNG T CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	744 E 12TH ST	None	OAKLAND	CA	94606	3625	01	06001	37.79305344	-122.2524674	Alameda County
283962	Fee-for-Service	1477000867	1477000867	1	1	LACHICA, RUBEN MD	9/12/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	144713	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
283973	Fee-for-Service	1366754699	1366754699	1	1	LOPEZ, GREGORY D MD	8/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117559	20	Orthopedic Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
283986	Fee-for-Service	1477866705	1477866705	1	1	LINGALA, SHILPA MD	7/15/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	124331	10	Gastroenterology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
284030	Fee-for-Service	1750624060	1750624060	1	1	LAVI, MORDECHAI S MD	2/19/2020	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	-	38	Geriatrics	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
284033	Fee-for-Service	1417907940	1417907940	1	34	LPCH MEDICAL GROUP DIV OF LU	6/7/2023	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	EN'S HOSPITAL AT STANFOR	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
284041	Fee-for-Service	1033371521	1033371521	1	1	LAU, BONNIE MD	5/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120010	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
284065	Fee-for-Service	1417907940	1417907940	1	20	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	1776 YGNACIO VALLEY ROAD	STE 100	WALNUT CREEK	CA	94598	3100	07	06013	37.91657746	-122.0403263	Contra Costa County
284077	Fee-for-Service	1417907940	1417907940	1	6	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 220	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
284079	Fee-for-Service	1447641345	1447641345	1	1	L A URGENT CARE MEDICAL CENT	8/29/2024	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ER	401 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	3620	19	06037	34.01634247	-118.1020649	Los Angeles County
284080	Fee-for-Service	1255321568	1255321568	1	2	LUTMAN, CHRISTOPHER V MD	1/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140803	78	Neoplastic Diseases/Oncology	0	In state provider	None	1325 E CHURCH ST	STE 202	SANTA MARIA	CA	93454	5915	42	06083	34.95209265	-120.4147348	Santa Barbara County
284081	Fee-for-Service	1952343113	1952343113	1	1	LEAVITT, ANDREW D MD	6/30/1993	207R00000X	NA	Other	026	PHYSICIANS	65749	41	Internal Medicine	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
284098	Fee-for-Service	1679554398	1679554398	1	1	LEBARON, DANETTE S MD	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	53286	40	Pediatrics	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
284112	Fee-for-Service	1558802835	1558802835	1	1	LEE, ALICE A MD	7/31/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	158635	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
284117	Fee-for-Service	1417907940	1417907940	1	1	LPCH MEDICAL GROUP DIV OF LU	10/17/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	EN'S HOSPITAL AT STANFOR	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
284119	Fee-for-Service	1134593999	1134593999	1	1	LONG BEACH FAMILY HEALTH	3/17/2017	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE SERVICES INC	2385 PACIFIC AVENUE	None	LONG BEACH	CA	90806	3025	19	06037	33.800517	-118.193798	Los Angeles County
284141	Fee-for-Service	1255078861	1255078861	1	1	LAZARO, NIGEL OT	6/8/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2115 MONTIEL RD	STE 103	SAN MARCOS	CA	92069	3587	37	06073	33.1322413	-117.1176172	San Diego County
284154	Fee-for-Service	1619354339	1619354339	1	1	LEE, JASON M DO	8/3/2020	2084P0804X	NA	Psychiatry	026	PHYSICIANS	18303	36	Psychiatry	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
284159	Fee-for-Service	1033432869	1033432869	1	1	LIPSITZ, JULIE M LMFT	6/1/2017	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 COMMERICAL ST	None	NEVADA CITY	CA	95959	8748	29	06057	39.2631102	-121.017656	Nevada County
284164	Fee-for-Service	1548521206	1548521206	1	1	LU, JENNIFER T DO	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14165	01	General Practice	0	In state provider	None	2151 N HARBOR BLVD	None	FULLERTON	CA	92835	3801	30	06059	33.89443025	-117.9288328	Orange County
284166	Fee-for-Service	1477866705	1477866705	1	1	LINGALA, SHILPA MD	7/15/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	124331	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
284168	Fee-for-Service	1851528442	1851528442	1	1	LIAO, JESSICA S MD	6/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114066	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
284174	Fee-for-Service	1255429874	1255429874	1	1	LAZAR, RONALD E MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	73606	05	Anesthesiology	0	In state provider	None	26520 CACTUS AVE	# F2027	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
284175	Fee-for-Service	1740625102	1740625102	1	1	LI, LONG MD	10/9/2020	207ZP0102X	NA	Other	026	PHYSICIANS	169374	22	Pathology (M.D. only)	0	In state provider	None	3301 C ST	STE 200 E	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
284194	Fee-for-Service	1376617985	1376617985	1	1	LIN, TING-KUN M MD	12/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	76217	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
284214	Fee-for-Service	1417907940	1417907940	1	34	LPCH MEDICAL GROUP DIV OF LU	1/25/2024	208000000X	NA	Pediatric Primary Care	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	EN'S HOSPITAL AT STANFOR	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
284243	Fee-for-Service	1770945909	1770945909	1	1	LIU, JASON Y MD	8/11/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	156183	None	None	0	In state provider	None	1450 TREAT BLVD	STE 220B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
284256	Fee-for-Service	1417907940	1417907940	1	6	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 220	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
284260	Fee-for-Service	1952343113	1952343113	1	1	LEAVITT, ANDREW D MD	6/30/1993	207R00000X	NA	Other	026	PHYSICIANS	65749	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
284286	Fee-for-Service	1821484841	1821484841	1	1	LEE, JASMINE MD	7/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144915	01	General Practice	0	In state provider	None	200 MEDICAL PLAZA	530	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
284295	Fee-for-Service	1417907940	1417907940	1	18	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 240	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
284345	Fee-for-Service	1932736527	1932736527	1	1	LIVINGSTON, JOSHUA MD	5/26/2023	207P00000X	NA	Other	026	PHYSICIANS	176886	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
284350	Fee-for-Service	1740625102	1740625102	1	1	LI, LONG MD	10/9/2020	207ZP0102X	NA	Other	026	PHYSICIANS	169374	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	3301 C ST	STE 200 E	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
284392	Fee-for-Service	1417907940	1417907940	1	34	LPCH MEDICAL GROUP DIV OF LU	9/7/2023	208000000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	EN'S HOSPITAL AT STANFOR	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
284393	Fee-for-Service	1366559155	1366559155	1	1	LUU, THEHANG H MD	7/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83609	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
284431	Fee-for-Service	1417907940	1417907940	1	6	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 220	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
284447	Fee-for-Service	1386602746	1386602746	1	1	LEONARD, EVA P S MD	2/3/1987	207R00000X	NA	Other	026	PHYSICIANS	39845	41	Internal Medicine	0	In state provider	None	6699 ALVARADO RD	STE 2307	SAN DIEGO	CA	92120	5241	37	06073	32.77665383	-117.0540279	San Diego County
284467	Fee-for-Service	1417907940	1417907940	1	1	LPCH MEDICAL GROUP DIV OF LU	11/15/2005	282NC2000X	NA	Hospitals	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	EN'S HOSPITAL AT STANFOR	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
284490	Fee-for-Service	1356339485	1356339485	1	1	LU, HONGGANG HENRY MD	5/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93109	22	Pathology (M.D. only)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
284528	Fee-for-Service	1013584531	1013584531	1	1	LAI, KRISTA MD	10/29/2024	2086S0120X	NA	General Surgery	026	PHYSICIANS	None	85	Surgery-Pediatric	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
284560	Fee-for-Service	1134705668	1134705668	1	1	LAU, MEGAN N	10/22/2024	208M00000X	NA	Other	026	PHYSICIANS	186381	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
284564	Fee-for-Service	1366559155	1366559155	1	1	LUU, THEHANG H MD	7/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83609	41	Internal Medicine	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
284574	Fee-for-Service	1295861581	1295861581	1	2	LAOHABURANAKIT, PETEY	7/15/2022	207RC0200X	NA	Other	026	PHYSICIANS	72406	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
284589	Fee-for-Service	1356920805	1356920805	1	1	LAWSON, JUSTINE DO	9/27/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22895	08	Family Practice	0	In state provider	None	17615 MORO RD	None	SALINAS	CA	93907	8541	27	06053	36.80320219	-121.663727	Monterey County
284602	Fee-for-Service	1417907940	1417907940	1	6	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 220	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
284603	Fee-for-Service	1225240286	1225240286	1	1	LIM, MICHAEL MD	9/29/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	76130	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
284618	Fee-for-Service	1306921077	1306921077	1	1	LOUIE, DAVID G S MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40302	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
284654	Fee-for-Service	1841697414	1841697414	1	1	LOMA LINDA UNIVERSITY	6/28/2017	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CHILDRENS HOSPITAL	11234 ANDERSON ST	SUITE A, ROOM 1816	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
284664	Fee-for-Service	1104872118	1104872118	1	1	LOMA LINDA UNIVERSITY	5/13/1988	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	ANESTHESIOLOGY MED GRP	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
284704	Fee-for-Service	1740784305	1740784305	1	1	LE, AIMEE MD	7/28/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	163777	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
284705	Fee-for-Service	1548780711	1548780711	1	1	LEU, NATHANIEL T MD	7/30/2021	207P00000X	NA	Other	026	PHYSICIANS	171444	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
284708	Fee-for-Service	1588634059	1588634059	1	1	LIN, JASON Y MD	7/16/1998	207RP1001X	NA	Pulmonology	026	PHYSICIANS	39356	41	Internal Medicine	0	In state provider	None	1700 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5115	36	06071	34.130214	-117.2788065	San Bernardino County
284728	Fee-for-Service	1861029357	1861029357	1	1	LIN, JOANNE DO	6/9/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	20535	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
284729	Fee-for-Service	1427443068	1427443068	1	1	LLOYD, SHANE A MD	7/15/2020	2085R0001X	NA	Other	026	PHYSICIANS	146615	32	Radiation Therapy (D.O. only)	0	In state provider	None	1 HOAG DR	BUILDING 41	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
284749	Fee-for-Service	1184187759	1184187759	1	1	LUNA, LAUREN A CNP	9/2/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43360 MISSION BLVD	SUITE 100	FREMONT	CA	94539	5829	01	06001	37.53249631	-121.9198141	Alameda County
284758	Fee-for-Service	1437513660	1437513660	1	1	LALEZARI, SHADI MD	4/16/2024	2086S0122X	NA	General Surgery	026	PHYSICIANS	152791	24	Plastic Surgery	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
284763	Fee-for-Service	1497159370	1497159370	1	1	LANKAMP, BARBARA	5/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
284770	Fee-for-Service	1417907940	1417907940	1	6	LPCH MEDICAL GROUP DIV OF LU	6/23/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 220	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
284786	Fee-for-Service	1306921077	1306921077	1	1	LOUIE, DAVID G S MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40302	01	General Practice	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
284803	Fee-for-Service	1013022722	1013022722	1	1	LIU, WILLIAM M MD	1/17/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	51849	41	Internal Medicine	0	In state provider	None	510 N PROSPECT AVE	STE 208	REDONDO BEACH	CA	90277	3030	19	06037	33.85259344	-118.379739	Los Angeles County
284832	Fee-for-Service	1841281144	1841281144	1	1	LARIJANI, MOHAMMAD MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64442	66	Emergency Medicine (Urgent Care)	0	In state provider	None	47111 MONROE STREET	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
284833	Fee-for-Service	1164464996	1164464996	2	1	LONGS DRUG STORES CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	675 TRANCAS ST	None	NAPA	CA	94558	3084	28	06055	38.32483605	-122.2868753	Napa County
284848	Fee-for-Service	1235428038	1235428038	1	1	LY, TIFFANY MD	2/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123352	41	Internal Medicine	0	In state provider	None	1300 CRANE ST	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
284872	Fee-for-Service	1770834822	1770834822	1	1	LAL, PRAVINA L LCSW	9/19/2018	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	517 S HEWES	UNIT A	ORANGE	CA	92869	4913	30	06059	33.78015629	-117.804561	Orange County
284873	Fee-for-Service	1417907940	1417907940	1	28	LPCH MEDICAL GROUP DIV OF LU	4/1/2015	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	LUCILE PACKARD CHILDRENS	2915 TELEGRAPH AVE	STE 200	BERKELEY	CA	94705	2030	01	06001	37.85719633	-122.2595246	Alameda County
284896	Fee-for-Service	1619079746	1619079746	1	1	LAVELY, DIANE LCSW	2/11/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	490 S FARRELL DR	STE C208	PALM SPRINGS	CA	92262	7944	33	06065	33.81651	-116.5180015	Riverside County
284913	Fee-for-Service	1417394891	1417394891	1	1	LIN, CHRISTOPHER DO	9/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12322	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
284915	Fee-for-Service	1669757985	1669757985	2	1	LIU, DONGMEI LAC	5/8/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1455 SAN MARINO AVE	#B	SAN MARINO	CA	91108	2033	19	06037	34.12247271	-118.1065314	Los Angeles County
284918	Fee-for-Service	1598824161	1598824161	1	1	LEVIN, DAVID A MD	7/31/1992	207R00000X	NA	Other	026	PHYSICIANS	70343	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
284936	Fee-for-Service	1417907940	1417907940	1	6	LPCH MEDICAL GROUP DIV OF LU	6/23/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 220	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
284937	Fee-for-Service	1972709640	1972709640	1	1	LOPES RUBIN, CHARLOTTE M	5/12/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
284963	Fee-for-Service	1023018009	1023018009	1	1	LUECHA, ANGSUMARN A MD	2/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81197	08	Family Practice	0	In state provider	None	1514 VALLEY VISTA DRIVE	None	DIAMOND BAR	CA	91765	3929	19	06037	33.99491668	-117.8399137	Los Angeles County
284964	Fee-for-Service	1437207370	1437207370	1	1	LOO, RONALD K MD	11/30/1986	208800000X	NA	Other	026	PHYSICIANS	59228	01	General Practice	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
284965	Fee-for-Service	1083101653	1083101653	1	1	LOVEDAY, JENNA DO	4/25/2023	207R00000X	NA	Other	026	PHYSICIANS	19392	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
284970	Fee-for-Service	1013022722	1013022722	1	1	LIU, WILLIAM M MD	1/17/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	51849	83	Rheumatology	0	In state provider	None	510 N PROSPECT AVE	STE 208	REDONDO BEACH	CA	90277	3030	19	06037	33.85259344	-118.379739	Los Angeles County
284997	Fee-for-Service	1841281144	1841281144	1	1	LARIJANI, MOHAMMAD MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64442	41	Internal Medicine	0	In state provider	None	47111 MONROE STREET	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
285036	Fee-for-Service	1417907940	1417907940	1	28	LPCH MEDICAL GROUP DIV OF LU	4/1/2015	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE PACKARD CHILDRENS	2915 TELEGRAPH AVE	STE 200	BERKELEY	CA	94705	2030	01	06001	37.85719633	-122.2595246	Alameda County
285039	Fee-for-Service	1932214368	1932214368	1	1	LAZALDE, PATRICIA A PHD	1/12/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
285042	Fee-for-Service	1043238413	1043238413	1	1	LAI, CHIA-CHI G MD INC	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	42437	41	Internal Medicine	0	In state provider	None	500 N GARFIELD AVE	STE 100	MONTEREY PARK	CA	91754	1746	19	06037	34.0674894	-118.1228646	Los Angeles County
285064	Fee-for-Service	1790766160	1790766160	1	1	LARSON, STEVEN E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	41825	77	Infectious Disease	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
285075	Fee-for-Service	1245626639	1245626639	1	1	LEE, EUN KYUNG J MD	10/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	145174	-	NOT APPLICABLE	0	In state provider	None	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	43	06085	37.34293689	-121.9270392	Santa Clara County
285102	Fee-for-Service	1417907940	1417907940	1	6	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 220	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
285116	Fee-for-Service	1225690282	1225690282	1	1	LIU, LINGSHU	4/11/2024	207L00000X	NA	Other	026	PHYSICIANS	188346	None	None	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
285122	Fee-for-Service	1619036480	1619036480	1	1	LEONG, SAM B PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1100 SANCHEZ ST	None	SAN FRANCISCO	CA	94114	3825	38	06075	37.75137322	-122.4296422	San Francisco County
285123	Fee-for-Service	1104878073	1104878073	1	1	LICHTENSTEIN, BERNARD MD	4/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	37396	41	Internal Medicine	0	In state provider	None	4282 GENESEE AVE	STE 202	SAN DIEGO	CA	92117	4989	37	06073	32.82092667	-117.1828683	San Diego County
285148	Fee-for-Service	1750482097	1750482097	1	1	LAIRD, THADDEUS A MD	1/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	70932	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
285182	Fee-for-Service	1174703854	1174703854	1	1	LEE, GRACE S MD	4/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101258	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
285200	Fee-for-Service	1417907940	1417907940	1	28	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE PACKARD CHILDRENS	2915 TELEGRAPH AVE	STE 200	BERKELEY	CA	94705	2030	01	06001	37.85719633	-122.2595246	Alameda County
285205	Fee-for-Service	1043238413	1043238413	1	1	LAI, CHIA-CHI G MD INC	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	42437	10	Gastroenterology (M.D. only)	0	In state provider	None	500 N GARFIELD AVE	STE 100	MONTEREY PARK	CA	91754	1746	19	06037	34.0674894	-118.1228646	Los Angeles County
285229	Fee-for-Service	1790766160	1790766160	1	1	LARSON, STEVEN E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	41825	41	Internal Medicine	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
285245	Fee-for-Service	1891737003	1891737003	1	1	LOUIE, KEVIN W MD	8/31/1984	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	45653	20	Orthopedic Surgery	0	In state provider	None	1381 9TH AVE	None	SAN FRANCISCO	CA	94122	2308	38	06075	37.76252699	-122.4662342	San Francisco County
285249	Fee-for-Service	1154607448	1154607448	1	1	LIU, MARGARET J	8/6/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
285264	Fee-for-Service	1417907940	1417907940	1	6	LPCH MEDICAL GROUP DIV OF LU	6/23/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	106 LA CASA VIA	SUITE 220	WALNUT CREEK	CA	94598	3012	07	06013	37.91255783	-122.0428047	Contra Costa County
285321	Fee-for-Service	1265633887	1265633887	1	1	LU, KIM D MD	8/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126567	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
285362	Fee-for-Service	1417907940	1417907940	1	28	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE PACKARD CHILDRENS	2915 TELEGRAPH AVE	STE 200	BERKELEY	CA	94705	2030	01	06001	37.85719633	-122.2595246	Alameda County
285388	Fee-for-Service	1972690204	1972690204	1	1	LEVIN, MICHELLE PHD	11/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	325 W HOSPITALITY LANE	STE 312	SAN BERNARDINO	CA	92408	3212	36	06071	34.0658995	-117.29034	San Bernardino County
285433	Fee-for-Service	1063524122	1063524122	1	1	LIN, ROYCE C MD	10/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79349	41	Internal Medicine	0	In state provider	None	995 POTRERO AVE	None	SAN FRANCISCO	CA	94110	2859	38	06075	37.75729541	-122.4066641	San Francisco County
285452	Fee-for-Service	1366520447	1366520447	1	1	LAMPEL, HEATHER P MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92007	01	General Practice	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
285464	Fee-for-Service	1942323761	1942323761	1	1	LAM-BLANCO, PRISCILLA S	8/14/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95818	4807	34	06067	38.596581	-121.4303535	Sacramento County
285473	Fee-for-Service	1417238205	1417238205	1	1	LALEZARI, SEPEHR MD	1/18/2018	208600000X	NA	General Surgery	026	PHYSICIANS	141683	02	General Surgery	0	In state provider	None	321 N LARCHMONT BLVD	505	LOS ANGELES	CA	90004	3025	19	06037	34.0769016	-118.323663	Los Angeles County
285481	Fee-for-Service	1265633887	1265633887	1	1	LU, KIM D MD	8/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126567	40	Pediatrics	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
285485	Fee-for-Service	1942657549	1942657549	1	1	LEE, MI SUN	6/24/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
285507	Fee-for-Service	1699220590	1699220590	1	1	LINSLEY, LAURIE LMFT	8/23/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
285519	Fee-for-Service	1417907940	1417907940	1	28	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE PACKARD CHILDRENS	2915 TELEGRAPH AVE	STE 200	BERKELEY	CA	94705	2030	01	06001	37.85719633	-122.2595246	Alameda County
285523	Fee-for-Service	1063871986	1063871986	1	1	LAKE HUGHES RECOVERY INC.	4/21/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	49713 GORMAN POST RD	None	GORMAN	CA	93243	9701	19	06037	34.79615998	-118.8513898	Los Angeles County
285530	Fee-for-Service	1871751065	1871751065	1	1	LEE, LAN NA MD	3/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	117279	None	None	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
285542	Fee-for-Service	1760778781	1760778781	1	1	LEE, MICHAEL T MD	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144355	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
285543	Fee-for-Service	1821090788	1821090788	1	1	LE, TOMMY D DO	5/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12370	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
285568	Fee-for-Service	1417341959	1417341959	1	1	LAMEE, JONATHAN MD	8/3/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	171920	None	None	0	In state provider	None	147 BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
285570	Fee-for-Service	1780780874	1780780874	1	1	LIPPMAN, SCOTT M MD	5/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	37790	68	Hematology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
285584	Fee-for-Service	1992818322	1992818322	1	1	LOPEZ, LUIS F MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79059	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	815 DR MARTIN LUTHER KIN	None	BAKERSFIELD	CA	93307	1365	15	06029	35.3655	-118.985202	Kern County
285591	Fee-for-Service	1265731038	1265731038	1	1	LI-DUEN CLARK M.D.	11/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	46-001 KAMEHAMEHA HWY	STE 204	KANEOHE	HI	96744	3724	00	None	21.4186309	-157.8021989	Honolulu County
285606	Fee-for-Service	1366873879	1366873879	1	1	LACROIX, CATHERINE LMFT	8/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
285607	Fee-for-Service	1225560477	1225560477	1	1	LAUW, MARIETYA I MD	4/10/2023	207ZP0105X	NA	Other	026	PHYSICIANS	163715	None	None	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
285638	Fee-for-Service	1447499199	1447499199	1	1	LEE, INSUN MD	7/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119066	05	Anesthesiology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
285650	Fee-for-Service	1992855704	1992855704	1	1	LITTELL, RAMEY D MD	5/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	70685	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
285678	Fee-for-Service	1417907940	1417907940	1	28	LPCH MEDICAL GROUP DIV OF LU	4/1/2015	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE PACKARD CHILDRENS	2915 TELEGRAPH AVE	STE 200	BERKELEY	CA	94705	2030	01	06001	37.85719633	-122.2595246	Alameda County
285680	Fee-for-Service	1548604929	1548604929	1	1	LIU, CHYONGJY J DO	7/1/2021	207L00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
285710	Fee-for-Service	1619470408	1619470408	1	1	LEE, RYAN J MD	8/30/2021	207R00000X	NA	Other	026	PHYSICIANS	173676	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
285725	Fee-for-Service	1780780874	1780780874	1	1	LIPPMAN, SCOTT M MD	5/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	37790	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
285769	Fee-for-Service	1528486735	1528486735	1	1	LEE, KATE J MD	12/19/2018	207L00000X	NA	Other	026	PHYSICIANS	141733	05	Anesthesiology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
285794	Fee-for-Service	1285757914	1285757914	1	1	LIGHTNER, SANDRA J LMFT	11/26/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5816 CORPORATE AVE	SUITE 170	CYPRESS	CA	90630	3757	30	06059	33.80797458	-118.0315872	Orange County
285797	Fee-for-Service	1033836135	1033836135	1	1	LO, JOSHUA	5/25/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
285809	Fee-for-Service	1730114166	1730114166	1	1	LAURIDSEN, JOHN I MD	9/20/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	26222	03	Allergy	0	In state provider	None	500 S ANAHEIM HILLS RD	STE 230	ANAHEIM	CA	92807	4760	30	06059	33.8427954	-117.7772895	Orange County
285819	Fee-for-Service	1063847978	1063847978	1	1	LEVINE, ALEXA LMFT	4/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
285832	Fee-for-Service	1417907940	1417907940	1	28	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE PACKARD CHILDRENS	2915 TELEGRAPH AVE	STE 200	BERKELEY	CA	94705	2030	01	06001	37.85719633	-122.2595246	Alameda County
285862	Fee-for-Service	1942395983	1942395983	1	1	LIN, INIL L MD	1/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	84233	01	General Practice	0	In state provider	None	12362 BEACH BLVD	STE 10	STANTON	CA	90680	3944	30	06059	33.78298855	-117.9927453	Orange County
285875	Fee-for-Service	1568965366	1568965366	1	1	LIANG, BRANNEN MD	11/25/2019	207R00000X	NA	Other	026	PHYSICIANS	164124	41	Internal Medicine	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
285886	Fee-for-Service	1780746628	1780746628	1	1	LEBOVIC, JOSEPH MD INC	2/8/2015	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	26000	30	Radiology	0	In state provider	None	9675 BRIGHTON WAY	STE 240	BEVERLY HILLS	CA	90210	5138	19	06037	34.06763711	-118.4052901	Los Angeles County
285900	Fee-for-Service	1588998512	1588998512	1	1	LE, JENNY H OD	1/2/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	44407 10TH ST W	B	LANCASTER	CA	93534	3345	19	06037	34.68965953	-118.148053	Los Angeles County
285969	Fee-for-Service	1891999462	1891999462	1	1	LU, CYNTHIA C DO	7/9/2015	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	10956	01	General Practice	0	In state provider	None	3605 HOSPITAL ROAD	None	ATWATER	CA	95301	5173	24	06047	37.36678073	-120.576731	Merced County
285975	Fee-for-Service	1881156859	1881156859	1	1	LI, JESSICA L MD	9/11/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	187369	None	None	0	In state provider	None	15400 LOS GATOS BLVD	None	LOS GATOS	CA	95032	2502	43	06085	37.24572659	-121.957997	Santa Clara County
285986	Fee-for-Service	1417907940	1417907940	1	28	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE PACKARD CHILDRENS	2915 TELEGRAPH AVE	STE 200	BERKELEY	CA	94705	2030	01	06001	37.85719633	-122.2595246	Alameda County
286006	Fee-for-Service	1710146295	1710146295	1	1	LOHIYA, SUNITA MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	41259	08	Family Practice	0	In state provider	None	1120 W WARNER AVE	STE A	SANTA ANA	CA	92707	3179	30	06059	33.71616652	-117.882981	Orange County
286013	Fee-for-Service	1306955414	1306955414	1	1	LANCE, ERINN B CNM	6/7/2010	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
286034	Fee-for-Service	1871649186	1871649186	1	1	LAPACHET, ELIZABETH S	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
286047	Fee-for-Service	1477626638	1477626638	1	1	LA CIENEGA ENTERPRISE, INC	11/12/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	LA CIENEGA PHARMACY	1528 LA CIENEGA BLVD	None	LOS ANGELES	CA	90035	3712	19	06037	34.0497409	-118.3760893	Los Angeles County
286050	Fee-for-Service	1558813642	1558813642	1	1	LARUMBE-SMITH, STEPHANIE K C	12/29/2021	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	NM	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
286053	Fee-for-Service	1518230853	1518230853	1	1	LAWRENCE, CADE T MD	7/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120153	None	None	0	In state provider	None	47111 MONROE STREET	EMERGENCY DEPARTMENT	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
286070	Fee-for-Service	1053303040	1053303040	1	1	LEAVITT, GARY MD	12/24/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
286101	Fee-for-Service	1568786556	1568786556	1	1	LIVWELL PSYCHOLOGY SERVICES	6/11/2012	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	20688 4TH ST	None	SARATOGA	CA	95070	5894	43	06085	37.25756343	-122.0360119	Santa Clara County
286103	Fee-for-Service	1932587623	1932587623	1	1	LEE, RANDY DO	3/15/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15546	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
286116	Fee-for-Service	1326450909	1326450909	1	1	LEYVA LOERA, AMBAR LMFT	8/1/2022	171M00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
286119	Fee-for-Service	1205871183	1205871183	1	1	LATIF,KHALID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	ONE GENESYS PARKWAY	None	GRAND BLANC	MI	48439	8063	00	None	42.89245321	-83.64137612	Genesee County
286121	Fee-for-Service	1215497664	1215497664	1	1	LAM, MICHELLE MD	6/6/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	181203	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
286144	Fee-for-Service	1538381678	1538381678	1	1	LIEN, JOHN H MD INC	5/18/2004	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	63910	01	General Practice	0	In state provider	None	200 JOSE FIGUERES AVE	SUITE 330	SAN JOSE	CA	95116	1555	43	06085	37.36122014	-121.8505998	Santa Clara County
286151	Fee-for-Service	1851405203	1851405203	1	1	LEW, BRANDON L DO	7/20/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	6305	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
286160	Fee-for-Service	1710146295	1710146295	1	1	LOHIYA, SUNITA MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	41259	01	General Practice	0	In state provider	None	1120 W WARNER AVE	STE A	SANTA ANA	CA	92707	3179	30	06059	33.71616652	-117.882981	Orange County
286173	Fee-for-Service	1730125105	1730125105	1	1	LEYBA, MAURO K JR MD	2/28/1988	207RR0500X	NA	Other	026	PHYSICIANS	41228	83	Rheumatology	0	In state provider	None	7085 N CHESTNUT AVENUE	SUITE 109	FRESNO	CA	93720	0353	10	06019	36.83911703	-119.7362963	Fresno County
286174	Fee-for-Service	1699095901	1699095901	1	1	LINEAGEN, INC	4/17/2018	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	2677 E PARLEYS WAY	None	SALT LAKE CITY	UT	84109	1617	00	None	40.71940827	-111.8151149	Salt Lake County
286212	Fee-for-Service	1760633549	1760633549	1	1	LASSOF, MARK A MD	7/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93400	34	Urology and Urological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
286240	Fee-for-Service	1023302148	1023302148	1	1	LANNING, RYAN M MD	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
286251	Fee-for-Service	1942356365	1942356365	1	1	LIU, ZHAO MD	9/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	1	Border provider	None	2501 STOCKTON HILL RD	None	KINGMAN	AZ	86401	4140	00	None	35.20926	-114.0352695	Mohave County
286253	Fee-for-Service	1174544134	1174544134	2	1	LITTLE TOKYO PHARMACY, INC.	2/23/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	402 E 2ND ST	None	LOS ANGELES	CA	90012	4209	19	06037	34.04718624	-118.2386058	Los Angeles County
286281	Fee-for-Service	1093726457	1093726457	1	1	LOMBARDO, JOSEPH A MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39958	08	Family Practice	0	In state provider	None	2220 CLARK AVE	None	LONG BEACH	CA	90815	2521	19	06037	33.79772674	-118.1338339	Los Angeles County
286285	Fee-for-Service	1972558021	1972558021	1	1	LEUNG, VINCENT MD	5/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	52006	20	Orthopedic Surgery	0	In state provider	None	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	36	06071	34.1268333	-117.2705634	San Bernardino County
286295	Fee-for-Service	1538381678	1538381678	1	1	LIEN, JOHN H MD INC	5/18/2004	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	63910	41	Internal Medicine	0	In state provider	None	200 JOSE FIGUERES AVE	SUITE 330	SAN JOSE	CA	95116	1555	43	06085	37.36122014	-121.8505998	Santa Clara County
286320	Fee-for-Service	1477870186	1477870186	1	1	LEE, JOHN K MD	3/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119154	41	Internal Medicine	0	In state provider	None	2 WEST FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
286323	Fee-for-Service	1912447012	1912447012	1	1	LIU, PETER	7/24/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
286326	Fee-for-Service	1730125105	1730125105	1	1	LEYBA, MAURO K JR MD	2/28/1988	207RR0500X	NA	Other	026	PHYSICIANS	41228	41	Internal Medicine	0	In state provider	None	7085 N CHESTNUT AVENUE	SUITE 109	FRESNO	CA	93720	0353	10	06019	36.83911703	-119.7362963	Fresno County
286336	Fee-for-Service	1346335650	1346335650	1	1	LEONG, OREN T MD	1/17/2019	207L00000X	NA	Other	026	PHYSICIANS	32686	05	Anesthesiology	0	In state provider	None	2105 FOREST AVE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
286432	Fee-for-Service	1265922520	1265922520	1	1	LOMITA ACUPUNCTURE, INC.	10/18/2019	261Q00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1852 LOMITA BLVD.	100	LOMITA	CA	90717	1902	19	06037	33.79826058	-118.3107507	Los Angeles County
286442	Fee-for-Service	1538381678	1538381678	1	1	LIEN, JOHN H MD INC	5/18/2004	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	63910	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 JOSE FIGUERES AVE	SUITE 330	SAN JOSE	CA	95116	1555	43	06085	37.36122014	-121.8505998	Santa Clara County
286476	Fee-for-Service	1396124087	1396124087	1	1	LIN, ERICA MD	10/12/2020	207R00000X	NA	Other	026	PHYSICIANS	154695	None	None	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
286482	Fee-for-Service	1417990201	1417990201	2	2	LONGS DRUG STORES CALIFORNIA	2/11/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1617 CANYON DR	None	PINOLE	CA	94564	2151	07	06013	37.99537501	-122.3019132	Contra Costa County
286501	Fee-for-Service	1144362278	1144362278	1	1	LINDER, ALAN M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	34386	None	None	0	In state provider	None	17251 HESPERIAN BLVD	None	SAN LORENZO	CA	94580	3150	01	06001	37.67561829	-122.1244523	Alameda County
286546	Fee-for-Service	1306982855	1306982855	1	14	LA LASER CENTER, PC, A PROFE	6/19/2024	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	CANCER CENTER	6181 N THESTA ST	STE 104	FRESNO	CA	93710	8604	10	06019	36.826191	-119.7831295	Fresno County
286560	Fee-for-Service	1972941334	1972941334	1	1	LUCERO, MATTHEW I DO	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13185	41	Internal Medicine	0	In state provider	None	4053 LONE TREE WAY	SUITE 101	ANTIOCH	CA	94531	6210	07	06013	37.97569499	-121.800733	Contra Costa County
286582	Fee-for-Service	1801086970	1801086970	1	1	LEE, DONNA H CRNA	2/9/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
286645	Fee-for-Service	1689686941	1689686941	1	1	LIPKIS, DONALD C MD INC	1/26/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	27123	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6719 ALVARADO RD	STE 206	SAN DIEGO	CA	92120	5261	37	06073	32.77684978	-117.055137	San Diego County
286682	Fee-for-Service	1124060934	1124060934	2	1	LONGS DRUG STORE CA LLC	2/4/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	733 E MAIN ST	None	SANTA MARIA	CA	93454	4507	42	06083	34.95315298	-120.4256283	Santa Barbara County
286690	Fee-for-Service	1306982855	1306982855	1	14	LA LASER CENTER, PC, A PROFE	6/19/2024	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	CANCER CENTER	6181 N THESTA ST	STE 104	FRESNO	CA	93710	8604	10	06019	36.826191	-119.7831295	Fresno County
286726	Fee-for-Service	1790864825	1790864825	1	1	LEONG, WESLEY L MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55107	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
286727	Fee-for-Service	1760638282	1760638282	1	1	LIPSHUTZ, H G MD	11/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123986	30	Radiology	0	In state provider	None	8700 BEVERLY BLVD	STE M 335	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
286740	Fee-for-Service	1831188341	1831188341	1	1	LEE, SANDY Y MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67422	18	Ophthalmology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
286765	Fee-for-Service	1811390693	1811390693	1	1	LONG BEACH POST ACUTE LLC	10/1/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1201 WALNUT AVENUE	None	LONG BEACH	CA	90813	3822	19	06037	33.78175071	-118.1720185	Los Angeles County
286773	Fee-for-Service	1194767046	1194767046	1	1	LOWELL, CLIFFORD A MD	2/28/1989	207R00000X	NA	Other	026	PHYSICIANS	67944	01	General Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
286789	Fee-for-Service	1689686941	1689686941	1	1	LIPKIS, DONALD C MD INC	1/26/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	27123	41	Internal Medicine	0	In state provider	None	6719 ALVARADO RD	STE 206	SAN DIEGO	CA	92120	5261	37	06073	32.77684978	-117.055137	San Diego County
286792	Fee-for-Service	1780107433	1780107433	1	1	LOGAN, MARK A	11/3/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
286799	Fee-for-Service	1992895346	1992895346	1	1	LUE, SHIH LIN MD INC	1/1/1979	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	33091	10	Gastroenterology (M.D. only)	0	In state provider	None	16415 COLORADO AVE	STE 402	PARAMOUNT	CA	90723	5052	19	06037	33.8853075	-118.1614695	Los Angeles County
286804	Fee-for-Service	1922026517	1922026517	2	1	LONGS DRUG STORE CAL LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2293 H DELA ROSA SR ST	None	SOLEDAD	CA	93960	3382	27	06053	36.415566	-121.3200405	Monterey County
286809	Fee-for-Service	1427324516	1427324516	1	1	LIN, LISA D MD	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136401	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
286830	Fee-for-Service	1497966584	1497966584	1	1	LAURA SWIBEL ROSENTHAL, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2160 S 1ST AVE	None	MAYWOOD	IL	60153	3328	00	None	41.86025379	-87.83381752	Cook County
286833	Fee-for-Service	1306982855	1306982855	1	14	LA LASER CENTER, PC, A PROFE	6/19/2024	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	CANCER CENTER	6181 N THESTA ST	STE 104	FRESNO	CA	93710	8604	10	06019	36.826191	-119.7831295	Fresno County
286836	Fee-for-Service	1669411260	1669411260	1	1	LILJEBLAD, EILEEN A MD	11/8/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	33565	None	None	0	In state provider	None	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
286865	Fee-for-Service	1790949535	1790949535	1	1	LA, MIKE QC MD	8/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112861	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
286871	Fee-for-Service	1912206483	1912206483	1	1	LIN, ALAN C DO	8/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12422	41	Internal Medicine	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
286890	Fee-for-Service	1871338319	1871338319	1	1	LINDSEY, RICHARD M NP	9/1/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
286901	Fee-for-Service	1487770632	1487770632	1	1	LIMANNI, ELENA A CNM	12/2/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	21263 ERWIN ST	None	WOODLAND HILLS	CA	91367	3715	19	06037	34.18286951	-118.5949215	Los Angeles County
286914	Fee-for-Service	1194767046	1194767046	1	1	LOWELL, CLIFFORD A MD	2/28/1989	207R00000X	NA	Other	026	PHYSICIANS	67944	90	Pathology-Forensic	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
286919	Fee-for-Service	1508283839	1508283839	1	1	LAM, FELICIA H MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149841	40	Pediatrics	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
286925	Fee-for-Service	1124798061	1124798061	1	1	LLOYD, BRANDON S PT	12/10/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2222 FRANCISCO DR	STE 120	EL DORADO HILLS	CA	95762	3762	09	06017	38.71039358	-121.08565	El Dorado County
286931	Fee-for-Service	1689686941	1689686941	1	1	LIPKIS, DONALD C MD INC	1/26/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	27123	10	Gastroenterology (M.D. only)	0	In state provider	None	6719 ALVARADO RD	STE 206	SAN DIEGO	CA	92120	5261	37	06073	32.77684978	-117.055137	San Diego County
286959	Fee-for-Service	1427324516	1427324516	1	1	LIN, LISA D MD	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136401	10	Gastroenterology (M.D. only)	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
286984	Fee-for-Service	1336609734	1336609734	1	1	LANDGRAF, STEPHANIE MD	10/30/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178612	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
286986	Fee-for-Service	1295911592	1295911592	1	1	LINDEMAN, HAIDUONG G MFT	12/4/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	49675	-	NOT APPLICABLE	0	In state provider	None	140 ARBOR DR	None	SAN DIEGO	CA	92103	2007	37	06073	32.75382424	-117.1635451	San Diego County
287000	Fee-for-Service	1790949535	1790949535	1	1	LA, MIKE QC MD	8/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112861	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
287055	Fee-for-Service	1194767046	1194767046	1	1	LOWELL, CLIFFORD A MD	2/28/1989	207R00000X	NA	Other	026	PHYSICIANS	67944	22	Pathology (M.D. only)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
287066	Fee-for-Service	1306982855	1306982855	1	10	LA LASER CENTER, PC, A PROFE	6/12/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	CANCER	1310 LOS TABLAS RD,	STE 105	TEMPLETON	CA	93465	9746	40	06079	35.55442349	-120.722643	San Luis Obispo County
287083	Fee-for-Service	1982687984	1982687984	1	1	LEVY, NINA R MD	11/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	83540	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
287088	Fee-for-Service	1912128547	1912128547	1	1	LIU, JOY DO	3/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9350	08	Family Practice	0	In state provider	None	1600 CREEKSIDE DR	STE 3200	FOLSOM	CA	95630	3447	34	06067	38.669994	-121.147488	Sacramento County
287104	Fee-for-Service	1134758469	1134758469	1	1	LY, HAU	9/26/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19555	None	None	0	In state provider	None	8170 LAGUNA BLVD	STE 210	ELK GROVE	CA	95758	7902	34	06067	38.421054	-121.405365	Sacramento County
287114	Fee-for-Service	1053600353	1053600353	1	1	LEE, STEVE Y MD	6/26/2020	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
287123	Fee-for-Service	1356081723	1356081723	1	1	LEWIS, CHRISTINA L NP	8/17/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
287144	Fee-for-Service	1386279172	1386279172	1	1	LEBESCO, KRISTI CNP	9/28/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
287145	Fee-for-Service	1356364608	1356364608	1	1	LAU, CHARLES T MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133930	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
287165	Fee-for-Service	1285082446	1285082446	1	1	LIU, ANDY MD	7/14/2020	207R00000X	NA	Other	026	PHYSICIANS	153687	41	Internal Medicine	0	In state provider	None	845 JACKSON ST	None	SAN FRANCISCO	CA	94133	4851	38	06075	37.79571919	-122.4089166	San Francisco County
287185	Fee-for-Service	1063701209	1063701209	1	1	LEVY, ROBERT E MD	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123350	10	Gastroenterology (M.D. only)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
287206	Fee-for-Service	1306982855	1306982855	1	10	LA LASER CENTER, PC, A PROFE	6/12/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	CANCER	1310 LOS TABLAS RD,	STE 105	TEMPLETON	CA	93465	9746	40	06079	35.55442349	-120.722643	San Luis Obispo County
287210	Fee-for-Service	1194883769	1194883769	1	1	LEE, CHI KEUNG MD	3/31/1995	2088P0231X	NA	Other	026	PHYSICIANS	83839	34	Urology and Urological Surgery	0	In state provider	None	2999 REGENT ST	STE 612	BERKELEY	CA	94705	2121	01	06001	37.85592021	-122.2566436	Alameda County
287238	Fee-for-Service	1205326451	1205326451	1	1	LAM, JIMMY MD	10/6/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	191252	None	None	0	In state provider	None	99 N LA CIENEGA BLVD	None	BEVERLY HILLS	CA	90211	2222	19	06037	34.06736471	-118.3763201	Los Angeles County
287249	Fee-for-Service	1053600353	1053600353	1	1	LEE, STEVE Y MD	6/26/2020	207R00000X	NA	Other	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
287273	Fee-for-Service	1063503050	1063503050	1	1	LEWIN, SHERYL L MD	8/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72249	24	Plastic Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
287305	Fee-for-Service	1598119208	1598119208	1	1	LAI, KHA N MD	8/19/2019	208M00000X	NA	Other	026	PHYSICIANS	153947	41	Internal Medicine	0	In state provider	None	2100 WEBSTER ST	115	SAN FRANCISCO	CA	94115	2373	38	06075	37.7904826	-122.4324477	San Francisco County
287308	Fee-for-Service	1659391183	1659391183	1	1	LE-CARTER, PHUONG MD	5/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104205	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
287309	Fee-for-Service	1528059219	1528059219	1	1	LEON, IRAIS MD	5/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	62796	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18TH AVE & HWY 53	None	CLEARLAKE	CA	95422	0000	17	06033	38.936934	-122.6222415	Lake County
287321	Fee-for-Service	1063701209	1063701209	1	1	LEVY, ROBERT E MD	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123350	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
287325	Fee-for-Service	1477866614	1477866614	1	1	LAI, LILLIAN M MD	4/3/2017	2085P0229X	NA	Other	026	PHYSICIANS	135794	30	Radiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
287340	Fee-for-Service	1861109522	1861109522	1	1	LOPEZ, BRIAN R PSYD	6/1/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
287351	Fee-for-Service	1528747458	1528747458	1	1	LEE, HAILEE CCC-SLP	2/10/2025	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2440 W. SHAW AVE	STE 209	FRESNO	CA	93711	3300	10	06019	36.80840874	-119.8363001	Fresno County
287354	Fee-for-Service	1134175698	1134175698	1	1	LAWRENCE J KERZNER MD	3/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	701 PARK AVE	None	MINNEAPOLIS	MN	55415	1623	00	None	44.97241797	-93.26300044	Hennepin County
287372	Fee-for-Service	1497935969	1497935969	1	1	LEE, STARR	10/6/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
287376	Fee-for-Service	1790376218	1790376218	1	1	LUSSIER, ASHLYN LMFT	8/30/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28100 BOUQUET CANYON RD.	SUITE 218	SANTA CLARITA	CA	91350	2009	19	06037	34.45052733	-118.497654	Los Angeles County
287378	Fee-for-Service	1922070861	1922070861	1	1	LEE, SANG II MD	5/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151928	None	None	0	In state provider	None	5350 HOLLISTER AVE	SUITE F	SANTA BARBARA	CA	93111	2326	42	06083	34.4351156	-119.8109023	Santa Barbara County
287383	Fee-for-Service	1134622749	1134622749	1	1	LAKE HUGHES RECOVERY O P, IN	2/21/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	C.	124 N TOWNSEND AVE	None	LOS ANGELES	CA	90063	2334	19	06037	34.03671907	-118.1881108	Los Angeles County
287385	Fee-for-Service	1053600353	1053600353	1	1	LEE, STEVE Y MD	6/26/2020	207R00000X	NA	Other	026	PHYSICIANS	None	78	Neoplastic Diseases/Oncology	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
287389	Fee-for-Service	1811045644	1811045644	1	1	LANE, KENNETH C MD	5/26/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	43669	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
287400	Fee-for-Service	1417907940	1417907940	1	5	LPCH MEDICAL GROUP DIV OF LU	6/23/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LUCILE	5575 W LAS POSITA BLVD	SUITE 340	PLEASANTON	CA	94588	5804	01	06001	37.69214859	-121.8796532	Alameda County
287406	Fee-for-Service	1265649305	1265649305	1	1	LIANG, PULIN	9/1/1995	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	43 S PARK VICTORIA DR	None	MILPITAS	CA	95035	5720	43	06085	37.43467395	-121.8840813	Santa Clara County
287421	Fee-for-Service	1003133216	1003133216	1	1	LEONG, TRACY S MD	7/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119718	07	Dermatology	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3844	36	06071	34.12632952	-117.1956652	San Bernardino County
287426	Fee-for-Service	1720313513	1720313513	1	1	LOPEZ, KATHERINE LCSW	10/28/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
287440	Fee-for-Service	1528059219	1528059219	1	1	LEON, IRAIS MD	5/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	62796	41	Internal Medicine	0	In state provider	None	18TH AVE & HWY 53	None	CLEARLAKE	CA	95422	0000	17	06033	38.936934	-122.6222415	Lake County
287441	Fee-for-Service	1386879336	1386879336	1	1	LAZAGA, FRANCISCO J MD	6/4/2019	390200000X	NA	Other	026	PHYSICIANS	161677	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
287443	Fee-for-Service	1740540970	1740540970	1	1	LIU, TAMMY K T DO	9/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13512	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
287447	Fee-for-Service	1649271818	1649271818	1	1	LEE, CHOO SENG MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	44732	13	Neurology (M.D. only)	0	In state provider	None	680 GUZZI LN	STE 202	SONORA	CA	95370	5288	55	06109	37.97611058	-120.3719921	Tuolumne County
287450	Fee-for-Service	1104840461	1104840461	1	1	LACE, JOHN W MD	7/16/2009	174400000X	NA	Other	026	PHYSICIANS	85746	41	Internal Medicine	0	In state provider	None	140 LITTON DR	STE 120	GRASS VALLEY	CA	95945	5080	29	06057	39.23422354	-121.0525426	Nevada County
287456	Fee-for-Service	1891873642	1891873642	1	1	LIM-YOUNG, KATHERINE MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67824	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
287487	Fee-for-Service	1790323566	1790323566	1	1	LOVING SOUL HOSPICE	8/5/2023	251G00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 221	VAN NUYS	CA	91411	4719	19	06037	34.18570347	-118.450386	Los Angeles County
287507	Fee-for-Service	1508282369	1508282369	1	1	LEE, FRANCES L MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129095	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
287514	Fee-for-Service	1609253293	1609253293	1	1	LIND, BRADEN MD	7/19/2019	207R00000X	NA	Other	026	PHYSICIANS	150632	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
287520	Fee-for-Service	1982010013	1982010013	1	1	LUDEMAN, LORI B MD	3/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135764	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
287529	Fee-for-Service	1487737839	1487737839	1	1	LEV-ON, TOPAZ MD	1/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83608	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
287530	Fee-for-Service	1417907940	1417907940	1	5	LPCH MEDICAL GROUP DIV OF LU	11/12/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LUCILE	5575 W LAS POSITA BLVD	SUITE 340	PLEASANTON	CA	94588	5804	01	06001	37.69214859	-121.8796532	Alameda County
287537	Fee-for-Service	1962541847	1962541847	1	1	LIAO, DAVID S MD	2/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112736	18	Ophthalmology	0	In state provider	None	1127 WILSHIRE BLVD	STE 1620	LOS ANGELES	CA	90017	4007	19	06037	34.05270508	-118.2641005	Los Angeles County
287541	Fee-for-Service	1235540964	1235540964	1	1	LAM, PAMELA DO	8/26/2019	207R00000X	NA	Other	026	PHYSICIANS	14238	41	Internal Medicine	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
287548	Fee-for-Service	1861811630	1861811630	1	1	LIAQAT, MARYAM MD	7/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156546	07	Dermatology	0	In state provider	None	200 UCLA MEDICAL PLZ	BLDG 465	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
287578	Fee-for-Service	1104840461	1104840461	1	1	LACE, JOHN W MD	7/16/2009	174400000X	NA	Other	026	PHYSICIANS	85746	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	140 LITTON DR	STE 120	GRASS VALLEY	CA	95945	5080	29	06057	39.23422354	-121.0525426	Nevada County
287606	Fee-for-Service	1700819505	1700819505	1	1	LIM, DERRICK G OD, INC	11/1/1999	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5657 ATLANTIC AVE	None	LONG BEACH	CA	90805	4710	19	06037	33.85911969	-118.1850591	Los Angeles County
287627	Fee-for-Service	1124200365	1124200365	1	1	LEE, PHILIP H MD	12/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100399	05	Anesthesiology	0	In state provider	None	FRESNO & R ST	None	FRESNO	CA	93721	1312	10	06019	36.741663	-119.7841005	Fresno County
287637	Fee-for-Service	1770596439	1770596439	1	1	LOS ANGELES COUNTY	7/1/2000	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	LA PUENTE SUBCENTER	15930 CENTRAL AVE	None	LA PUENTE	CA	91744	5410	19	06037	34.01942824	-117.9506314	Los Angeles County
287665	Fee-for-Service	1417907940	1417907940	1	5	LPCH MEDICAL GROUP DIV OF LU	6/23/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	LUCILE	5575 W LAS POSITA BLVD	SUITE 340	PLEASANTON	CA	94588	5804	01	06001	37.69214859	-121.8796532	Alameda County
287673	Fee-for-Service	1235683954	1235683954	1	1	LYONS, TIMOTHY PSYD	2/14/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3749 SUDBURY RD	None	CAMERON PARK	CA	95682	8613	09	06017	38.66830303	-120.9795629	El Dorado County
287700	Fee-for-Service	1962580464	1962580464	1	1	LEE, BRIAN P MD	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79929	13	Neurology (M.D. only)	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
287753	Fee-for-Service	1326004730	1326004730	1	1	LEFF, ARNOLD S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31564	41	Internal Medicine	0	In state provider	None	700 FREDERICK ST	STE 301	SANTA CRUZ	CA	95062	2239	44	06087	36.98031434	-122.004438	Santa Cruz County
287768	Fee-for-Service	1770596439	1770596439	1	1	LOS ANGELES COUNTY	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	LA PUENTE SUBCENTER	15930 CENTRAL AVE	None	LA PUENTE	CA	91744	5410	19	06037	34.01942824	-117.9506314	Los Angeles County
287781	Fee-for-Service	1750549192	1750549192	1	1	LAI, ELSON MD	6/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116241	18	Ophthalmology	0	In state provider	None	1031 W CHAPMAN AVE	STE 204	ORANGE	CA	92868	2872	30	06059	33.78791049	-117.8632755	Orange County
287787	Fee-for-Service	1417907940	1417907940	1	5	LPCH MEDICAL GROUP DIV OF LU	3/23/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LUCILE	5575 W LAS POSITA BLVD	SUITE 340	PLEASANTON	CA	94588	5804	01	06001	37.69214859	-121.8796532	Alameda County
287815	Fee-for-Service	1376930602	1376930602	1	1	LIU, TARYN R DO	8/26/2020	2084N0402X	NA	Neurology	026	PHYSICIANS	15128	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
287820	Fee-for-Service	1194172247	1194172247	1	1	LE MARCHAND, CHLOE E MD	11/3/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153162	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
287822	Fee-for-Service	1396766671	1396766671	1	1	LENART, JOHN MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63766	05	Anesthesiology	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
287842	Fee-for-Service	1194752279	1194752279	1	1	LIN, HSIN L MD	2/8/2016	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	39795	40	Pediatrics	0	In state provider	None	140 N ORANGE AVE	SUITE 104	WEST COVINA	CA	91790	2032	19	06037	34.07369406	-117.9431173	Los Angeles County
287865	Fee-for-Service	1851409593	1851409593	1	1	LOPES, AIMEE M DO	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	7089	08	Family Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
287881	Fee-for-Service	1326004730	1326004730	1	1	LEFF, ARNOLD S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31564	08	Family Practice	0	In state provider	None	700 FREDERICK ST	STE 301	SANTA CRUZ	CA	95062	2239	44	06087	36.98031434	-122.004438	Santa Cruz County
287893	Fee-for-Service	1518978261	1518978261	1	1	LITTELL, JOANNA R LMFT	9/26/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
287916	Fee-for-Service	1417907940	1417907940	1	5	LPCH MEDICAL GROUP DIV OF LU	10/13/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LUCILE	5575 W LAS POSITA BLVD	SUITE 340	PLEASANTON	CA	94588	5804	01	06001	37.69214859	-121.8796532	Alameda County
287935	Fee-for-Service	1528139417	1528139417	1	1	LIM, JOHN Y MD	4/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76097	84	Surgery-Head and Neck	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
287943	Fee-for-Service	1376930602	1376930602	1	1	LIU, TARYN R DO	8/26/2020	2084N0402X	NA	Neurology	026	PHYSICIANS	15128	79	Neurology-Child	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
287954	Fee-for-Service	1255358081	1255358081	1	1	LUISIRI, PHOT MD	7/31/2009	207R00000X	NA	Other	026	PHYSICIANS	51641	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
287971	Fee-for-Service	1538529649	1538529649	1	1	LAURIN, JENNIFER D CRNA	10/17/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
287980	Fee-for-Service	1285382861	1285382861	1	1	LIU, HEIDI Y NP	3/16/2022	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
288007	Fee-for-Service	1326004730	1326004730	1	1	LEFF, ARNOLD S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31564	38	Geriatrics	0	In state provider	None	700 FREDERICK ST	STE 301	SANTA CRUZ	CA	95062	2239	44	06087	36.98031434	-122.004438	Santa Cruz County
288036	Fee-for-Service	1982646717	1982646717	2	1	LONGS DRUG STORES CA LLC	12/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1570 ROSECRANS AVE	None	MANHATTAN BEACH	CA	90266	3718	19	06037	33.90179648	-118.3848705	Los Angeles County
288037	Fee-for-Service	1306982855	1306982855	1	16	LA LASER CENTER, PC, A PROFE	6/12/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	None	1300 EAST CYPRESS	BUILDIING A	SANTA MARIA	CA	93257	2071	42	06083	34.95102551	-120.4164	Santa Barbara County
288040	Fee-for-Service	1417907940	1417907940	1	5	LPCH MEDICAL GROUP DIV OF LU	9/28/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LUCILE	5575 W LAS POSITA BLVD	SUITE 340	PLEASANTON	CA	94588	5804	01	06001	37.69214859	-121.8796532	Alameda County
288043	Fee-for-Service	1528593902	1528593902	1	1	LIN, JOY E MD	7/26/2022	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	158012	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
288063	Fee-for-Service	1417244849	1417244849	1	1	LEE, JANE MD	6/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141475	02	General Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
288066	Fee-for-Service	1932542156	1932542156	1	1	LOUDIN, MICHAEL G MD	9/17/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	159541	10	Gastroenterology (M.D. only)	0	In state provider	None	3000 Q STREET	2ND FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
288071	Fee-for-Service	1225230618	1225230618	1	1	LO, HELEN G MD	8/24/2022	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
288079	Fee-for-Service	1255358081	1255358081	1	1	LUISIRI, PHOT MD	7/31/2009	207R00000X	NA	Other	026	PHYSICIANS	51641	83	Rheumatology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
288096	Fee-for-Service	1487913505	1487913505	1	1	LIFECARE SOLUTIONS INC	5/31/2012	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	394 BEL MARIN KEYS BLVD	SUITE 4	NOVATO	CA	94949	5651	21	06041	38.0761033	-122.5370222	Marin County
288125	Fee-for-Service	1699962803	1699962803	1	1	LEE, TOM K MD INC	12/31/1986	207RH0003X	NA	Oncology	026	PHYSICIANS	24374	68	Hematology	0	In state provider	None	3100 TELEGRAPH AVE	STE 3106	OAKLAND	CA	94609	3210	01	06001	37.82037533	-122.2667839	Alameda County
288148	Fee-for-Service	1023403334	1023403334	1	1	LIANG, DAVID DO	7/17/2019	207L00000X	NA	Other	026	PHYSICIANS	16613	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
288153	Fee-for-Service	1306982855	1306982855	1	16	LA LASER CENTER, PC, A PROFE	6/12/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	1300 EAST CYPRESS	BUILDIING A	SANTA MARIA	CA	93257	2071	42	06083	34.95102551	-120.4164	Santa Barbara County
288154	Fee-for-Service	1417907940	1417907940	1	5	LPCH MEDICAL GROUP DIV OF LU	2/23/2021	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	LUCILE	5575 W LAS POSITA BLVD	SUITE 340	PLEASANTON	CA	94588	5804	01	06001	37.69214859	-121.8796532	Alameda County
288171	Fee-for-Service	1538101670	1538101670	1	1	LY, LUONG MD	4/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86007	77	Infectious Disease	0	In state provider	None	255 E BONITA AVE	None	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
288191	Fee-for-Service	1831519867	1831519867	1	1	LO, TIFFANY MD	9/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137578	40	Pediatrics	0	In state provider	None	555 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
288192	Fee-for-Service	1538390117	1538390117	1	1	LAVELLE, STEPHANIE E LCSW	12/30/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
288194	Fee-for-Service	1528407384	1528407384	1	1	LEE-GUZMAN, CORINNE N DO	1/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14805	41	Internal Medicine	0	In state provider	None	2030 SUTTER PLACE	SUITE 1000	DAVIS	CA	95616	6215	57	06113	38.56292466	-121.7715423	Yolo County
288195	Fee-for-Service	1700049376	1700049376	1	1	LIU, EUGENE W MD	1/3/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	170908	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
288205	Fee-for-Service	1457572869	1457572869	1	1	LAN, CYNTHIA T-C MD	8/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106611	68	Hematology	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
288210	Fee-for-Service	1982696100	1982696100	1	1	LEE, SHARON W OD	9/14/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2250 HAYES ST	STE 208	SAN FRANCISCO	CA	94117	1078	38	06075	37.77302042	-122.45342	San Francisco County
288218	Fee-for-Service	1568686491	1568686491	1	1	LIN, JEANNETTE P MD	5/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	95118	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
288256	Fee-for-Service	1750470134	1750470134	1	1	LA CLINIC OF MEDICINE GENETI	12/9/2004	193400000X	NA	Other	026	PHYSICIANS	70174	41	Internal Medicine	0	In state provider	AND PREVENTIVE CARE	369 N FAIRFAX AVE	STE 2	LOS ANGELES	CA	90036	2175	19	06037	34.077987	-118.361508	Los Angeles County
288277	Fee-for-Service	1417907940	1417907940	1	5	LPCH MEDICAL GROUP DIV OF LU	6/23/2014	282NC2000X	NA	Hospitals	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LUCILE	5575 W LAS POSITA BLVD	SUITE 340	PLEASANTON	CA	94588	5804	01	06001	37.69214859	-121.8796532	Alameda County
288290	Fee-for-Service	1669834669	1669834669	1	1	LAHHAM, SARI MD	8/24/2020	207P00000X	NA	Other	026	PHYSICIANS	153013	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
288324	Fee-for-Service	1639162266	1639162266	1	1	LIU, JIA-YIA MD	1/7/2015	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	71172	77	Infectious Disease	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
288326	Fee-for-Service	1629006812	1629006812	1	1	LE, DZUY V	6/16/2023	208600000X	NA	General Surgery	026	PHYSICIANS	133409	None	None	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
288336	Fee-for-Service	1568686491	1568686491	1	1	LIN, JEANNETTE P MD	5/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	95118	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
288351	Fee-for-Service	1659422772	1659422772	1	1	LYNCH, CAROLINE Y	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
288359	Fee-for-Service	1023065760	1023065760	1	1	LENOIR, MICHAEL A MD	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	33136	40	Pediatrics	0	In state provider	None	2940 SUMMIT ST	STE 1	OAKLAND	CA	94609	3410	01	06001	37.81849213	-122.2647718	Alameda County
288373	Fee-for-Service	1487718805	1487718805	1	1	LAMBING, CHERYL L MD	12/11/2002	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	73033	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
288394	Fee-for-Service	1710514583	1710514583	1	1	LIN, ANDREW C MD	7/31/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	187668	18	Ophthalmology	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
288416	Fee-for-Service	1538617691	1538617691	1	1	LOW, CHEN D NP	10/31/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
288454	Fee-for-Service	1487012779	1487012779	1	1	LIVINGSTON COMMUNITY HEALTH	8/1/2017	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1617 MAIN STREET	None	LIVINGSTON	CA	95334	1250	24	06047	37.37645459	-120.7233764	Merced County
288468	Fee-for-Service	1154677516	1154677516	1	1	LOGAN, MEGHAN S LMFT	3/9/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	45445 PORTOLA AVE	SUITE 1	PALM DESERT	CA	92260	4844	33	06065	33.7186073	-116.3737698	Riverside County
288474	Fee-for-Service	1023065760	1023065760	1	1	LENOIR, MICHAEL A MD	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	33136	43	Pediatric Allergy	0	In state provider	None	2940 SUMMIT ST	STE 1	OAKLAND	CA	94609	3410	01	06001	37.81849213	-122.2647718	Alameda County
288481	Fee-for-Service	1972742427	1972742427	1	1	LIN, MICHAEL Y MD	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106314	20	Orthopedic Surgery	0	In state provider	None	2488 N CALIFORNIA ST	None	STOCKTON	CA	95204	5508	39	06077	37.97587328	-121.2911856	San Joaquin County
288513	Fee-for-Service	1962561670	1962561670	1	1	LEAVITT, PAMELA D	10/5/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
288522	Fee-for-Service	1720201338	1720201338	1	1	LANGIT-COLE, ALICE G	6/22/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90801	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
288552	Fee-for-Service	1346202975	1346202975	1	1	LEWTON, ZACHARY R	1/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55988	13	Neurology (M.D. only)	0	In state provider	None	500 DOYLE PARK	SUITE G-04	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
288558	Fee-for-Service	1235283755	1235283755	1	1	LEVINE, RICHARD A MD	9/21/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	55260	-	NOT APPLICABLE	0	In state provider	None	1816 SCENIC AVE	None	BERKELEY	CA	94709	1324	01	06001	37.87558576	-122.2622904	Alameda County
288569	Fee-for-Service	1487012779	1487012779	1	1	LIVINGSTON COMMUNITY HEALTH	5/7/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1617 MAIN STREET	None	LIVINGSTON	CA	95334	1250	24	06047	37.37645459	-120.7233764	Merced County
288589	Fee-for-Service	1023065760	1023065760	1	1	LENOIR, MICHAEL A MD	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	33136	03	Allergy	0	In state provider	None	2940 SUMMIT ST	STE 1	OAKLAND	CA	94609	3410	01	06001	37.81849213	-122.2647718	Alameda County
288597	Fee-for-Service	1972742427	1972742427	1	1	LIN, MICHAEL Y MD	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106314	46	Hand Surgery	0	In state provider	None	2488 N CALIFORNIA ST	None	STOCKTON	CA	95204	5508	39	06077	37.97587328	-121.2911856	San Joaquin County
288625	Fee-for-Service	1992019350	1992019350	1	2	LOVING CARE TO YOU	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7 MT LASSEN DR	SUITE D-116	SAN RAFAEL	CA	94903	1150	21	06041	38.0261184	-122.5687318	Marin County
288638	Fee-for-Service	1487173522	1487173522	1	1	LAM, GABRIEL LCSW INC	4/25/2018	251S00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	230 S. 8TH STREET	None	EL CENTRO	CA	92243	4371	13	06025	32.79120957	-115.5614864	Imperial County
288649	Fee-for-Service	1083645725	1083645725	1	1	LO, LUCY J MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72703	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
288654	Fee-for-Service	1881600989	1881600989	1	1	LEE, JERRY C MD	8/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128506	30	Radiology	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
288655	Fee-for-Service	1821480732	1821480732	1	1	LEE, MARY M DO	12/12/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	19531	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
288664	Fee-for-Service	1366465866	1366465866	1	1	LONGMONT UNITED HOSPITAL	2/8/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1950 MOUNTAIN VIEW AVE	None	LONGMONT	CO	80501	9865	00	None	40.18134367	-105.1260049	Boulder County
288671	Fee-for-Service	1407186414	1407186414	1	1	LU, THUY P MD	11/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110219	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
288740	Fee-for-Service	1306982855	1306982855	1	20	LA LASER CENTER, PC, A PROFE	9/20/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	None	621 W LINE ST.,	STE 105	BISHOP	CA	93514	3320	14	06027	37.36140642	-118.4007835	Inyo County
288773	Fee-for-Service	1366465866	1366465866	1	1	LONGMONT UNITED HOSPITAL	2/8/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1950 MOUNTAIN VIEW AVE	None	LONGMONT	CO	80501	9865	00	None	40.18134367	-105.1260049	Boulder County
288815	Fee-for-Service	1942235007	1942235007	1	1	LOEHR, MARY M MD	11/30/1995	207P00000X	NA	Other	026	PHYSICIANS	28797	01	General Practice	0	In state provider	None	492 3RD AVE	STE 105	CHULA VISTA	CA	91910	4614	37	06073	32.63490965	-117.0774465	San Diego County
288820	Fee-for-Service	1710502414	1710502414	1	1	LIN, TZU LU DPM	8/1/2023	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	110 NEW STINE RD	None	BAKERSFIELD	CA	93309	2605	15	06029	35.35333762	-119.0610348	Kern County
288839	Fee-for-Service	1578676300	1578676300	1	1	LOGANI, SANGEETA C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	75525	18	Ophthalmology	0	In state provider	None	18546 ROSCOE BLVD	STE 304	NORTHRIDGE	CA	91324	4669	19	06037	34.22069869	-118.537684	Los Angeles County
288844	Fee-for-Service	1710266283	1710266283	1	1	LAWRENCE-REID, NAOMI E MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128030	None	None	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
288848	Fee-for-Service	1306982855	1306982855	1	20	LA LASER CENTER, PC, A PROFE	9/20/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	621 W LINE ST.,	STE 105	BISHOP	CA	93514	3320	14	06027	37.36140642	-118.4007835	Inyo County
288875	Fee-for-Service	1902993843	1902993843	1	1	LEE, KIRSTIN A MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66213	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
288958	Fee-for-Service	1174085690	1174085690	2	1	LI, CUIPING MD	6/14/2023	207R00000X	NA	Other	026	PHYSICIANS	175949	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
288982	Fee-for-Service	1184688137	1184688137	1	1	LO, BERNARD MD	7/30/1981	207R00000X	NA	Other	026	PHYSICIANS	32367	01	General Practice	0	In state provider	None	505 PARNASSUS AVE	# 997M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
289002	Fee-for-Service	1306982855	1306982855	1	19	LA LASER CENTER, PC, A PROFE	8/9/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	OF BAKERSFIELD III	631 W AVE Q	STE B	PALMDALE	CA	93551	3892	19	06037	34.58716061	-118.1417509	Los Angeles County
289054	Fee-for-Service	1730887050	1730887050	1	1	LOS ANGELES CENTERS FOR ALCO	2/26/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	HOL AND DRUG ABUSE	10924 MAIN ST	None	LOS ANGELES	CA	90061	2028	19	06037	33.936669	-118.273864	Los Angeles County
289061	Fee-for-Service	1447330816	1447330816	1	1	LINDSEY, DAVID E	11/7/2006	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	405 REDCLIFF DR	STE 100	REDDING	CA	96002	0160	45	06089	40.57465323	-122.3639452	Shasta County
289081	Fee-for-Service	1124515739	1124515739	1	1	LIN, JONATHAN MD	3/13/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	164656	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
289082	Fee-for-Service	1598386443	1598386443	1	1	LEE, WESLEY MD	10/18/2023	208M00000X	NA	Other	026	PHYSICIANS	187069	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
289088	Fee-for-Service	1396893285	1396893285	1	1	LEWIS, KAERYN N MD	2/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84303	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
289091	Fee-for-Service	1861882946	1861882946	1	1	LA LIBERTAD MEDICAL CLINIC	12/8/2015	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	7900 PACIFIC BLVD	SUITE C AND D	WALNUT PARK	CA	90255	6662	19	06037	33.966414	-118.2251935	Los Angeles County
289105	Fee-for-Service	1306982855	1306982855	1	19	LA LASER CENTER, PC, A PROFE	8/9/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	OF BAKERSFIELD III	631 W AVE Q	STE B	PALMDALE	CA	93551	3892	19	06037	34.58716061	-118.1417509	Los Angeles County
289140	Fee-for-Service	1740216068	1740216068	1	1	LUDI, HECTOR D MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	55549	02	General Surgery	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
289160	Fee-for-Service	1619135878	1619135878	1	1	LOGIUDICE, PHILIP MD INC	12/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	18670	02	General Surgery	0	In state provider	None	2274 RUE LE CHARLENE	None	RANCHO PALOS VERD	CA	90275	6357	19	06037	33.73528948	-118.321047	Los Angeles County
289173	Fee-for-Service	1306982855	1306982855	1	18	LA LASER CENTER, PC, A PROFE	6/19/2024	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	N CANCER	40663 MURRIETA HOT SPRIN	#C3	MURRIETA	CA	92562	9015	33	06065	33.55583645	-117.1852823	Riverside County
289176	Fee-for-Service	1508084518	1508084518	1	1	LOPANSRI, SUMALA MD	2/28/1986	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	LO MEDICAL GROUP	223 N GARFIELD AVE	STE 306	MONTEREY PARK	CA	91754	1700	19	06037	34.0646166	-118.1228948	Los Angeles County
289180	Fee-for-Service	1134989676	1134989676	1	1	LAUREEN A LESTER PSYD PSYCHO	5/1/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	LOGIST A PROFESSIONAL CO	7921 KINGSWOOD DR	STE A5B	CITRUS HEIGHTS	CA	95610	7710	34	06067	38.670192	-121.2705855	Sacramento County
289199	Fee-for-Service	1649226341	1649226341	1	1	LEVIN, DENNIS F MD	8/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67397	01	General Practice	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
289205	Fee-for-Service	1306982855	1306982855	1	19	LA LASER CENTER, PC, A PROFE	8/9/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	OF BAKERSFIELD III	631 W AVE Q	STE B	PALMDALE	CA	93551	3892	19	06037	34.58716061	-118.1417509	Los Angeles County
289220	Fee-for-Service	1306063276	1306063276	1	1	LE, NANETTE H DO	5/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10271	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
289276	Fee-for-Service	1306982855	1306982855	1	18	LA LASER CENTER, PC, A PROFE	6/19/2024	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	N CANCER	40663 MURRIETA HOT SPRIN	#C3	MURRIETA	CA	92562	9015	33	06065	33.55583645	-117.1852823	Riverside County
289287	Fee-for-Service	1336178185	1336178185	1	1	LOBUE, THOMAS D MD	9/30/1988	193400000X	NA	Other	026	PHYSICIANS	59847	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	18210 YORBA LINDA BLVD	STE 401	YORBA LINDA	CA	92886	4060	30	06059	33.8883981	-117.8154098	Orange County
289288	Fee-for-Service	1164843652	1164843652	1	1	LOGAN, DANIELLE R LMFT	7/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
289303	Fee-for-Service	1033505615	1033505615	1	1	LURYE, FELIX MD	12/16/2022	207LP2900X	NA	Other	026	PHYSICIANS	166969	None	None	0	In state provider	None	2323 16TH ST	STE 407	BAKERSFIELD	CA	93301	3454	15	06029	35.37238027	-119.0288508	Kern County
289304	Fee-for-Service	1831398676	1831398676	2	1	LONGS DRUG STORES CA LLC	12/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	635 S MELROSE	None	VISTA	CA	92081	6622	37	06073	33.18695911	-117.2535197	San Diego County
289335	Fee-for-Service	1164406989	1164406989	1	1	LUKACS, JOZSEF MD	3/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	49414	30	Radiology	0	In state provider	None	800 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8359	08	06015	41.77272521	-124.1940494	Del Norte County
289347	Fee-for-Service	1740529593	1740529593	1	1	LEE, WAYNE K MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149030	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
289387	Fee-for-Service	1396768446	1396768446	1	1	LAU, ALAN C K MD	9/23/1985	207R00000X	NA	Other	026	PHYSICIANS	42146	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
289392	Fee-for-Service	1184716458	1184716458	1	1	LAXA, MARY ANNE T MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76409	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	399 E HIGHLAND AVE	STE 527	SAN BERNARDINO	CA	92404	3880	36	06071	34.1358627	-117.2757898	San Bernardino County
289394	Fee-for-Service	1417975608	1417975608	1	1	LAM, JOHN S MD	4/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82799	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
289396	Fee-for-Service	1710185350	1710185350	1	1	LIPSCOMB, ALLEN E LCSW	5/6/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9201 W SUNSET BLVD	SUITE 812	WEST HOLLYWOOD	CA	90069	3709	19	06037	34.09054375	-118.392295	Los Angeles County
289401	Fee-for-Service	1831426345	1831426345	1	1	LONG, ALEXIS F MD	1/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108263	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
289451	Fee-for-Service	1003829797	1003829797	1	1	LONG BEACH GASTROENTEROLOGY	11/1/1992	174400000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	3833 WORSHAM AVENUE	SUITE 300	LONG BEACH	CA	90808	1745	19	06037	33.828552	-118.1462755	Los Angeles County
289462	Fee-for-Service	1992867147	1992867147	1	1	LEMON, ROBERT H MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	61547	68	Hematology	0	In state provider	None	2280 HARRISON AVE	SUITE A	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
289527	Fee-for-Service	1114371531	1114371531	1	1	LEE, SUSAN A MD	8/1/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
289537	Fee-for-Service	1144282401	1144282401	1	1	LE, HUONG T MD	6/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	63906	41	Internal Medicine	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
289546	Fee-for-Service	1992867147	1992867147	1	1	LEMON, ROBERT H MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	61547	78	Neoplastic Diseases/Oncology	0	In state provider	None	2280 HARRISON AVE	SUITE A	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
289550	Fee-for-Service	1588299747	1588299747	1	1	LEONARD, JAMIE L PT	7/21/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	41769 ENTERPRISE CIR N	STE 104	TEMECULA	CA	92590	5626	33	06065	33.51823541	-117.1701538	Riverside County
289559	Fee-for-Service	1790843365	1790843365	1	1	LEE, EDMOND S MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	54583	41	Internal Medicine	0	In state provider	None	600 N GARFIELD AVE	STE 200	MONTEREY PARK	CA	91754	1169	19	06037	34.06820797	-118.1228835	Los Angeles County
289562	Fee-for-Service	1336116276	1336116276	1	1	LYNCH,DAVID JOHN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	460 MYLAN PARK LANE	None	MORGANTOWN	WV	26501	2243	00	None	39.63776756	-80.03415629	Monongalia County
289568	Fee-for-Service	1922446533	1922446533	1	1	LAGRIMAS, TANYA M MD	9/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133746	01	General Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
289614	Fee-for-Service	1629457452	1629457452	1	2	LEPP, NATHANIEL MD	10/21/2021	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	None	-	NOT APPLICABLE	0	In state provider	None	795 WILLOW RD	BLDG 332	MENLO PARK	CA	94025	2539	41	06081	37.466676	-122.160384	San Mateo County
289618	Fee-for-Service	1144282401	1144282401	1	1	LE, HUONG T MD	6/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	63906	05	Anesthesiology	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
289641	Fee-for-Service	1790843365	1790843365	1	1	LEE, EDMOND S MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	54583	78	Neoplastic Diseases/Oncology	0	In state provider	None	600 N GARFIELD AVE	STE 200	MONTEREY PARK	CA	91754	1169	19	06037	34.06820797	-118.1228835	Los Angeles County
289659	Fee-for-Service	1578136511	1578136511	1	1	LONG, VINCENT MD	9/12/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
289682	Fee-for-Service	1144764242	1144764242	1	1	LOW, JENNIFER YEUK LAN PIKAK	11/6/2019	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	E NP	39350 CIVIC CENTER DR	SUITE 300	FREMONT	CA	94538	2331	01	06001	37.55399458	-121.9756047	Alameda County
289686	Fee-for-Service	1629154141	1629154141	1	1	LAKE, ROGER F MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39126	08	Family Practice	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
289718	Fee-for-Service	1790843365	1790843365	1	1	LEE, EDMOND S MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	54583	68	Hematology	0	In state provider	None	600 N GARFIELD AVE	STE 200	MONTEREY PARK	CA	91754	1169	19	06037	34.06820797	-118.1228835	Los Angeles County
289736	Fee-for-Service	1780606632	1780606632	1	1	LA CLINICA VALLEJO	8/1/2006	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	DENTAL	2920 SONOMA BLVD	STE A	VALLEJO	CA	94590	3879	48	06095	38.11333463	-122.2546213	Solano County
289737	Fee-for-Service	1578136511	1578136511	1	1	LONG, VINCENT MD	9/12/2024	207R00000X	NA	Other	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
289745	Fee-for-Service	1144463761	1144463761	1	1	LEE, JENNIFER C MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117309	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO STREET	None	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
289807	Fee-for-Service	1780606632	1780606632	1	1	LA CLINICA VALLEJO	8/1/2006	261QD0000X	NA	Dental Clinic	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	DENTAL	2920 SONOMA BLVD	STE A	VALLEJO	CA	94590	3879	48	06095	38.11333463	-122.2546213	Solano County
289811	Fee-for-Service	1700391752	1700391752	1	1	LIFE OF HOPE	10/17/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	301 W HUNTINGTON DR	SUITE 116	ARCADIA	CA	91007	3462	19	06037	34.13481053	-118.0425638	Los Angeles County
289835	Fee-for-Service	1235243049	1235243049	1	1	LAMANUZZI, SARAH A MD	6/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	90401	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1065 BUCKS LANE	None	QUINCY	CA	95971	9507	32	06063	39.93916024	-120.9619096	Plumas County
289876	Fee-for-Service	1306982855	1306982855	1	15	LA LASER CENTER, PC, A PROFE	6/14/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	SKIN CANCER	876 W GRAND AVE	None	PORTERVILLE	CA	93257	2071	54	06107	36.07689277	-119.0370172	Tulare County
289903	Fee-for-Service	1851449755	1851449755	1	1	LIM, JOHNSON MD	8/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81929	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
289908	Fee-for-Service	1306982855	1306982855	1	2	LA LASER CENTER, PC, A PROFE	8/18/2023	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	KIN AND CANCER	161 AVENIDA VAQUERO	None	SAN CLEMENTE	CA	92672	3601	30	06059	33.44373814	-117.6431813	Orange County
289940	Fee-for-Service	1306982855	1306982855	1	15	LA LASER CENTER, PC, A PROFE	6/14/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	SKIN CANCER	876 W GRAND AVE	None	PORTERVILLE	CA	93257	2071	54	06107	36.07689277	-119.0370172	Tulare County
289968	Fee-for-Service	1023468998	1023468998	1	1	LOW, AUSTIN LAC	4/4/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	6000 FAIRWAY DR	STE 2	ROCKLIN	CA	95677	4244	31	06061	38.79220243	-121.2621624	Placer County
289988	Fee-for-Service	1720434186	1720434186	1	1	LEE, TIMOTHY MD	4/26/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	154505	08	Family Practice	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
290015	Fee-for-Service	1669724811	1669724811	1	1	LCM PHARMACEUTICALS INC	5/23/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15440 BEACH BLVD	SUITE 120	WESTMINSTER	CA	92683	6240	30	06059	33.737913	-117.989271	Orange County
290042	Fee-for-Service	1104308048	1104308048	1	1	LE, CATHERINE OT	4/22/2022	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	706 N DIAMOND BAR BLVD	STE B2	DIAMOND BAR	CA	91765	1059	19	06037	34.03167081	-117.8089198	Los Angeles County
290077	Fee-for-Service	1306982855	1306982855	1	9	LA LASER CENTER, PC, A PROFE	5/23/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	CANCER	144 S L ST	None	TULARE	CA	93274	4104	54	06107	36.20739498	-119.3445917	Tulare County
290105	Fee-for-Service	1235699729	1235699729	1	1	LONERGAN, PETER E MD	5/4/2020	208800000X	NA	Other	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
290106	Fee-for-Service	1861224891	1861224891	1	1	LATIMER, JAYSON LCSW	9/10/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
290112	Fee-for-Service	1538447164	1538447164	1	1	LARRY LATSON, MD	8/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 1ST AVE	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
290113	Fee-for-Service	1629457452	1629457452	1	1	LEPP, NATHANIEL E MD	5/23/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	149023	08	Family Practice	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
290133	Fee-for-Service	1306982855	1306982855	1	9	LA LASER CENTER, PC, A PROFE	5/23/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	CANCER	144 S L ST	None	TULARE	CA	93274	4104	54	06107	36.20739498	-119.3445917	Tulare County
290136	Fee-for-Service	1093938417	1093938417	1	1	LANDRY, CHENITA M MD	12/2/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	116090	None	None	0	In state provider	None	3828 SCHAUFELE AVENUE	SUITE 200	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
290158	Fee-for-Service	1831668292	1831668292	1	1	LIZARRAGA MEDICAL CENTER INC	4/10/2021	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	895 W. VALLEY BLVD.	None	COLTON	CA	92324	2001	36	06071	34.0687227	-117.3383592	San Bernardino County
290178	Fee-for-Service	1336505197	1336505197	1	1	LEGACY MARKETING WORLDWIDE I	5/24/2021	363LP2300X	NA	Nurse Practitioner	022	PHYSICIANS GROUP	-	None	None	0	In state provider	NC.	3300 SAN FERNANDO	None	BURBANK	CA	91504	2530	19	06037	34.20472375	-118.3470714	Los Angeles County
290199	Fee-for-Service	1306982855	1306982855	1	9	LA LASER CENTER, PC, A PROFE	5/23/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	CANCER	144 S L ST	None	TULARE	CA	93274	4104	54	06107	36.20739498	-119.3445917	Tulare County
290217	Fee-for-Service	1780713503	1780713503	1	1	LESTER, RONALD G LCSW	11/2/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	19906	-	NOT APPLICABLE	0	In state provider	None	30500 ARRASTRE CANYON RD	None	ACTON	CA	93510	2160	19	06037	34.449291	-118.1973465	Los Angeles County
290246	Fee-for-Service	1881049872	1881049872	1	1	LIN, ELAINE J MD	1/16/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	150780	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
290263	Fee-for-Service	1548313505	1548313505	1	1	LIU'S ACUPUNCTURE CLINIC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1441 FRANKLIN ST	STE 203	OAKLAND	CA	94612	3219	01	06001	37.80450024	-122.269584	Alameda County
290268	Fee-for-Service	1518241264	1518241264	1	1	LIEBERMAN, BRIAN D PSYD	5/1/2017	103TS0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	381 BAYSIDE RD	None	ARCATA	CA	95521	6497	12	06023	40.86293406	-124.0739007	Humboldt County
290271	Fee-for-Service	1487164315	1487164315	1	1	LI, MAN L PT	1/7/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
290285	Fee-for-Service	1528479144	1528479144	1	1	LAU, RYAN MD	8/30/2019	207ZP0102X	NA	Other	026	PHYSICIANS	152247	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
290316	Fee-for-Service	1861528663	1861528663	1	1	LUU, QUANG C MD	6/14/2007	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	82886	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
290334	Fee-for-Service	1528479144	1528479144	1	1	LAU, RYAN MD	8/30/2019	207ZP0102X	NA	Other	026	PHYSICIANS	152247	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
290365	Fee-for-Service	1245263417	1245263417	1	1	LEE, ALBERT S DO INC	9/7/2004	207L00000X	NA	Other	026	PHYSICIANS	7897	05	Anesthesiology	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
290380	Fee-for-Service	1205913167	1205913167	1	1	LEE, SANDRA H MD	10/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88328	40	Pediatrics	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
290404	Fee-for-Service	1629487368	1629487368	1	1	LOUGH, JOHN B MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144363	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
290435	Fee-for-Service	1861559197	1861559197	1	1	LEVY, JOAN I PHD	7/18/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3558 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
290440	Fee-for-Service	1932627221	1932627221	1	1	LOO, SHERI A NP	9/28/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
290454	Fee-for-Service	1518996446	1518996446	1	1	LAVER, DAVID ALLEN DPM	7/1/1979	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2191 MOWRY AVE	STE 600A	FREMONT	CA	94538	1725	01	06001	37.55710897	-121.9814562	Alameda County
290519	Fee-for-Service	1043557606	1043557606	1	1	LAU, DEBORAH F	11/12/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2020 N BROADWAY	STE 101	SANTA ANA	CA	92706	2622	30	06059	33.76342937	-117.8696026	Orange County
290549	Fee-for-Service	1114409570	1114409570	1	1	LYNN, TABITHA DOULA	2/2/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
290552	Fee-for-Service	1679014443	1679014443	1	1	LEY, JENNIFER L LMFT	11/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	250 W. MAIN STREET	SUITE 101	TUSTIN	CA	92780	7717	30	06059	33.74204833	-117.8258263	Orange County
290561	Fee-for-Service	1538482328	1538482328	1	1	LO, ERNEST N MD	4/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106446	41	Internal Medicine	0	In state provider	None	2340 CLAY ST	2ND FLOOR	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
290563	Fee-for-Service	1821087164	1821087164	1	1	LUBBOCK COUNTY HOSPITAL DIST	2/1/1999	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	602 N INDIANA AVE	None	LUBBOCK	TX	79415	1526	00	None	33.607017	-101.8878105	Lubbock County
290568	Fee-for-Service	1467401455	1467401455	1	1	LEMBACH, LARA A MD	4/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	62493	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
290598	Fee-for-Service	1821087164	1821087164	1	1	LUBBOCK COUNTY HOSPITAL DIST	6/23/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	602 N INDIANA AVE	None	LUBBOCK	TX	79415	1526	00	None	33.607017	-101.8878105	Lubbock County
290641	Fee-for-Service	1801556543	1801556543	1	1	LARRACAS, ERIKA K CCC-SLP	5/26/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	630 S INDIAN HILL BLVD S	None	CLAREMONT	CA	91711	5461	19	06037	34.084494	-117.7191945	Los Angeles County
290649	Fee-for-Service	1922062215	1922062215	1	1	LIEBERSTEIN, LOTH E MD	10/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	10	Gastroenterology (M.D. only)	1	Border provider	None	10619 PROFESSIONAL CIR	None	RENO	NV	89521	5831	00	None	39.42779657	-119.7542429	Washoe County
290654	Fee-for-Service	1669494001	1669494001	1	1	LAKE, STEVEN J MD	9/1/1995	207R00000X	NA	Other	026	PHYSICIANS	34049	41	Internal Medicine	0	In state provider	None	911 E SAN ANTONIO DR	STE 6	LONG BEACH	CA	90807	2204	19	06037	33.83829601	-118.1824972	Los Angeles County
290660	Fee-for-Service	1205317740	1205317740	1	1	LUCKEY, ANDREW E JR MD	1/1/1979	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34426	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3580 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2602	19	06037	33.93044434	-118.2058277	Los Angeles County
290662	Fee-for-Service	1083656813	1083656813	2	1	LONGS DRUG STORES CA LLC	12/18/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	581 W CHANNEL ISLANDS BL	None	PORT HUENEME	CA	93041	2133	56	06111	34.1760635	-119.214801	Ventura County
290673	Fee-for-Service	1932117447	1932117447	1	1	LADENHEIM, JAY A MD	10/31/1989	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	68492	01	General Practice	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
290678	Fee-for-Service	1427129287	1427129287	1	1	LANE, BRIAN P MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73829	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
290682	Fee-for-Service	1194744045	1194744045	1	1	LONG, FRANKLIN R MD	12/12/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53745	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
290698	Fee-for-Service	1093897662	1093897662	1	1	LEITERMAN, JONATHAN C AU	6/9/2020	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5525 ETIWANDA AVE	STE 201	TARZANA	CA	91356	6135	19	06037	34.17046451	-118.5308463	Los Angeles County
290718	Fee-for-Service	1326281064	1326281064	1	1	LIU, JUSTIN MD PROFESSIONAL	8/20/2013	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	76636	25	Physical Medicine and Rehabilitation	0	In state provider	MEDICAL CORPORATION	355 DARDANELLI LANE	None	LOS GATOS	CA	95032	1438	43	06085	37.262493	-121.967456	Santa Clara County
290734	Fee-for-Service	1689082133	1689082133	1	1	LE & NGUYEN PACIFIC PHARMACY	12/1/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	LLC	10515 MCFADDEN AVE	SUITE 104	GARDEN GROVE	CA	92843	5301	30	06059	33.73794933	-117.9456667	Orange County
290743	Fee-for-Service	1225105059	1225105059	1	1	LEE, DANIEL S MD	1/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	56021	84	Surgery-Head and Neck	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
290761	Fee-for-Service	1881205953	1881205953	1	1	LOPEZ, MICHAEL E	8/20/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
290795	Fee-for-Service	1689766982	1689766982	1	1	LIN, ROY MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62245	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
290815	Fee-for-Service	1417126830	1417126830	1	1	LEE, ANDREW P MD	9/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101220	04	Otology, Laryngology, Rhinology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
290832	Fee-for-Service	1952353831	1952353831	1	1	LIM, LOUIS C MD	7/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80343	05	Anesthesiology	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
290852	Fee-for-Service	1538195094	1538195094	1	1	LEACH, JEFFREY O MD	1/1/1979	207R00000X	NA	Other	026	PHYSICIANS	30939	41	Internal Medicine	0	In state provider	None	2067 W VISTA WAY	STE 200	VISTA	CA	92083	6033	37	06073	33.18505594	-117.285958	San Diego County
290943	Fee-for-Service	1578760195	1578760195	1	1	LEE, HELEN E D.O.	8/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9806	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
290946	Fee-for-Service	1942656152	1942656152	1	1	LINGWOOD, ANNA-JOY E CNP	11/19/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4829 CLAIREMONT DR	None	SAN DIEGO	CA	92117	2706	37	06073	32.83175462	-117.2052088	San Diego County
290964	Fee-for-Service	1073718250	1073718250	1	1	LEMON, ALEXANDER P MD	9/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98262	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
290992	Fee-for-Service	1760485171	1760485171	1	1	LE, VINCENT DO	7/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8549	08	Family Practice	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
290993	Fee-for-Service	1306982855	1306982855	1	11	LA LASER CENTER, PC, A PROFE	6/14/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	SKIN CANCER	2100 E TAHQUITZ CANYON W	None	PALM SPRINGS	CA	92262	7006	33	06065	33.82322451	-116.5235355	Riverside County
290998	Fee-for-Service	1437654530	1437654530	1	1	LEE, HANNAH H DPM	5/16/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	20130 LAKE CHABOT ROAD	SUITE 202	CASTRO VALLEY	CA	94546	5306	01	06001	37.69738066	-122.087041	Alameda County
291007	Fee-for-Service	1306982855	1306982855	1	11	LA LASER CENTER, PC, A PROFE	6/14/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	SKIN CANCER	2100 E TAHQUITZ CANYON W	None	PALM SPRINGS	CA	92262	7006	33	06065	33.82322451	-116.5235355	Riverside County
291012	Fee-for-Service	1700999414	1700999414	1	1	LE, MINH MD	3/7/2011	207R00000X	NA	Other	026	PHYSICIANS	72624	None	None	0	In state provider	None	25 NORTH 14TH ST	STE 700	SAN JOSE	CA	95112	6214	43	06085	37.34293357	-121.8775187	Santa Clara County
291024	Fee-for-Service	1467869289	1467869289	1	1	LIVINGSTON, ERIN MD	11/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143803	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
291059	Fee-for-Service	1437619533	1437619533	1	1	LICATA, CHRISTINE J MD	6/29/2022	390200000X	NA	Other	026	PHYSICIANS	176389	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
291119	Fee-for-Service	1073778577	1073778577	1	1	LEE, CHRISTINA	6/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101770	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
291121	Fee-for-Service	1154939239	1154939239	1	1	LENNON, KIMBERLY L LMFT	7/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	256 CAJON ST	SUITE E	REDLANDS	CA	92373	5278	36	06071	34.05204454	-117.1802319	San Bernardino County
291151	Fee-for-Service	1417498676	1417498676	1	1	LE, AMY MD	8/30/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	157346	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
291174	Fee-for-Service	1306982855	1306982855	1	3	LA LASER CENTER, PC, A PROFE	8/18/2023	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	CANCER	1210 NEVADA ST	None	REDLANDS	CA	92374	2895	36	06071	34.069554	-117.2174405	San Bernardino County
291199	Fee-for-Service	1194740845	1194740845	2	1	LIN, NANCY MD	6/27/2024	2080P0203X	NA	Other	026	PHYSICIANS	133315	40	Pediatrics	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
291244	Fee-for-Service	1366582264	1366582264	1	1	LOUDERMILK, JOHN R MD	1/1/1984	207P00000X	NA	Other	026	PHYSICIANS	40700	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4747 ENGLE RD	None	CARMICHAEL	CA	95608	2223	34	06067	38.6320173	-121.3545928	Sacramento County
291257	Fee-for-Service	1366582264	1366582264	1	1	LOUDERMILK, JOHN R MD	1/1/1984	207P00000X	NA	Other	026	PHYSICIANS	40700	41	Internal Medicine	0	In state provider	None	4747 ENGLE RD	None	CARMICHAEL	CA	95608	2223	34	06067	38.6320173	-121.3545928	Sacramento County
291264	Fee-for-Service	1184483075	1184483075	1	1	LIU, LIANG	2/27/2025	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	11274 LOS ALAMITOS BLVD	None	LOS ALAMITOS	CA	90720	3958	30	06059	33.798744	-118.0718035	Orange County
291307	Fee-for-Service	1477627073	1477627073	1	1	LUO, JEFFREY MD	1/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89452	20	Orthopedic Surgery	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
291321	Fee-for-Service	1417484874	1417484874	1	1	LU, RUFEI MD	8/8/2023	207ZN0500X	NA	Other	026	PHYSICIANS	172980	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
291328	Fee-for-Service	1750381372	1750381372	1	1	LABELLE, JAMES E MD	5/31/1985	207P00000X	NA	Other	026	PHYSICIANS	55021	01	General Practice	0	In state provider	None	4141 KEARNY VILLA RD	None	SAN DIEGO	CA	92123	1705	37	06073	32.814594	-117.141219	San Diego County
291335	Fee-for-Service	1750381372	1750381372	1	1	LABELLE, JAMES E MD	5/31/1985	207P00000X	NA	Other	026	PHYSICIANS	55021	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4141 KEARNY VILLA RD	None	SAN DIEGO	CA	92123	1705	37	06073	32.814594	-117.141219	San Diego County
291341	Fee-for-Service	1326541186	1326541186	1	1	LI, KAREN MD	4/7/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	164138	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
291380	Fee-for-Service	1992141865	1992141865	1	1	LYNN, MAY T MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142168	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
291425	Fee-for-Service	1306982855	1306982855	1	12	LA LASER CENTER, PC, A PROFE	6/18/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	R	2409 ARTESIA BLVD	None	REDONDO BEACH	CA	90278	3207	19	06037	33.87292349	-118.3677075	Los Angeles County
291427	Fee-for-Service	1922204882	1922204882	1	1	LIANG, REED T MD	8/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104811	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
291429	Fee-for-Service	1306982855	1306982855	1	12	LA LASER CENTER, PC, A PROFE	6/18/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	R	2409 ARTESIA BLVD	None	REDONDO BEACH	CA	90278	3207	19	06037	33.87292349	-118.3677075	Los Angeles County
291433	Fee-for-Service	1306982855	1306982855	1	12	LA LASER CENTER, PC, A PROFE	6/18/2024	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	R	2409 ARTESIA BLVD	None	REDONDO BEACH	CA	90278	3207	19	06037	33.87292349	-118.3677075	Los Angeles County
291446	Fee-for-Service	1306074109	1306074109	1	1	LOVEN, TINA C DO	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13944	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
291465	Fee-for-Service	1528067931	1528067931	1	2	LAS POSAS HOME HEALTH	3/22/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	1601 CARMEN DRIVE	STE 202	CAMARILLO	CA	93010	3100	56	06111	34.23278038	-119.0515313	Ventura County
291482	Fee-for-Service	1215469127	1215469127	1	1	LEUNG, DAVID MD	7/1/2020	390200000X	NA	Other	026	PHYSICIANS	159008	41	Internal Medicine	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
291513	Non-Physician Medical Practitioner	None	1215284005	0	0	LITTMANN, ERIN G	9/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2374 POPPYVIEW AVE	None	SAN RAMON	CA	94582	5880	00	06000	37.76848058	-121.9136034	Contra Costa County
291546	Non-Physician Medical Practitioner	None	1285376590	0	0	LEHR, ASHLYN C NP	12/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6555 COYLE AVENUE	SUITE 380	CARMICHAEL	CA	95608	0302	00	06000	38.66859	-121.3118055	Sacramento County
291549	Non-Physician Medical Practitioner	None	1093276099	0	0	LAM, YAN NP	2/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	00	06000	38.55204	-121.455387	Sacramento County
291558	Non-Physician Medical Practitioner	None	1437403599	0	0	LUCKEN, PATRICIA L	10/14/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11769 OLD RANCH RD	None	VICTORVILLE	CA	92392	9241	00	06000	34.46435826	-117.3690569	San Bernardino County
291563	Non-Physician Medical Practitioner	None	1184840803	0	0	LANUZA, MARC JUN	7/19/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	40580 ALBRAE ST	None	FREMONT	CA	94538	2448	00	06000	37.51978341	-121.9847474	Alameda County
291602	Non-Physician Medical Practitioner	None	1093727133	0	0	LYNCH, MARTHA JANE	4/19/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1300 E COOLEY DR	None	COLTON	CA	92324	3905	00	06000	34.0544745	-117.306315	San Bernardino County
291608	Non-Physician Medical Practitioner	None	1720434848	0	0	LU, HSIAOAI E NP	7/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13353 CASSIA ST	None	RANCHO CUCAMONGA	CA	91739	9550	00	06000	34.13992612	-117.5130997	San Bernardino County
291633	Non-Physician Medical Practitioner	None	1215546767	0	0	LEE, ERIKA A NP	11/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2727 N PECK RD	None	EL MONTE	CA	91733	2434	00	06000	34.060311	-118.0306097	Los Angeles County
291637	Non-Physician Medical Practitioner	None	1487009171	0	0	LEMONS, KATRINA R NP	10/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	PO BOX 18051	None	SOUTH LAKE TAHOE	CA	96151	8051	00	06000	0	0	None
291640	Non-Physician Medical Practitioner	None	1265743918	0	0	LIMCOLIOC, APRIL A E	5/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	280 HANNIGAN WAY	None	VALLEJO	CA	94589	1893	00	06000	38.14985401	-122.2346164	Solano County
291648	Non-Physician Medical Practitioner	None	1396212049	0	0	LEGASPI, CAROLYN NP	2/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
291649	Non-Physician Medical Practitioner	None	1285382861	0	0	LIU, HEIDI Y NP	10/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
291674	Non-Physician Medical Practitioner	None	1477716363	0	0	LOVELY, LEAH C	7/27/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST., SUIT	KECK HOSPITAL OF USC/DEP	LOS ANGELES	CA	90033	0000	00	06000	34.06269295	-118.2030006	Los Angeles County
291705	Non-Physician Medical Practitioner	None	1649693540	0	0	LIN, RAY	11/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	360 SAN MIGUEL DR	STE 309	NEWPORT BEACH	CA	92660	7836	00	06000	33.61321911	-117.8722084	Orange County
291709	Non-Physician Medical Practitioner	None	1932627221	0	0	LOO, SHERI A NP	1/30/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	134 LUNADO WAY	None	SAN FRANCISCO	CA	94127	2855	00	06000	37.72489514	-122.4712169	San Francisco County
291736	Non-Physician Medical Practitioner	None	1699946418	0	0	LEWIS, TONIANN NP	3/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	202 WINTERTON CT	None	BAKERSFIELD	CA	93312	7061	00	06000	35.35704322	-119.1260607	Kern County
291739	Non-Physician Medical Practitioner	None	1588441703	0	0	LOVENTHAL, MAYA P PA	3/13/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
291781	Non-Physician Medical Practitioner	None	1285362764	0	0	LY, SYDNIE L PA-C	2/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	00	06000	33.49890392	-117.1612965	Riverside County
291782	Non-Physician Medical Practitioner	None	1124890132	0	0	LIAW, ALEXANDER M PA	3/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	276 S MILL ST	STE C	TEHACHAPI	CA	93561	1678	00	06000	35.13089495	-118.4526363	Kern County
291828	Non-Physician Medical Practitioner	None	1336782903	0	0	LAM, LAWRENCE PA	1/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
291837	Non-Physician Medical Practitioner	None	1477021848	0	0	LY, CHRISTINA PA-C	6/10/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
291838	Non-Physician Medical Practitioner	None	1104101062	0	0	LEE, JIHYUN	10/29/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5540 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4120	00	06000	34.10855455	-118.1948437	Los Angeles County
291841	Non-Physician Medical Practitioner	None	1972271336	0	0	LENOX, GAVIN E PA-C	6/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	1651	00	06000	34.27771547	-119.2540344	Ventura County
291846	Non-Physician Medical Practitioner	None	1679112353	0	0	LU, KRISTY A NP	1/15/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26 RANCHO DEL MAR	None	APTOS	CA	95003	3973	00	06000	36.97832273	-121.9080422	Santa Cruz County
291850	Non-Physician Medical Practitioner	None	1619638087	0	0	LAZAGA, CECILIA D NP	3/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
291854	Non-Physician Medical Practitioner	None	1669021531	0	0	LIN, SOPHIA K PA-C	11/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
291857	Non-Physician Medical Practitioner	None	1720231863	0	0	LIN, SANDOR TZU-SHENG	9/16/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 E 2ND AVE	None	ESCONDIDO	CA	92025	4212	00	06000	33.12175817	-117.0787555	San Diego County
291866	Non-Physician Medical Practitioner	None	1659674802	0	0	LUDI, GISELLE YVONNE	2/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
291909	Non-Physician Medical Practitioner	None	1912561416	0	0	LACAYO, ROCIO V NP	2/19/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 TRANCAS ST	SUITE 201	NAPA	CA	94558	2904	00	06000	38.32316569	-122.2981938	Napa County
291967	Non-Physician Medical Practitioner	None	1538225594	0	0	LOUIE, VERONICA	4/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	00	06000	37.66312028	-122.4631592	San Mateo County
292009	Non-Physician Medical Practitioner	None	1215243522	0	0	LAUREN, HING-HERNANDEZ A	8/27/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13161 JEFFERSON ST	None	LE GRAND	CA	95333	9766	00	06000	37.2293683	-120.2509644	Merced County
292054	Non-Physician Medical Practitioner	None	1689048530	0	0	LAM, CARIE T	2/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	724 SOUTH NINTH STREET	None	ALHAMBRA	CA	91801	1601	00	06000	34.08397689	-118.1331682	Los Angeles County
292065	Non-Physician Medical Practitioner	None	1184225377	0	0	LIEU, MONICA H PA	7/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	00	06000	33.89815111	-117.8419708	Orange County
292099	Non-Physician Medical Practitioner	None	1417208224	0	0	LEOS, DAVID PA	9/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	00	06000	33.03623896	-117.2837308	San Diego County
292119	Non-Physician Medical Practitioner	None	1619740966	0	0	LE, MAI T PA	10/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	00	06000	37.54866156	-121.9750739	Alameda County
292138	Non-Physician Medical Practitioner	None	1801915962	0	0	LATOUR, PATRICIA ANN	5/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 WASHINGTON SQ	None	SAN JOSE	CA	95192	0037	00	06000	37.335654	-121.8822075	Santa Clara County
292157	Non-Physician Medical Practitioner	None	1811290638	0	0	LEDERER, SHEILA A	4/20/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3502 BERETANIA WAY	None	SACRAMENTO	CA	95384	2547	00	06000	38.649465	-121.537692	Sacramento County
292166	Non-Physician Medical Practitioner	None	1386656510	0	0	LOZANO-DIAZ, MARIA G	12/21/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3128 55TH ST	None	SAN DIEGO	CA	92105	3715	00	06000	32.73945555	-117.0775059	San Diego County
292200	Non-Physician Medical Practitioner	None	1871172569	0	0	LEE, SARAH C PA-C	3/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2800 L ST	STE 10	SACRAMENTO	CA	95816	5616	00	06000	38.571237	-121.469958	Sacramento County
292202	Non-Physician Medical Practitioner	None	1861926198	0	0	LUC, TALIA H NP	10/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1134 ASH ST	None	BRAWLEY	CA	92227	2737	00	06000	32.99197004	-115.5396833	Imperial County
292208	Non-Physician Medical Practitioner	None	1568445070	0	0	LAURENCE, JOHN A PA	11/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
292232	Non-Physician Medical Practitioner	None	1932331527	0	0	LYNN, BEDSTED E	8/24/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3812 N 1ST ST	None	FRESNO	CA	93726	4301	00	06000	36.78707387	-119.7723363	Fresno County
292261	Non-Physician Medical Practitioner	None	1962797274	0	0	LOVE, NICOLE R	6/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1504 RADFORD LOOP	None	EL DORADO HILLS	CA	95762	9514	00	06000	38.62382686	-121.0541224	El Dorado County
292286	Non-Physician Medical Practitioner	None	1558620021	0	0	LEGASPI, LEONARDO ASUTILLA	5/14/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3710 EAST CESAR CHAVEZ A	None	LOS ANGELES	CA	90063	2219	00	06000	34.04048853	-118.1854845	Los Angeles County
292289	Non-Physician Medical Practitioner	None	1417129156	0	0	LIAO, ELLEN	2/23/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1730 0'FARRELL ST	APT 318	SAN FRANCISCO	CA	94115	5276	00	06000	37.78323945	-122.4332209	San Francisco County
292335	Non-Physician Medical Practitioner	None	1538921770	0	0	LUNDT, HEATHER	4/7/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
292410	Non-Physician Medical Practitioner	None	1568909315	0	0	LE, MARY T NP	5/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	00	06000	38.556288	-121.458474	Sacramento County
292419	Non-Physician Medical Practitioner	None	1295793057	0	0	LAMPKIN, KATHI	12/30/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 30TH STREET	SUITE 407	OAKLAND	CA	94609	3245	00	06000	37.81892183	-122.2640154	Alameda County
292431	Non-Physician Medical Practitioner	None	1306297858	0	0	LOCKWOOD, BETH A NP	2/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5628 MICKSHELLEY CIR	None	KLAMATH FALLS	OR	97603	9031	00	06000	42.17433877	-121.7201256	Klamath County
292432	Non-Physician Medical Practitioner	None	1952703233	0	0	LAPOINTE, JENNIFER M CNM	8/10/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3322 HUNTLY DRIVE	None	ROSSMORE	CA	90720	3836	00	06000	33.79322537	-118.075065	Orange County
292447	Non-Physician Medical Practitioner	None	1083949762	0	0	LIM, JAMIE M	11/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 BEACH BLVD	APT E 508	LA HABRA	CA	90631	1103	00	06000	33.91167027	-117.9740127	Orange County
292469	Non-Physician Medical Practitioner	None	1265065395	0	0	LEHMAN, DAVIS A PA	1/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
292493	Non-Physician Medical Practitioner	None	1366623407	0	0	LOPEZ-MOORE, JESSICA ANNE	2/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 OLD RIVER RD	SUITE 105	BAKERSFIELD	CA	93311	9503	00	06000	35.352648	-119.1122505	Kern County
292498	Non-Physician Medical Practitioner	None	1215219365	0	0	LUM, JESSICA MAY	12/4/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15725 WHITTIER BLVD	SUITE 250	WHITTIER	CA	90603	2347	00	06000	33.94435533	-117.9931159	Los Angeles County
292503	Non-Physician Medical Practitioner	None	1891865747	0	0	LA, PHUONG ANH THI	5/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2071 COMPTON AVE	SUITE 102	CORONA	CA	92881	7278	00	06000	33.848487	-117.5361705	Riverside County
292545	Non-Physician Medical Practitioner	None	1487017372	0	0	LEW, NICOLE J NP	8/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2319 FALLWATER LN	None	CARMICHAEL	CA	95608	7400	00	06000	38.608857	-121.3398405	Sacramento County
292549	Non-Physician Medical Practitioner	None	1669218095	0	0	LEMOINE, ALIESE A PA	8/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
292574	Non-Physician Medical Practitioner	None	1649444852	0	0	LAYTON, DEBORAH C NP	6/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31955 MIRADA CIR	None	MURRIETA	CA	92563	3241	00	06000	33.56606743	-117.1023555	Riverside County
292589	Non-Physician Medical Practitioner	None	1336858604	0	0	LE, LARRY PA	7/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10880 WILSHIRE BLVD	1101	LOS ANGELES	CA	90024	4112	00	06000	34.05897499	-118.4431123	Los Angeles County
292593	Non-Physician Medical Practitioner	None	1043979362	0	0	LEE, JASMINE H PA-C	6/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2823 FRESNO ST	None	FRESNO	CA	93721	1324	00	06000	36.7423511	-119.7834688	Fresno County
292621	Non-Physician Medical Practitioner	None	1407263288	0	0	LEW, BRANDON W G	11/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8240 E RUSH ST	UNIT E	ROSEMEAD	CA	91770	3650	00	06000	34.05156254	-118.0891665	Los Angeles County
292655	Non-Physician Medical Practitioner	None	1194716415	0	0	LARKIN, HILLARY JANE	5/1/1999	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
292660	Non-Physician Medical Practitioner	None	1881070407	0	0	LYAPIN, ALEXEY V NP	9/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	585 SHELL PKWY	STE 5204	REDWOOD CITY	CA	94065	1729	00	06000	37.53427978	-122.2429266	San Mateo County
292673	Non-Physician Medical Practitioner	None	1689331126	0	0	LUCACI, BIANCA R NP	9/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29826 HAUN ROAD	SUITE 203	MENIFEE	CA	92586	6547	00	06000	33.68719818	-117.1748757	Riverside County
292701	Non-Physician Medical Practitioner	None	1972734366	0	0	LOPEZ, MARILYN GRACE	9/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	SUMC - PEDS PHYSICIAN BI	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
292719	Non-Physician Medical Practitioner	None	1720726680	0	0	LUU, DUONG PA	1/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
292757	Non-Physician Medical Practitioner	None	1578030961	0	0	LINK-HERRERA, JULIA R PA	11/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	726 4TH ST	None	MARYSVILLE	CA	95901	5656	00	06000	39.13872267	-121.5944372	Yuba County
292771	Non-Physician Medical Practitioner	None	1801284096	0	0	LUMBOY, CHARLES V D NP	1/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1575 MANZANITA AVE	None	SAN LEANDRO	CA	94579	1325	00	06000	37.69451101	-122.1588205	Alameda County
292845	Non-Physician Medical Practitioner	None	1003686155	0	0	LAI-NGUYEN, THAIBINH P PA-C	4/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	00	06000	37.66508443	-120.9962589	Stanislaus County
292872	Non-Physician Medical Practitioner	None	1962025346	0	0	LANDA, EVE J PA	9/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5215 TORRANCE BLVD	STE 300	TORRANCE	CA	90503	4009	00	06000	33.83760237	-118.3692467	Los Angeles County
292899	Non-Physician Medical Practitioner	None	1124575261	0	0	LELLA, MARGO NP	9/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	00	06000	37.36269	-118.407312	Inyo County
292942	Non-Physician Medical Practitioner	None	1386374692	0	0	LEE, JIYOON NP	9/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	00	06000	37.36797679	-122.0297112	Santa Clara County
292957	Non-Physician Medical Practitioner	None	1487345773	0	0	LEENDERS, KRISTINE M NP	2/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1180 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4857	00	06000	33.839505	-116.5455735	Riverside County
292967	Non-Physician Medical Practitioner	None	1407530546	0	0	LATIFI, SAMAN	10/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2545 W HAMMER LN	None	STOCKTON	CA	95209	2839	00	06000	38.0214303	-121.3461515	San Joaquin County
292968	Non-Physician Medical Practitioner	None	1528756459	0	0	LOCKMAN, ABIGAIL R PA	1/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	101B 102B 104B 106B 108B	LOMA LINDA	CA	92354	3128	00	06000	34.04805253	-117.249534	San Bernardino County
292998	Non-Physician Medical Practitioner	None	1770096414	0	0	LONG, HALEY J	12/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22215 WILOW ST	None	FLORISTAN	CA	96111	4524	00	06000	39.395178	-120.021201	Nevada County
293030	Non-Physician Medical Practitioner	None	1396834578	0	0	LEE, ANN M CNP	1/23/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	00	06000	38.65716	-121.1738175	Sacramento County
293078	Non-Physician Medical Practitioner	None	1427514470	0	0	LUCRIDA, LIZLYN ROSE L NP	2/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 SCRIPPS DRIVE	STE 102	SACRAMENTO	CA	95825	6206	00	06000	38.573181	-121.4118135	Sacramento County
293082	Non-Physician Medical Practitioner	None	1164912267	0	0	LEE, ALICE K NP	5/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
293088	Non-Physician Medical Practitioner	None	1427701572	0	0	LEBRAY, KORYLEA NP	8/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	00	06000	33.94354395	-117.394926	Riverside County
293090	Non-Physician Medical Practitioner	None	1689212482	0	0	LICCIARDELLO, MEGHAN PA	3/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5602 UNIVERSITY AVE	None	SAN DIEGO	CA	92105	2308	00	06000	32.7481088	-117.0743149	San Diego County
293096	Non-Physician Medical Practitioner	None	1386387090	0	0	LUSHANKO, CAILEY CRNA	6/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
293098	Non-Physician Medical Practitioner	None	1205504842	0	0	LU, NINA NP	8/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1220 LAS TABLAS RD	SUITE 1418	TEMPLETON	CA	93465	9756	00	06000	35.55442452	-120.7211175	San Luis Obispo County
293144	Non-Physician Medical Practitioner	None	1356747067	0	0	LOUIE, MICHAEL B PA-C	10/2/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
293156	Non-Physician Medical Practitioner	None	1295170298	0	0	LE, HONGAN B NP	8/17/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5830 LAGUNA TRAIL WAY	None	ELK GROVE	CA	95758	4739	00	06000	38.421108	-121.435542	Sacramento County
293159	Non-Physician Medical Practitioner	None	1174876585	0	0	LIM, JUSTINE	2/27/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
293162	Non-Physician Medical Practitioner	None	1851131114	0	0	LEE, JUNGSOO	7/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3114 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	00	06000	34.02383346	-118.137193	Los Angeles County
293163	Non-Physician Medical Practitioner	None	1285185512	0	0	LAUER, MICHELLE J PA	7/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
293168	Non-Physician Medical Practitioner	None	1861024671	0	0	LEUNG, AGNES N PA-C	2/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	455 OCONNOR DR	SUITE 210	SAN JOSE	CA	95128	1633	00	06000	37.326654	-121.939897	Santa Clara County
293180	Non-Physician Medical Practitioner	None	1689779159	0	0	LIPTON, LISA B	8/31/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5301 F ST	#220	SACRAMENTO	CA	95819	3226	00	06000	38.571354	-121.4368695	Sacramento County
293184	Non-Physician Medical Practitioner	None	1811774276	0	0	LAVOISE, JESSICA J PA	4/1/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
293187	Non-Physician Medical Practitioner	None	1841301363	0	0	LIU, BARBARA CHING-MAN	11/17/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
293198	Non-Physician Medical Practitioner	None	1073663985	0	0	LANE, GINGER	11/23/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	10104 DRYFORK AVE	None	LAS VEGAS	NV	89129	8121	00	06000	36.22353851	-115.316649	Clark County
293225	Non-Physician Medical Practitioner	None	1932297470	0	0	LAGOMARSINO, MARGARET	4/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	800 SERENO DRIVE	None	VALLEJO	CA	94589	2411	00	06000	38.12792924	-122.2506587	Solano County
293239	Non-Physician Medical Practitioner	None	1164206710	0	0	LITHGOW, TERESA NP	9/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	334 VIA VERA CRUZ	SUITE 251	SAN MARCOS	CA	92078	2642	00	06000	33.13698477	-117.1888034	San Diego County
293246	Non-Physician Medical Practitioner	None	1609280346	0	0	LOS ANGELES COMMUNITY CLINIC, INC.	7/15/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1830 W OLYMPIC BLVD	SUITE 124	LOS ANGELES	CA	90006	3734	00	06000	34.05055886	-118.2773468	Los Angeles County
293248	Non-Physician Medical Practitioner	None	1942574967	0	0	LULICH, KRISTIN M CNP	6/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
293250	Non-Physician Medical Practitioner	None	1912300344	0	0	LIVESEY, AMBERLEE D	7/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	551 BLUE MEADOW COURT	None	BAKERSFIELD	CA	93308	9259	00	06000	35.44047551	-119.032155	Kern County
293251	Non-Physician Medical Practitioner	None	1679012223	0	0	LEE, MINDY A NP	11/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
293268	Non-Physician Medical Practitioner	None	1437287315	0	0	LEE, WILLIAM J	10/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	880 LA MIRADA ST	None	LAGUNA BEACH	CA	92651	3753	00	06000	33.528123	-117.7609735	Orange County
293272	Non-Physician Medical Practitioner	None	1952577520	0	0	LIANG, JAYCE T D NP	8/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11641 NELSON STREET	None	LOMA LINDA	CA	92354	3716	00	06000	34.04205657	-117.2401614	San Bernardino County
293283	Non-Physician Medical Practitioner	None	1447925029	0	0	LE, JOCELYN H PA-C	9/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	00	06000	34.13502	-117.2758635	San Bernardino County
293308	Non-Physician Medical Practitioner	None	1609358019	0	0	LOWRY, SARAH E NP	11/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
293321	Non-Physician Medical Practitioner	None	1457719320	0	0	LOWERY, TASHA N M NP	8/9/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	402 GLENWOOD DRIVE	None	BIG BEAR LAKE	CA	92315	1619	00	06000	34.25664231	-116.8703187	San Bernardino County
293331	Non-Physician Medical Practitioner	None	1831661537	0	0	LIN, SHAN JU NP	3/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
293335	Non-Physician Medical Practitioner	None	1528712247	0	0	LIU, JOYCE S PA-C	5/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	00	06000	34.062852	-117.9446658	Los Angeles County
293379	Non-Physician Medical Practitioner	None	1073009734	0	0	LEBADA, NAJWA PA-C	8/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11100 WARNER AVENUE	SUITE 206	FOUNTAIN VALLEY	CA	92708	7511	00	06000	33.716291	-117.9355051	Orange County
293389	Non-Physician Medical Practitioner	None	1811493075	0	0	LAU, ALICE NP	1/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 S. SAN MATEO DR.	None	SAN MATEO	CA	94401	3805	00	06000	37.5656736	-122.3254527	San Mateo County
293397	Non-Physician Medical Practitioner	None	1649260944	0	0	LYNN, OWINGS J	5/9/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2025 MORSE AVE	NEUROSURGERY DEPARTMENT	SACRAMENTO	CA	95825	2115	00	06000	38.602089	-121.3925895	Sacramento County
293427	Non-Physician Medical Practitioner	None	1669738225	0	0	LEE, MARK J PA-C	9/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 CESAR E CHAVEZ AVE	STE 2200	LOS ANGELES	CA	90033	2476	00	06000	34.05101259	-118.217259	Los Angeles County
293428	Non-Physician Medical Practitioner	None	1720527336	0	0	LAKE, KRISTEN N NP	10/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2110 PROFESSIONAL DR	STE 120	ROSEVILLE	CA	95661	3779	00	06000	38.74234873	-121.2521259	Placer County
293449	Non-Physician Medical Practitioner	None	1669875142	0	0	LACY, CLAUDIA PA	9/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27200 CALAROGA	None	HAYWARD	CA	94545	4339	00	06000	37.63347961	-122.0897735	Alameda County
293459	Non-Physician Medical Practitioner	None	1952776759	0	0	LACOMBE, JEAN PA-C	4/30/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	191 E ALESSANDRO BLVD	9A	RIVERSIDE	CA	92508	5095	00	06000	33.91628074	-117.3284633	Riverside County
293470	Non-Physician Medical Practitioner	None	1164971131	0	0	LARRY, JANINE G NP	10/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
293490	Non-Physician Medical Practitioner	None	1447247820	0	0	LEVITT, MIRIAM NP	10/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2258 W BIRCH AVENUE	None	FRESNO	CA	93711	7120	00	06000	36.84135787	-119.8321678	Fresno County
293497	Non-Physician Medical Practitioner	None	1962421115	0	0	LIP, STACEY W	10/21/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE 1100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
293509	Non-Physician Medical Practitioner	None	1225465230	0	0	LAGUNAS, SAMUEL J	3/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	715 S INDIANA ST	None	ANAHEIM	CA	92805	5554	00	06000	33.82471806	-117.9225316	Orange County
293533	Non-Physician Medical Practitioner	None	1578590717	0	0	LANIER, JAME Z	3/17/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26625 DEL ROSA DR	None	HEMET	CA	92544	7566	00	06000	33.7353602	-116.9296981	Riverside County
293539	Non-Physician Medical Practitioner	None	1689110322	0	0	LEUNG, CYNTHIA H NP	8/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1447 CEDARWOOD LANE	STE A	PLEASANTON	CA	94566	6175	00	06000	37.67102566	-121.8742221	Alameda County
293542	Non-Physician Medical Practitioner	None	1457607517	0	0	LEE, SARAH K NP	1/30/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	219 W SPARKLEBERRY AVENU	None	ORANGE	CA	92865	5011	00	06000	33.83982987	-117.8530477	Orange County
293552	Non-Physician Medical Practitioner	None	1548917685	0	0	LOPEZ RIVERA, AMY M PA-C	10/9/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10590 TOWN CENTER DR	170	RANCHO CUCAMONGA	CA	91730	0360	00	06000	34.11101693	-117.5740616	San Bernardino County
293557	Non-Physician Medical Practitioner	None	1952138893	0	0	LAING, CARRIE NP	10/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1508 ALHAMBRA BLVD	200	SACRAMENTO	CA	95816	6510	00	06000	38.567007	-121.468068	Sacramento County
293574	Non-Physician Medical Practitioner	None	1043061971	0	0	LE FLORE, NADIA	5/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1690 BARTON RD	2ND FLOOR	REDLANDS	CA	92373	4229	00	06000	34.04836346	-117.2125293	San Bernardino County
293576	Non-Physician Medical Practitioner	None	1740954536	0	0	LOPEZ, TIESE	12/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
293588	Non-Physician Medical Practitioner	None	1326174939	0	0	LUCHEMBE, RITA S	5/29/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12021 WILMINGTON AVE	None	LOS ANGELES	CA	90059	3019	00	06000	33.922863	-118.2431655	Los Angeles County
293640	Non-Physician Medical Practitioner	None	1336784586	0	0	LANE, AMANDA NP	3/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	00	06000	34.148637	-118.4312035	Los Angeles County
293644	Non-Physician Medical Practitioner	None	1053358044	0	0	LARKIN, SUZANNE CLARA	4/7/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 E ANAHEIM ST	None	WILMINGTON	CA	90744	4516	00	06000	33.78003976	-118.2608958	Los Angeles County
293663	Non-Physician Medical Practitioner	None	1285459941	0	0	LOPEZ, CRISTINA NP	12/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	504 S SIERRA MADRE BLVD	None	PASADENA	CA	91107	5240	00	06000	34.137603	-118.101464	Los Angeles County
293664	Non-Physician Medical Practitioner	None	1548681075	0	0	LEWIS, RACHEL R NP	2/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	33965 GOLDEN CROWN WAY	None	YUCAIPA	CA	92399	6965	00	06000	34.0436339	-117.0633744	San Bernardino County
293677	Non-Physician Medical Practitioner	None	1609272699	0	0	LEE, MICHELLE J	5/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	688 S BERENDO ST	SUITE 206	LOS ANGELES	CA	90005	1773	00	06000	34.0602861	-118.2941174	Los Angeles County
293687	Non-Physician Medical Practitioner	None	1417590092	0	0	LASONDE, BRIAN F PA	10/31/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
293688	Non-Physician Medical Practitioner	None	1760596076	0	0	LORCH, LYNNETTE ANN	4/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
293695	Non-Physician Medical Practitioner	None	1720243454	0	0	LA CLINICA DE LA RAZA, INC.	2/10/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	220 HOSPITAL DR	None	VALLEJO	CA	94589	2517	00	06000	38.13109785	-122.238998	Solano County
293709	Non-Physician Medical Practitioner	None	1497245138	0	0	LOPEZ, JASON	11/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	519 E 20TH ST	None	SANTA ANA	CA	92706	2903	00	06000	33.76252798	-117.8618551	Orange County
293712	Non-Physician Medical Practitioner	None	1154724052	0	0	LARSON, BRETT L	1/26/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14 MONARCH BAY PLAZA	APT 122	DANA POINT	CA	92629	3467	00	06000	33.48495723	-117.7237206	Orange County
293743	Non-Physician Medical Practitioner	None	1568715324	0	0	LIM, HENGKY NP	9/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	37255 KINGCUP TER	None	PALMDALE	CA	93551	6231	00	06000	34.55933904	-118.1679155	Los Angeles County
293753	Non-Physician Medical Practitioner	None	1558570085	0	0	LOPEZ-ZEPEDA, THERESA	11/24/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	69175 RAMON RD BLDG A	None	CATHEDRAL CITY	CA	92234	3344	00	06000	33.813621	-116.456193	Riverside County
293780	Non-Physician Medical Practitioner	None	1023663762	0	0	LAI, MICHELLE PA	11/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	00	06000	37.9611947	-121.3009489	San Joaquin County
293815	Non-Physician Medical Practitioner	None	1174119598	0	0	LUO, KERY J PA-C	10/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1205 E NORTH STREET	None	MANTECA	CA	95336	4932	00	06000	37.80110374	-121.1974853	San Joaquin County
293824	Non-Physician Medical Practitioner	None	1639840390	0	0	LIEN, KATHY NP	10/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	00	06000	37.51438187	-122.2607682	San Mateo County
293830	Non-Physician Medical Practitioner	None	1407968712	0	0	LY, THUC N PA-C	5/27/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	876 N MIGUEL RD	None	WALNUT	CA	91789	0000	00	06000	34.02846817	-117.8760746	Los Angeles County
293874	Non-Physician Medical Practitioner	None	1033358908	0	0	LEVEQUE, HEATHER S NP	12/31/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	74 BISHOP ROAD	None	CROCKETT	CA	94525	1514	00	06000	38.0521743	-122.2116169	Contra Costa County
293875	Non-Physician Medical Practitioner	None	1548801459	0	0	LU, KELLY PA-C	7/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2734 EL CAMINO REAL	None	SANTA CLARA	CA	95051	3007	00	06000	37.35228637	-121.9754073	Santa Clara County
293917	Non-Physician Medical Practitioner	None	1083302541	0	0	LANZILLO, ALBERT PA	12/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	00	06000	33.78034779	-117.8655767	Orange County
293939	Non-Physician Medical Practitioner	None	1740531706	0	0	LIMBURG, KRISTA D	11/16/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25215 CARANCHO RD	None	TEMECULA	CA	92590	4078	00	06000	33.47042208	-117.2320857	Riverside County
293996	Non-Physician Medical Practitioner	None	1013654482	0	0	LAYVAS, CORY M NP	10/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
294021	Non-Physician Medical Practitioner	None	1215054374	0	0	LAM, ADELYNE M	5/23/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	507 N MCPHERRIN AVE	None	MONTEREY PARK	CA	91754	1133	00	06000	34.06776163	-118.1276437	Los Angeles County
294022	Non-Physician Medical Practitioner	None	1811462088	0	0	LOMIBAO, JACQUELINE C NP	6/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
294024	Non-Physician Medical Practitioner	None	1528433588	0	0	LIVINGSTON COMMUNITY HEALTH	9/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12619 BENTLEY ST	None	WATERFORD	CA	95386	9011	00	06000	37.64073442	-120.7613165	Stanislaus County
294027	Non-Physician Medical Practitioner	None	1932787330	0	0	LUPIAN, JOSE A NP	5/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	00	06000	33.49890392	-117.1612965	Riverside County
294042	Non-Physician Medical Practitioner	None	1083938161	0	0	LEW, JULIENNE NP	9/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
294048	Non-Physician Medical Practitioner	None	1689432320	0	0	LONAPPAN, HENA T PA-C	4/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26024 ACERO	None	MISSION VIEJO	CA	92691	2768	00	06000	33.61784172	-117.6769661	Orange County
294053	Non-Physician Medical Practitioner	None	1568151090	0	0	LOERA, JANETTE NP	8/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7035 N MAPLE AVE	102A	FRESNO	CA	93720	8027	00	06000	36.83856379	-119.7452911	Fresno County
294062	Non-Physician Medical Practitioner	None	1386027373	0	0	LANGLEY, MARYELLEN M NP	4/7/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	930 N MUHLENBERG ST	None	ALLENTOWN	PA	18104	3623	00	06000	40.60590675	-75.51449454	Lehigh County
294098	Non-Physician Medical Practitioner	None	1154650927	0	0	LEAVENS, JENNIFER M NP	1/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	981 GEORGETOWN AVE	None	TURLOCK	CA	95382	0849	00	06000	37.51828379	-120.860687	Stanislaus County
294119	Non-Physician Medical Practitioner	None	1508881574	0	0	LEE, JAY PUN	12/15/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23785 EL TORO RD	SUITE 609	LAKE FOREST	CA	92630	4762	00	06000	33.6165367	-117.7056695	Orange County
294124	Non-Physician Medical Practitioner	None	1275055972	0	0	LEE, MICHELLE K NP	12/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	00	06000	37.51438187	-122.2607682	San Mateo County
294144	Non-Physician Medical Practitioner	None	1619482098	0	0	LLORICO, DIANNE B NP	2/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 CORPORATE POINTE	STE 465	CULVER CITY	CA	90230	8706	00	06000	33.98867148	-118.3837334	Los Angeles County
294160	Non-Physician Medical Practitioner	None	1184902900	0	0	LE, DUYPHUONG L NP	8/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10390 COLOMA AVENUE	B	RANCHO CORDOVA	CA	95670	2152	00	06000	38.596176	-121.3042725	Sacramento County
294215	Non-Physician Medical Practitioner	None	1790073252	0	0	LI, ZHENBO	6/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	711 W ADAMS STREET	None	BLACK RIVER FALLS	WI	54615	9108	00	06000	44.30238521	-90.8551325	Jackson County
294218	Non-Physician Medical Practitioner	None	1093087306	0	0	LARRY, JAMON PA	7/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
294219	Non-Physician Medical Practitioner	None	1043649163	0	0	LOPEZ, ERIN E	10/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	700 E COTATI AVE	None	COTATI	CA	94931	4032	00	06000	38.33006033	-122.6959291	Sonoma County
294244	Non-Physician Medical Practitioner	None	1649844812	0	0	LEE, LISA PA-C	10/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	00	06000	37.36797679	-122.0297112	Santa Clara County
294254	Non-Physician Medical Practitioner	None	1083686901	0	0	LONG, GENEVIEVE A PA-C	12/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	00	06000	33.83753681	-116.5424435	Riverside County
294296	Non-Physician Medical Practitioner	None	1578897591	0	0	LAU, JENIVI M	7/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24712 ROLLINGWOOD RD	None	LAKE FOREST	CA	92630	3120	00	06000	33.63681935	-117.6994745	Orange County
294301	Non-Physician Medical Practitioner	None	1093201568	0	0	LECOMTE, TRINH NP	7/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1792 TRIBUTE RD	200	SACRAMENTO	CA	95815	4305	00	06000	38.598219	-121.445964	Sacramento County
294322	Non-Physician Medical Practitioner	None	1558880062	0	0	LI, YANXIA	6/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5555 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	4000	00	06000	37.69212528	-121.8803442	Alameda County
294340	Non-Physician Medical Practitioner	None	1154655504	0	0	LABRUM, JENNIFER L PA	5/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	00	06000	37.89281357	-122.0598728	Contra Costa County
294358	Non-Physician Medical Practitioner	None	1497263867	0	0	LISKIN, REBECCA F NP	3/6/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12 CAMINO ENCINAS	None	ORINDA	CA	94563	3304	00	06000	37.87679015	-122.1800856	Contra Costa County
294398	Non-Physician Medical Practitioner	None	1508307695	0	0	LAFFERTY, ELIZABETH PA	6/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19066 MAGNOLIA ST	None	HUNTINGTON BEACH	CA	92646	2232	00	06000	33.68568661	-117.9714001	Orange County
294402	Non-Physician Medical Practitioner	None	1548735715	0	0	LOPEZ, VIRGINIA A NP	10/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3298	00	06000	33.78674051	-117.8888713	Orange County
294406	Non-Physician Medical Practitioner	None	1134232465	0	0	LAM, VIRGINIA HM	3/20/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1242 ULUNAHELE ST	None	KAILUA	HI	96734	4338	00	06000	21.38298563	-157.7510932	Honolulu County
294407	Non-Physician Medical Practitioner	None	1770681165	0	0	LIM, SANG-SUK R NP	11/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9231 CATHWELL LANE	None	TUJUNGA	CA	91042	3320	00	06000	34.23701077	-118.2779685	Los Angeles County
294414	Non-Physician Medical Practitioner	None	1760459622	0	0	LEPORE, DANIEL J	11/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	477 N EL CAMINO REAL	STE A202	ENCINITAS	CA	92024	0000	00	06000	33.05700866	-117.262449	San Diego County
294450	Non-Physician Medical Practitioner	None	1598382806	0	0	LANMAN, JESSICA B PA	10/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
294462	Non-Physician Medical Practitioner	None	1801310552	0	0	LIU, JAMIE K PA-C	3/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9210 COLIMA ROAD	STE. 108	WHITTIER	CA	90605	1829	00	06000	33.94990465	-118.0056421	Los Angeles County
294466	Non-Physician Medical Practitioner	None	1437423506	0	0	LUONG, THUY D NP	2/17/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12841 FOREST DR	UNIT C	GARDEN GROVE	CA	92840	6529	00	06000	33.77632274	-117.9106141	Orange County
294470	Non-Physician Medical Practitioner	None	1215331913	0	0	LI, TRUDIE C NP	8/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 IRENE AVE	None	ROSEVILLE	CA	95618	3228	00	06000	38.74194092	-121.2866287	Placer County
294472	Non-Physician Medical Practitioner	None	1346003167	0	0	LE, THI AN HAO	3/21/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1245 WILSHIRE BLVD	STE 303	LOS ANGELES	CA	90017	4803	00	06000	34.05362775	-118.2661889	Los Angeles County
294493	Non-Physician Medical Practitioner	None	1902596232	0	0	LIMFAT, ALLISON PA	8/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	438 W LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	00	06000	34.10243051	-118.105902	Los Angeles County
294511	Non-Physician Medical Practitioner	None	1346306917	0	0	LAVALLEY, CHEROKEE LYNETTE	1/22/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10024 S VERMONT AVE	None	LOS ANGELES	CA	90044	3112	00	06000	33.944832	-118.291573	Los Angeles County
294602	Non-Physician Medical Practitioner	None	1508923814	0	0	LEVINSON, TERESA	1/9/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5168 HONPIE RD	None	PLACERVILLE	CA	95667	8635	00	06000	38.6943603	-120.9018271	El Dorado County
294613	Non-Physician Medical Practitioner	None	1922101922	0	0	LEE, MARGE	6/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2772 KALAMER ST	None	SACRAMENTO	CA	95835	1554	00	06000	38.6793958	-121.5272399	Sacramento County
294680	Non-Physician Medical Practitioner	None	1144698721	0	0	LUO, CINDY	12/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	82 LOIS LANE	None	SAN FRANCISCO	CA	94134	2460	00	06000	37.71330711	-122.3980113	San Francisco County
294692	Non-Physician Medical Practitioner	None	1609435940	0	0	LUGATIMAN PALMA, DIVA CHRISTY	10/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
294705	Non-Physician Medical Practitioner	None	1417924499	0	0	LODGE, SANDRA PA-C	11/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
294716	Non-Physician Medical Practitioner	None	1689391336	0	0	LEIMBACH, DANIELLE N PA	1/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	00	06000	34.04805253	-117.249534	San Bernardino County
294721	Non-Physician Medical Practitioner	None	1407829773	0	0	LA JOLLA ENDOSCOPY CENTER LP	12/1/1999	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9850 GENESEE AVE	SUITE 980	LA JOLLA	CA	92037	1234	00	06000	32.882913	-117.226341	San Diego County
294742	Non-Physician Medical Practitioner	None	1659808376	0	0	LUCATERO, JENNIFER A PA-C	11/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1777 BENEDICT WAY	None	POMONA	CA	91767	3505	00	06000	34.07745474	-117.7227681	Los Angeles County
294753	Non-Physician Medical Practitioner	None	1184248650	0	0	LESLIE, HAYDEN N PA-C	11/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
294773	Non-Physician Medical Practitioner	None	1689317794	0	0	LEE, KEVIN J PA	10/31/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
294818	Non-Physician Medical Practitioner	None	1205131356	0	0	LAW, LINDSEY N PA-C	8/29/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
294823	Non-Physician Medical Practitioner	None	1407515224	0	0	LEE, ELIZABETH PA-C	11/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 CESAR E CHAVEZ AVE	STE 2200	LOS ANGELES	CA	90033	2476	00	06000	34.05101259	-118.217259	Los Angeles County
294828	Non-Physician Medical Practitioner	None	1295265981	0	0	LEINS, SARAH A PA-C	9/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
294830	Non-Physician Medical Practitioner	None	1053763284	0	0	LOOMIS, REILLY O PA-C	5/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
294833	Non-Physician Medical Practitioner	None	1285075804	0	0	LY, MICHELLE NP	12/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
294858	Non-Physician Medical Practitioner	None	1770986671	0	0	LANDGREBE, RACHEL A G NP	12/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1148 DAVIS ST	None	REDWOOD CITY	CA	94061	2239	00	06000	37.47482179	-122.2292786	San Mateo County
294865	Non-Physician Medical Practitioner	None	1639389497	0	0	LANNI-BRUTON, MARIA L	7/26/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4437 MAYCREST AVE	None	LOS ANGELES	CA	90032	1301	00	06000	34.09724554	-118.1613866	Los Angeles County
294879	Non-Physician Medical Practitioner	None	1831744382	0	0	LANGAEE, TINA PA-C	3/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	631 S BROOKHURST ST	SUITE # 101	ANAHEIM	CA	92804	3510	00	06000	33.823647	-117.9589675	Orange County
294883	Non-Physician Medical Practitioner	None	1558954636	0	0	LE, CHRISTOPHER B PA	1/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
294893	Non-Physician Medical Practitioner	None	1528427994	0	0	LANE, NATHANIEL G	12/13/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22742 FOXBOROUGH WAY	None	LAKE FOREST	CA	92630	5013	00	06000	33.6327758	-117.6822373	Orange County
294902	Non-Physician Medical Practitioner	None	1578001640	0	0	LEE, VALERIE K	1/15/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8312 BELLHAVEN ST	None	LA PALMA	CA	90623	1915	00	06000	33.8414493	-118.0497589	Orange County
294910	Non-Physician Medical Practitioner	None	1053881748	0	0	LAU, MELANIE PA	4/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
294930	Non-Physician Medical Practitioner	None	1982204590	0	0	LEWIS, GABRIELLE	1/13/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
294942	Non-Physician Medical Practitioner	None	1003106386	0	0	LIM, MARLENE SOLOMON	4/9/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5755 E KINGS CANYON RD	SUITE 104	FRESNO	CA	93727	4744	00	06000	36.7362951	-119.6933795	Fresno County
294964	Non-Physician Medical Practitioner	None	1750930129	0	0	LA, JESSICA PA	5/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	00	06000	34.13489987	-118.0424069	Los Angeles County
294966	Non-Physician Medical Practitioner	None	1437692753	0	0	LI, YING S	2/13/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	62 STRATUS LN	None	TUSTIN	CA	92782	6527	00	06000	33.70455792	-117.8035939	Orange County
294989	Non-Physician Medical Practitioner	None	1720663701	0	0	LOUIS, DOMONIQUE NP	5/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	00	06000	37.89859467	-122.0843018	Contra Costa County
295001	Non-Physician Medical Practitioner	None	1134475148	0	0	LEE, YASMINE S NP	7/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	151 CALDERON AVE	APT 279	MOUNTAIN VIEW	CA	94041	1460	00	06000	37.39134094	-122.0718038	Santa Clara County
295005	Non-Physician Medical Practitioner	None	1861866550	0	0	LE, TONYA F NP	3/30/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4381 GUNDRY AVE	None	LONG BEACH	CA	90807	2532	00	06000	33.837615	-118.173839	Los Angeles County
295013	Non-Physician Medical Practitioner	None	1003060898	0	0	LEVINE, DAVID W	12/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	00	06000	33.9760587	-117.3800672	Riverside County
295049	Non-Physician Medical Practitioner	None	1891707618	0	0	LACHAPELLE, BRIAN K PA	10/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
295056	Non-Physician Medical Practitioner	None	1235503814	0	0	LOKIE GOMEZ, JACQUELINE PA	3/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	729 N MEDICAL CENTER DRI	223	CLOVIS	CA	93611	6879	00	06000	36.84152435	-119.6624818	Fresno County
295060	Non-Physician Medical Practitioner	None	1932719762	0	0	LAT, ANGELICA NP	11/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
295083	Non-Physician Medical Practitioner	None	1457062416	0	0	LAWRENCE, SHAWN M PA	1/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	00	06000	34.1010559	-117.6369445	San Bernardino County
295090	Non-Physician Medical Practitioner	None	1740310531	0	0	LANCE, MICHAEL THOMAS	2/4/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8891 CENTRAL AVE	None	MONTCLAIR	CA	91763	1618	00	06000	34.092729	-117.6895115	San Bernardino County
295116	Non-Physician Medical Practitioner	None	1639546054	0	0	LAM, HAI HOANG P NP	1/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4529 MYRTLE AVE	None	SAN DIEGO	CA	92105	3528	00	06000	32.74209153	-117.0970785	San Diego County
295160	Non-Physician Medical Practitioner	None	1588496194	0	0	LIZARRAGA SIKIC, ANDREA K NP	8/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
295172	Non-Physician Medical Practitioner	None	1932983244	0	0	LUONG, SIDNEY PA-C	2/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24411 HEALTH CENTER DR	SUITE 350	LAGUNA HILLS	CA	92653	3687	00	06000	33.6087201	-117.7076948	Orange County
295199	Non-Physician Medical Practitioner	None	1598254468	0	0	LIM, JOHNNY PA-C	4/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	707 S GARFIELD AVE	None	ALHAMBRA	CA	91801	5859	00	06000	34.088688	-118.123106	Los Angeles County
295222	Non-Physician Medical Practitioner	None	1083493712	0	0	LI, CHUN W NP	12/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	603 E LATHAM AVE	None	HEMET	CA	92543	4342	00	06000	33.74933852	-116.96598	Riverside County
295243	Non-Physician Medical Practitioner	None	1811439979	0	0	LUEPHANG, SHELLEY E	2/15/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	8515 OOLTEWAH GEORGETOWN	None	OOLTEWAH	TN	37363	9581	00	06000	35.15971556	-85.03628326	Hamilton County
295247	Non-Physician Medical Practitioner	None	1619563673	0	0	LATAP, REY JOHN R NP	8/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
295274	Non-Physician Medical Practitioner	None	1225011752	0	0	LEFEVRE, KATHLEEN PATRICIA	12/16/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 MARTIN LUTHER KING	None	OAKLAND	CA	94612	1318	00	06000	37.81192328	-122.2730188	Alameda County
295292	Non-Physician Medical Practitioner	None	1811396500	0	0	LIPSKY, RACHEL S	7/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7660 BEVERLY BLVD	RANGE 1-134	LOS ANGELES	CA	90036	2734	00	06000	34.07611353	-118.3568424	Los Angeles County
295295	Non-Physician Medical Practitioner	None	1811531361	0	0	LLOYD, DEBRA L NP	11/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	120 BIRMINGHAM DRIVE	240A	CARDIFF BY THE SE	CA	92007	1757	00	06000	33.02310224	-117.2826142	San Diego County
295302	Non-Physician Medical Practitioner	None	1912023177	0	0	LOUGHRAN, COLLEEN M	9/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5660 PICASSO DR	None	YORBA LINDA	CA	92887	5606	00	06000	33.87697077	-117.710384	Orange County
295315	Non-Physician Medical Practitioner	None	1649770785	0	0	LIN, HUNG-FU NP	10/30/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
295316	Non-Physician Medical Practitioner	None	1417637646	0	0	LE, KRISTINE NP	9/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11100 WARNER AVE	STE 368	FOUNTAIN VALLEY	CA	92708	7514	00	06000	33.716291	-117.9355051	Orange County
295338	Non-Physician Medical Practitioner	None	1336279785	0	0	LINDAHL, SARAH H	4/14/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19845 LAKE CHABOT RD	SUITE #302	CASTRO VALLEY	CA	94546	4055	00	06000	37.69995352	-122.087795	Alameda County
295346	Non-Physician Medical Practitioner	None	1972817138	0	0	LE, CHINH T NP	6/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9243 ALMONDWILLOW WAY	None	ELK GROVE	CA	95624	5402	00	06000	38.422566	-121.344768	Sacramento County
295352	Non-Physician Medical Practitioner	None	1518362466	0	0	LYND, KELSEY L NP	12/26/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1610 CALIFORNIA ST	APT 2	MOUNTAIN VIEW	CA	94041	2912	00	06000	37.39498535	-122.0897879	Santa Clara County
295355	Non-Physician Medical Practitioner	None	1346601887	0	0	LE, JESSICA U	4/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4089 CRANFORD CIRCLE	None	SAN JOSE	CA	95124	3304	00	06000	37.25417389	-121.9461003	Santa Clara County
295362	Non-Physician Medical Practitioner	None	1083009427	0	0	LESINSKI, THOMAS PA-C	10/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	00	06000	37.78956486	-122.417072	San Francisco County
295387	Non-Physician Medical Practitioner	None	1538417415	0	0	LEE, YOONAH	3/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	514 S CATALINA ST	APT 203	LOS ANGELES	CA	90020	2216	00	06000	34.06486964	-118.295363	Los Angeles County
295466	Non-Physician Medical Practitioner	None	1669829818	0	0	LEE, MINLI L NP	6/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	415 W CARROLL AVE	STE 100	GLENDORA	CA	91741	4208	00	06000	34.13420945	-117.870876	Los Angeles County
295468	Non-Physician Medical Practitioner	None	1710380654	0	0	LE, JASMINE T NP	1/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	632 GAYLAWN CT	None	LA PUENTE	CA	91744	3901	00	06000	34.03039058	-117.952271	Los Angeles County
295469	Non-Physician Medical Practitioner	None	1821744731	0	0	LE, APRIL C NP	12/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
295497	Non-Physician Medical Practitioner	None	1669526810	0	0	LANEY, ALISON JEANNE	12/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27303 SLEEPY HOLLOW AVEN	None	HAYWARD	CA	94545	4203	00	06000	37.63208871	-122.0939191	Alameda County
295514	Non-Physician Medical Practitioner	None	1912047820	0	0	LINDE, STEVEN MARK	1/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 MARSHALL WAY	None	PLACERVILLE	CA	95667	6533	00	06000	38.72453536	-120.7921649	El Dorado County
295518	Non-Physician Medical Practitioner	None	1740816552	0	0	LEGGETT, DREW	8/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	615 OCEAN ST	None	SANTA CRUZ	CA	95060	4005	00	06000	36.97734512	-122.0204895	Santa Cruz County
295554	Non-Physician Medical Practitioner	None	1205603149	0	0	LURSLURCHACHAI, POONLARP NP	1/6/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	480B TESCONI CIR	None	SANTA ROSA	CA	95401	4691	00	06000	38.44950583	-122.7351601	Sonoma County
295561	Non-Physician Medical Practitioner	None	1144565763	0	0	LEE, JENNIFER P NP	9/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2063 LEMONWOOD COURT	None	SAN RAMON	CA	94582	5218	00	06000	37.76670858	-121.9126968	Contra Costa County
295578	Non-Physician Medical Practitioner	None	1578796439	0	0	LIES, SHAWN C	11/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	766 HARRISON ST	APT 314	SAN FRANCISCO	CA	94107	1279	00	06000	37.78143761	-122.3988493	San Francisco County
295585	Non-Physician Medical Practitioner	None	1811477987	0	0	LIEBEL, TARALYN L NP	1/3/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3600 W FLAGSTAFF AVE	None	VISALIA	CA	93277	0000	00	06000	36.359649	-119.331567	Tulare County
295591	Non-Physician Medical Practitioner	None	1326562166	0	0	LEONORAS, ABIGAIL C NP	3/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2545 S BRUCE ST	STE 200	LAS VEGAS	NV	89169	1731	00	06000	36.143271	-115.1254975	Clark County
295610	Non-Physician Medical Practitioner	None	1275248403	0	0	LIPSCOMB, ELI R NP	2/26/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	00	06000	33.1857	-117.290538	San Diego County
295630	Non-Physician Medical Practitioner	None	1063259216	0	0	LIAO, KATHERINE PA	4/4/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
295654	Non-Physician Medical Practitioner	None	1467290403	0	0	LE, LUAN NP	3/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1760 TERMINO AVE	100	LONG BEACH	CA	90804	2182	00	06000	33.78889871	-118.1458784	Los Angeles County
295655	Non-Physician Medical Practitioner	None	1194948984	0	0	LUCAS, CHRISTINA	1/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3801 SACRAMENTO ST	SUITE 216	SAN FRANCISCO	CA	94118	1625	00	06000	37.78707021	-122.4555217	San Francisco County
295695	Non-Physician Medical Practitioner	None	1124306931	0	0	LIMLAHAPAN, VALEDA K NP	4/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3815 GEORGIA ST	106	SAN DIEGO	CA	92103	7614	00	06000	32.74754931	-117.1449428	San Diego County
295710	Non-Physician Medical Practitioner	None	1952701500	0	0	LESIN, DEBRA NP	11/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22801 PERA RD	None	WOODLAND HILLS	CA	91364	3836	00	06000	34.15435846	-118.623447	Los Angeles County
295740	Non-Physician Medical Practitioner	None	1477760635	0	0	LAVIN, BARBARA C NP	7/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
295749	Non-Physician Medical Practitioner	None	1013673680	0	0	LEYNES, CAROL L PA-C	1/31/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1313 W 8TH ST	STE 100	LOS ANGELES	CA	90017	4420	00	06000	34.05048998	-118.269586	Los Angeles County
295751	Non-Physician Medical Practitioner	None	1336122399	0	0	LACROIX, DIANE C NP	10/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	00	06000	33.1857	-117.290538	San Diego County
295757	Non-Physician Medical Practitioner	None	1164037644	0	0	LY, MATTHEW A NP	9/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
295763	Non-Physician Medical Practitioner	None	1407207905	0	0	LA, LESLIE V	3/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6805 N ROCKHOLD AVE	None	SAN GABRIEL	CA	91775	1033	00	06000	34.12270001	-118.0874598	Los Angeles County
295770	Non-Physician Medical Practitioner	None	1518742659	0	0	LINARES, EVELIN NP	11/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1491 E LA PALMA AVE	STE B	ANAHEIM	CA	92805	1564	00	06000	33.84730519	-117.8982466	Orange County
295797	Non-Physician Medical Practitioner	None	1154505402	0	0	LARAWAY, JUDD M PA-C	8/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
295833	Non-Physician Medical Practitioner	None	1962022160	0	0	LEVINGSTON, LAURA E NP	2/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8329 BRIMHALL RD	SUITE 801	BAKERSFIELD	CA	93312	2243	00	06000	35.366706	-119.0959425	Kern County
295878	Non-Physician Medical Practitioner	None	1093734568	0	0	LO, LING PA	11/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19582 BEACH BLVD	212	HUNTINGTON BEACH	CA	92648	5923	00	06000	33.67831649	-117.9885198	Orange County
295896	Non-Physician Medical Practitioner	None	1457718843	0	0	LIBBOS, THEA M PA-C	2/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
295911	Non-Physician Medical Practitioner	None	1023668290	0	0	LEYVA, MARIA F PA-C	1/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3701 BROADWAY	None	OAKLAND	CA	94611	5613	00	06000	37.82533768	-122.258094	Alameda County
295943	Non-Physician Medical Practitioner	None	1043405798	0	0	LAU LEE, JEANNIE W NP	8/7/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1920 E KATELLA AVE	STE M	ORANGE	CA	92867	5146	00	06000	33.80935	-117.8339093	Orange County
295958	Non-Physician Medical Practitioner	None	1346905171	0	0	LE, MICHELLE K NP	6/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2200 W. 3RD ST.	SUITE 120	LOS ANGELES	CA	90057	1934	00	06000	34.06329642	-118.2739484	Los Angeles County
295972	Non-Physician Medical Practitioner	None	1871853200	0	0	LAMBERT, JESSAMY M	2/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	65 SUN VALLEY DR	None	WALNUT CREEK	CA	94597	1850	00	06000	37.93122847	-122.0633377	Contra Costa County
295989	Non-Physician Medical Practitioner	None	1215913249	0	0	LEDBETTER, MELINDA A PA-C	2/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	23 NORTH ST	None	PRESQUE ISLE	ME	04769	2291	00	06000	46.68885	-68.0098995	Aroostook County
296016	Non-Physician Medical Practitioner	None	1184315657	0	0	LI, ANGELA Z PA-C	9/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
296031	Non-Physician Medical Practitioner	None	1639186067	0	0	LEONARD, JUDITH WHITNEY	2/1/1999	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23321 EL TORO RD	SUITES F & G	LAKE FOREST	CA	92630	4825	00	06000	33.62411283	-117.6963344	Orange County
296067	Non-Physician Medical Practitioner	None	1528464476	0	0	LI, CONNIE NP	10/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	383 KING ST	APT 714	SAN FRANCISCO	CA	94158	1686	00	06000	37.77493422	-122.3955381	San Francisco County
296091	Non-Physician Medical Practitioner	None	1144647660	0	0	LIU, DAVID H	5/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2240 GATEWAY OAKS DR	STE 318	SACRAMENTO	CA	95833	3219	00	06000	38.60838	-121.517487	Sacramento County
296115	Non-Physician Medical Practitioner	None	1871100404	0	0	LEW, ETHAN PA	3/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
296133	Non-Physician Medical Practitioner	None	1487205225	0	0	LIMPRATHAN, SUPHANNEE NP	9/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	00	06000	34.065126	-118.446237	Los Angeles County
296148	Non-Physician Medical Practitioner	None	1164022448	0	0	LEE, KWANG YEON CAROL NP	11/13/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
296153	Non-Physician Medical Practitioner	None	1942751797	0	0	LARSEN, KATIE J NP	5/15/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7252 KENTLAND AVE	None	WEST HILLS	CA	91307	1609	00	06000	34.2024937	-118.618563	Los Angeles County
296162	Non-Physician Medical Practitioner	None	1427690965	0	0	LEE, PATRICIA Y PA-C	8/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	00	06000	40.57278686	-122.3958519	Shasta County
296210	Non-Physician Medical Practitioner	None	1245016526	0	0	LIEU, VINCENT C NP	10/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 N. TUSTIN AVE	UNIT # 216	SANTA ANA	CA	92705	3528	00	06000	33.754167	-117.834191	Orange County
296222	Non-Physician Medical Practitioner	None	1023847365	0	0	LOR, KELSEY NP	1/31/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 REDONDO AVE	STE B	LONG BEACH	CA	90814	2651	00	06000	33.768324	-118.152404	Los Angeles County
296250	Non-Physician Medical Practitioner	None	1487617064	0	0	LETZ, KEVIN LEE	2/29/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	SUMC - PEDS PHYSICIAN BI	PALO ALTO	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
296252	Non-Physician Medical Practitioner	None	1578834164	0	0	LA CLINICA DE LA RAZA, INC.	10/29/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2021 MAIN ST	None	OAKLEY	CA	94561	3302	00	06000	38.00403621	-121.7329113	Contra Costa County
296254	Non-Physician Medical Practitioner	None	1366584534	0	0	LASCUNA, MARIA A	12/11/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	826 E MANNING AVE	None	REEDLEY	CA	93654	2232	00	06000	36.60418846	-119.4408009	Fresno County
296281	Non-Physician Medical Practitioner	None	1609562214	0	0	LEON, CHRISTINE M PA-C	4/2/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 PRAIRIE CITY RD	None	FOLSOM	CA	95630	9594	00	06000	38.652012	-121.166901	Sacramento County
296286	Non-Physician Medical Practitioner	None	1194059493	0	0	LEWIS, ANGELICA V.	9/29/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1245 WILSHIRE BLVD	SUITE 703	LOS ANGELES	CA	90017	4810	00	06000	34.05362775	-118.2661889	Los Angeles County
296296	Non-Physician Medical Practitioner	None	1396391470	0	0	LUCASAN, ROMULO NP	8/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	00	06000	34.13489987	-118.0424069	Los Angeles County
296312	Non-Physician Medical Practitioner	None	1912996687	0	0	L, RIPLEY-BROTHERS D	6/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	00	06000	33.03623896	-117.2837308	San Diego County
296344	Non-Physician Medical Practitioner	None	1023393188	0	0	LIN, JOY D	7/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4480 SPENCER STREET	#132	TORRANCE	CA	90503	2454	00	06000	33.843924	-118.3602275	Los Angeles County
296352	Non-Physician Medical Practitioner	None	1023410578	0	0	LUCKETT, DE COURCY E NP	10/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15911 POMEROL LN	None	SAN DIEGO	CA	92127	4314	00	06000	32.99133886	-117.1033388	San Diego County
296354	Non-Physician Medical Practitioner	None	1891147898	0	0	LENGUYEN, SANDRA PA	5/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	00	06000	33.698367	-117.9194115	Orange County
296376	Non-Physician Medical Practitioner	None	1417183229	0	0	LOUIE, EVA Y NP	12/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3403 CSM DR	APT 207	SAN MATEO	CA	94402	3659	00	06000	37.53101912	-122.3371957	San Mateo County
296387	Non-Physician Medical Practitioner	None	1902202765	0	0	LEWIS, ALISHA C CNM	5/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15190 FOX RIDGE DRIVE	None	FONTANA	CA	92336	0205	00	06000	34.15720118	-117.4733141	San Bernardino County
296397	Non-Physician Medical Practitioner	None	1790835825	0	0	LAN, NANCY C	1/11/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	DEPT 148	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
296399	Non-Physician Medical Practitioner	None	1124048640	0	0	LANGONE, DENNIS J	5/11/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1615 BRANDYWINE COURT	None	LODI	CA	95240	7401	00	06000	38.11219662	-121.2874357	San Joaquin County
296400	Non-Physician Medical Practitioner	None	1952662686	0	0	LIVINGSTONE COMMUNITY DEVELOPMENT CORPORATION	6/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12362 BEACH BLVD STE 10	None	STANTON	CA	90680	3944	00	06000	33.78298855	-117.9927453	Orange County
296403	Non-Physician Medical Practitioner	None	1598112062	0	0	LEM, KELLI N PA-C	3/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
296431	Non-Physician Medical Practitioner	None	1558911123	0	0	LOMIBAO, GRACE M NP	3/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
296437	Non-Physician Medical Practitioner	None	1477106813	0	0	LUND, ALINA NP	11/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
296446	Non-Physician Medical Practitioner	None	1639291149	0	0	LENIHAN, KATHLEEN MARIE	8/12/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
296462	Non-Physician Medical Practitioner	None	1184987042	0	0	LO, ZACHARY S NP	7/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1138 WATERTON LANE	None	SAN JOSE	CA	95131	2746	00	06000	37.37639854	-121.8724201	Santa Clara County
296469	Non-Physician Medical Practitioner	None	1053607895	0	0	LEGO, MELISSA HILARIO	3/5/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1701 E CESAR E CHAVEZ AV	# 230	LOS ANGELES	CA	90033	2464	00	06000	34.05112725	-118.2173921	Los Angeles County
296476	Non-Physician Medical Practitioner	None	1962287987	0	0	LE, NATHALIE NHU TAM H PA	12/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
296480	Non-Physician Medical Practitioner	None	1144672494	0	0	LAMBERT, GAGE I PA	5/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
296481	Non-Physician Medical Practitioner	None	1811207756	0	0	LISTER, CRYSTAL JOY	7/5/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
296490	Non-Physician Medical Practitioner	None	1194044271	0	0	LEE, CINDY H NP	1/26/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	56 CORALWOOD	None	IRVINE	CA	92618	2244	00	06000	33.7008556	-117.733151	Orange County
296500	Non-Physician Medical Practitioner	None	1275747677	0	0	LANGBEIN, SARAH	9/4/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	80 GRAND AVE	None	OAKLAND	CA	94612	3725	00	06000	37.81147674	-122.2656076	Alameda County
296515	Non-Physician Medical Practitioner	None	1740772896	0	0	LUCAS, EDELAINE Q NP	1/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11800 WILSHIRE BLVD	None	LOS ANGELES	CA	90025	6606	00	06000	34.0475456	-118.4632671	Los Angeles County
296534	Non-Physician Medical Practitioner	None	1790937787	0	0	LIWANAG, MELISSA PA	6/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	525 3RD AVE	None	CHULA VISTA	CA	91910	5696	00	06000	32.63367609	-117.0769202	San Diego County
296537	Non-Physician Medical Practitioner	None	1740613041	0	0	LAZARUS, JOSHUA P	11/18/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1218 W ELLERY WAY	None	FRESNO	CA	93711	2013	00	06000	36.82826636	-119.8134466	Fresno County
296539	Non-Physician Medical Practitioner	None	1013934553	0	0	LEWANDOWSKI, PAUL J	5/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	118 PONDEROSA CT	None	SANTA CRUZ	CA	95060	1012	00	06000	37.02345652	-122.0368717	Santa Cruz County
296544	Non-Physician Medical Practitioner	None	1942605811	0	0	LIN, DIANA J	11/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	295 MADISON AVE	None	PASADENA	CA	91101	2870	00	06000	34.15108835	-118.1384677	Los Angeles County
296565	Non-Physician Medical Practitioner	None	1427585322	0	0	LUDVIK, JACOB D NP	10/13/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1379 RANGETON DR	None	DIAMOND BAR	CA	91789	3824	00	06000	33.99552125	-117.8477325	Los Angeles County
296576	Non-Physician Medical Practitioner	None	1992341234	0	0	LATIF, KIRAN NP	8/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7965 SIERRA AVE	STE E	FONTANA	CA	92336	3329	00	06000	34.109001	-117.4357835	San Bernardino County
296595	Non-Physician Medical Practitioner	None	1568007441	0	0	LEE, BEI B PA-C	5/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3866	00	06000	38.74399612	-121.2349547	Placer County
296602	Non-Physician Medical Practitioner	None	1922477991	0	0	LIM, ANTHONY R	10/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	923 LIDFORD AVE	None	LA PUENTE	CA	91744	3225	00	06000	34.03567149	-117.9314507	Los Angeles County
296663	Non-Physician Medical Practitioner	None	1639621634	0	0	LANGFORD, AMBER L NP	2/15/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7910 YESAL AVE	None	ATASCADERO	CA	93422	5216	00	06000	35.4843263	-120.6481015	San Luis Obispo County
296666	Non-Physician Medical Practitioner	None	1861084360	0	0	LEIBOLD, ALLISON D PA	9/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
296732	Non-Physician Medical Practitioner	None	1396053369	0	0	LOPEZ, ROCIO CNP	8/23/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3912 CIBOLA COURT	None	BAKERSFIELD	CA	93309	7665	00	06000	35.31879753	-119.0856391	Kern County
296750	Non-Physician Medical Practitioner	None	1659610665	0	0	LEGASPI, EILEEN R NP	5/21/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10421 FOSSIL WAY	None	ELK GROVE	CA	95757	1658	00	06000	38.379078	-121.447701	Sacramento County
296775	Non-Physician Medical Practitioner	None	1942843511	0	0	LIANG, CHEN PA	8/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	00	06000	34.1010559	-117.6369445	San Bernardino County
296795	Non-Physician Medical Practitioner	None	1003388232	0	0	LEE, SEAN J PA-C	2/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	438 N MARTEL AVE	None	LOS ANGELES	CA	90036	2514	00	06000	34.079373	-118.3510915	Los Angeles County
296833	Non-Physician Medical Practitioner	None	1952869281	0	0	LEAHEY, SHERYL A NP	6/9/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
296847	Non-Physician Medical Practitioner	None	1356154595	0	0	LY, CLARENCE NP	2/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	914 W FOOTHILL BLVD	STE B	UPLAND	CA	91786	3785	00	06000	34.10676719	-117.6635985	San Bernardino County
296870	Non-Physician Medical Practitioner	None	1467741298	0	0	LE, THAO NGOC	10/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14544 7TH ST	None	VICTORVILLE	CA	92395	4214	00	06000	34.5148385	-117.314799	San Bernardino County
296899	Non-Physician Medical Practitioner	None	1750393609	0	0	LEWIS, DEANNA L PA	10/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2010 EAST CARSON STREET	None	LONG BEACH	CA	90807	3040	00	06000	33.83242453	-118.16721	Los Angeles County
296908	Non-Physician Medical Practitioner	None	1417226655	0	0	LYNCH, GENEVIEVE M NP	11/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2632 ARGOLIS WAY	None	SACRAMENTO	CA	95826	2226	00	06000	38.567727	-121.356765	Sacramento County
296940	Non-Physician Medical Practitioner	None	1043935018	0	0	LABADLABAD, ANGELICA PA-C	3/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	00	06000	34.5406159	-117.2658221	San Bernardino County
296943	Non-Physician Medical Practitioner	None	1063613958	0	0	LAYTON-CUNNIGAN, KELI	1/4/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	728 BRIANNA WAY	None	CORONA	CA	92879	8605	00	06000	33.88914052	-117.5346599	Riverside County
296947	Non-Physician Medical Practitioner	None	1689231995	0	0	LEWIS, AMBER D NP	7/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	805 LA VETA	STE 101	ORANGE	CA	98268	3901	00	06000	33.78064152	-117.8606475	Orange County
296961	Non-Physician Medical Practitioner	None	1649726530	0	0	LUNA, JOANNA NP	6/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
296994	Non-Physician Medical Practitioner	None	1821109372	0	0	LANUM, PHILLIP C PA	12/18/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
297021	Non-Physician Medical Practitioner	None	1740814219	0	0	LEE, LIDIA Y PA	3/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5215 TORRANCE BLVD	STE 300	TORRANCE	CA	90503	4009	00	06000	33.83760237	-118.3692467	Los Angeles County
297039	Non-Physician Medical Practitioner	None	1740634203	0	0	LUNA, ALFONSO	12/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1385 COVENTRY RD	None	CONCORD	CA	94518	1118	00	06000	37.97040166	-122.0213925	Contra Costa County
297055	Non-Physician Medical Practitioner	None	1972787695	0	0	LEE, AUDIE L	2/13/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1245 WILSHIRE BLVD	SUITE 606	LOS ANGELES	CA	90017	0000	00	06000	34.05362775	-118.2661889	Los Angeles County
297056	Non-Physician Medical Practitioner	None	1871630558	0	0	LIND, LINDA	1/25/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13404 HIDDEN VALLEY ROAD	None	GRASS VALLEY	CA	95949	8763	00	06000	39.1716112	-121.1004526	Nevada County
297076	Non-Physician Medical Practitioner	None	1710728696	0	0	LOREI, MADELYN PA-C	9/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 S VINCENT AVE	SUITE 205	WEST COVINA	CA	91790	6712	00	06000	34.0662144	-117.9274205	Los Angeles County
297112	Non-Physician Medical Practitioner	None	1134409253	0	0	LOEHR, GRACE L CNM	10/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2030 COFFEE RD	STE A1	MODESTO	CA	95355	2498	00	06000	37.672569	-120.9757125	Stanislaus County
297129	Non-Physician Medical Practitioner	None	1780026294	0	0	LALLO, JENNIFER L NP	10/14/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1238 E CHAMPLAIN DRIVE	APT 201	FRESNO	CA	93720	5069	00	06000	36.87075946	-119.761261	Fresno County
297140	Non-Physician Medical Practitioner	None	1497274385	0	0	LAUC, LEDA LURLEEN R NP	1/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7575 N CEDAR	STE 101	FRESNO	CA	93720	2693	00	06000	36.84611202	-119.7569009	Fresno County
297157	Non-Physician Medical Practitioner	None	1487809489	0	0	LEE, ANGELA YUEN CHEE	11/12/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DRIVE	FALK CARDIOVASCULAR RESE	STANFORD	CA	94305	5407	00	06000	37.43304542	-122.1759654	Santa Clara County
297199	Non-Physician Medical Practitioner	None	1831112754	0	0	LARA, ROSEMARIE	4/13/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 MEDICAL PLAZA	#200	LOS ANGELES	CA	90095	0001	00	06000	34.06473399	-118.445865	Los Angeles County
297207	Non-Physician Medical Practitioner	None	1396891321	0	0	LUNA, JONATHAN P	12/31/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9590 PINON RD	None	APPLE VALLEY	CA	92308	0508	00	06000	34.42667753	-117.082535	San Bernardino County
297208	Non-Physician Medical Practitioner	None	1518265677	0	0	LAMBERT, SABRINA R	7/15/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1111 SINEX AVE	None	PACIFIC GROVE	CA	93950	3818	00	06000	36.61864875	-121.932747	Monterey County
297225	Non-Physician Medical Practitioner	None	1568931574	0	0	LEACH, NADIA C PA	11/19/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1450 SAN PABLO STREET	SUITE 6200	LOS ANGELES	CA	90033	4500	00	06000	34.06189518	-118.203256	Los Angeles County
297228	Non-Physician Medical Practitioner	None	1154533487	0	0	LEUNG, CHERRY	5/28/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
297291	Non-Physician Medical Practitioner	None	1144568239	0	0	LABARGE, LORELEI E	5/23/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	438 W GRAND AVE	504	OAKLAND	CA	94612	2337	00	06000	37.81163449	-122.2671178	Alameda County
297292	Non-Physician Medical Practitioner	None	1528763968	0	0	LEE, JUDY NP	3/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3650 E SOUTH ST	SUITE 310	LAKEWOOD	CA	90712	1519	00	06000	33.8601747	-118.1494013	Los Angeles County
297311	Non-Physician Medical Practitioner	None	1457670119	0	0	LANE, KIMBERLY NP	3/15/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8851 CENTER DRIVE	SUITE 501	LA MESA	CA	91942	3017	00	06000	32.78189749	-117.0075062	San Diego County
297333	Non-Physician Medical Practitioner	None	1740664184	0	0	LADERER, CLAYTON M	10/5/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2255 LARIAT LN	None	WALNUT CREEK	CA	94596	6544	00	06000	37.87213095	-122.0328887	Contra Costa County
297338	Non-Physician Medical Practitioner	None	1790204659	0	0	LIN, TIFFANY J NP	7/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2827 S LA BREA AVE	5	LOS ANGELES	CA	90016	3541	00	06000	34.02905914	-118.3525344	Los Angeles County
297345	Non-Physician Medical Practitioner	None	1326670217	0	0	LE, CHRISTOPHER PA-C	2/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	72780 COUNTRY CLUB DR	STE C300	RANCHO MIRAGE	CA	92270	4150	00	06000	33.75795596	-116.392246	Riverside County
297402	Non-Physician Medical Practitioner	None	1306879192	0	0	LACKORE, JEFFREY L	7/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	86 RENWOOD LANE	None	AMERICAN CANYON	CA	94503	3134	00	06000	38.1682489	-122.2420376	Napa County
297418	Non-Physician Medical Practitioner	None	1598419004	0	0	LIAO, ALVIN PA-C	1/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 WARNER	SUITE 140	FOUNTAIN VALLEY	CA	92708	3207	00	06000	33.71568247	-117.977193	Orange County
297421	Non-Physician Medical Practitioner	None	1982039038	0	0	L0ZANO, MELISSA J	4/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2709 CARDINAL DR	None	COSTA MESA	CA	92626	4715	00	06000	33.6695523	-117.9367009	Orange County
297437	Non-Physician Medical Practitioner	None	1053340562	0	0	LO, ESTHER Y K NP	3/12/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9070 OAK CREEK RD	None	CHERRY VALLEY	CA	92223	5816	00	06000	33.9878979	-116.9721205	Riverside County
297444	Non-Physician Medical Practitioner	None	1285122499	0	0	LEE, MICHELLE NP	7/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	00	06000	37.63347961	-122.0897735	Alameda County
297446	Non-Physician Medical Practitioner	None	1942638630	0	0	LE BLANC-CABOT, MELETTE PA	10/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	00	06000	34.28200485	-118.4030797	Los Angeles County
297474	Non-Physician Medical Practitioner	None	1730738733	0	0	LOMONGSOD, ALEXA NP	11/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	00	06000	38.00771973	-122.1331484	Contra Costa County
297482	Non-Physician Medical Practitioner	None	1831514322	0	0	LA COSTA, RACHEL M PA	2/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
297514	Non-Physician Medical Practitioner	None	1497134688	0	0	LEWIS, TASHANA NP	11/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	954 WEST FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
297520	Non-Physician Medical Practitioner	None	1962032961	0	0	LAPLANA, JOEY G NP	4/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6555 COYLE	SUITE 220	CARMICHAEL	CA	95608	0303	00	06000	38.66859	-121.3118055	Sacramento County
297531	Non-Physician Medical Practitioner	None	1588167704	0	0	LEE, JU H NP	9/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	00	06000	34.06169385	-118.2044698	Los Angeles County
297535	Non-Physician Medical Practitioner	None	1154712933	0	0	LIANG, MARISA T PA-C	3/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	00	06000	37.63347961	-122.0897735	Alameda County
297541	Non-Physician Medical Practitioner	None	1598466724	0	0	LAO, STEPHANIE ROSE NP	11/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3180 COLLINS DR	STE A	MERCED	CA	95348	3161	00	06000	37.32165459	-120.4760862	Merced County
297547	Non-Physician Medical Practitioner	None	1366220238	0	0	LONDONO, LAURA PA-C	11/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	415 KNOLLCREST DR	STE 101	REDDING	CA	96002	0181	00	06000	40.57267376	-122.3643496	Shasta County
297560	Non-Physician Medical Practitioner	None	1568842706	0	0	LIN, HSIN-YING NP	5/3/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17711 MANCHESTER AVE	None	IRVINE	CA	92614	6649	00	06000	33.67326456	-117.8291009	Orange County
297563	Non-Physician Medical Practitioner	None	1437438538	0	0	LOPEZ, THERESA D NP	8/3/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3494 JUMILLA WAY	None	SACRAMENTO	CA	95834	9622	00	06000	38.630205	-121.537764	Sacramento County
297565	Non-Physician Medical Practitioner	None	1508139056	0	0	LU, SHARON YI	7/16/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1850 S AZUSA AVE STE 88	None	HACIENDA HEIGHTS	CA	91745	6813	00	06000	33.98895597	-117.9322797	Los Angeles County
297567	Non-Physician Medical Practitioner	None	1578007662	0	0	LIWAG, APRIL Y NP	11/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1106 DAVIS WAY	None	PLACENNTIA	CA	92870	5228	00	06000	33.86980839	-117.8462694	Orange County
297616	Non-Physician Medical Practitioner	None	1003008855	0	0	LEE, ALISIA D	3/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2112 COURTLEIGH DRIVE	UNIT C	BAKERSFIELD	CA	93309	4596	00	06000	35.33489249	-119.0620909	Kern County
297620	Non-Physician Medical Practitioner	None	1669057766	0	0	LEONEZ, EVA NP	3/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
297646	Non-Physician Medical Practitioner	None	1154089068	0	0	LEAL, DESIREE JAYNE D NP	9/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
297661	Non-Physician Medical Practitioner	None	1710386693	0	0	LOMELI-LOIBL, CADELBA G NP	2/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
297686	Non-Physician Medical Practitioner	None	1316652092	0	0	LEE, BENJAMIN	1/6/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
297709	Non-Physician Medical Practitioner	None	1609340835	0	0	LOPEZ, EFRAIN NP	10/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7677 CENTER AVE	SUITE 214	HUNTINGTON BEACH	CA	92647	3074	00	06000	33.736257	-117.995535	Orange County
297737	Non-Physician Medical Practitioner	None	1740659994	0	0	LEDEZMA, AURORA C PA-C	1/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 E HIGHLAND AVE	STE 351	SAN BERNARDINO	CA	92404	3830	00	06000	34.1358627	-117.2757778	San Bernardino County
297755	Non-Physician Medical Practitioner	None	1952564320	0	0	LEITHEM, DESIREE S NP	1/3/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	639 ALEX WAY	None	ENCINITAS	CA	92024	2379	00	06000	33.05791006	-117.272794	San Diego County
297769	Non-Physician Medical Practitioner	None	1982279634	0	0	LERMA, BRIDGETT NP	9/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16500 VENTURA BLVD	STE 375	ENCINO	CA	91436	2016	00	06000	34.15756758	-118.4926374	Los Angeles County
297809	Non-Physician Medical Practitioner	None	1093144289	0	0	LEON, LEBERATION B D NP	3/21/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11514 RENVILLE ST	None	LAKEWOOD	CA	90715	1234	00	06000	33.84474509	-118.0881514	Los Angeles County
297819	Non-Physician Medical Practitioner	None	1700396306	0	0	LUONG, TRACY T NP	1/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	310 ELIZABETH AVE	None	MONTEREY PARK	CA	91755	2006	00	06000	34.06534141	-118.1093377	Los Angeles County
297833	Non-Physician Medical Practitioner	None	1558592667	0	0	LUNDBERG, MATTHEW S	3/13/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1852 TUSCAN GROVE PL	None	CAMARILLO	CA	93012	8960	00	06000	34.2380815	-118.9657639	Ventura County
297841	Non-Physician Medical Practitioner	None	1972238871	0	0	LEE, MENG-CHEN NP	9/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3132 W MARCH LN	STE 5	STOCKTON	CA	95219	2354	00	06000	37.9839146	-121.3516231	San Joaquin County
297957	Non-Physician Medical Practitioner	None	1356519474	0	0	LOO, ARIEL G NP	10/24/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	191 S BUENA VISTA ST	370	BURBANK	CA	91505	4554	00	06000	34.15872557	-118.3283863	Los Angeles County
297965	Non-Physician Medical Practitioner	None	1720096944	0	0	LEWIS, STEPHANIE EVETTE	12/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1444 N BIRCH AVE	None	RIALTO	CA	92376	2905	00	06000	34.125858	-117.353648	San Bernardino County
297979	Non-Physician Medical Practitioner	None	1053062943	0	0	LARSON, WILLIE D CNM	3/25/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	00	06000	34.19395645	-118.463265	Los Angeles County
297989	Non-Physician Medical Practitioner	None	1215618061	0	0	LIMON, IRENE PA-C	12/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
297995	Non-Physician Medical Practitioner	None	1841362514	0	0	LOBIANCO, LINDA C	12/10/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3305 HORNSEA WAY	None	SACRAMENTO	CA	95834	2554	00	06000	38.649834	-121.533354	Sacramento County
298013	Non-Physician Medical Practitioner	None	1376626150	0	0	LAMBERT, DANIEL S	11/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4839 S DARROW DRIVE	F-148	TEMPE	AZ	85282	6684	00	06000	33.381261	-111.959757	Maricopa County
298025	Non-Physician Medical Practitioner	None	1467449082	0	0	LEE, LI F NP	2/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 PEACOCK HILL	None	SANTA ANA	CA	92705	2358	00	06000	33.77022669	-117.7810175	Orange County
298031	Non-Physician Medical Practitioner	None	1376633685	0	0	LONG, STEPHEN	6/25/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1700 WADE CIR	None	KLAMATH FALLS	OR	97601	1581	00	06000	42.24698037	-121.7790534	Klamath County
298076	Non-Physician Medical Practitioner	None	1245666981	0	0	LANGE, DIANNA L	10/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2100 POWELL STREET	SUITE 900	EMERYVILLE	CA	94608	0000	00	06000	37.83953006	-122.2990736	Alameda County
298122	Non-Physician Medical Practitioner	None	1366672040	0	0	LYNCH, SEAN T	10/7/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10280 HOLDEN TRAILS RD	None	LAKESIDE	CA	92040	2243	00	06000	32.863239	-116.956866	San Diego County
298191	Non-Physician Medical Practitioner	None	1093123176	0	0	LAI, DINH NP	1/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	993 N BROADWAY	SUITE A	LOS ANGELES	CA	90012	1763	00	06000	34.0663686	-118.2361889	Los Angeles County
298199	Non-Physician Medical Practitioner	None	1467817783	0	0	LLAMAS, DANA PA	9/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	00	06000	33.94354395	-117.394926	Riverside County
298257	Non-Physician Medical Practitioner	None	1114263506	0	0	LINK, LORI	4/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2020 SUTTER PL	None	DAVIS	CA	95616	6201	00	06000	38.56287659	-121.7715536	Yolo County
298258	Non-Physician Medical Practitioner	None	1275781981	0	0	LEWIS, CHRISTOPHER A	8/18/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	161 N MILL ST	None	TEHACHAPI	CA	93561	1347	00	06000	35.13410412	-118.4520157	Kern County
298265	Non-Physician Medical Practitioner	None	1699219634	0	0	LELAND, ALYSSA A	1/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	388 CASTILIAN AVE	None	THOUSAND OAKS	CA	91320	3608	00	06000	34.18368873	-118.9027484	Ventura County
298284	Non-Physician Medical Practitioner	None	1992956742	0	0	LYONS-FARINO, JESSICA K PA	9/27/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
298290	Non-Physician Medical Practitioner	None	1972961092	0	0	LAMBAREN, KRISTY R NP	8/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1889 HARDING AVE	None	ALTADENA	CA	91001	3554	00	06000	34.17856687	-118.1014494	Los Angeles County
298302	Non-Physician Medical Practitioner	None	1215609128	0	0	LAM, JANET NP	4/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	899 VALENCIA ST	GROUND FLOOR	SAN FRANCISCO	CA	94110	1736	00	06000	37.75867161	-122.4212468	San Francisco County
298305	Non-Physician Medical Practitioner	None	1043641236	0	0	LANDON, JEFFREY R PA-C	4/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	610 EUCLID AVE	200	NATIONAL CITY	CA	91950	2951	00	06000	32.68419388	-117.0829524	San Diego County
298319	Non-Physician Medical Practitioner	None	1912179813	0	0	LANE, LINDA K NP	3/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
298343	Non-Physician Medical Practitioner	None	1316901689	0	0	LIGON, ESKER-D C NP	3/19/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10530 STELLA ST	None	OAKLAND	CA	94605	5326	00	06000	37.74835124	-122.1434685	Alameda County
298346	Non-Physician Medical Practitioner	None	1164021481	0	0	LAFRAUGH, AUDREY L PA	6/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	00	06000	38.644479	-121.1349735	Sacramento County
298349	Non-Physician Medical Practitioner	None	1841528692	0	0	LEE, CHEN-CHI	1/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	00	06000	34.06794352	-118.1229278	Los Angeles County
298394	Non-Physician Medical Practitioner	None	1902330863	0	0	LEGESSE, RUTH A	12/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3431 S LA BREA AVE	APT 205	LOS ANGELES	CA	90016	5232	00	06000	34.02440019	-118.3553503	Los Angeles County
298418	Non-Physician Medical Practitioner	None	1760620330	0	0	LODI MEMORIAL HOSPITAL ASSOCIATION, INC.	5/7/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 W KETTLEMAN LANE	SUITE 200	LODI	CA	95242	4337	00	06000	38.11558533	-121.2964501	San Joaquin County
298425	Non-Physician Medical Practitioner	None	1528496593	0	0	LOERA, CHRISTOPHER R	9/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	140 N GREENWOOD AVE	None	PASADENA	CA	91107	3517	00	06000	34.14852	-118.110693	Los Angeles County
298426	Non-Physician Medical Practitioner	None	1093552465	0	0	LIEU, JENNIFER NP	10/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2324 SACRAMENTO ST	111	SAN FRANCISCO	CA	94115	2383	00	06000	37.79020149	-122.4313011	San Francisco County
298431	Non-Physician Medical Practitioner	None	1386993079	0	0	LAUTNER, JULIE M NP	9/15/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
298441	Non-Physician Medical Practitioner	None	1356376842	0	0	LEER, KRISTI J PA	9/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	00	06000	37.89281357	-122.0598728	Contra Costa County
298463	Non-Physician Medical Practitioner	None	1619002334	0	0	LEWIS, CHERYL MARIE	5/4/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1292 SAWLEAF CT	None	SAN LUIS OBISPO	CA	93401	7816	00	06000	35.24826016	-120.6312578	San Luis Obispo County
298497	Non-Physician Medical Practitioner	None	1861275927	0	0	LAPAIX, MARILYN O NP	10/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
298503	Non-Physician Medical Practitioner	None	1427640150	0	0	LEWIS, KELLY D NP	7/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12276 HESPERIA RD	STE 123	VICTORVILLE	CA	92395	5838	00	06000	34.47424926	-117.2915621	San Bernardino County
298511	Non-Physician Medical Practitioner	None	1770337040	0	0	LANG, HAILEY A PA	11/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
298514	Non-Physician Medical Practitioner	None	1669713889	0	0	LE, ALEX PA	4/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4676 ADMIRALTY WAY	4TH FLOOR	MARINA DEL REY	CA	90292	6601	00	06000	33.98035311	-118.4403749	Los Angeles County
298520	Non-Physician Medical Practitioner	None	1326354671	0	0	LIU, AN-CHI NP	1/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2401 S HACIENDA BLVD	APT 210	HACIENDA HILLS	CA	91745	4733	00	06000	33.9919646	-117.968813	Los Angeles County
298526	Non-Physician Medical Practitioner	None	1972883320	0	0	LAVINE, HAVA G NP	11/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2129 MORRO VISTA DR	None	LAS VEGAS	NV	89135	1411	00	06000	36.15001707	-115.3386271	Clark County
298558	Non-Physician Medical Practitioner	None	1063456101	0	0	LEUNG, WENDY S NP	5/5/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5550 WILSHIRE BLVD	#240	LOS ANGELES	CA	90036	4858	00	06000	34.06231042	-118.3501553	Los Angeles County
298567	Non-Physician Medical Practitioner	None	1992715320	0	0	LOVERING, GLORIA C NP	1/4/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1871 N DUPREE LANE	None	CLOVIS	CA	93619	7683	00	06000	36.864076	-119.7000842	Fresno County
298568	Non-Physician Medical Practitioner	None	1093338089	0	0	LOUIE, OLIVIA PA	5/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
298578	Non-Physician Medical Practitioner	None	1073688016	0	0	LEMKE, JUDITH H NP	9/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	957 FAIRWAY AVE	None	UKIAH	CA	95482	3710	00	06000	39.15832923	-123.2251071	Mendocino County
298582	Non-Physician Medical Practitioner	None	1447677646	0	0	LEYSON, CHRISTINE A NP	11/21/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4255 W 5TH STREET	UNIT 301	LOS ANGELES	CA	90020	4196	00	06000	34.06532861	-118.3119774	Los Angeles County
298598	Non-Physician Medical Practitioner	None	1851026041	0	0	LUMANAUW-FORD, JARED J NP	10/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9888 GENESEE	None	LA JOLLA	CA	92037	1205	00	06000	32.8865608	-117.2250386	San Diego County
298604	Non-Physician Medical Practitioner	None	1568801181	0	0	LOYA, JACOB A	5/9/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	468 GATES STREET	None	SAN FRANCISCO	CA	94110	6065	00	06000	37.73749729	-122.4140917	San Francisco County
298615	Non-Physician Medical Practitioner	None	1093385775	0	0	LEONE, MELINA NP	1/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	00	06000	33.80318951	-118.066068	Orange County
298641	Non-Physician Medical Practitioner	None	1609329424	0	0	LEE, JONATHAN Y PA-C	5/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7225 RAINBOW DR	None	SAN JOSE	CA	95129	4552	00	06000	37.30146258	-122.0315034	Santa Clara County
298647	Non-Physician Medical Practitioner	None	1114531407	0	0	LOOMIS, LOGAN H PA-C	4/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41880 KALMIA ST	SUITE 100	MURRIETA	CA	92562	8835	00	06000	33.55740114	-117.2157733	Riverside County
298687	Non-Physician Medical Practitioner	None	1003284811	0	0	LUTCHMAN, KELSEY PA	3/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27700 MEDICAL CENTER	None	MISSION VIEJO	CA	92691	6426	00	06000	33.56008604	-117.6657795	Orange County
298762	Non-Physician Medical Practitioner	None	1578222154	0	0	LEE, YUJIN E PA-C	1/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	00	06000	37.25111017	-121.9465891	Santa Clara County
298783	Non-Physician Medical Practitioner	None	1679648547	0	0	LOLACHI, CHRISTINA L	5/28/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	80 LESSAY	None	NEWPORT COAST	CA	92657	1060	00	06000	33.61069679	-117.8358553	Orange County
298795	Non-Physician Medical Practitioner	None	1467407767	0	0	LISTER, JOANNE M NP	9/17/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9825 CHESAPEAKE DR	None	RANCHO CUCAMONGA	CA	91701	5956	00	06000	34.12769517	-117.5909143	San Bernardino County
298798	Non-Physician Medical Practitioner	None	1114532272	0	0	LANDEROS DE SANTIAGO, YADIRA	10/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
298819	Non-Physician Medical Practitioner	None	1578630349	0	0	LIBBON, JIMMY P	5/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 WHEATSTONE FARM	None	LADERA RANCH	CA	92694	1035	00	06000	33.54981067	-117.6445821	Orange County
298848	Non-Physician Medical Practitioner	None	1982338331	0	0	LE, DIANA H PA	3/12/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10880 WILSHIRE BLVD	1101	LOS ANGELES	CA	90024	4112	00	06000	34.05897499	-118.4431123	Los Angeles County
298861	Non-Physician Medical Practitioner	None	1770346371	0	0	LAM, JASON PA-C	4/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	616 N GARFIELD AVE	203	MONTEREY PARK	CA	91754	1153	00	06000	34.06916465	-118.1229039	Los Angeles County
298883	Non-Physician Medical Practitioner	None	1710933767	0	0	LANGI, MARLIS L NP	9/23/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 CANAL ST	None	KING CITY	CA	93930	3432	00	06000	36.20731142	-121.1325532	Monterey County
298907	Non-Physician Medical Practitioner	None	1720379647	0	0	LEOPOLD, ALLISON NP	12/9/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3111 CAMINO DEL RIO	STE 625	SAN DIEGO	CA	92108	5718	00	06000	32.77510996	-117.1277427	San Diego County
298918	Non-Physician Medical Practitioner	None	1912150822	0	0	LOWRY, KELLIE LYNN	7/2/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	55 FRANCISCO ST	SUITE 300	SAN FRANCISCO	CA	94133	2122	00	06000	37.80556164	-122.4060858	San Francisco County
298929	Non-Physician Medical Practitioner	None	1417330952	0	0	LOUCKS, MEGAN C PA-C	9/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
298957	Non-Physician Medical Practitioner	None	1366978207	0	0	LINGL, SUZANNE E NP	4/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
298962	Non-Physician Medical Practitioner	None	1730447459	0	0	LEWIS, MELISSA A NP	7/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	215 E OKEEFE STREET	APT 3	EAST PALO ALTO	CA	94303	2101	00	06000	37.46233299	-122.1497092	San Mateo County
299005	Non-Physician Medical Practitioner	None	1134527641	0	0	LOKESHWAR, SAMYUKTHA P	1/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	778 CANOAS CREEK CIRCLE	None	SAN JOSE	CA	95136	6262	00	06000	37.28217915	-121.8680541	Santa Clara County
299035	Non-Physician Medical Practitioner	None	1306627674	0	0	LEE, DAISY	12/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1798 N GAREY AVE	None	POMONA	CA	91767	2918	00	06000	34.076894	-117.7522688	Los Angeles County
299064	Non-Physician Medical Practitioner	None	1255597563	0	0	LAU, KORRINA W NP	3/13/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3688 NORWOOD AVE	None	SAN JOSE	CA	95148	2817	00	06000	37.33370557	-121.7727236	Santa Clara County
299071	Non-Physician Medical Practitioner	None	1588037618	0	0	LOPICOCOLO, CHRISTOPHER T NP	3/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	733 N KINGS ROAD	APT 340	WEST HOLLYWOOD	CA	90069	5965	00	06000	34.08454269	-118.3717873	Los Angeles County
299112	Non-Physician Medical Practitioner	None	1689722670	0	0	LAURSEN, GERALD J	3/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21621 HUMMINGBIRD ST	None	TRABUCO CANYON	CA	92679	3491	00	06000	33.648351	-117.570551	Orange County
299123	Non-Physician Medical Practitioner	None	1295201036	0	0	LEE, SU JUNG NP	11/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4849 VAN NUYS BLVD	211	SHERMAN OAKS	CA	91403	2110	00	06000	34.159113	-118.4487465	Los Angeles County
299140	Non-Physician Medical Practitioner	None	1447735006	0	0	LI, WILLIAM PA-C	9/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	00	06000	37.67984327	-122.4730264	San Mateo County
299167	Non-Physician Medical Practitioner	None	1477261857	0	0	LEE, STACY Y PA	1/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	00	06000	33.93112671	-118.2035532	Los Angeles County
299227	Non-Physician Medical Practitioner	None	1730420449	0	0	LO, CAROLYN V NP	11/19/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1850 SAND HILL RD	APT 39	PALO ALTO	CA	94304	2148	00	06000	37.43135348	-122.1866312	Santa Clara County
299256	Non-Physician Medical Practitioner	None	1649813742	0	0	LUNA, JOJO NP	5/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
299262	Non-Physician Medical Practitioner	None	1336494632	0	0	LIN, JEFFREY PA	11/14/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	00	06000	32.79293009	-117.0952438	San Diego County
299269	Non-Physician Medical Practitioner	None	1245364785	0	0	LOPEZ, JOSE	1/16/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4417 RICHARD CIRCLE	None	LOS ANGELES	CA	90032	1223	00	06000	34.09703942	-118.1640152	Los Angeles County
299277	Non-Physician Medical Practitioner	None	1013487206	0	0	LAPARAN, CHRISTIAN B NP	12/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
299284	Non-Physician Medical Practitioner	None	1851718605	0	0	LOPEZ, ALFRED S JR NP	2/17/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2322 ROSEWELL AVE	None	LONG BEACH	CA	90815	1717	00	06000	33.80015809	-118.1434077	Los Angeles County
299288	Non-Physician Medical Practitioner	None	1871983023	0	0	LIAO, TZU YI	7/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1935 SILVER HAWK DR	None	DIAMOND BAR	CA	91765	4510	00	06000	33.9867294	-117.8286066	Los Angeles County
299343	Non-Physician Medical Practitioner	None	1700027703	0	0	LOZA, GUSTAVO A PA	10/31/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3298	00	06000	33.78674051	-117.8888713	Orange County
299365	Non-Physician Medical Practitioner	None	1801968037	0	0	LAU, KIMBERLY Y	4/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2350 GEARY BLVD FL 2	None	SAN FRANCISCO	CA	94115	3305	00	06000	37.78305866	-122.4421313	San Francisco County
299377	Non-Physician Medical Practitioner	None	1659526911	0	0	LOPEZ, JOEL	1/2/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11725 GARVEY AVE STE 5B	None	EL MONTE	CA	91732	4535	00	06000	34.06287148	-118.02222	Los Angeles County
299384	Non-Physician Medical Practitioner	None	1346760022	0	0	LE, JOHN NP	11/10/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	00	06000	34.15729818	-118.3277073	Los Angeles County
299402	Non-Physician Medical Practitioner	None	1235354945	0	0	LOCK, JUDY NP	12/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
299433	Non-Physician Medical Practitioner	None	1225382955	0	0	LOS ANGELES CHRISTIAN HEALTH CENTERS	8/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	456 S MAIN ST	None	LOS ANGELES	CA	90013	1390	00	06000	34.046956	-118.2482653	Los Angeles County
299440	Non-Physician Medical Practitioner	None	1275359648	0	0	LONG, SALLY L NP	1/22/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 E HIGHLAND AVE	# 551	SAN BERNARDINO	CA	92404	3861	00	06000	34.1358627	-117.2757778	San Bernardino County
299443	Non-Physician Medical Practitioner	None	1063022937	0	0	LUC, KELLY PA-C	10/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	00	06000	33.808185	-118.1850575	Los Angeles County
299462	Non-Physician Medical Practitioner	None	1871114785	0	0	LI, YAN NP	8/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	43360 MISSION BLVD	SUITE 100	FREMONT	CA	94539	5829	00	06000	37.53249631	-121.9198141	Alameda County
299464	Non-Physician Medical Practitioner	None	1962079624	0	0	LUDWICK, ANDREA NP	2/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	00	06000	33.12181055	-117.2840499	San Diego County
299479	Non-Physician Medical Practitioner	None	1407276819	0	0	LE, HOAIHUONG N	2/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	909 E HOMESTEAD RD	None	SUNNYVALE	CA	94087	4901	00	06000	37.33772499	-122.0128312	Santa Clara County
299482	Non-Physician Medical Practitioner	None	1578238507	0	0	LEE, SUSAN J PA-C	2/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	00	06000	33.49890392	-117.1612965	Riverside County
299500	Non-Physician Medical Practitioner	None	1972739498	0	0	LATEINER, KRISTEN H NP	4/24/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1479 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	2986	00	06000	37.91301169	-122.0438513	Contra Costa County
299504	Non-Physician Medical Practitioner	None	1538941638	0	0	LEE, CHRISTINE R PA-C	4/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31720 S TEMECULA PARKWAY	203	TEMECULA	CA	92592	2034	00	06000	33.4799323	-117.1033702	Riverside County
299509	Non-Physician Medical Practitioner	None	1306168943	0	0	LE, KATIE NP	8/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7660 BEVERLY BLVD	APT 153	LOS ANGELES	CA	90036	2739	00	06000	34.07611353	-118.3568424	Los Angeles County
299530	Non-Physician Medical Practitioner	None	1912350752	0	0	LING, AMANDA E NP	11/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2355 BROADWAY	None	OAKLAND	CA	94612	2485	00	06000	37.81316834	-122.265691	Alameda County
299535	Non-Physician Medical Practitioner	None	1417647751	0	0	LAM, NATALIE PA-C	11/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1819	00	06000	34.073505	-117.3505995	San Bernardino County
299549	Non-Physician Medical Practitioner	None	1831727015	0	0	LEE, SOLANDA T PA	6/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
299571	Non-Physician Medical Practitioner	None	1861765877	0	0	LOS ANGELES COUNTY AUDITOR CONTROLLER	2/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	522 S. SAN PEDRO STREET	None	LOS ANGELES	CA	90013	2102	00	06000	34.0436196	-118.2442541	Los Angeles County
299575	Non-Physician Medical Practitioner	None	1992154934	0	0	LYON, ERIC D	3/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29135 OAKPATH DR	None	AGOURA HILLS	CA	91301	1677	00	06000	34.1547109	-118.7613988	Los Angeles County
299593	Non-Physician Medical Practitioner	None	1952758328	0	0	LEWIS, AMBER	11/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
299604	Non-Physician Medical Practitioner	None	1447889738	0	0	LIU, QIONG PA	7/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
299611	Non-Physician Medical Practitioner	None	1467910455	0	0	LEFFALL, BRITNEY NP	3/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
299612	Non-Physician Medical Practitioner	None	1013344167	0	0	LEE, JINHO A	6/29/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	148 S GRAMERCY PL	#10	LOS ANGELES	CA	90004	4961	00	06000	34.07152872	-118.3124241	Los Angeles County
299632	Non-Physician Medical Practitioner	None	1124437868	0	0	LANG, CATHERINE F NP	8/15/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
299647	Non-Physician Medical Practitioner	None	1730425695	0	0	LOPEZ-FREYRE, LYNDA Y NP	2/14/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	245 CLIPPER WAY	None	SEAL BEACH	CA	90740	5955	00	06000	33.74564149	-118.109358	Orange County
299650	Non-Physician Medical Practitioner	None	1780649210	0	0	LEONARD -BERNIER, LATISHA RAE	1/7/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1919 E THOMAS RD	EAST BUILDING	PHOENIX	AZ	85016	7710	00	06000	33.478749	-112.0426515	Maricopa County
299654	Non-Physician Medical Practitioner	None	1588665368	0	0	LAI, HELEN PC NP	9/21/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	140 N BRADBURY DR	None	SAN GABRIEL	CA	91775	2806	00	06000	34.10342156	-118.1077139	Los Angeles County
299700	Non-Physician Medical Practitioner	None	1295080315	0	0	LACOURSE, RACHEL PA-C	1/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5671 BALBOA AVE	None	SAN DIEGO	CA	92111	2705	00	06000	32.82010691	-117.1788026	San Diego County
299702	Non-Physician Medical Practitioner	None	1053540120	0	0	LAZAREWICZ, NICOLAS RICHARD	1/20/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	421 NUT TREE RD	None	VACAVILLE	CA	95687	3508	00	06000	38.36441975	-121.9525909	Solano County
299705	Non-Physician Medical Practitioner	None	1659557650	0	0	LAMB, AMY R CNM	8/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4107 NATIONAL AVE	None	BURBANK	CA	91505	4107	00	06000	34.15099764	-118.3438069	Los Angeles County
299718	Non-Physician Medical Practitioner	None	1952135634	0	0	LOPEZ, PATRICK E NP	2/17/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
299737	Non-Physician Medical Practitioner	None	1902188303	0	0	LEACH, CAITLIN B NP	1/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	450 FOURTH AVE.	STE 408	CHULA VISTA	CA	91910	4430	00	06000	32.63513513	-117.0820663	San Diego County
299757	Non-Physician Medical Practitioner	None	1700898772	0	0	LARRABEE, BETTY J	3/28/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1409 E BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	00	06000	37.66742737	-120.9731413	Stanislaus County
299758	Non-Physician Medical Practitioner	None	1124300207	0	0	LIVINGSTON COMMUNITY HEALTH	10/25/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7970 LANDER AVE	SUITE A	HILMAR	CA	95324	8310	00	06000	37.403703	-120.850121	Merced County
299796	Non-Physician Medical Practitioner	None	1538747654	0	0	LUM, KATARINA NP	1/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2704 E WILLOW ST	None	SIGNAL HILL	CA	90755	2217	00	06000	33.80432955	-118.1594295	Los Angeles County
299815	Non-Physician Medical Practitioner	None	1164023347	0	0	LEWIS, WENDY PA-C	12/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
299838	Non-Physician Medical Practitioner	None	1801009253	0	0	LIN-AAMODT, SARAH	7/6/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3288 BELL RD	None	AUBURN	CA	95603	9243	00	06000	38.94193048	-121.1046075	Placer County
299852	Non-Physician Medical Practitioner	None	1144728502	0	0	LIU, LILY	8/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	00	06000	38.74390969	-121.2319271	Placer County
299860	Non-Physician Medical Practitioner	None	1851522015	0	0	LA CLINICA DE LA RAZA, INC.	11/12/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1926 - 19TH AVENUE	None	OAKLAND	CA	94606	4126	00	06000	37.78963762	-122.2378966	Alameda County
299862	Non-Physician Medical Practitioner	None	1992082903	0	0	LUONG, DOLLY D	7/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	129 BERNICE AVE	None	STOCKTON	CA	95210	1902	00	06000	38.02348862	-121.3141475	San Joaquin County
299876	Non-Physician Medical Practitioner	None	1558547331	0	0	LINDO, FAE	5/7/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
299879	Non-Physician Medical Practitioner	None	1629797204	0	0	LEE, HANNAH NP	6/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
299903	Non-Physician Medical Practitioner	None	1891380325	0	0	LAYNE, KELSEY A PA-C	11/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 W LUGONIA AVE	STE 120	REDLANDS	CA	92374	9704	00	06000	34.07027851	-117.218421	San Bernardino County
299951	Non-Physician Medical Practitioner	None	1689348963	0	0	LAIRD, HOLLY R NP	2/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3010 BEARD ROAD	None	NAPA	CA	94558	3442	00	06000	38.32003352	-122.2948827	Napa County
299956	Non-Physician Medical Practitioner	None	1225069008	0	0	LOWE, JULIA B PA	10/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	00	06000	38.66314048	-121.794696	Yolo County
299959	Non-Physician Medical Practitioner	None	1467950493	0	0	LIEN, ALAN F	8/6/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	215 QUEST PARK ST	STE 1035	HENDERSON	NV	89074	1498	00	06000	36.04271987	-115.0503596	Clark County
299980	Non-Physician Medical Practitioner	None	1366761611	0	0	LORING, CATHERINE MARIE	10/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7218 VAN NUYS BLVD	SUITE D	VAN NUYS	CA	91405	6804	00	06000	34.20173513	-118.4487045	Los Angeles County
300004	Non-Physician Medical Practitioner	None	1760164131	0	0	LOCKARD-LOOB, ALLISON Z PA-C	9/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	00	06000	33.93112671	-118.2035532	Los Angeles County
300007	Non-Physician Medical Practitioner	None	1841688041	0	0	LEWIS, CASSIE M NP	2/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4400 DUCKHORN DR	STE 100	SACRAMENTO	CA	95834	2589	00	06000	38.65086	-121.531833	Sacramento County
300026	Non-Physician Medical Practitioner	None	1720268576	0	0	LIEPMANN, JULIA C	5/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11506 VAUXHALL BRIDGE DR	None	BAKERSFIELD	CA	93311	9204	00	06000	35.32867178	-119.1302103	Kern County
300044	Non-Physician Medical Practitioner	None	1225117096	0	0	LONG, WEN	11/17/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1762 SUNNYPARK	None	REDLANDS	CA	92374	5575	00	06000	34.0504925	-117.1402965	San Bernardino County
300054	Non-Physician Medical Practitioner	None	1902265317	0	0	LUNT, CLARKE D	11/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1973 S DALLAS BLVD	None	BOUNTIFUL	UT	84010	5305	00	06000	0	0	None
300063	Non-Physician Medical Practitioner	None	1902001712	0	0	LOVORN, DANA L	9/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	10167 N ENCORE ST	None	CASA GRANDE	AZ	85122	9853	00	06000	32.97152769	-111.7769527	Pinal County
300083	Non-Physician Medical Practitioner	None	1124865530	0	0	LEE, RACHEL NP	12/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	625 S FAIR OAKS AVE	STE 215	PASADENA	CA	91105	2613	00	06000	34.134894	-118.1504155	Los Angeles County
300093	Non-Physician Medical Practitioner	None	1255787297	0	0	LUONG, DAVID D	12/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4519 PACIFIC RIM WAY	None	SAN JOSE	CA	95121	2966	00	06000	37.29893693	-121.7801878	Santa Clara County
300113	Non-Physician Medical Practitioner	None	1053795625	0	0	LAM, VINCENT PA	4/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 EAST VALLEY PKWY	None	ESCONDIDO	CA	92025	3084	00	06000	33.12542915	-117.0764725	San Diego County
300131	Non-Physician Medical Practitioner	None	1770267700	0	0	LIZARRAGA, JESUS NP	6/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	00	06000	33.83760674	-118.3572569	Los Angeles County
300135	Non-Physician Medical Practitioner	None	1063938710	0	0	LEE, SAWANEE NP	12/14/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3330 E FOOTHILL BLVD	APT 526	PASADENA	CA	91107	3962	00	06000	34.15005709	-118.0819953	Los Angeles County
300153	Non-Physician Medical Practitioner	None	1477986248	0	0	LOGAN, APRIL M NP	4/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10650 ALYSSUM LANE	APT 202	VENTURA	CA	93004	4852	00	06000	34.27797563	-119.153755	Ventura County
300162	Non-Physician Medical Practitioner	None	1750656559	0	0	LAM, ANNE QUACH	3/5/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11017 VALLEY MALL	None	EL MONTE	CA	91731	2600	00	06000	34.07470785	-118.0346252	Los Angeles County
300168	Non-Physician Medical Practitioner	None	1821269135	0	0	LEE, ANGELA RENEE	10/4/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1318 E FLORENCE AVE	None	LOS ANGELES	CA	90001	1935	00	06000	33.97472353	-118.251306	Los Angeles County
300170	Non-Physician Medical Practitioner	None	1861953499	0	0	LE, DANIEL N PA	11/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
300179	Non-Physician Medical Practitioner	None	1295289122	0	0	LESTER, OLGA CNP	8/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	229 WEST CHERRY AVE	None	PORTERVILLE	CA	93257	3401	00	06000	36.06917549	-119.0215574	Tulare County
300236	Non-Physician Medical Practitioner	None	1073911087	0	0	LUCAS, LORENZEN PA-C	9/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8001 LORRAINE AVE	None	STOCKTON	CA	95210	4202	00	06000	38.02141518	-121.2832641	San Joaquin County
300238	Non-Physician Medical Practitioner	None	1831596667	0	0	LILLY, ANNA M NP	3/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
300249	Non-Physician Medical Practitioner	None	1780159806	0	0	LE, DIEM-TRINH T NP	4/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	416 W FOOTHILL BLVD	None	RIALTO	CA	92376	4953	00	06000	34.10677653	-117.3773835	San Bernardino County
300251	Non-Physician Medical Practitioner	None	1649556309	0	0	LIU, CHRISTINE NP	7/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3710 E CESAR CHAVEZ AVE	None	LOS ANGELES	CA	90063	2219	00	06000	34.04048853	-118.1854845	Los Angeles County
300254	Non-Physician Medical Practitioner	None	1952753691	0	0	LI, HO YAN J PA-C	12/17/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	215 W. 4TH ST	None	PERRIS	CA	92570	2010	00	06000	33.78233553	-117.2305035	Riverside County
300301	Non-Physician Medical Practitioner	None	1467663666	0	0	LEO, HOLLY L NP	4/17/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2714 NORTH FREEMAN LANE	None	SANTA ANA	CA	92706	1155	00	06000	33.773832	-117.878789	Orange County
300312	Non-Physician Medical Practitioner	None	1245696897	0	0	LEONARD ALIBRIO, AMBER L NP	3/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	373 CORONADO AVE	None	LONG BEACH	CA	90814	2668	00	06000	33.77073709	-118.1535603	Los Angeles County
300314	Non-Physician Medical Practitioner	None	1669915666	0	0	LOPEZ, JOHNETTE R NP	1/14/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3240 BELLAIRE AVE	None	CLOVIS	CA	93619	3909	00	06000	36.7915625	-119.6498385	Fresno County
300321	Non-Physician Medical Practitioner	None	1699425785	0	0	LUCCON, ELVIN NP	6/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1920 COLORADO AVENUE	None	SANTA MONICA	CA	90404	3414	00	06000	34.02564555	-118.477319	Los Angeles County
300354	Non-Physician Medical Practitioner	None	1841984770	0	0	LEE, CARISSA PA-C	9/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6263	00	06000	36.327888	-119.294919	Tulare County
300371	Non-Physician Medical Practitioner	None	1467932228	0	0	LEE, GRACE PA-C	1/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
300376	Non-Physician Medical Practitioner	None	1710618236	0	0	LOVETT, CHRISTINA M NP	8/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	00	06000	38.443806	-122.701374	Sonoma County
300449	Non-Physician Medical Practitioner	None	1841676467	0	0	LIN, MONIKA C PA	11/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
300461	Non-Physician Medical Practitioner	None	1245310770	0	0	LATEY, JENNIFER T K	8/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8971 MARY HILL DR	None	GARDEN GROVE	CA	92841	4667	00	06000	33.78031352	-117.9757017	Orange County
300463	Non-Physician Medical Practitioner	None	1831406776	0	0	LANES, AARON G PA-C	12/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1661 SOQUEL DR	STE F	SANTA CRUZ	CA	95065	1816	00	06000	36.98895429	-121.9821088	Santa Cruz County
300476	Non-Physician Medical Practitioner	None	1184404261	0	0	LY, COLLEEN A PA	2/11/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4060 4TH AVE	STE 700	SAN DIEGO	CA	92103	2121	00	06000	32.75053673	-117.1616539	San Diego County
300483	Non-Physician Medical Practitioner	None	1922485895	0	0	LIANG, JENNA K F NP	5/29/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	111 JONES ST	STE 505	SAN FRANCISCO	CA	94102	3966	00	06000	37.78235521	-122.4123109	San Francisco County
300502	Non-Physician Medical Practitioner	None	1902519358	0	0	LOPEZ, TRISTEN M NP	3/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	43839 15TH ST W	None	LANCASTER	CA	93534	4756	00	06000	34.678791	-118.156867	Los Angeles County
300512	Non-Physician Medical Practitioner	None	1871607762	0	0	LYONS, SHENAYE A NP	4/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
300516	Non-Physician Medical Practitioner	None	1346872231	0	0	LE, CATHY T PA	8/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23181 VERDUGO DR	STE 103A	LAGUNA HILLS	CA	92653	1313	00	06000	33.62609529	-117.7293191	Orange County
300567	Non-Physician Medical Practitioner	None	1588789754	0	0	LAZO, RODERICK	3/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13334 OLIVE TREE LN	None	POWAY	CA	92064	4920	00	06000	32.958657	-117.025386	San Diego County
300572	Non-Physician Medical Practitioner	None	1760092688	0	0	LEONG, KEOKI L PA	3/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3301 C ST	None	SACRAMENTO	CA	95816	3300	00	06000	38.579877	-121.456143	Sacramento County
300579	Non-Physician Medical Practitioner	None	1467407973	0	0	LIM-KYO, SHIELA-LYN MACATIAG	10/7/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	45 CALLERY CT	None	FREMONT	CA	94539	4756	00	06000	37.54762514	-121.9342115	Alameda County
300644	Non-Physician Medical Practitioner	None	1497260772	0	0	LI, ANNIE W PA-C	1/3/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	00	06000	34.13502	-117.2758635	San Bernardino County
300651	Non-Physician Medical Practitioner	None	1881331098	0	0	LU, JANICE NP	8/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
300668	Non-Physician Medical Practitioner	None	1881082329	0	0	LIFELONG MEDICAL CARE	4/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2344 6TH ST	None	BERKELEY	CA	94710	2412	00	06000	37.86198466	-122.295766	Alameda County
300674	Non-Physician Medical Practitioner	None	1881301034	0	0	LUU, HOANG D NP	2/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4639	00	06000	34.01070086	-118.1110129	Los Angeles County
300701	Non-Physician Medical Practitioner	None	1922378942	0	0	LEIBOVSKY, MARIA V	8/25/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5131 BAY VIEW CIRCLE	None	STOCKTON	CA	95219	2033	00	06000	37.98251942	-121.3674797	San Joaquin County
300749	Non-Physician Medical Practitioner	None	1730654658	0	0	LY, SUE C NP	3/22/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39180 FARWELL DR	SUITE 211	FREMONT	CA	94538	1000	00	06000	37.53211262	-121.9981587	Alameda County
300757	Non-Physician Medical Practitioner	None	1710044482	0	0	LAFFAN, ANGELA M	11/14/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	218 DE ANZA BLVD	None	SAN MATEO	CA	94402	3913	00	06000	37.52047913	-122.3369289	San Mateo County
300775	Non-Physician Medical Practitioner	None	1548974637	0	0	LEYVAS, TYLEN NP	4/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	00	06000	34.0956033	-118.2916918	Los Angeles County
300781	Non-Physician Medical Practitioner	None	1821146028	0	0	LEE, SUZANNE	11/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	00	06000	38.55204	-121.455387	Sacramento County
300782	Non-Physician Medical Practitioner	None	1427833623	0	0	LEILER, MONIQUE	12/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
300789	Non-Physician Medical Practitioner	None	1417217860	0	0	LEONARDS, GERONNA D NP	4/24/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5130 BRITTANY COURT	None	SANTA MARIA	CA	93455	7500	00	06000	34.86381195	-120.401841	Santa Barbara County
300790	Non-Physician Medical Practitioner	None	1710614227	0	0	LIU, BONNIE Y PA-C	2/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
300813	Non-Physician Medical Practitioner	None	1609898998	0	0	LITTMAN-DAVIS, KAREN A	9/29/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22663 FENWALL DR	None	SANTA CLARITA	CA	91350	3658	00	06000	34.45187478	-118.5326214	Los Angeles County
300838	Non-Physician Medical Practitioner	None	1992259691	0	0	LIU, TERESA	8/30/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4558 W POINT LOMA BLVD	None	SAN DIEGO	CA	92107	1241	00	06000	32.75205767	-117.2344633	San Diego County
300847	Non-Physician Medical Practitioner	None	1154835189	0	0	LARSON-MCQUAID, EMILY R	10/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	728 CRESCENT DRIVE	None	MONROVIA	CA	91016	1535	00	06000	34.15583113	-118.0144874	Los Angeles County
300885	Non-Physician Medical Practitioner	None	1205350956	0	0	LU, YANG NP	1/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12584 CENTRAL AVE	None	CHINO	CA	91710	3507	00	06000	34.024617	-117.689479	San Bernardino County
300904	Non-Physician Medical Practitioner	None	1184852394	0	0	LINDSTROM, BETHANY RUTH	1/11/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	669 W RENETTE AVE	None	EL CAJON	CA	92020	5833	00	06000	32.7839934	-116.9698421	San Diego County
300910	Non-Physician Medical Practitioner	None	1164824066	0	0	LE, LAM Q PA	8/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	00	06000	35.356203	-119.0612695	Kern County
300938	Non-Physician Medical Practitioner	None	1821457607	0	0	LEE, SUYEON	2/12/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8714 SIERRA VIEW CT	None	RANCHO CUCAMONGA	CA	91730	3175	00	06000	34.09987745	-117.6150469	San Bernardino County
300989	Non-Physician Medical Practitioner	None	1033698915	0	0	LE, THU T NP	7/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	782 EAST HARDING WAY	None	STOCKTON	CA	95204	6101	00	06000	37.96910043	-121.284224	San Joaquin County
301005	Non-Physician Medical Practitioner	None	1992068522	0	0	LAMEL, HEIDI MARIN	9/19/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3 MEDICAL PLAZA DR STE 2	None	ROSEVILLE	CA	95661	3089	00	06000	38.76566391	-121.2457432	Placer County
301019	Non-Physician Medical Practitioner	None	1982126199	0	0	LAMON, ABBY M PA	9/6/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
301026	Non-Physician Medical Practitioner	None	1841950581	0	0	LEWIS, ALYSSA R PA	4/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	00	06000	34.42967671	-119.7228362	Santa Barbara County
301034	Non-Physician Medical Practitioner	None	1558777961	0	0	LEE, HYE YOUNG NP	1/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
301040	Non-Physician Medical Practitioner	None	1679870695	0	0	LOPEZ, MARIA E PA-C	11/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8253 SIERRA AVE	SUITE 200	FONTANA	CA	92335	3578	00	06000	34.10379	-117.4357525	San Bernardino County
301051	Non-Physician Medical Practitioner	None	1396143855	0	0	LARROQUE, MARK L	12/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 SAN CARLOS WAY	None	NOVATO	CA	94945	1643	00	06000	38.12018775	-122.5909316	Marin County
301077	Non-Physician Medical Practitioner	None	1912435553	0	0	LEE, JI YOUN NP	10/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 S VIRGIL AVE	501	LOS ANGELES	CA	90020	1450	00	06000	34.064964	-118.2870335	Los Angeles County
301079	Non-Physician Medical Practitioner	None	1295018026	0	0	LIN, MARIA W Y	3/21/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2739 E LARKWOOD STREET	None	WEST COVINA	CA	91791	2927	00	06000	34.06311	-117.8865725	Los Angeles County
301096	Non-Physician Medical Practitioner	None	1659843522	0	0	LE, TIFFANY MAE H NP	3/31/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
301099	Non-Physician Medical Practitioner	None	1720381221	0	0	LABAT BUTLER, JEANNIE RENEE	7/8/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3544 PINEWOOD DR	None	HAYWARD	CA	94542	2608	00	06000	37.64989454	-122.029607	Alameda County
301112	Non-Physician Medical Practitioner	None	1053960724	0	0	LUCZAK, CAROLINE PA	4/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	594 EL CAMINO REAL	None	SANTA CLARA	CA	95050	4345	00	06000	37.35293214	-121.9385135	Santa Clara County
301141	Non-Physician Medical Practitioner	None	1316265846	0	0	LIN, AILEEN NP	12/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	612 SAN BENITO AVE	None	MENLO PARK	CA	94025	1936	00	06000	37.47404108	-122.1945781	San Mateo County
301167	Non-Physician Medical Practitioner	None	1982220745	0	0	LOVE, MEAGAN M PA	7/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	517 N MAIN ST	STE 100	SANTA ANA	CA	92701	4619	00	06000	33.74951945	-117.8675809	Orange County
301176	Non-Physician Medical Practitioner	None	1134804248	0	0	LENTZ, ERIC	7/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
301189	Non-Physician Medical Practitioner	None	1568753242	0	0	LEE, ESTHER H NP	6/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	761 N 11TH STREET	None	SAN JOSE	CA	95112	3147	00	06000	37.35565683	-121.8908015	Santa Clara County
301267	Non-Physician Medical Practitioner	None	1275698854	0	0	LEBRUN, AMY	11/19/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2401 W UNIVERSITY AVE	None	MUNCIE	IN	47303	3428	00	06000	40.19758382	-85.41506596	Delaware County
301288	Non-Physician Medical Practitioner	None	1023649498	0	0	LACUESTA, BARBARA NP	8/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	00	06000	32.781195	-117.0070695	San Diego County
301298	Non-Physician Medical Practitioner	None	1689179517	0	0	LACHMAN, HANNAH N NP	5/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
301309	Non-Physician Medical Practitioner	None	1245546860	0	0	LAVIADDIN, ERIC D	3/24/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5117 LINDLEY AVE	None	TARZANA	CA	91356	4349	00	06000	34.16257733	-118.527244	Los Angeles County
301321	Non-Physician Medical Practitioner	None	1861050692	0	0	LI, ELLIN D PA	3/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	00	06000	34.062852	-117.9446658	Los Angeles County
301345	Non-Physician Medical Practitioner	None	1205207669	0	0	LEWIS, VERONICA A NP	8/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	703 E CHESTNUT STREET	APT 15	GLENDALE	CA	91205	2209	00	06000	34.13992849	-118.2466884	Los Angeles County
301378	Non-Physician Medical Practitioner	None	1245678424	0	0	LEMERT, SARA R	9/22/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20118 ITASCA STREET	None	CHATSWORTH	CA	91311	5412	00	06000	34.24459716	-118.5719906	Los Angeles County
301385	Non-Physician Medical Practitioner	None	1184332272	0	0	LEE, MATTHEW S PA-C	7/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 CESAR E CHAVEZ AVE	STE 2200	LOS ANGELES	CA	90033	2476	00	06000	34.05101259	-118.217259	Los Angeles County
301417	Non-Physician Medical Practitioner	None	1679056451	0	0	LAGAZO, CHRISTINA A NP	10/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	00	06000	34.062852	-117.9446658	Los Angeles County
301422	Non-Physician Medical Practitioner	None	1881231066	0	0	LACSON, CARALISA NP	6/25/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
301427	Non-Physician Medical Practitioner	None	1396055240	0	0	LA, ELAINE	2/23/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	407 W COLLEGE ST.	None	LOS ANGELES	CA	90012	0000	00	06000	34.06413934	-118.237719	Los Angeles County
301445	Non-Physician Medical Practitioner	None	1780765420	0	0	LE, LING	8/1/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4955 VAN NUYS BLVD	SUITE # 411	SHERMAN OAKS	CA	91403	1801	00	06000	34.160805	-118.4487295	Los Angeles County
301455	Non-Physician Medical Practitioner	None	1750803680	0	0	LONG, SAMANTHA PA	3/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 S. CENTRAL AVENUE	None	GLENDALE	CA	91204	2508	00	06000	34.12811155	-118.2577764	Los Angeles County
301478	Non-Physician Medical Practitioner	None	1811064678	0	0	LARINTO, JOHN T	3/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20502 PIERVIEW LANE	None	HUNTINGTON BEACH	CA	92646	6030	00	06000	33.66487414	-117.956019	Orange County
301572	Non-Physician Medical Practitioner	None	1134558125	0	0	LOVETT, TRACIE NP	7/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7111 FRESNO ST	STE 200	FRESNO	CA	93720	2965	00	06000	36.83951763	-119.7815709	Fresno County
301580	Non-Physician Medical Practitioner	None	1932628112	0	0	LUONG, JAMES M PA	11/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8673 W PICO BLVD	None	LOS ANGELES	CA	90035	2377	00	06000	34.05430223	-118.3810857	Los Angeles County
301582	Non-Physician Medical Practitioner	None	1134519374	0	0	LEMUS, MARIO C	3/4/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2649 WEST WHITENDALE	None	VISALIA	CA	93277	7271	00	06000	36.305415	-119.320164	Tulare County
301589	Non-Physician Medical Practitioner	None	1588907638	0	0	LACY, JON C	12/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4515 W 1ST ST	3	LOS ANGELES	CA	90004	5058	00	06000	34.07306001	-118.3099448	Los Angeles County
301593	Non-Physician Medical Practitioner	None	1033463930	0	0	LEDER, GREGORY D	2/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4661 VISTA BUENA	None	SANTA BARBARA	CA	93110	1945	00	06000	34.43624394	-119.7823109	Santa Barbara County
301620	Non-Physician Medical Practitioner	None	1730487802	0	0	LATIOLAIT, TRICIA A PA-C	6/14/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7601 ATLANTIC AVE	None	CUDAHY	CA	90201	5019	00	06000	33.96721523	-118.187457	Los Angeles County
301650	Non-Physician Medical Practitioner	None	1891801833	0	0	LUIS, CASTRO PA	6/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1832 W SUNSET BLVD	None	LOS ANGELES	CA	90026	3227	00	06000	34.07796606	-118.260369	Los Angeles County
301692	Non-Physician Medical Practitioner	None	1801236625	0	0	LANG, DONALD J NP	10/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	532 CIRCLE DRIVE S	None	FRESNO	CA	93704	4763	00	06000	36.78535836	-119.8056948	Fresno County
301694	Non-Physician Medical Practitioner	None	1104234871	0	0	LORAN, DAVID NP	2/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5671 BALBOA AVE	None	SAN DIEGO	CA	92111	2705	00	06000	32.82010691	-117.1788026	San Diego County
301701	Non-Physician Medical Practitioner	None	1891904892	0	0	LEEFERS, VIKI J MD	7/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1845 LILAC LANE	None	ALPINE	CA	91901	2928	00	06000	32.824719	-116.795754	San Diego County
301717	Non-Physician Medical Practitioner	None	1396289518	0	0	LAHIP, JONAH NP	12/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1018 CALLOWAY	None	BAKERSFIELD	CA	93312	6337	00	06000	35.36734178	-119.1115596	Kern County
301738	Non-Physician Medical Practitioner	None	1912724758	0	0	LAURENZANO, LAURA C NP	1/15/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	00	06000	34.42967671	-119.7228362	Santa Barbara County
301764	Non-Physician Medical Practitioner	None	1396966636	0	0	LIM, LILY ANNE	6/18/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9449 IMPERIAL HWY	SUITE 120	DOWNEY	CA	90242	2814	00	06000	33.91714048	-118.1262915	Los Angeles County
301776	Non-Physician Medical Practitioner	None	1194339382	0	0	LIU, ALBERT B NP	3/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39650 LIBERTY ST	STE 310	FREMONT	CA	94358	2227	00	06000	37.54662058	-121.9736002	Alameda County
301853	Non-Physician Medical Practitioner	None	1417089590	0	0	LELKE-WALLWAY, WENDI S NP	5/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
301857	Non-Physician Medical Practitioner	None	1467910489	0	0	LANDES, DEBORAH L CNM	6/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	110 TAMPICO DRIVE	SUITE 210	WALNUT CREEK	CA	94598	2512	00	06000	37.91113845	-122.0458263	Contra Costa County
301871	Non-Physician Medical Practitioner	None	1043872260	0	0	LOVELACE, KRISTINA K NP	5/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3528	00	06000	33.89242734	-118.2947128	Los Angeles County
301878	Non-Physician Medical Practitioner	None	1255870614	0	0	LAM, HELEN PA	2/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4760 SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	00	06000	34.09811852	-118.293408	Los Angeles County
301884	Non-Physician Medical Practitioner	None	1033798467	0	0	LI, WENLI NP	5/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25431 CABOT RD	STE 118	LAGUNA HILLS	CA	92653	5527	00	06000	33.59115448	-117.6744575	Orange County
301886	Non-Physician Medical Practitioner	None	1023768033	0	0	LOPEZ, SELINA D NP	5/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	845 LA VETA	STE 108	ORANGE	CA	92868	3930	00	06000	33.78064548	-117.8611107	Orange County
301894	Non-Physician Medical Practitioner	None	1134152887	0	0	LAUNDY, JOAN P	5/8/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	00	06000	32.89687721	-117.2418677	San Diego County
301895	Non-Physician Medical Practitioner	None	1891881215	0	0	LAZAREK, TIMOTHY FRANCIS	1/23/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5353 CLEMENTE PL	None	SAN DIEGO	CA	92117	1019	00	06000	32.84167799	-117.2103045	San Diego County
301904	Non-Physician Medical Practitioner	None	1710162359	0	0	LUONG, ANNY	10/2/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 FOREST AVE	APT 1106	PALO ALTO	CA	94301	2631	00	06000	37.44722878	-122.1562442	Santa Clara County
301910	Non-Physician Medical Practitioner	None	1053496794	0	0	LOUCH, GLENDA	9/3/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	06000	39.742164	-104.8350375	Adams County
301923	Non-Physician Medical Practitioner	None	1003325853	0	0	LEE, CHIALIN PA	9/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
301929	Non-Physician Medical Practitioner	None	1457658171	0	0	L, JOHNSON J	3/7/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15934 LA COSTA ALTA DR	None	MORENO VALLEY	CA	92555	5936	00	06000	33.88899097	-117.178454	Riverside County
301932	Non-Physician Medical Practitioner	None	1639239759	0	0	LINDHOLM-NORMAN, SANDRA LEE	12/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	320 LENNON LANE	None	WALNUT CREEK	CA	94598	3120	00	06000	37.92699561	-122.0292732	Contra Costa County
301960	Non-Physician Medical Practitioner	None	1366819757	0	0	LI, MICHELLE M	7/12/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	437 WESTCLIFFE PL	None	WALNUT CREEK	CA	94597	3268	00	06000	37.91555032	-122.057574	Contra Costa County
301978	Non-Physician Medical Practitioner	None	1356710909	0	0	LINGAFELDT, MARGARET C NP	5/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	00	06000	39.74352822	-121.8495394	Butte County
301993	Non-Physician Medical Practitioner	None	1275018764	0	0	LUI, TIMOTHY ALBERT B PA	6/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
301998	Non-Physician Medical Practitioner	None	1154606192	0	0	LEMES, AMY M	7/6/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3332 CHESAPEAKE BAY AVE	None	DAVIS	CA	95616	2608	00	06000	38.55676099	-121.7927375	Yolo County
302007	Non-Physician Medical Practitioner	None	1104281088	0	0	LEE, CARINA	2/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4747 HAMILTON STREET	UNIT 3	SAN DIEGO	CA	92116	9211	00	06000	32.76361026	-117.136358	San Diego County
302049	Non-Physician Medical Practitioner	None	1215113782	0	0	LOGAN, DEBORAH N CNM	8/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	139 RIVERIA DRIVE	APT 27	LOS GATOS	CA	93292	7402	00	06000	0	0	None
302065	Non-Physician Medical Practitioner	None	1710534342	0	0	LINVILLE, ROBIN M PA	5/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
302067	Non-Physician Medical Practitioner	None	1407145576	0	0	LAU, SAMANTHA NP	2/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	00	06000	34.13990611	-118.2182985	Los Angeles County
302069	Non-Physician Medical Practitioner	None	1477743136	0	0	LUCERO, LESLEY PA-C	7/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 OLD RIVER ROAD	None	BAKERSFIELD	CA	93311	9781	00	06000	35.351487	-119.1143025	Kern County
302108	Non-Physician Medical Practitioner	None	1043648132	0	0	LEAL, CARLOS M	2/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1009 DOUGLAS AVE	None	OXNARD	CA	93030	4416	00	06000	34.2089382	-119.1893807	Ventura County
302131	Non-Physician Medical Practitioner	None	1407367006	0	0	LAYTON, BRIAN M PA-C	12/3/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	00	06000	40.57278686	-122.3958519	Shasta County
302133	Non-Physician Medical Practitioner	None	1891074886	0	0	LARA, KRISTI MARIE	5/10/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 EASTLAKE AVE	NOR 8302E	LOS ANGELES	CA	90089	0112	00	06000	34.06169385	-118.2044698	Los Angeles County
302140	Non-Physician Medical Practitioner	None	1154407468	0	0	LOLLAR, LESTER L NP	1/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1255 LIBERTY STREET	None	REDDING	CA	96001	0814	00	06000	40.58769807	-122.3879041	Shasta County
302148	Non-Physician Medical Practitioner	None	1154036515	0	0	LOAKES, ALEXANDRA V PA	6/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
302160	Non-Physician Medical Practitioner	None	1659803369	0	0	LEVINE, NATALIE E NP	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
302167	Non-Physician Medical Practitioner	None	1316460249	0	0	LEI, SAMMY PA-C	4/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	309 WEST BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	00	06000	34.01597577	-118.1003516	Los Angeles County
302173	Non-Physician Medical Practitioner	None	1558391128	0	0	LOCK, CAMA G	7/17/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	775 CAMBRIDGE AVE	None	MENLO PARK	CA	94025	5303	00	06000	37.44650014	-122.1756149	San Mateo County
302189	Non-Physician Medical Practitioner	None	1982755161	0	0	LONG, LORI A	6/30/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	365 SPARROW DRIVE	None	GALT	CA	95632	2409	00	06000	38.261457	-121.3212285	Sacramento County
302201	Non-Physician Medical Practitioner	None	1841710886	0	0	LEDBETTER, MICHELLE M	12/31/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	913 W CENTRAL AVE	None	BENTONVILLE	AR	72712	5035	00	06000	36.372267	-94.2231555	Benton County
302229	Non-Physician Medical Practitioner	None	1184266207	0	0	LEE, CAROLYN PA-C	4/7/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	STE 1300	LOS ANGELES	CA	90033	5312	00	06000	34.06269295	-118.2030006	Los Angeles County
302242	Non-Physician Medical Practitioner	None	1164672796	0	0	LEE, MELODY	5/4/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	520 N PROSPECT AVE	None	REDONDO BEACH	CA	90277	3041	00	06000	33.8529819	-118.3802954	Los Angeles County
302276	Non-Physician Medical Practitioner	None	1093254674	0	0	LAI, NINA Y PA-C	7/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
302281	Non-Physician Medical Practitioner	None	1912961038	0	0	LEE, GRACE J	1/11/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19 ABETO	None	IRVINE	CA	92620	1802	00	06000	33.72072369	-117.7660985	Orange County
302357	Non-Physician Medical Practitioner	None	1023190212	0	0	LEW, JENNIFER A	3/21/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1730 COLBY AVENUE	APT 305	LOS ANGELES	CA	90025	4376	00	06000	34.04226678	-118.4504268	Los Angeles County
302360	Non-Physician Medical Practitioner	None	1174213193	0	0	LYMAN, MADELINE PA	10/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1742 OREGON STREET	None	REDDING	CA	96001	1717	00	06000	40.5808265	-122.3932989	Shasta County
302361	Non-Physician Medical Practitioner	None	1174987754	0	0	LUNA, ANALI G NP	1/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7910 FROST ST	STE 280	SAN DIEGO	CA	92123	2776	00	06000	32.80027449	-117.153846	San Diego County
302363	Non-Physician Medical Practitioner	None	1669728549	0	0	LEWIS, GLENDON G PA-C	1/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	925 CORPORATE CENTER	SUITE A	SANTA ROSA	CA	95407	5453	00	06000	38.425383	-122.7536235	Sonoma County
302368	Non-Physician Medical Practitioner	None	1841788783	0	0	LUNA, ANDREW PA-C	8/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4060 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2526	00	06000	34.02390148	-118.184319	Los Angeles County
302390	Non-Physician Medical Practitioner	None	1649674797	0	0	LOPEZ, MARK ERWIN S NP	10/12/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	00	06000	38.555631	-121.459203	Sacramento County
302392	Non-Physician Medical Practitioner	None	1962046714	0	0	LEE, ELLEN K PA-C	1/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1495 RIVER PARK DR	200	SACRAMENTO	CA	95815	4500	00	06000	38.599524	-121.437738	Sacramento County
302401	Non-Physician Medical Practitioner	None	1336476092	0	0	LEAVY-BUTLER, ANDREA S NP	4/13/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1107 SHRADER ST	None	SAN FRANCISCO	CA	94117	4216	00	06000	37.76445676	-122.4511805	San Francisco County
302472	Non-Physician Medical Practitioner	None	1689002586	0	0	LOPEZ, YARICKZA M	1/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7722 MALLON COURT	None	SACRAMENTO	CA	95829	6601	00	06000	38.469726	-121.3105635	Sacramento County
302584	Non-Physician Medical Practitioner	None	1518397959	0	0	LAIRD, BARBARA B NP	1/24/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	140 E COMMONWEALTH AVE	SUITE 101	FULLERTON	CA	92832	1905	00	06000	33.87034048	-117.922437	Orange County
302642	Non-Physician Medical Practitioner	None	1609908243	0	0	LITIEMA, CECIL K NP	12/8/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5156 W LOCUST AVE	None	FRESNO	CA	93722	2103	00	06000	36.83971831	-119.8848478	Fresno County
302654	Non-Physician Medical Practitioner	None	1124439930	0	0	LIN, CHRISTINE C	4/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 HERITAGE MEADOWS RD	None	PLEASANT HILL	CA	94523	3192	00	06000	37.94229459	-122.0905961	Contra Costa County
302670	Non-Physician Medical Practitioner	None	1407639883	0	0	LUAFAU, CHRISTIAN PA	5/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2050 S EUCLID ST	None	ANAHEIM	CA	92802	3111	00	06000	33.79714857	-117.941245	Orange County
302678	Non-Physician Medical Practitioner	None	1114669405	0	0	LEVY, RACHEL V	5/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
302711	Non-Physician Medical Practitioner	None	1326600388	0	0	LENCIONI, ERIN E PA	1/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
302714	Non-Physician Medical Practitioner	None	1750958161	0	0	LAI, AMY D PA	8/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	00	06000	34.13101049	-118.151532	Los Angeles County
302727	Non-Physician Medical Practitioner	None	1770182990	0	0	LEUNG, RICKY	10/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
302735	Non-Physician Medical Practitioner	None	1295196756	0	0	LEE, SU Y NP	8/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1313 VALLEY VIEW RD	107	GLENDALE	CA	91202	1748	00	06000	34.16541964	-118.260367	Los Angeles County
302756	Non-Physician Medical Practitioner	None	1770711038	0	0	LIVERATO, JANEL PA-C	4/11/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	370 N WIGET LANE	STE 210	WALNUT CREEK	CA	94598	2452	00	06000	37.92948925	-122.0275099	Contra Costa County
302766	Non-Physician Medical Practitioner	None	1043796402	0	0	LU, JONATHAN F NP	2/12/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1211 W LA PALMA AVE	STE 207	ANAHEIM	CA	92801	2139	00	06000	33.84718298	-117.933758	Orange County
302778	Non-Physician Medical Practitioner	None	1417416702	0	0	LOBO, ANNA SUZETTE	8/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
302786	Non-Physician Medical Practitioner	None	1356777130	0	0	LOCKWOOD, LAUREN M CNM	9/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6718 PINEHAVEN RD	None	OAKLAND	CA	94611	1014	00	06000	37.84700671	-122.2084038	Alameda County
302788	Non-Physician Medical Practitioner	None	1588210504	0	0	LIM-QUEVEDO, JENNIFER A	4/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3401 W SUNFLOWER AVE	STE 250	SANTA ANA	CA	92704	6948	00	06000	33.69575566	-117.9144503	Orange County
302804	Non-Physician Medical Practitioner	None	1588815161	0	0	LU, LINH M	5/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7150 N MAPLE AVE	APT 104	FRESNO	CA	93720	0104	00	06000	36.84019969	-119.745308	Fresno County
302881	Non-Physician Medical Practitioner	None	1740760347	0	0	LUI, FLORA F NP	1/14/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	438 W LAS TUNAS DRIVE	None	SAN GABRIEL	CA	91776	1216	00	06000	34.10243051	-118.105902	Los Angeles County
302885	Non-Physician Medical Practitioner	None	1306600317	0	0	LACSON, CARLO PA-C	2/25/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	00	06000	34.06287152	-118.2029433	Los Angeles County
302897	Non-Physician Medical Practitioner	None	1598708661	0	0	LUBATTI, ANNA M	4/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11361 REGENT DRIVE	None	RANCHO CUCAMONGA	CA	91730	8320	00	06000	34.1159704	-117.55724	San Bernardino County
302913	Non-Physician Medical Practitioner	None	1336729151	0	0	LEE, RENEE C PA-C	11/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1819	00	06000	34.073505	-117.3505995	San Bernardino County
302939	Non-Physician Medical Practitioner	None	1811261084	0	0	LANE, ANAIS D NP	12/21/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3300 E SOUTH ST	STE 304	LONG BEACH	CA	90805	4549	00	06000	33.86018093	-118.1537163	Los Angeles County
302958	Non-Physician Medical Practitioner	None	1316564156	0	0	LARSON, EVA D PA	2/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	BLDG 25	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
303007	Non-Physician Medical Practitioner	None	1265100317	0	0	LIN, CONNIE H NP	9/24/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	00	06000	34.13101049	-118.151532	Los Angeles County
303018	Non-Physician Medical Practitioner	None	1194806588	0	0	LEHRMAN, LEIGH-ANNE PA	6/24/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8756 EMPIRE GRADE	None	SANTA CRUZ	CA	95060	9421	00	06000	37.07420053	-122.1302356	Santa Cruz County
303024	Non-Physician Medical Practitioner	None	1922345412	0	0	LAM, MICHELLE KWOK-YIU	11/6/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	00	06000	36.83626596	-119.7674879	Fresno County
303034	Non-Physician Medical Practitioner	None	1942372198	0	0	LUDLOW, CHRISTOPHER C	5/4/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8185 RIDGELAND TERRACE	None	REDDING	CA	96001	2462	00	06000	40.52246939	-122.5027661	Shasta County
303037	Non-Physician Medical Practitioner	None	1215416102	0	0	LUU, KAREN NP	3/4/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	00	06000	34.03273663	-118.4516927	Los Angeles County
303044	Non-Physician Medical Practitioner	None	1922021799	0	0	LOMINSKA, SUSAN	8/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	00	06000	34.1010559	-117.6369445	San Bernardino County
303048	Non-Physician Medical Practitioner	None	1013315316	0	0	LOFT, LINDSAY A NP	11/22/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3180 LOMA VISTA ROAD	None	VENTURA	CA	93003	2918	00	06000	34.27597728	-119.2533382	Ventura County
303049	Non-Physician Medical Practitioner	None	1841498565	0	0	LU, ERIC PA-C	8/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	896 S HARBOR BLVD	None	ANAHEIM	CA	92805	5158	00	06000	33.82203054	-117.9155263	Orange County
303053	Non-Physician Medical Practitioner	None	1992307078	0	0	LOVELL, ANN PA	4/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1756 N MAIN ST	None	SALINAS	CA	93906	5103	00	06000	36.71800104	-121.6534748	Monterey County
303061	Non-Physician Medical Practitioner	None	1326355660	0	0	LEMUS, MICHAEL H	9/25/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	40911 LONG HOLLOW DRIVE	None	COARSEGOLD	CA	93614	9630	00	06000	37.16489443	-119.804926	Madera County
303064	Non-Physician Medical Practitioner	None	1245741552	0	0	LEE, JANE NP	9/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3000 Q STREET	2ND FLOOR	SACRAMENTO	CA	95816	7058	00	06000	38.564991	-121.4696565	Sacramento County
303080	Non-Physician Medical Practitioner	None	1992307235	0	0	LEBS, JESSICA R PA-C	11/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27700 MEDICAL CENTER	None	MISSION VIEJO	CA	92691	6426	00	06000	33.56008604	-117.6657795	Orange County
303100	Non-Physician Medical Practitioner	None	1306821145	0	0	LINDSEY, BUCHERT L	5/3/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1095 MARSHALL WAY	None	PLACEVILLE	CA	95667	8238	00	06000	38.7257686	-120.7910663	El Dorado County
303104	Non-Physician Medical Practitioner	None	1912205204	0	0	LAMALE, AARON M NP	5/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	34 RIVAS AVE	None	SAN FRANCISCO	CA	94132	2139	00	06000	37.71684968	-122.4815932	San Francisco County
303124	Non-Physician Medical Practitioner	None	1669729802	0	0	LEE, PORSCHE E	5/29/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 N SAN FERNANDO RD	UNIT 619	LOS ANGELES	CA	90031	1345	00	06000	34.07658141	-118.222599	Los Angeles County
303132	Non-Physician Medical Practitioner	None	1700591575	0	0	LEGASPI, ROWENA S NP	1/27/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2438 PONDEROSA DRIVE N	C-101	CAMARILLO	CA	93010	2369	00	06000	34.24219545	-119.0227012	Ventura County
303154	Non-Physician Medical Practitioner	None	1124372974	0	0	LOS ANGELES CHRISTIAN HEALTH CENTERS	8/6/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1005 S CENTRAL AVE	None	LOS ANGELES	CA	90021	2039	00	06000	34.03131259	-118.2446231	Los Angeles County
303160	Non-Physician Medical Practitioner	None	1558411405	0	0	LEE, VICTOR HO	7/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3012 SUMMIT ST	2ND FLOOR KAISER CARDIOV	OAKLAND	CA	94609	3480	00	06000	37.81947101	-122.264516	Alameda County
303191	Non-Physician Medical Practitioner	None	1356931182	0	0	LUCERO, ANTHONY R NP	2/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	536 CAMINO MERCADO	STE.306	ARROYO GRANDE	CA	93420	1418	00	06000	35.12986992	-120.6006027	San Luis Obispo County
303194	Non-Physician Medical Practitioner	None	1033432604	0	0	LEE, GORDON Y PA	2/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 SAN PABLO AVE	None	ALBANY	CA	94706	1127	00	06000	37.89781848	-122.3014067	Alameda County
303200	Non-Physician Medical Practitioner	None	1689709271	0	0	LE FLOCH, NATHALIE MARIE PIERRE	9/21/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
303217	Non-Physician Medical Practitioner	None	1275189813	0	0	LAMB, KERRY PA-C	7/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2811 WILSHIRE BLVD	STE 930	SANTA MONICA	CA	90403	4809	00	06000	34.03785224	-118.4752132	Los Angeles County
303220	Non-Physician Medical Practitioner	None	1588303424	0	0	LORD, KORY PA-C	3/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1495 RIVER PARK DR	200	SACRAMENTO	CA	95815	4500	00	06000	38.599524	-121.437738	Sacramento County
303264	Non-Physician Medical Practitioner	None	1851908834	0	0	LOREY, KATHARINE E PA	9/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
303280	Non-Physician Medical Practitioner	None	1104324151	0	0	LEE, JESSICA S NP	2/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	00	06000	37.592811	-122.382351	San Mateo County
303292	Non-Physician Medical Practitioner	None	1841355617	0	0	LOCKHART, DONNA K	4/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3554 ROUND BARN BLVD STE	None	SANTA ROSA	CA	95403	0930	00	06000	38.47599	-122.725557	Sonoma County
303297	Non-Physician Medical Practitioner	None	1326781238	0	0	LADWIG-COX, CARISSA	7/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3975 JACKSON STREET	STE 207	RIVERSIDE	CA	92503	3948	00	06000	33.92729721	-117.4413503	Riverside County
303298	Non-Physician Medical Practitioner	None	1356322911	0	0	LOPEZ, CRISTINA	2/22/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2570 JENSEN AVE	SUITE 102	SANGER	CA	93657	2269	00	06000	36.70680647	-119.5736715	Fresno County
303346	Non-Physician Medical Practitioner	None	1689126260	0	0	LOZADA, MICHELLE C NP	2/8/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1525 WHITE BIRCH TERRACE	UNIT 315	FREMONT	CA	94536	7806	00	06000	37.56133285	-121.9776639	Alameda County
303363	Non-Physician Medical Practitioner	None	1114434354	0	0	LIMA, DELANI	11/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
303415	Non-Physician Medical Practitioner	None	1386155208	0	0	LAM, YVONNE PA-C	11/28/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2740 S BRISTOL ST	STE 208	SANTA ANA	CA	92704	6233	00	06000	33.70999696	-117.8854626	Orange County
303421	Non-Physician Medical Practitioner	None	1316109614	0	0	LEVINE, JENNIFER H PA-C	5/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	477 N EL CAMINO REAL	SUITE D200	ENCINITAS	CA	92024	1328	00	06000	33.05700866	-117.262449	San Diego County
303432	Non-Physician Medical Practitioner	None	1336445048	0	0	LINNELL, DYLAN J	7/8/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3605 BIG BEND LANE	None	RENO	NV	89509	7428	00	06000	39.48282289	-119.8471635	Washoe County
303455	Non-Physician Medical Practitioner	None	1609111624	0	0	LU, JOCELYN C	3/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8680 N GLENN AVE	APT 221	FRESNO	CA	93711	6944	00	06000	36.8630894	-119.7939706	Fresno County
303534	Non-Physician Medical Practitioner	None	1386683845	0	0	LYKINS, ELIZABETH M PA-C	4/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	550 S GREEN VALLEY RD	None	WATSONVILLE	CA	95076	3053	00	06000	36.92586689	-121.7796602	Santa Cruz County
303568	Non-Physician Medical Practitioner	None	1003465105	0	0	LISING, KENNETH PAOLO D NP	12/6/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2141 N HARBOR BLVD	STE 25000	FULLERTON	CA	92835	3830	00	06000	33.89443025	-117.9288328	Orange County
303570	Non-Physician Medical Practitioner	None	1295226256	0	0	LEE, CINDY	6/23/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3585 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2654	00	06000	33.93049543	-118.2057312	Los Angeles County
303612	Non-Physician Medical Practitioner	None	1720292212	0	0	LIVERMORE, SARAH	11/5/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4311 3RD AVE	None	SAN DIEGO	CA	92103	1407	00	06000	32.758578	-117.1637685	San Diego County
303615	Non-Physician Medical Practitioner	None	1467599290	0	0	LO, JENNIFER S PA	12/31/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 ROWLAND WAY	SUITE 200	NOVATO	CA	94945	5011	00	06000	38.09698106	-122.5587348	Marin County
303624	Non-Physician Medical Practitioner	None	1023445780	0	0	LA CLINICA DE LA RAZA, INC.	2/5/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 28TH AVE	None	OAKLAND	CA	94601	2455	00	06000	37.78277725	-122.2270438	Alameda County
303633	Non-Physician Medical Practitioner	None	1790279081	0	0	LEVY, ERICA	11/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2873 E BLACK HORSE DR	None	ONTARIO	CA	91761	9109	00	06000	34.009614	-117.589122	San Bernardino County
303636	Non-Physician Medical Practitioner	None	1336757293	0	0	LIU, ROCHELLE PA	10/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
303652	Non-Physician Medical Practitioner	None	1306673504	0	0	LAI, ISAAC PA	1/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	00	06000	33.969141	-118.0489095	Los Angeles County
303671	Non-Physician Medical Practitioner	None	1598074064	0	0	LEE, DONNA WEISHIN	11/23/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	770 WELCH ROAD	SUITE 100	PALO ALTO	CA	94304	0000	00	06000	37.43748087	-122.1759625	Santa Clara County
303680	Non-Physician Medical Practitioner	None	1275242158	0	0	LOPEZ, ALEXIS NP	8/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	00	06000	32.79692047	-117.1567137	San Diego County
303692	Non-Physician Medical Practitioner	None	1700598661	0	0	LEWIS, DAVID E PA	5/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
303714	Non-Physician Medical Practitioner	None	1649822008	0	0	LUONG, VANN PA-C	10/30/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	825 DELBON AVE	None	TURLOCK	CA	95382	2016	00	06000	37.51052943	-120.8386573	Stanislaus County
303723	Non-Physician Medical Practitioner	None	1831507599	0	0	LEVY, SIMJA Y	11/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	692 VINELAND AVE	None	HENDERSON	NV	89052	2826	00	06000	36.01192135	-115.1021448	Clark County
303741	Non-Physician Medical Practitioner	None	1427681022	0	0	LIN, JOYCE PA-C	5/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
303751	Non-Physician Medical Practitioner	None	1750928388	0	0	LAGUNA, LISA T NP	5/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 E HARDY ST	205	INGLEWOOD	CA	90301	4021	00	06000	33.9491005	-118.348857	Los Angeles County
303754	Non-Physician Medical Practitioner	None	1154926418	0	0	LIYANAGE, MONICA NP	12/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3670 DEGNAN BLVD	None	LOS ANGELES	CA	90018	4015	00	06000	34.02110503	-118.329693	Los Angeles County
303760	Non-Physician Medical Practitioner	None	1699923433	0	0	LOPEZ, LISA M NP	4/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	533 AUTUMN ROAD	None	MADERA	CA	93637	4136	00	06000	36.95900119	-120.0954001	Madera County
303761	Non-Physician Medical Practitioner	None	1952065005	0	0	LE, MADISON NP	4/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	00	06000	32.72663119	-117.1611714	San Diego County
303762	Non-Physician Medical Practitioner	None	1659604577	0	0	LERNER, DIANA A NP	3/9/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	731 SILK TREE STREET	None	IRVINE	CA	92606	4512	00	06000	33.69173893	-117.8199968	Orange County
303793	Non-Physician Medical Practitioner	None	1306469804	0	0	LOUIE, JAMIE Y PA-C	5/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
303808	Non-Physician Medical Practitioner	None	1083293641	0	0	LO, YEU M NP	3/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	568 E HERNDON AVE	STE 201	FRESNO	CA	93720	2989	00	06000	36.83752653	-119.7776433	Fresno County
303917	Non-Physician Medical Practitioner	None	1477212728	0	0	LE, CAROLYN A PA-C	9/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17782 COWAN STE A	None	IRVINE	CA	92614	6041	00	06000	33.69590054	-117.862371	Orange County
303935	Non-Physician Medical Practitioner	None	1225468614	0	0	LEDERMAN, ANNA CNM	1/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
303941	Non-Physician Medical Practitioner	None	1013030899	0	0	LEE, SUSIE K	6/26/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8730 ALDEN DR.	235	LOS ANGELES	CA	90048	6101	00	06000	34.07526353	-118.3830885	Los Angeles County
303952	Non-Physician Medical Practitioner	None	1962615369	0	0	LUNA, JAIME R PA-C	8/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2650 S BRISTOL ST	STE 101-103	SANTA ANA	CA	92704	5751	00	06000	33.71118647	-117.885452	Orange County
303971	Non-Physician Medical Practitioner	None	1407136617	0	0	LUO, SHAZHOU	12/19/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 NORTH SANTA ANITA AV	None	ARCADIA	CA	91006	3108	00	06000	34.14134577	-118.0313747	Los Angeles County
303973	Non-Physician Medical Practitioner	None	1316396807	0	0	LEVY, SHARON B NP	6/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
303991	Non-Physician Medical Practitioner	None	1811453525	0	0	LEARMAN, CAMERON R PA-C	9/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
304007	Non-Physician Medical Practitioner	None	1487721239	0	0	LOCKER, AMY	2/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4543 E COLORADO ST	None	LONG BEACH	CA	90814	3024	00	06000	33.76990148	-118.139517	Los Angeles County
304015	Non-Physician Medical Practitioner	None	1144595752	0	0	LOZIER, SUSAN G PA-C	7/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2215 TRUXTUN AVE	STE 100	BAKERSFIELD	CA	93301	3602	00	06000	35.37327448	-119.0278665	Kern County
304022	Non-Physician Medical Practitioner	None	1750785531	0	0	LEE, EUNA NP	5/4/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11432 SOUTH STREET	APT 153	CERRITOS	CA	90703	6611	00	06000	33.8583365	-118.089702	Los Angeles County
304028	Non-Physician Medical Practitioner	None	1770127870	0	0	LAU, JENNIFER PA	6/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
304031	Non-Physician Medical Practitioner	None	1598203408	0	0	LOPEZ, LEA R NP	4/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26 RANCHO DEL MAR	None	APTOS	CA	95003	3973	00	06000	36.97832273	-121.9080422	Santa Cruz County
304042	Non-Physician Medical Practitioner	None	1114944899	0	0	LEIBHAM CULLIVAN, PAULA NP	10/7/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	703 STRATFORD	APT 11	DEL MAR	CA	92014	1568	00	06000	32.95087042	-117.2637458	San Diego County
304056	Non-Physician Medical Practitioner	None	1093095028	0	0	LAHEY, MEREDITH M	1/30/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 FRANCISCO ST	APT 3	SAN FRANCISCO	CA	94123	2318	00	06000	37.80317635	-122.4253464	San Francisco County
304058	Non-Physician Medical Practitioner	None	1427110329	0	0	LIVINGSTON COMMUNITY HEALTH	10/25/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1140 MAIN ST	None	LIVINGSTON	CA	95334	1257	00	06000	37.37992056	-120.7234222	Merced County
304072	Non-Physician Medical Practitioner	None	1376774521	0	0	LEE, TEH LIANG	8/13/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
304078	Non-Physician Medical Practitioner	None	1053739706	0	0	LOY, TAMARA	3/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	152 PIONEER LN	STE D	BISHOP	CA	93514	2563	00	06000	37.36269	-118.407312	Inyo County
304092	Non-Physician Medical Practitioner	None	1295244325	0	0	LE, DANIEL NP	10/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9191 WESTMINSTER AVE	SUITE 207	GARDEN GROVE	CA	92844	2751	00	06000	33.75946879	-117.9688437	Orange County
304131	Non-Physician Medical Practitioner	None	1134980048	0	0	LUDY, CHASE NP	8/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7111 INDIANA AVE	STE 100	RIVERSIDE	CA	92504	4543	00	06000	33.93924242	-117.3973049	Riverside County
304149	Non-Physician Medical Practitioner	None	1194900191	0	0	LEE, AIMEE JUSTIENNE	8/8/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	H2160	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
304160	Non-Physician Medical Practitioner	None	1275398372	0	0	LICON, DANIEL NP	7/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	185 E 7TH AVE	STE A	CHICO	CA	95926	3356	00	06000	39.74473059	-121.8488381	Butte County
304175	Non-Physician Medical Practitioner	None	1831396415	0	0	LITTLE, STACEY D PA-C	9/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
304190	Non-Physician Medical Practitioner	None	1851340681	0	0	LOPEZ, RAYMOND	7/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9433 ORANGE ST	None	ALTA LOMA	CA	91701	4149	00	06000	34.13865519	-117.5998236	San Bernardino County
304230	Non-Physician Medical Practitioner	None	1578877932	0	0	LONG GOLDMAN, ELIZABETH KAY	11/16/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1735 MISSION ST	None	SAN FRANCISCO	CA	94103	2417	00	06000	37.76957692	-122.4199811	San Francisco County
304240	Non-Physician Medical Practitioner	None	1245996776	0	0	LIM, BENZEN BYRON PA	12/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1086 S FAIRFAX AVE	None	LOS ANGELES	CA	90019	4401	00	06000	34.05592638	-118.3648554	Los Angeles County
304258	Non-Physician Medical Practitioner	None	1164060489	0	0	LING, JENNIE B CNP	1/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 UPPER RAGSDALE DR	STE B-210	MONTEREY	CA	93940	7851	00	06000	36.57940327	-121.8142876	Monterey County
304316	Non-Physician Medical Practitioner	None	1477571065	0	0	LYTHGOE, TODD DALE	11/8/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1560 RENAISSANCE TOWNE D	SUITE 210	BOUNTIFUL	UT	84010	7680	00	06000	40.87401251	-111.8879684	Davis County
304327	Non-Physician Medical Practitioner	None	1518262302	0	0	LEWIS, ANHTHU N	4/22/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	321 MIDDLEFIELD RD STE 2	None	MENLO PARK	CA	94025	4010	00	06000	37.45657153	-122.168099	San Mateo County
304342	Non-Physician Medical Practitioner	None	1922718485	0	0	LOWERY, PATRICK PA	9/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
304356	Non-Physician Medical Practitioner	None	1346723152	0	0	LOPEZ, DYLAN PA	7/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2200 E. MAPLE AVE	None	EL SEGUNDO	CA	90245	6507	00	06000	33.92690475	-118.3857342	Los Angeles County
304395	Non-Physician Medical Practitioner	None	1659728368	0	0	LOWE, VICTORIA F PA	7/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1301 CALIFORNIA STREET	None	REDLANDS	CA	92374	2910	00	06000	34.07159807	-117.2263378	San Bernardino County
304423	Non-Physician Medical Practitioner	None	1447073895	0	0	LAFFOON, TIFFANY NP	3/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5451 WALNUT AVE	None	CHINO	CA	91710	2609	00	06000	34.02626886	-117.6858645	San Bernardino County
304430	Non-Physician Medical Practitioner	None	1023033552	0	0	LIAO, JIM	8/5/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 MEDICAL PLZ	STE 400	LOS ANGELES	CA	90095	0001	00	06000	34.06473399	-118.445865	Los Angeles County
304437	Non-Physician Medical Practitioner	None	1083698245	0	0	LAUERMAN, JAMES A	2/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20191 HILL SPRING ROAD	None	WILDOMAR	CA	92595	8266	00	06000	33.61353423	-117.3025961	Riverside County
304451	Non-Physician Medical Practitioner	None	1326411349	0	0	LIN, WENDY T	1/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	419 AVONDALE AVE	None	MONTEREY PARK	CA	91754	1610	00	06000	34.063721	-118.1284493	Los Angeles County
304468	Non-Physician Medical Practitioner	None	1225167356	0	0	LAPOINTE, MARIANNE ELIZABETH	4/5/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21397 AQUEDUCT CIRCLE	None	PINE GROVE	CA	95665	0000	00	06000	38.39770441	-120.6284015	Amador County
304480	Non-Physician Medical Practitioner	None	1639113418	0	0	LA, HELEN HUONG	12/17/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	00	06000	34.13489987	-118.0424069	Los Angeles County
304481	Non-Physician Medical Practitioner	None	1831858257	0	0	LIZER, SAMANTHA PA	7/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8635 W 3RD ST	STE 485W	LOS ANGELES	CA	90048	6121	00	06000	34.07361928	-118.3803143	Los Angeles County
304507	Non-Physician Medical Practitioner	None	1013633585	0	0	LIVINGSTON, JAYME E PA	4/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1310 W STEWART DR	STE 508	ORANGE	CA	92868	3856	00	06000	33.78236048	-117.8664975	Orange County
304508	Non-Physician Medical Practitioner	None	1083858948	0	0	LOCK, SARAH	8/20/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 COFFEE RD	None	MODESTO	CA	95355	4201	00	06000	37.653219	-120.975542	Stanislaus County
304512	Non-Physician Medical Practitioner	None	1598426389	0	0	LAPINSKAS, WALTER NP	2/24/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4500 BROCKTON AVE.	SUITE 305	RIVERSIDE	CA	92501	4027	00	06000	33.97785263	-117.3836152	Riverside County
304513	Non-Physician Medical Practitioner	None	1922560002	0	0	LARSEN, MACKENZIE M PA-C	12/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	00	06000	37.25111017	-121.9465891	Santa Clara County
304538	Non-Physician Medical Practitioner	None	1033230693	0	0	LUPYAN-TEYTELMAN, LYUBOV	7/2/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1261 TRAVIS BLVD	SUITE 170	FAIRFIELD	CA	94533	4825	00	06000	38.25812361	-122.0495417	Solano County
304553	Non-Physician Medical Practitioner	None	1871743542	0	0	LE, JENNIFER NP	3/24/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1029 LOYOLA AVE	None	CLOVIS	CA	93619	7554	00	06000	36.8625543	-119.6976392	Fresno County
304571	Non-Physician Medical Practitioner	None	1548743800	0	0	LEUNG, SIN Y PA-C	11/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 N CALIFORNIA ST	None	STOCKTON	CA	95204	6005	00	06000	37.97165921	-121.2895813	San Joaquin County
304572	Non-Physician Medical Practitioner	None	1578135760	0	0	LIU, ROBERT PA	4/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
304583	Non-Physician Medical Practitioner	None	1144777681	0	0	LEUENBERGER, BRITTANY PA	10/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	5730	00	06000	36.57482436	-121.8101797	Monterey County
304596	Non-Physician Medical Practitioner	None	1205318920	0	0	LEE, RACHAEL O NP	10/10/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	516 40TH STREET	None	SACRAMENTO	CA	95819	2702	00	06000	38.574486	-121.450266	Sacramento County
304598	Non-Physician Medical Practitioner	None	1922589670	0	0	LUO, CHENG NP	10/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4225 TWEEDY BLVD	STE B	SOUTH GATE	CA	90280	6217	00	06000	33.94330446	-118.1970199	Los Angeles County
304612	Non-Physician Medical Practitioner	None	1548298532	0	0	LOS ANGELES GAY AND LESBIAN COMMUNITY SERVICE CENT	7/2/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
304636	Non-Physician Medical Practitioner	None	1306254644	0	0	LASRADO, ALVITA R NP	3/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5172 DEL SUR CIR	None	LA PALMA	CA	90623	2211	00	06000	33.84010623	-118.0428267	Orange County
304642	Non-Physician Medical Practitioner	None	1295355154	0	0	LEWIS, GABRIELLE G NP	12/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	00	06000	33.77224313	-117.8672259	Orange County
304646	Non-Physician Medical Practitioner	None	1245600774	0	0	LI, DENISE T NP	9/23/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13484 SAN PABLO AVE	None	SAN PABLO	CA	94806	3904	00	06000	37.95525748	-122.3352645	Contra Costa County
304657	Non-Physician Medical Practitioner	None	1104596535	0	0	LIN, KATIE PA	9/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	616 N GARFIELD AVE	203	MONTEREY PARK	CA	91754	1153	00	06000	34.06916465	-118.1229039	Los Angeles County
304707	Non-Physician Medical Practitioner	None	1013506740	0	0	LEE, ERICA NP	5/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1837 SUNNY CREST	None	FULLERTON	CA	92835	3616	00	06000	33.89224326	-117.9312781	Orange County
304710	Non-Physician Medical Practitioner	None	1477816353	0	0	LUHN, SUZANNAH C NP	9/9/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4614 EDGEWOOD AVE	None	OAKLAND	CA	94602	1404	00	06000	37.81007335	-122.2182147	Alameda County
304718	Non-Physician Medical Practitioner	None	1649804139	0	0	LEVINGS, MICHAELA PA-C	6/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
304726	Non-Physician Medical Practitioner	None	1568657302	0	0	LOPEZ, ELIZABETH ANN NP	1/27/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8608 EGAN WY	None	BAKERSFIELD	CA	93311	1242	00	06000	35.31316347	-119.0979533	Kern County
304741	Non-Physician Medical Practitioner	None	1538398789	0	0	LEE, HUI-FEN FRANCES NP	2/20/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	235 E BADILLO ST	None	COVINA	CA	91723	1917	00	06000	34.08632446	-117.88677	Los Angeles County
304749	Non-Physician Medical Practitioner	None	1780231795	0	0	LIEBO, EMILY S PA	11/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 E OCEAN AVE	None	LOMPOC	CA	93436	7092	00	06000	34.63941491	-120.4393023	Santa Barbara County
304752	Non-Physician Medical Practitioner	None	1477316727	0	0	LAM, CHANDARONG	3/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
304757	Non-Physician Medical Practitioner	None	1417210204	0	0	LE, TUAN M	11/25/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11350 CAMINO RUIZ	None	SAN DIEGO	CA	92126	1633	00	06000	32.92831277	-117.144053	San Diego County
304759	Non-Physician Medical Practitioner	None	1598352312	0	0	LANG, PO L NP	1/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5565 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3020	00	06000	32.77978322	-117.0094766	San Diego County
304806	Non-Physician Medical Practitioner	None	1093040933	0	0	LIEN, VY	11/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
304821	Non-Physician Medical Practitioner	None	1336502582	0	0	LABARDA, KRISOLITO M NP	9/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6299 FILLY COURT	None	RANCHO CUCAMONGA	CA	91739	9590	00	06000	34.13924251	-117.5331717	San Bernardino County
304822	Non-Physician Medical Practitioner	None	1740698430	0	0	LEE, RASHIDA NP	10/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	461 TENNESSEE ST	SUITE C	REDLANDS	CA	92373	8161	00	06000	34.058745	-117.2000975	San Bernardino County
304884	Non-Physician Medical Practitioner	None	1417263070	0	0	LYDA, LESLIE A NP	3/12/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2679 CORANADO ST	None	WEST SACRAMENTO	CA	95691	5066	00	06000	38.54942451	-121.5212406	Yolo County
304912	Non-Physician Medical Practitioner	None	1912502469	0	0	LEVIER, ANTOINETTE	1/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
304931	Non-Physician Medical Practitioner	None	1144859158	0	0	LAJEVARDI, YASAMAN A PA-C	3/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1313 E HERNDON AVE	101B/203-206	FRESNO	CA	93720	3306	00	06000	36.834984	-119.7641925	Fresno County
304991	Non-Physician Medical Practitioner	None	1629302526	0	0	LE, ROSE T P NP	10/13/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1078 N COVENTRY AVE	None	CLOVIS	CA	93611	8182	00	06000	36.84966091	-119.6623991	Fresno County
304997	Non-Physician Medical Practitioner	None	1922643931	0	0	LING, ANGIE PA	1/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	00	06000	34.1010559	-117.6369445	San Bernardino County
304998	Non-Physician Medical Practitioner	None	1285254623	0	0	LONIS, PRESTON NP	11/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4849 VAN NUYS BLVD	211	SHERMAN OAKS	CA	91403	2110	00	06000	34.159113	-118.4487465	Los Angeles County
305003	Non-Physician Medical Practitioner	None	1871933879	0	0	LIPMAN, RACHEL E NP	3/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3605 VISTA WAY	BLDG B	OCEANSIDE	CA	92056	4565	00	06000	33.1818929	-117.3104591	San Diego County
305004	Non-Physician Medical Practitioner	None	1710392196	0	0	LUONG, LINDA L PA	4/2/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4010 FOOTHILLS BLVD	STE 102	ROSEVILLE	CA	95747	7241	00	06000	38.75415213	-121.3097843	Placer County
305008	Non-Physician Medical Practitioner	None	1457762072	0	0	LATINO KIDS HEALTH	3/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	901 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4737	00	06000	34.01042334	-118.1099428	Los Angeles County
305035	Non-Physician Medical Practitioner	None	1295335099	0	0	LOPEZ, JAIL NP	12/14/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3301 BEECHWOOD AVE	None	LYNWOOD	CA	90262	3301	00	06000	33.92961073	-118.2111703	Los Angeles County
305040	Non-Physician Medical Practitioner	None	1194077305	0	0	LAIRD-WILSON, JOSHUA W	7/8/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2721 SOUTH NORFOLK ST	APT 211	SAN MATEO	CA	94403	1669	00	06000	37.54788034	-122.286577	San Mateo County
305056	Non-Physician Medical Practitioner	None	1609208198	0	0	LAZAR, ANITA A PA	6/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
305059	Non-Physician Medical Practitioner	None	1821533712	0	0	LAMPUGNALE, BLAISE M	4/4/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	814 WESTCHESTER PL	None	LOS ANGELES	CA	90005	3501	00	06000	34.0575989	-118.3154352	Los Angeles County
305078	Non-Physician Medical Practitioner	None	1104839414	0	0	LACK, DENISE	4/5/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 MISSION BLVD	SUITE 2600	JACKSON	CA	95642	2536	00	06000	38.35163001	-120.7670107	Amador County
305119	Non-Physician Medical Practitioner	None	1629713839	0	0	LEAL, ANDREA F	8/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4240 LATHAM ST	STE A	RIVERSIDE	CA	92501	1741	00	06000	34.00198519	-117.3739252	Riverside County
305154	Non-Physician Medical Practitioner	None	1700288586	0	0	LUI, KIMBERLY NP	4/15/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3021 ANZA ST	APT 4	SAN FRANCISCO	CA	94121	3031	00	06000	37.7783196	-122.4807592	San Francisco County
305160	Non-Physician Medical Practitioner	None	1477007573	0	0	LYON, STEPHEN A PA	7/6/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6860 AVENIDA ENCINAS	None	CARLSBAD	CA	92009	3201	00	06000	33.10754269	-117.3146974	San Diego County
305166	Non-Physician Medical Practitioner	None	1174126080	0	0	LE, CAROLINE M PA-C	3/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11103 VENICE BLVD	None	LOS ANGELES	CA	90034	6914	00	06000	34.01379685	-118.4159354	Los Angeles County
305224	Non-Physician Medical Practitioner	None	1265188940	0	0	LAY, ASHLEY	1/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 E ROMIE LN	A	SALINAS	CA	93901	4031	00	06000	36.65998191	-121.6461895	Monterey County
305230	Non-Physician Medical Practitioner	None	1356692958	0	0	LEWIN, THU A NP	4/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	00	06000	37.78594176	-122.421322	San Francisco County
305243	Non-Physician Medical Practitioner	None	1881043842	0	0	LIMPER, KARYNE S NP	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
305260	Non-Physician Medical Practitioner	None	1750785838	0	0	LANNING, TABITHA I	11/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4108 W NELLIS AVE	None	VISALIA	CA	93277	0666	00	06000	36.293643	-119.336193	Tulare County
305274	Non-Physician Medical Practitioner	None	1619272168	0	0	LIMPAHAN, MADELE A	5/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	535 DIMM ST	None	RICHMOND	CA	94805	1942	00	06000	37.93686692	-122.3228044	Contra Costa County
305283	Non-Physician Medical Practitioner	None	1275906943	0	0	LOPEZ, ALEXANDRIA K NP	7/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	931 BUENA VISTA ST	STE 302	DUARTE	CA	91010	1714	00	06000	34.141635	-117.9775755	Los Angeles County
305286	Non-Physician Medical Practitioner	None	1114535044	0	0	LOPEZ, JOSE NP	11/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 W FERN AVE	None	REDLANDS	CA	92373	5916	00	06000	34.05016907	-117.1793443	San Bernardino County
305310	Non-Physician Medical Practitioner	None	1508875873	0	0	LEVINE, DENNIS M NP	4/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	775 HERITAGE AVE	None	CLOVIS	CA	93619	7644	00	06000	36.85888575	-119.703287	Fresno County
305326	Non-Physician Medical Practitioner	None	1952507881	0	0	LEE, CONNIE	12/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	850 COUNTRY CLUB DR	None	BURBANK	CA	91501	1126	00	06000	34.20000332	-118.2920042	Los Angeles County
305385	Non-Physician Medical Practitioner	None	1194141523	0	0	LEE, SUSIE M	1/12/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2304 W NORWOOD PLACE	None	ALHAMBRA	CA	91803	2823	00	06000	34.07560268	-118.1489866	Los Angeles County
305394	Non-Physician Medical Practitioner	None	1407028384	0	0	LEVIHIM, FARIBA NP	1/13/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5727 BECKFORD AVE	None	TARZANA	CA	91356	1139	00	06000	34.17516168	-118.5514846	Los Angeles County
305399	Non-Physician Medical Practitioner	None	1801565155	0	0	LUU, JELINA	5/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1275 N ROSE DR	STE 126	PLACENTIA	CA	92870	3919	00	06000	33.8868003	-117.8420447	Orange County
305404	Non-Physician Medical Practitioner	None	1942789888	0	0	LUCIEW, JOSHUA D PA-C	1/29/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
305415	Non-Physician Medical Practitioner	None	1609070663	0	0	LEHMANN, LEANDRA E	10/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5436 SALMON RIVER CT	None	RENO	NV	89511	8282	00	06000	39.38780801	-119.8234388	Washoe County
305424	Non-Physician Medical Practitioner	None	1912317819	0	0	LOGAN, SCOTT	1/21/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 E CARRILLO ST	None	SANTA BARBARA	CA	93101	1460	00	06000	34.42588572	-119.6972176	Santa Barbara County
305427	Non-Physician Medical Practitioner	None	1720757776	0	0	LLANES, CRYSTAL L PA-C	9/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
305446	Non-Physician Medical Practitioner	None	1194735589	0	0	LE, TUYET M	2/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2158 OPAL RIDGE	None	VISTA	CA	92081	8814	00	06000	33.15041612	-117.2414694	San Diego County
305464	Non-Physician Medical Practitioner	None	1205466349	0	0	LOCKE, LAURA M NP	9/8/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
305477	Non-Physician Medical Practitioner	None	1619145307	0	0	LIFELONG MEDICAL CARE	4/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9933 MACARTHUR BLVD	None	OAKLAND	CA	94605	4853	00	06000	37.74646247	-122.1566447	Alameda County
305487	Non-Physician Medical Practitioner	None	1245666403	0	0	LUANSING, JEAN C PA-C	4/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
305495	Non-Physician Medical Practitioner	None	1700598521	0	0	LAPPIN, MONICA PA	1/21/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9000 MING AVE	STE L-1B	BAKERSFIELD	CA	93311	1318	00	06000	35.33989328	-119.1034715	Kern County
305498	Non-Physician Medical Practitioner	None	1518390541	0	0	LYNCH, KRISTINA P	10/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1848 E MOUNTAIN ST	None	PASADENA	CA	91104	4014	00	06000	34.16178189	-118.1122453	Los Angeles County
305518	Non-Physician Medical Practitioner	None	1770186256	0	0	LEITE, EMANUELLA M PA	9/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
305555	Non-Physician Medical Practitioner	None	1194198762	0	0	LUI, CELINA NP	12/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1126 S CHARLOTTE AVENUE	None	SAN GABRIEL	CA	91776	3122	00	06000	34.08756224	-118.0882893	Los Angeles County
305587	Non-Physician Medical Practitioner	None	1386194116	0	0	LEE, SOOIN NP	1/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
305598	Non-Physician Medical Practitioner	None	1134188501	0	0	LUFTIG, JOSHUA SALOME INEZ	8/8/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 EAST 31 STREET	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
305633	Non-Physician Medical Practitioner	None	1841683406	0	0	LIUO, KO GENG NP	2/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1010 W CHAPMAN AVE	None	ORANGE	CA	92868	2847	00	06000	33.78785047	-117.8631495	Orange County
305634	Non-Physician Medical Practitioner	None	1770164022	0	0	LIANG, TING MEI PA-C	1/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
305637	Non-Physician Medical Practitioner	None	1225660186	0	0	LOOMIS, STEPHANIE U PA	10/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
305639	Non-Physician Medical Practitioner	None	1760406607	0	0	LAUGHLIN, MARY K NP	3/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	363 OAKTREE CIRCLE	None	MURPHYS	CA	95247	9481	00	06000	38.14365477	-120.4578447	Calaveras County
305650	Non-Physician Medical Practitioner	None	1720813132	0	0	LE, DIEM CHAU S NP	9/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	201 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6385	00	06000	37.36812305	-122.0312314	Santa Clara County
305662	Non-Physician Medical Practitioner	None	1376884874	0	0	LANGLEY, SARA NP	8/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	00	06000	34.06704253	-118.3835029	Los Angeles County
305675	Non-Physician Medical Practitioner	None	1598215915	0	0	LAMBERT, VIKTORIYA NP	12/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
305681	Non-Physician Medical Practitioner	None	1073288858	0	0	LI, WHITTY J PA-C	9/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 CESAR E CHAVEZ AVE	STE 2200	LOS ANGELES	CA	90033	2476	00	06000	34.05101259	-118.217259	Los Angeles County
305683	Non-Physician Medical Practitioner	None	1831477348	0	0	LOWE, MARIA F NP	12/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
305693	Non-Physician Medical Practitioner	None	1255317350	0	0	LAROCK, KRISTI LYNN	9/30/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MOWRY AVE	SUITE 222	FREMONT	CA	94538	1605	00	06000	37.555011	-121.9801005	Alameda County
305702	Non-Physician Medical Practitioner	None	1902061906	0	0	LOGEE, KATHERINE	8/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1841 CYMBELINE ST	None	ROSEVILLE	CA	95747	4974	00	06000	38.7600474	-121.3551475	Placer County
305708	Non-Physician Medical Practitioner	None	1891238838	0	0	LY, SENG T NP	8/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
305759	Non-Physician Medical Practitioner	None	1043732670	0	0	LIU, ERICA C	9/28/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	215 W MAUNA LOA AVE	None	GLENDORA	CA	91740	4352	00	06000	34.12511752	-117.8663445	Los Angeles County
305761	Non-Physician Medical Practitioner	None	1225138860	0	0	L, RANDALL A	12/23/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6705 POESIA CT	None	ELK GROVE	CA	95758	5830	00	06000	38.429352	-121.4253225	Sacramento County
305778	Non-Physician Medical Practitioner	None	1538329990	0	0	LI, ERIN L NP	11/2/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	749 RICKY CT	None	CAMPBELL	CA	95008	7802	00	06000	37.28351445	-121.9631805	Santa Clara County
305809	Non-Physician Medical Practitioner	None	1912387119	0	0	LIPANOVICH, COLLEEN M NP	12/8/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1336 COVE CT	None	OCEANO	CA	93445	9410	00	06000	35.10601232	-120.6158777	San Luis Obispo County
305810	Non-Physician Medical Practitioner	None	1386297331	0	0	LEE, ANDREW A NP	5/12/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1531 ESPLANADE	None	CHICO	CA	95926	3310	00	06000	39.74248474	-121.8493369	Butte County
305811	Non-Physician Medical Practitioner	None	1518458165	0	0	LEONARD, SEAN P NP	4/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	00	06000	32.83028739	-117.1459009	San Diego County
305823	Non-Physician Medical Practitioner	None	1770190340	0	0	LEE, ALEXANDER NP	4/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1513 GRAND AVE	STE. 360	LOS ANGELES	CA	90015	3075	00	06000	34.03596303	-118.266212	Los Angeles County
305875	Non-Physician Medical Practitioner	None	1831526466	0	0	LOUIE, JANINE K NP	10/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2715 S NORFOLK STREET	313	SAN MATEO	CA	94403	1606	00	06000	37.54846275	-122.2871327	San Mateo County
305876	Non-Physician Medical Practitioner	None	1639577364	0	0	LAW, CHRISTINA NP	3/25/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 ORKNEY COURT	None	ROSEVILLE	CA	95661	6056	00	06000	38.75902048	-121.2312424	Placer County
305904	Non-Physician Medical Practitioner	None	1023883642	0	0	LANZAR, MELINA PA-C	2/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	00	06000	37.66508443	-120.9962589	Stanislaus County
305906	Non-Physician Medical Practitioner	None	1083902688	0	0	LEE, SANDRA Y NP	5/9/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1021 MAD RIVER ROAD	None	MAD RIVER	CA	95552	1021	00	06000	40.43219957	-123.4861948	Trinity County
305937	Non-Physician Medical Practitioner	None	1376823484	0	0	LI, QING	2/6/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19049 BRITTANY PL	None	ROWLAND HEIGHTS	CA	91748	4964	00	06000	33.96857849	-117.8854325	Los Angeles County
305974	Non-Physician Medical Practitioner	None	1376252817	0	0	LUCIANO, SHANTEL A NP	8/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3151 AIRWAY AVE	SUITE G1	COSTA MESA	CA	92626	4624	00	06000	33.67783408	-117.8720921	Orange County
305979	Non-Physician Medical Practitioner	None	1194845651	0	0	LUU, ELAINE	8/13/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5 BON AIR RD STE 150	None	LARKSPUR	CA	94939	1143	00	06000	37.9438204	-122.5395357	Marin County
305990	Non-Physician Medical Practitioner	None	1598072498	0	0	LINDSAY, VICTORIA J	5/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	511 BATH ST	None	SANTA BARBARA	CA	93101	3403	00	06000	34.41386476	-119.6993335	Santa Barbara County
306004	Non-Physician Medical Practitioner	None	1245968452	0	0	LO, GRACE PA-C	3/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2707 E VALLEY BLVD	215	WEST COVINA	CA	91792	3197	00	06000	34.00296323	-117.8868537	Los Angeles County
306016	Non-Physician Medical Practitioner	None	1629415765	0	0	LI-WONG, ANNIE NP	2/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	876 HURON AVE	None	SAN FRANCISCO	CA	94112	4038	00	06000	37.71042307	-122.4516942	San Francisco County
306031	Non-Physician Medical Practitioner	None	1376895201	0	0	LEIBY, SOPHIA PA-C	10/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	00	06000	38.556288	-121.458474	Sacramento County
306043	Non-Physician Medical Practitioner	None	1093003485	0	0	LAVIGNE, ROBERT M PA-C	8/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	00	06000	34.13990611	-118.2182985	Los Angeles County
306057	Non-Physician Medical Practitioner	None	1427730332	0	0	LELAND, RAYNA PA	9/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	00	06000	34.062852	-117.9446658	Los Angeles County
306098	Non-Physician Medical Practitioner	None	1518007137	0	0	LUDLOW, CATHERINE A NP	1/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8185 RIDGELAND TERRACE	DR	REDDING	CA	96001	9523	00	06000	40.52246939	-122.5027661	Shasta County
306135	Non-Physician Medical Practitioner	None	1366577066	0	0	LEA, JUDITH	11/15/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
306165	Non-Physician Medical Practitioner	None	1013380336	0	0	LU, JOANA C	4/5/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1218 N LOMBARD DR	None	ANAHEIM	CA	92801	2103	00	06000	33.85149957	-117.9341631	Orange County
306181	Non-Physician Medical Practitioner	None	1093094187	0	0	LEWIS, TANGIE NP	10/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	318 YACHTSMAN DR	None	VALLEJO	CA	94591	2906	00	06000	38.0708378	-122.2037314	Solano County
306202	Non-Physician Medical Practitioner	None	1518050897	0	0	LARSON, QUENLYN J	12/19/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 SPYGLASS RD	None	SMITH RIVER	CA	95367	0555	00	06000	41.97391915	-124.1905995	Del Norte County
306207	Non-Physician Medical Practitioner	None	1902353451	0	0	LANG, BRITTANY M NP	2/13/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6148 BRECKINRIDGE CT	None	CHINO	CA	91710	5387	00	06000	34.00789771	-117.6706654	San Bernardino County
306209	Non-Physician Medical Practitioner	None	1427351212	0	0	LANCASTER, MICHELLE M PA-C	6/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25150 HANCOCK AVENUE	SUITE 210	MURRIETA	CA	92562	5989	00	06000	33.56635084	-117.1823956	Riverside County
306219	Non-Physician Medical Practitioner	None	1104637735	0	0	LE, PHU C NP	1/28/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 S LA BREA BLVD	SUITE 205	INGLEWOOD	CA	90301	2321	00	06000	33.95921962	-118.3533372	Los Angeles County
306241	Non-Physician Medical Practitioner	None	1568195212	0	0	LAURENT, CONNIE C NP	4/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18092 WIKA ROAD	SUITE 220	APPLE VALLEY	CA	92307	2132	00	06000	34.54070062	-117.2694542	San Bernardino County
306244	Non-Physician Medical Practitioner	None	1457463242	0	0	LINGWALL-OVERSTREET, LARA C	1/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3250 RURAL LN	None	CORONA	CA	92882	8378	00	06000	33.83935467	-117.591156	Riverside County
306256	Non-Physician Medical Practitioner	None	1790359081	0	0	LOE, THOMAS E PA-C	10/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	00	06000	39.506454	-121.5412785	Butte County
306259	Non-Physician Medical Practitioner	None	1255362984	0	0	LEE, PAMELA J	9/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5500 TORRANCE BLVD	UNIT A102	TORRANCE	CA	90503	4048	00	06000	33.83827781	-118.3740218	Los Angeles County
306303	Non-Physician Medical Practitioner	None	1396328332	0	0	LE, PHUONG TRAM	12/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
306320	Non-Physician Medical Practitioner	None	1396398251	0	0	LUCAS, VICTORIA M PA	11/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	00	06000	38.74247397	-121.2508672	Placer County
306327	Non-Physician Medical Practitioner	None	1558018978	0	0	LAUDERMAN, ASHLEY NP	12/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95926	2281	00	06000	39.750084	-121.7934327	Butte County
306336	Non-Physician Medical Practitioner	None	1508572785	0	0	LEONE, HANNAH V PA	4/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	00	06000	34.062852	-117.9446658	Los Angeles County
306341	Non-Physician Medical Practitioner	None	1235202391	0	0	LOUIE, ALLISON K PA	1/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2704 E WILLOW ST	None	SIGNAL HILL	CA	90755	2217	00	06000	33.80432955	-118.1594295	Los Angeles County
306375	Non-Physician Medical Practitioner	None	1316979479	0	0	LIN, ALBERT L	8/1/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1010 W LA VETA AVE	SUITE 710	ORANGE	CA	92868	4300	00	06000	33.78028244	-117.8635552	Orange County
306438	Non-Physician Medical Practitioner	None	1588087282	0	0	LE, GEORGE Q NP	4/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	00	06000	34.06287152	-118.2029433	Los Angeles County
306462	Non-Physician Medical Practitioner	None	1295108843	0	0	LAMBRIGHT, TIFFANY N NP	10/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
306472	Non-Physician Medical Practitioner	None	1861642506	0	0	LOPEZ, EVELYN E NP	2/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3550 CARTER DR	APT 61	S SAN FRANCISCO	CA	94080	5028	00	06000	37.64251368	-122.4641648	San Mateo County
306490	Non-Physician Medical Practitioner	None	1821532292	0	0	LUONG, TRAN H	1/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3984 HERITAGE AVE	None	CLOVIS	CA	93619	5089	00	06000	36.86139827	-119.6356117	Fresno County
306503	Non-Physician Medical Practitioner	None	1265883649	0	0	LINKE, KATHLEEN A PA	10/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	40404 CALIFORNIA OAKS RD	STE C	MURRIETA	CA	92562	5786	00	06000	33.57857707	-117.1998797	Riverside County
306506	Non-Physician Medical Practitioner	None	1669749156	0	0	LAPINSKAS, MEGAN E NP	3/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	32118 CORTE SOLEDAD ST	None	TEMECULA	CA	92592	6466	00	06000	33.51452851	-117.0976756	Riverside County
306548	Non-Physician Medical Practitioner	None	1558009332	0	0	LIMON, CYNTHIA PA	10/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 LAGUNA RD	STE 100	FULLERTON	CA	92835	3634	00	06000	33.89326085	-117.9300987	Orange County
306560	Non-Physician Medical Practitioner	None	1760222384	0	0	LOPEZ, FABIOLA E NP	7/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
306605	Non-Physician Medical Practitioner	None	1184133365	0	0	LEGLER, KETURAH L NP	12/11/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2076 WILLIAMS ST	None	PALO ALTO	CA	94306	1414	00	06000	37.42515286	-122.1504736	Santa Clara County
306620	Non-Physician Medical Practitioner	None	1376566968	0	0	LEE, SANDRA L	10/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2321 W SIERRA AVE	None	FRESNO	CA	93711	1237	00	06000	36.82995553	-119.8336995	Fresno County
306622	Non-Physician Medical Practitioner	None	1841833449	0	0	LAU, JENNIFER E PA-C	10/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2321 HARRISON AVE	STE S	EUREKA	CA	95501	3216	00	06000	40.786857	-124.1396125	Humboldt County
306631	Non-Physician Medical Practitioner	None	1215470851	0	0	LAP?SLEY, JACQUELINE A NP	5/25/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	950 N KINGS RD	UNIT 219	WEST HOLLYWOOD	CA	90069	6205	00	06000	34.08820781	-118.3717489	Los Angeles County
306650	Non-Physician Medical Practitioner	None	1972929404	0	0	LAIS, KATHERINE R NP	7/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
306653	Non-Physician Medical Practitioner	None	1497909113	0	0	LY, JULIE MYSINH	1/25/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 S BROOKHURST RD	None	FULLERTON	CA	92833	3207	00	06000	33.865002	-117.959396	Orange County
306690	Non-Physician Medical Practitioner	None	1619742327	0	0	LEGRAND, TRAVIS	8/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
306694	Non-Physician Medical Practitioner	None	1700269917	0	0	LATHAM, KELLY PA-C	9/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 W STEWART DR	None	ORANGE	CA	92868	3849	00	06000	33.78236558	-117.8648414	Orange County
306705	Non-Physician Medical Practitioner	None	1083942734	0	0	LAWHORN, CHRISTA	8/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1701 E FLORIDA AVE	None	HEMET	CA	92544	4632	00	06000	33.74755247	-116.9539875	Riverside County
306707	Non-Physician Medical Practitioner	None	1922160746	0	0	LUNDE, REBECCA RC	4/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	00	06000	37.63110308	-122.4181613	San Mateo County
306722	Non-Physician Medical Practitioner	None	1194116970	0	0	LU, MING LUNG NP	5/23/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1120 W ALHAMBRA RD	APT 302	ALHAMBRA	CA	91801	2262	00	06000	34.09871014	-118.1356611	Los Angeles County
306755	Non-Physician Medical Practitioner	None	1891269502	0	0	LO, TAMMY E PA-C	4/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2141 N HARBOR BLVD	STE 25000	FULLERTON	CA	92835	3830	00	06000	33.89443025	-117.9288328	Orange County
306789	Non-Physician Medical Practitioner	None	1245343599	0	0	LANCTOT, CAYLEY M NP	5/9/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	837 LOMA PRIETA DRIVE	None	APTOS	CA	95003	5525	00	06000	36.96720648	-121.8725729	Santa Cruz County
306790	Non-Physician Medical Practitioner	None	1104801919	0	0	LEVICH, BRIDGET R	5/18/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST	ACC 1600	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
306818	Non-Physician Medical Practitioner	None	1871504548	0	0	L, ALLAIN D	7/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	00	06000	36.327888	-119.294919	Tulare County
306819	Non-Physician Medical Practitioner	None	1780452326	0	0	LYNCH, KELLY CNP	8/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	954 WEST FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
306836	Non-Physician Medical Practitioner	None	1790008175	0	0	LYNCH, GREGORY	4/6/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	585 N MOUNTAIN AVE	SUITE A	UPLAND	CA	91786	8516	00	06000	34.10114204	-117.6702497	San Bernardino County
306854	Non-Physician Medical Practitioner	None	1861029456	0	0	LOOK, PASCALE PA-C	7/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
306855	Non-Physician Medical Practitioner	None	1164766291	0	0	LYOU, TRACY A NP	6/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1118 MARIGOLD LANE	None	SANTA PAULA	CA	93060	1115	00	06000	34.37110761	-119.065466	Ventura County
306898	Non-Physician Medical Practitioner	None	1134406010	0	0	LEDBETTER, RODNEY ANDRE	11/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	00	06000	33.763572	-116.4056895	Riverside County
306899	Non-Physician Medical Practitioner	None	1427624576	0	0	LIU, SHUYAN NP	3/12/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
306931	Non-Physician Medical Practitioner	None	1497871636	0	0	LOPEZ, MICHAEL A	2/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1156 CROFTER DR	None	WALNUT	CA	91789	3849	00	06000	33.99681671	-117.8461427	Los Angeles County
306934	Non-Physician Medical Practitioner	None	1043474737	0	0	LEE, PAUL	2/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	549 WHEELING WAY	APT 4	LOS ANGELES	CA	90042	4957	00	06000	34.10342242	-118.1836384	Los Angeles County
306995	Non-Physician Medical Practitioner	None	1497871651	0	0	LEHMANN, PATRICK J	3/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3650 5TH AVE	UNIT 310	SAN DIEGO	CA	92103	4244	00	06000	32.744484	-117.1604275	San Diego County
307003	Non-Physician Medical Practitioner	None	1386112597	0	0	LEE, DAN BI	3/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
307040	Non-Physician Medical Practitioner	None	1821373051	0	0	L, ANDAYA A	12/20/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
307044	Non-Physician Medical Practitioner	None	1336800416	0	0	LEE, JEPHRYN H PA-C	1/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3095 OLD CONEJO RD	None	THOUSAND OAKS	CA	91320	2130	00	06000	34.18969088	-118.9412876	Ventura County
307061	Non-Physician Medical Practitioner	None	1124473178	0	0	LOMHEIM, JASON R PA	3/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	00	06000	33.808185	-118.1850575	Los Angeles County
307074	Non-Physician Medical Practitioner	None	1659899813	0	0	LIEVANOS, JENNIFER C	7/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5377 BUCKEYE CT	None	CHINO HILLS	CA	91709	6517	00	06000	33.95024104	-117.6879202	San Bernardino County
307086	Non-Physician Medical Practitioner	None	1225115207	0	0	LEVEQUE, JULIE A NP	3/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9163 CHALK HILL RD	None	HEALDSBURG	CA	95448	9574	00	06000	38.55510651	-122.7738485	Sonoma County
307089	Non-Physician Medical Practitioner	None	1487742961	0	0	LE, PETER T PA	10/13/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8883 WESTMINSTER AVE	None	GARDEN GROVE	CA	92844	2608	00	06000	33.75942652	-117.974097	Orange County
307090	Non-Physician Medical Practitioner	None	1144450057	0	0	LOPEZ-GLASS, GLORIA ARLENE	1/5/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17412 VENTURA BLVD	550	ENCINO	CA	91316	3827	00	06000	34.16118591	-118.5122779	Los Angeles County
307101	Non-Physician Medical Practitioner	None	1164860813	0	0	LINDSEY, SABRINA E NP	1/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
307109	Non-Physician Medical Practitioner	None	1932335080	0	0	LOPEZ, MARIO ALBERTO	6/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	823 GATEWAY CENTER WAY	None	SAN DIEGO	CA	92102	4541	00	06000	32.71503452	-117.1134945	San Diego County
307163	Non-Physician Medical Practitioner	None	1851972392	0	0	LEE, SANDRA J NP	8/25/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1450 SAN PABLO STREET	SUITE 6200	LOS ANGELES	CA	90033	4500	00	06000	34.06189518	-118.203256	Los Angeles County
307170	Non-Physician Medical Practitioner	None	1871011130	0	0	LAZAR, KATIE R PA	10/8/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	00	06000	38.556288	-121.458474	Sacramento County
307185	Non-Physician Medical Practitioner	None	1740428101	0	0	LICON, RICHARD A	11/13/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	36 BRASSIE LANE	None	COTO DE CAZA	CA	92679	4954	00	06000	33.59770088	-117.5798441	Orange County
307203	Non-Physician Medical Practitioner	None	1255916912	0	0	LUTFI, ALLISON NP	4/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	00	06000	33.89343304	-117.9279349	Orange County
307231	Non-Physician Medical Practitioner	None	1700617859	0	0	LEGAN, HALEY A PA	4/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 E CESAR E CHAVEZ AV	SUITE 2500	LOS ANGELES	CA	90033	2434	00	06000	34.05101259	-118.217259	Los Angeles County
307252	Non-Physician Medical Practitioner	None	1124311618	0	0	LEE, ELIZABETH NP	11/19/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12195 WINTON WAY	None	LOS ALTOS HILLS	CA	94024	6431	00	06000	37.34509707	-122.1100283	Santa Clara County
307284	Non-Physician Medical Practitioner	None	1134609415	0	0	LAKES, CARRI R NP	6/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6109 W RAMSEY ST	None	BANNING	CA	92220	3051	00	06000	33.92940576	-116.9437965	Riverside County
307303	Non-Physician Medical Practitioner	None	1669032918	0	0	LOGAN, LORNA NP	5/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14591 NEWPORT AVE.	100	TUSTIN	CA	92780	6026	00	06000	33.7317307	-117.8285651	Orange County
307370	Non-Physician Medical Practitioner	None	1922245596	0	0	LAVELLE, LAN A NP	10/8/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	822 KILNARNOCK WAY	None	RIVERSIDE	CA	92508	6077	00	06000	33.91437446	-117.3175515	Riverside County
307384	Non-Physician Medical Practitioner	None	1285151977	0	0	LEE, MICHELLE J PA	9/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	00	06000	33.85429563	-117.8166478	Orange County
307420	Non-Physician Medical Practitioner	None	1801552229	0	0	LAMBA, ERIN NP	9/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
307470	Non-Physician Medical Practitioner	None	1699066928	0	0	LAU, JESSICA W NP	4/18/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3015 PETITE COURT	None	LOS ANGELES	CA	90039	2311	00	06000	34.11007095	-118.2578908	Los Angeles County
307480	Non-Physician Medical Practitioner	None	1902275068	0	0	LINDLEY, DAVID B NP	11/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	00	06000	32.61822301	-117.0234938	San Diego County
307493	Non-Physician Medical Practitioner	None	1710116413	0	0	LUCIANO, RICHARD J NP	8/11/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4375 HUASNA RD	None	ARROYO GRANDE	CA	93420	6175	00	06000	35.13731728	-120.4976991	San Luis Obispo County
307507	Non-Physician Medical Practitioner	None	1174987788	0	0	LU, HELEN NP	7/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9512 LOWER AZUSA RD	None	TEMPLE CITY	CA	91780	2974	00	06000	34.08908653	-118.059808	Los Angeles County
307520	Non-Physician Medical Practitioner	None	1740607290	0	0	LEE, ANN J	9/19/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	330 W SCREENLAND DR	APT 124	BURBANK	CA	91505	3867	00	06000	34.15690163	-118.3428418	Los Angeles County
307530	Non-Physician Medical Practitioner	None	1598383382	0	0	LY, KARRIE V PA-C	2/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	00	06000	37.97026329	-121.2890849	San Joaquin County
307550	Non-Physician Medical Practitioner	None	1184308249	0	0	LANG, SARA E NP	8/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
307563	Non-Physician Medical Practitioner	None	1417949330	0	0	LANIER, GREGORY D	4/15/1991	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	36951 COOK ST STE 102	None	PALM DESERT	CA	92211	6082	00	06000	33.77939709	-116.3558683	Riverside County
307582	Non-Physician Medical Practitioner	None	1700972205	0	0	LEHMAN, ALLISON	1/18/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
307591	Non-Physician Medical Practitioner	None	1841469483	0	0	LOWE, IAN S	11/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1652 GREEN MEADOW AVE	None	TUSTIN	CA	92780	6659	00	06000	33.72124372	-117.8236659	Orange County
307621	Non-Physician Medical Practitioner	None	1417242280	0	0	LI, IVY NP	5/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5841 JAMESON CT	STE 1	CARMICHAEL	CA	95608	0820	00	06000	38.6514	-121.328586	Sacramento County
307625	Non-Physician Medical Practitioner	None	1336664069	0	0	LOWE, KATE L	10/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2518 N STREET	UNIT 2	SACRAMENTO	CA	95816	5871	00	06000	38.569977	-121.474593	Sacramento County
307663	Non-Physician Medical Practitioner	None	1285256545	0	0	LU, KELLEY PA	11/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	00	06000	34.062852	-117.9446658	Los Angeles County
307669	Non-Physician Medical Practitioner	None	1780922336	0	0	LIM, HAE JIN NP	7/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	370 DISTEL CIRCLE	None	LOS ALTOS	CA	94022	1404	00	06000	37.39572142	-122.1051204	Santa Clara County
307686	Non-Physician Medical Practitioner	None	1881175891	0	0	LO, HOPE NP	3/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3751 E SHIELDS AVE	None	FRESNO	CA	93726	0000	00	06000	36.7796958	-119.7618088	Fresno County
307697	Non-Physician Medical Practitioner	None	1417984410	0	0	LIM, TRACY D	1/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	550 WEST FOOTHILL BLVD	UNIT C	MONROVIA	CA	91016	2031	00	06000	34.15120951	-118.010817	Los Angeles County
307703	Non-Physician Medical Practitioner	None	1194476911	0	0	LAWLESS, AMY E NP	3/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2081 BRONZE STAR DR	None	WOODLAND	CA	95776	5423	00	06000	38.67049812	-121.7238394	Yolo County
307716	Non-Physician Medical Practitioner	None	1811162761	0	0	LUI, BELLA	5/29/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	170 CAPETOWN DRIVE	None	ALAMEDA	CA	94502	6471	00	06000	37.74261267	-122.2481996	Alameda County
307725	Non-Physician Medical Practitioner	None	1699177550	0	0	LANGSTON, JEANNETTE NP	10/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	255 TERRACINA BLVD	SUITE 202	REDLANDS	CA	92373	4870	00	06000	34.03788441	-117.2055761	San Bernardino County
307732	Non-Physician Medical Practitioner	None	1144956921	0	0	LAI, THAO NP	8/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	415 E HARDING WAY	STE D	STOCKTON	CA	95204	6118	00	06000	37.96819912	-121.2900761	San Joaquin County
307762	Non-Physician Medical Practitioner	None	1174053573	0	0	LIEN, ADA W	8/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2638 40TH AVE	None	SAN FRANCISCO	CA	94116	2705	00	06000	37.73756921	-122.4978326	San Francisco County
307764	Non-Physician Medical Practitioner	None	1679570980	0	0	LOS ANGELES UNIFIED SCHOOL DISTRICT	5/29/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	439 W 97TH ST	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
307773	Non-Physician Medical Practitioner	None	1720660848	0	0	LEGASPI, CHEANN CLARE T NP	5/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	520 N MAIN ST	SUITE 120	SANTA ANA	CA	92701	4623	00	06000	33.749316	-117.868123	Orange County
307778	Non-Physician Medical Practitioner	None	1962732339	0	0	LOPEZ, VERONICA NP	6/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1205 10TH AVE	#8	SAN FRANCISCO	CA	94122	2314	00	06000	37.76562629	-122.4675116	San Francisco County
307815	Non-Physician Medical Practitioner	None	1871977959	0	0	LEE, NORA H H	12/14/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	888 N ALAMEDA ST	APT 527	LOS ANGELES	CA	90012	4260	00	06000	34.05748919	-118.2371921	Los Angeles County
307818	Non-Physician Medical Practitioner	None	1679917686	0	0	LIANG, JULIA H L NP	5/8/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3520 CRESTVIEW DRIVE	None	NORCO	CA	92860	5141	00	06000	33.93346944	-117.5218186	Riverside County
307858	Non-Physician Medical Practitioner	None	1861787301	0	0	LATHROP, ASHLEY P	7/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1253 CALLE PECOS	None	THOUSAND OAKS	CA	91360	2350	00	06000	34.19787766	-118.9008889	Ventura County
307860	Non-Physician Medical Practitioner	None	1073073649	0	0	LEE, SHARON NP	9/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	191 E ALESSANDRO BLVD	9A	RIVERSIDE	CA	92508	5095	00	06000	33.91628074	-117.3284633	Riverside County
307871	Non-Physician Medical Practitioner	None	1568974236	0	0	LAWSON, STEPHEN PA-C	2/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	341 MAGNOLIA AVE	STE 101	CORONA	CA	92879	3331	00	06000	33.85291987	-117.5664344	Riverside County
307879	Non-Physician Medical Practitioner	None	1720416704	0	0	LU, PRUDENCE NP	10/7/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 N GARFIELD AVE	STE 107	MONTEREY PARK	CA	91754	1168	00	06000	34.06820797	-118.1228835	Los Angeles County
307890	Non-Physician Medical Practitioner	None	1245063809	0	0	LARMOND, YASMIN R NP	2/26/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3941 SAN DIMAS ST	101	BAKERSFIELD	CA	93301	5711	00	06000	35.39552345	-119.0082184	Kern County
307911	Non-Physician Medical Practitioner	None	1043201114	0	0	LOAYZA, TINA MARIE	3/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	877 OAK PARK BLVD	None	PISMO BEACH	CA	93449	3292	00	06000	35.13294806	-120.6057266	San Luis Obispo County
307923	Non-Physician Medical Practitioner	None	1992723662	0	0	LEE, CAROLYN YUKE GEE	7/19/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 STOCKTON BLVD	ROOM 2125	SACRAMENTO	CA	95817	1418	00	06000	38.556288	-121.458474	Sacramento County
307955	Non-Physician Medical Practitioner	None	1801209077	0	0	LABMEIER, ERIN E NP	6/30/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10185 MCLAREN PLACE	None	CUPERTINO	CA	95014	2335	00	06000	37.32521104	-122.0205671	Santa Clara County
307974	Non-Physician Medical Practitioner	None	1740979830	0	0	LUJAN, SANDRA NP	4/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	00	06000	33.67831005	-117.852138	Orange County
307978	Non-Physician Medical Practitioner	None	1528663937	0	0	LOPEZ, ADRIAN A NP	5/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1633 S COURT ST	None	VISALIA	CA	93277	4945	00	06000	36.315972	-119.292237	Tulare County
308004	Non-Physician Medical Practitioner	None	1679008379	0	0	LA BERGE-INDA, PRISCILLA PA	2/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8554 LA MESA BLVD	None	LA MESA	CA	91941	3958	00	06000	32.76889956	-117.0129515	San Diego County
308018	Non-Physician Medical Practitioner	None	1568229912	0	0	LIN, FRANK NP	2/13/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 N PALM CANYON	SUITE 206	PALM SPRINGS	CA	92262	4426	00	06000	33.838182	-116.546744	Riverside County
308042	Non-Physician Medical Practitioner	None	1396018727	0	0	LODI MEMORIAL HOSPITAL ASSOCIATION INC	9/18/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 S FAIRMONT AVE	SUITE 100	LODI	CA	95240	5100	00	06000	38.1206163	-121.2858323	San Joaquin County
308043	Non-Physician Medical Practitioner	None	1093836090	0	0	LAPEYRADE, MARIE-NICOLE	10/6/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4420 DUCKHORN DR STE 200	None	SACRAMENTO	CA	95834	2590	00	06000	38.651652	-121.532337	Sacramento County
308088	Non-Physician Medical Practitioner	None	1073005088	0	0	LIN, ANNIE PA-C	5/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	00	06000	34.09817553	-118.293237	Los Angeles County
308092	Non-Physician Medical Practitioner	None	1265812374	0	0	LEUANG, TONY PA-C	9/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31720 S TEMECULA PARKWAY	203	TEMECULA	CA	92592	2034	00	06000	33.4799323	-117.1033702	Riverside County
308124	Non-Physician Medical Practitioner	None	1427561786	0	0	LAVOY, COLETTE L PA	12/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6109 W RAMSEY ST	None	BANNING	CA	92220	3051	00	06000	33.92940576	-116.9437965	Riverside County
308145	Non-Physician Medical Practitioner	None	1295177376	0	0	LASZLO, ZSOFIA	3/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	325 W 8TH ST	APT 607	LOS ANGELES	CA	90014	3172	00	06000	34.04428393	-118.255542	Los Angeles County
308149	Non-Physician Medical Practitioner	None	1467857284	0	0	LICAUCO, JACQUELINE NP	4/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	191 S BUENA VISTA ST	SUITE 100	BURBANK	CA	91505	4562	00	06000	34.15872557	-118.3283863	Los Angeles County
308174	Non-Physician Medical Practitioner	None	1558976415	0	0	LI, AARON PA	5/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
308181	Non-Physician Medical Practitioner	None	1184214736	0	0	LE, SERENA PA	5/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2251 N HARBOR BLVD	None	FULLERTON	CA	92835	2601	00	06000	33.89691672	-117.9291749	Orange County
308241	Non-Physician Medical Practitioner	None	1972267631	0	0	LETU, SCOTT P PA-C	10/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	00	06000	32.99706	-117.05544	San Diego County
308288	Non-Physician Medical Practitioner	None	1992270649	0	0	LIEW, AMANDA K PA-C	4/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	370 DISTEL CIRCLE	None	LOS ALTOS	CA	94022	1404	00	06000	37.39572142	-122.1051204	Santa Clara County
308295	Non-Physician Medical Practitioner	None	1932967973	0	0	LARSON, MICHELLE E NP	3/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
308298	Non-Physician Medical Practitioner	None	1649204157	0	0	LUNA, ROSA L	9/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2820 SUNSET AVE	None	MADERA	CA	93637	2600	00	06000	36.96008615	-120.0951527	Madera County
308334	Non-Physician Medical Practitioner	None	1275146771	0	0	LAVARREDA, CHARISE NP	1/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
308352	Non-Physician Medical Practitioner	None	1487601928	0	0	LEE, JAMES Y	3/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3918 TRACY ST	None	LOS ANGELES	CA	90027	3208	00	06000	34.10759404	-118.2775223	Los Angeles County
308418	Non-Physician Medical Practitioner	None	1811715550	0	0	LI, CHRISTOPHER J PA-C	3/4/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3700 SOUTH ST	None	LAKEWOOD	CA	90712	1419	00	06000	33.86019848	-118.148166	Los Angeles County
308419	Non-Physician Medical Practitioner	None	1467541011	0	0	LAND, LINDA V NP	4/17/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2763 W BROWNING AVE	None	FRESNO	CA	93711	2514	00	06000	36.81906533	-119.8433731	Fresno County
308421	Non-Physician Medical Practitioner	None	1194359141	0	0	LY, KEVIN PA	6/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
308423	Non-Physician Medical Practitioner	None	1891248142	0	0	LAUNCHI, NATALIE NP	1/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	00	06000	33.90290859	-117.4941562	Riverside County
308426	Non-Physician Medical Practitioner	None	1982075859	0	0	LAM, JEANIE NP	5/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8235 ROCHESTER AVE	SUITE 110	RANCHO CUCAMONGA	CA	91730	0719	00	06000	34.103952	-117.5456935	San Bernardino County
308434	Non-Physician Medical Practitioner	None	1992432249	0	0	LANGE, MITCHELL H PA-C	12/9/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	969 S. SANTA FE AVE	A	VISTA	CA	92083	6910	00	06000	33.1927833	-117.2316819	San Diego County
308442	Non-Physician Medical Practitioner	None	1548069396	0	0	LUTHER, SARAH J NP	3/27/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
308466	Non-Physician Medical Practitioner	None	1841871639	0	0	LOWE, MARY K NP	5/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1665 ESPLANADE	None	CHICO	CA	95926	3312	00	06000	39.74388808	-121.8503372	Butte County
308511	Non-Physician Medical Practitioner	None	1750368650	0	0	LIGHT, MARIETTA F NP	3/16/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	347 E BARSTOW AVE	SUITE 108	FRESNO	CA	93710	6039	00	06000	36.81571648	-119.782494	Fresno County
308518	Non-Physician Medical Practitioner	None	1891899456	0	0	LEE, JULIA CHAW-CHIH NP	10/17/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5012 HARRIMAN AVE	None	SOUTH PASADENA	CA	91030	4018	00	06000	34.10389389	-118.1758034	Los Angeles County
308534	Non-Physician Medical Practitioner	None	1134526270	0	0	LAIRD, SHAWN M	3/19/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2406 MCDOUGAL PLACE	None	ALPINE	CA	91901	4107	00	06000	32.84882739	-116.7648485	San Diego County
308552	Non-Physician Medical Practitioner	None	1922778042	0	0	LIPSKY, CHARLOTTE A NP	9/27/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
308569	Non-Physician Medical Practitioner	None	1922297498	0	0	LEWIS, MARISA P	11/27/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10833 LE CONTE AVE	SUITE 265	LOS ANGELES	CA	90095	3075	00	06000	34.06373445	-118.443537	Los Angeles County
308571	Non-Physician Medical Practitioner	None	1619475381	0	0	LAFFEN, TIFFANY L CNP	12/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18800 MAIN ST	None	HUNTINGTON BEACH	CA	92648	1717	00	06000	33.68890364	-117.9949974	Orange County
308585	Non-Physician Medical Practitioner	None	1982868576	0	0	LARSON, DIANA K PA-C	1/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	34131 DATE PALM DR	F-2	CATHEDRAL CITY	CA	92234	6884	00	06000	33.80013	-116.4581675	Riverside County
308654	Non-Physician Medical Practitioner	None	1265081871	0	0	LEE, JENNIFER PA	2/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
308678	Non-Physician Medical Practitioner	None	1013429653	0	0	LEWKOWITZ, AUDREY ROSE G PA	3/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5137 GOLDEN FOOTHILL PKW	STE 120	EL DORADO HLS	CA	95762	9671	00	06000	38.63972246	-121.0689815	El Dorado County
308744	Non-Physician Medical Practitioner	None	1285626705	0	0	LAWTON, STEPHANIE E NP	8/3/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4150 BLOSSOMWOOD CT	None	ROCKLIN	CA	95677	4022	00	06000	38.80635232	-121.227792	Placer County
308755	Non-Physician Medical Practitioner	None	1659475101	0	0	LEWIS, JENNA ANNE	5/3/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2238 GEARY BLVD	KAISER PERMANENTE	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
308781	Non-Physician Medical Practitioner	None	1437474376	0	0	LOCKETT HOLLOWAY, ISAKE NP	7/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 WESTWOOD BLVD	None	LOS ANGELES	CA	90024	5608	00	06000	34.05159882	-118.4385447	Los Angeles County
308808	Non-Physician Medical Practitioner	None	1255988259	0	0	LI, JONATHAN R PA	3/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
308810	Non-Physician Medical Practitioner	None	1669672382	0	0	LEBRUN, BETTY LYNN	5/31/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	284 SPRUCE ST	None	GRIDLEY	CA	95948	2216	00	06000	39.36699345	-121.6910745	Butte County
308832	Non-Physician Medical Practitioner	None	1356500672	0	0	LALWANI, SAPNA	11/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1122 YORKSIRE DR	None	CUPERTINO	CA	95014	4917	00	06000	37.30540405	-122.0469116	Santa Clara County
308836	Non-Physician Medical Practitioner	None	1588364640	0	0	LEWIS, JUDITH K NP	4/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13010 HESPERIA ROAD	SUITE 200	VICTORVILLE	CA	92395	8315	00	06000	34.48843676	-117.2909745	San Bernardino County
308837	Non-Physician Medical Practitioner	None	1679136998	0	0	LAM, JOYCE Y PA	11/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
308878	Non-Physician Medical Practitioner	None	1225794795	0	0	LEYSON, LAUREN R PA-C	1/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	00	06000	34.04805253	-117.249534	San Bernardino County
308885	Non-Physician Medical Practitioner	None	1659642502	0	0	LUONG, VANGIE T	9/14/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7616 COLUMBIA ST	None	ROSEMEAD	CA	91770	2206	00	06000	34.07109608	-118.1032028	Los Angeles County
308899	Non-Physician Medical Practitioner	None	1689293946	0	0	LLERENAS, MICHELLE L NP	1/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
308946	Non-Physician Medical Practitioner	None	1568796803	0	0	LAM, LISA S	8/14/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	506 W VALLEY BLVD # 100	None	SAN GABRIEL	CA	91776	3731	00	06000	34.07936003	-118.1070139	Los Angeles County
308947	Non-Physician Medical Practitioner	None	1144988544	0	0	LARSON, SLOAN P NP	1/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2907 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	00	06000	36.98793933	-121.9782322	Santa Cruz County
308992	Non-Physician Medical Practitioner	None	1124118377	0	0	LUNDGREN, JOHN R	2/17/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3201 S STREET	APT 361	SACRAMENTO	CA	95816	7087	00	06000	38.562948	-121.467726	Sacramento County
309018	Non-Physician Medical Practitioner	None	1134772973	0	0	LUARCA, GENEVIEVE N NP	10/29/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2720 N HARBOR BOULEVARD	SUITE 210	FULLERTON	CA	92835	2626	00	06000	33.90126238	-117.9292154	Orange County
309021	Non-Physician Medical Practitioner	None	1396972626	0	0	LUONG, LINDA L	3/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11533 HALAWA LN	None	CYPRESS	CA	90630	5706	00	06000	33.79503382	-118.0150383	Orange County
309022	Non-Physician Medical Practitioner	None	1245519172	0	0	LASH, PATRICIA THALKEN	9/4/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1190 BAKER STREET	100	COSTA MESA	CA	92659	0000	00	06000	33.68016313	-117.9072448	Orange County
309024	Non-Physician Medical Practitioner	None	1972018513	0	0	LUMBANGAOL, TANYA PA	1/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1131 W 6TH ST	250	ONTARIO	CA	91762	1108	00	06000	34.084404	-117.6717015	San Bernardino County
309042	Non-Physician Medical Practitioner	None	1649518572	0	0	LEE, HYEYOUNG NP	8/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	00	06000	34.13990611	-118.2182985	Los Angeles County
309055	Non-Physician Medical Practitioner	None	1174178933	0	0	LEININGER, MICHAEL NP	2/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	130 LA CASA VIA	2-210	WALNUT CREEK	CA	94598	3045	00	06000	37.91175467	-122.0414101	Contra Costa County
309072	Non-Physician Medical Practitioner	None	1760187538	0	0	LANTZ, MEAGAN PA	9/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
309080	Non-Physician Medical Practitioner	None	1952904831	0	0	LOYD, JOSEPH J NP	12/7/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	00	06000	32.95809	-115.5537045	Imperial County
309087	Non-Physician Medical Practitioner	None	1154464154	0	0	LE, THOMAS M	4/8/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4110 ROCK LAKE DR	None	BAKERSFIELD	CA	93313	5031	00	06000	35.28464468	-119.0487278	Kern County
309148	Non-Physician Medical Practitioner	None	1174932800	0	0	LUU, ANH NGUYET T PA	8/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	00	06000	37.55102172	-121.9759026	Alameda County
309156	Non-Physician Medical Practitioner	None	1700065802	0	0	LOZOVOY, RUSLAN Y	3/25/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	900 N HERITAGE DR	BUILDING A	RIDGECREST	CA	93555	5536	00	06000	35.6381566	-117.675128	Kern County
309180	Non-Physician Medical Practitioner	None	1972661379	0	0	LEMMON, CAROL	11/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	00	06000	37.53039072	-122.2987772	San Mateo County
309212	Non-Physician Medical Practitioner	None	1346790706	0	0	LEE, SAMUEL J NP	4/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MILVIA ST.	None	BERKELEY	CA	94704	2636	00	06000	37.86338897	-122.2698455	Alameda County
309222	Non-Physician Medical Practitioner	None	1720638331	0	0	LE, COLLEEN N PA	12/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
309230	Non-Physician Medical Practitioner	None	1396198081	0	0	LIGUORI, CHRISTOPHER R	8/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1809 S CAIN ST	None	VISALIA	CA	93292	5154	00	06000	36.314388	-119.274822	Tulare County
309238	Non-Physician Medical Practitioner	None	1992347330	0	0	LEE, SOO HYUN S NP	11/15/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 S VINCENT AVE	SUITE 205	WEST COVINA	CA	91790	6712	00	06000	34.0662144	-117.9274205	Los Angeles County
309239	Non-Physician Medical Practitioner	None	1376133660	0	0	LOWE, CASEY PA	11/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
309249	Non-Physician Medical Practitioner	None	1972052496	0	0	LAM, DUNG GLORIA T NP	1/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	00	06000	37.51438187	-122.2607682	San Mateo County
309300	Non-Physician Medical Practitioner	None	1073053740	0	0	LEE, STELLA NP	2/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26 RANCHO DEL MAR	None	APTOS	CA	95003	3973	00	06000	36.97832273	-121.9080422	Santa Cruz County
309321	Non-Physician Medical Practitioner	None	1255889150	0	0	LIPANOVICH, ERICA B	10/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1638 BAKER ST	None	COSTA MESA	CA	92626	3702	00	06000	33.68080267	-117.9251824	Orange County
309327	Non-Physician Medical Practitioner	None	1790349652	0	0	LUU, EMILY PA	10/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	00	06000	34.148637	-118.4312035	Los Angeles County
309340	Non-Physician Medical Practitioner	None	1992186464	0	0	LOPEZ, NANCY A NP	6/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6399 E ROCHELLE LN	None	LONG BEACH	CA	90815	7439	00	06000	33.77623047	-118.10828	Los Angeles County
309350	Non-Physician Medical Practitioner	None	1295581817	0	0	LIU, MICHELLE NP	7/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	328 S. FIRST ST	F	ALHAMBRA	CA	91801	3790	00	06000	34.09104553	-118.1252904	Los Angeles County
309352	Non-Physician Medical Practitioner	None	1558826719	0	0	LAIRD, ELLERY PA	4/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	77 MORAGA WAY	STE G	ORINDA	CA	94563	3019	00	06000	37.87787873	-122.1803048	Contra Costa County
309388	Non-Physician Medical Practitioner	None	1043655004	0	0	LEE, ARIM NP	5/5/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14035 PASEO CEVERA	None	SAN DIEGO	CA	92129	2709	00	06000	32.96699727	-117.1166493	San Diego County
309396	Non-Physician Medical Practitioner	None	1962654269	0	0	LEROY, SUSIE M	8/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9427 N ARCHIE AVE	None	FRESNO	CA	93720	1402	00	06000	36.8731234	-119.7563173	Fresno County
309404	Non-Physician Medical Practitioner	None	1942914510	0	0	LEE, MYUNGHEE PA-C	8/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	340 4TH AVE	7A	CHULA VISTA	CA	91910	3813	00	06000	32.63831293	-117.0833536	San Diego County
309445	Non-Physician Medical Practitioner	None	1992010110	0	0	LEW, KATHLEEN L	9/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3815 SUSAN DRIVE	APT K4	SAN BRUNO	CA	94066	1132	00	06000	37.6370481	-122.4627821	San Mateo County
309453	Non-Physician Medical Practitioner	None	1881029080	0	0	LAU, STEPHANIE W	4/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1133 22ND ST	STE 2	SANTA MONICA	CA	90403	5727	00	06000	34.03339293	-118.4821954	Los Angeles County
309460	Non-Physician Medical Practitioner	None	1891172300	0	0	LASHBROOK, WESLEY B PA-C	8/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
309464	Non-Physician Medical Practitioner	None	1922276773	0	0	LASATER, STACY M	3/25/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	370 DEL NORTE AVE STE 20	None	YUBA CITY	CA	95991	4142	00	06000	39.14466521	-121.6166961	Sutter County
309479	Non-Physician Medical Practitioner	None	1598400772	0	0	LARSON, ALEC J PA	8/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	00	06000	37.97026329	-121.2890849	San Joaquin County
309492	Non-Physician Medical Practitioner	None	1427897495	0	0	LE, ANGELINE N PA	11/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	00	06000	34.062852	-117.9446658	Los Angeles County
309513	Non-Physician Medical Practitioner	None	1184291924	0	0	LAU, CYNTHIA NP	12/9/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20055 LAKE CHABOT RD	STE 230	CASTRO VALLEY	CA	94546	5333	00	06000	37.69836512	-122.0873587	Alameda County
309529	Non-Physician Medical Practitioner	None	1487199535	0	0	LANDECK, MEGAN NP	5/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11150 HIGHWAY 1	None	POINT REYES STATI	CA	94956	9756	00	06000	38.06731086	-122.8046644	Marin County
309542	Non-Physician Medical Practitioner	None	1023691334	0	0	LONG, SUSAN NP	3/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3300 E SOUTH ST	STE 308	LONG BEACH	CA	90805	4598	00	06000	33.86018093	-118.1537163	Los Angeles County
309568	Non-Physician Medical Practitioner	None	1871059964	0	0	LEE, HANNAH R PA	12/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
309585	Non-Physician Medical Practitioner	None	1710186721	0	0	LOSCALZO, RICHARD	8/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	745 BAYBERRY TER	None	BOCA RATON	FL	33486	5532	00	06000	26.3417573	-80.10151787	Palm Beach County
309601	Non-Physician Medical Practitioner	None	1285078097	0	0	LEE, ARLENE L NP	8/12/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 N EL MOLINO AVE	UNIT 211	PASADENA	CA	91101	1666	00	06000	34.150887	-118.1368725	Los Angeles County
309604	Non-Physician Medical Practitioner	None	1649816497	0	0	LECHUGA, CLARISSA PA-C	12/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5101 FLORENCE AVE	STE 4	BELL	CA	90201	3801	00	06000	33.96904913	-118.1757922	Los Angeles County
309607	Non-Physician Medical Practitioner	None	1841076189	0	0	LUU, STEPHANIE	10/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
309613	Non-Physician Medical Practitioner	None	1174567978	0	0	LAWLER, CHERI L	6/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	341 LEXINGTON ST	None	UPLAND	CA	91784	1468	00	06000	34.13854584	-117.6468999	San Bernardino County
309618	Non-Physician Medical Practitioner	None	1134647654	0	0	LEE, CHRISTINA PA-C	3/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20642 JOHN DR	None	CASTRO VALLEY	CA	94546	5103	00	06000	37.69270814	-122.090934	Alameda County
309652	Non-Physician Medical Practitioner	None	1881153187	0	0	LOPEZ, BENJAMIN S	4/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3600 BROADWAY	None	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
309657	Non-Physician Medical Practitioner	None	1417291170	0	0	LEANO, ANYLOU NP	8/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	00	06000	33.75116909	-116.9601666	Riverside County
309658	Non-Physician Medical Practitioner	None	1730113101	0	0	LOPEZ, DANIEL C	9/15/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20665 VIA BELARMINO	None	YORBA LINDA	CA	92887	3129	00	06000	33.88231652	-117.7747695	Orange County
309665	Non-Physician Medical Practitioner	None	1548740459	0	0	LEE, SIA NP	11/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1134 N DE WOLF AVE	None	FRESNO	CA	93737	9794	00	06000	36.75208769	-119.6447831	Fresno County
309669	Non-Physician Medical Practitioner	None	1114666765	0	0	LAPIG, LANELLE N NP	4/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20440 SHERMAN WAY	None	CANOGA PARK	CA	91306	3110	00	06000	34.20098249	-118.578753	Los Angeles County
309671	Non-Physician Medical Practitioner	None	1477542686	0	0	LUANSING, ERIK M PA	9/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	00	06000	33.85626255	-117.5559289	Riverside County
309688	Non-Physician Medical Practitioner	None	1821596503	0	0	LAKHANI, ALIYA	6/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
309713	Non-Physician Medical Practitioner	None	1083736599	0	0	LOMBARDI, MONIKA	3/7/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3333 S WEST STREET	None	VISALIA	CA	93277	7546	00	06000	36.300321	-119.296395	Tulare County
309726	Non-Physician Medical Practitioner	None	1457997892	0	0	LIANG, LETTY PA	1/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
309732	Non-Physician Medical Practitioner	None	1841851375	0	0	LEHMAN, LINDSEY C NP	9/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	44045 MARGARITA RD	STE 106	TEMECULA	CA	92592	2729	00	06000	33.48351542	-117.1027964	Riverside County
309735	Non-Physician Medical Practitioner	None	1699986935	0	0	LADNER, ZACHARY D	2/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4091 SAINT MARYS ST	None	MARTINEZ	CA	94553	3748	00	06000	37.99258157	-122.1354729	Contra Costa County
309770	Non-Physician Medical Practitioner	None	1710406442	0	0	LEGAN, MARGARET K	11/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2123 NICE AVE	UNIT K	MENTONE	CA	92359	9406	00	06000	34.06629518	-117.120171	San Bernardino County
309786	Non-Physician Medical Practitioner	None	1104893254	0	0	LARIN, CARLOS A	3/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10659 HALBRENT AVE	None	MISSION HILLS	CA	91345	2047	00	06000	34.26423597	-118.465624	Los Angeles County
309791	Non-Physician Medical Practitioner	None	1477954089	0	0	LAFTAVI, HELIA G	8/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 N HIGHLAND AVE	STE 321	LOS ANGELES	CA	90028	6213	00	06000	34.096563	-118.338659	Los Angeles County
309802	Non-Physician Medical Practitioner	None	1609321900	0	0	LEWIS, JEREMIAH C	1/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20505 COUNTY RD 93	None	WOODLAND	CA	95695	8924	00	06000	38.64105	-121.894245	Yolo County
309817	Non-Physician Medical Practitioner	None	1316188543	0	0	LA CLINICA DE LA RAZA, INC.	7/23/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	50 E LEWELLING BLVD	None	SAN LORENZO	CA	94580	1732	00	06000	37.688571	-122.122539	Alameda County
309829	Non-Physician Medical Practitioner	None	1356869846	0	0	LADERO, ROMEO R CNP	8/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N LAUREN ST	None	HEMET	CA	92543	4437	00	06000	33.749955	-116.9608485	Riverside County
309834	Non-Physician Medical Practitioner	None	1174331904	0	0	LEONARD, LAUREN D NP	3/14/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	FIVE MEDICAL PLAZA	STE 190	ROSEVILLE	CA	95661	2865	00	06000	38.76523677	-121.2493453	Placer County
309902	Non-Physician Medical Practitioner	None	1053795203	0	0	LEE, CHRISTOPHER S	1/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	520 S KINGSLEY DR	APT 206	LOS ANGELES	CA	90020	3509	00	06000	34.06479585	-118.3028183	Los Angeles County
309913	Non-Physician Medical Practitioner	None	1003456609	0	0	LONG, WANDA K NP	3/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	00	06000	34.13189479	-116.2767026	San Bernardino County
309923	Non-Physician Medical Practitioner	None	1619385309	0	0	LOERA, DANIEL	4/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17156 MANZANITA DR	None	FONTANA	CA	92335	5851	00	06000	34.07989956	-117.4300994	San Bernardino County
309936	Non-Physician Medical Practitioner	None	1821358979	0	0	LOPES, JULIE RENE	6/8/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13522 NEWPORT AVE STE 10	None	TUSTIN	CA	92780	3707	00	06000	33.74329025	-117.8167455	Orange County
309949	Non-Physician Medical Practitioner	None	1497009245	0	0	LOS ANGELES CHRISTIAN HEALTH CENTERS	8/6/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1920 MARENGO ST	None	LOS ANGELES	CA	90033	1317	00	06000	34.05751768	-118.2095235	Los Angeles County
309950	Non-Physician Medical Practitioner	None	1477095875	0	0	LAM, DARREN W	2/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	533 S ST ANDREWS PLACE	UNIT #314	LOS ANGELES	CA	90020	5320	00	06000	34.06435384	-118.3116192	Los Angeles County
309963	Non-Physician Medical Practitioner	None	1720002322	0	0	LAUREANO, TARA ANNE	7/31/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
309970	Non-Physician Medical Practitioner	None	1154090645	0	0	LEE, RANA J PA	10/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26800 CROWN VALLEY PKWY	STE 305, 315, 325, 330	MISSION VIEJO	CA	92691	8033	00	06000	33.56286021	-117.6673449	Orange County
309983	Non-Physician Medical Practitioner	None	1598316671	0	0	LITTON, KAITLYN NP	8/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 LIGHTHOUSE AVE	None	MONTEREY	CA	93940	1439	00	06000	36.61275747	-121.9010674	Monterey County
309989	Non-Physician Medical Practitioner	None	1003954116	0	0	LOPEZ, SARA OJEDA	3/1/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8110 BIRMINGHAM WAY	BLDG 28	SAN DIEGO	CA	92123	2758	00	06000	32.79648424	-117.1521397	San Diego County
310001	Non-Physician Medical Practitioner	None	1437724291	0	0	LOPEZ, JACOB PA	3/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7774 CHERRY AVE	None	FONTANA	CA	92336	4014	00	06000	34.11281482	-117.488717	San Bernardino County
310035	Non-Physician Medical Practitioner	None	1760419428	0	0	LOWREY, NICOLA M	6/10/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	509 25TH STREET	None	HERMOSA BEACH	CA	90254	2624	00	06000	33.87237745	-118.4006025	Los Angeles County
310040	Non-Physician Medical Practitioner	None	1659856888	0	0	LIU, KELVIN Z NP	1/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1701 SANTA ANITA AVE	None	EL MONTE	CA	91733	3411	00	06000	34.04810648	-118.0424794	Los Angeles County
310058	Non-Physician Medical Practitioner	None	1730845280	0	0	LILLY, TAHNEE PA-C	5/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1295 HAMNER AVE	STE C	NORCO	CA	92860	3161	00	06000	33.90023607	-117.5624777	Riverside County
310080	Non-Physician Medical Practitioner	None	1235745373	0	0	LIAN, RIZZA E NP	4/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
310107	Non-Physician Medical Practitioner	None	1134296981	0	0	LEU SINCLAIR, CHERYL Y	2/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3445 ROSEMARY AVE	None	GLENDALE	CA	91208	1510	00	06000	34.20182535	-118.2313894	Los Angeles County
310135	Non-Physician Medical Practitioner	None	1093807471	0	0	LUONG, TRANG	3/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5511 CHESBRO AVE	None	SAN JOSE	CA	95123	3020	00	06000	37.25299088	-121.8434007	Santa Clara County
310147	Non-Physician Medical Practitioner	None	1245671726	0	0	LA CLINICA DE LA RAZA, INC.	9/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1390 66TH AVE	None	OAKLAND	CA	94621	3506	00	06000	37.7620165	-122.1932801	Alameda County
310161	Non-Physician Medical Practitioner	None	1184997751	0	0	LOCQUIAO, MENDELEEV D	3/5/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10008 GRIZZLY ST	None	BAKERSFIELD	CA	93311	9528	00	06000	35.30648717	-119.1134403	Kern County
310167	Non-Physician Medical Practitioner	None	1295259141	0	0	LEE, MIYEON V NP	12/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	00	06000	33.6526055	-117.910746	Orange County
310184	Non-Physician Medical Practitioner	None	1871823237	0	0	LEE, KAO Y NP	8/28/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12160 FRANTZ LN	None	WILTON	CA	95693	9699	00	06000	38.396403	-121.221045	Sacramento County
310222	Non-Physician Medical Practitioner	None	1891456885	0	0	LEE, JISOO PA-C	2/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	00	06000	33.12288368	-117.3058276	San Diego County
310225	Non-Physician Medical Practitioner	None	1184322646	0	0	LEE, CALVIN P NP	7/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
310246	Non-Physician Medical Practitioner	None	1225417124	0	0	LE, TRACI N NP	10/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9191 WESTMINSTER AVE	SUITE 207	GARDEN GROVE	CA	92844	2751	00	06000	33.75946879	-117.9688437	Orange County
310255	Non-Physician Medical Practitioner	None	1497494058	0	0	LANTZY, JILL A NP	6/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
310271	Non-Physician Medical Practitioner	None	1114569878	0	0	LOPEZ, DAISY A NP	2/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	00	06000	33.78785649	-117.8276715	Orange County
310272	Non-Physician Medical Practitioner	None	1689952277	0	0	LEE, LILY YEUK YING	10/3/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
310284	Non-Physician Medical Practitioner	None	1487439600	0	0	LOPEZ, CHRISTINA PA	10/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	00	06000	39.74352822	-121.8495394	Butte County
310289	Non-Physician Medical Practitioner	None	1598052821	0	0	LAWRENCE-WALKER, AMPERES LAI-PING	10/22/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	627 W AVENUE Q	SUITE D	PALMDALE	CA	93551	3891	00	06000	34.58715647	-118.1417372	Los Angeles County
310302	Non-Physician Medical Practitioner	None	1922646587	0	0	LAM, TERANZE PA	3/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
310308	Non-Physician Medical Practitioner	None	1396157236	0	0	LITTLE, JONATHAN D	7/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3000 SHERWOOD AVENUE	APT 182	MODESTO	CA	95350	1301	00	06000	37.68284015	-120.9974518	Stanislaus County
310330	Non-Physician Medical Practitioner	None	1316908023	0	0	LURIE, HUGH	6/16/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	00	06000	37.78096053	-122.4637512	San Francisco County
310331	Non-Physician Medical Practitioner	None	1275262040	0	0	LAMB, STEVIE M PA	2/26/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 TRANCAS ST	None	NAPA	CA	94558	2906	00	06000	38.32349768	-122.2963137	Napa County
310333	Non-Physician Medical Practitioner	None	1669860177	0	0	LUNASON, HALEIGH E NP	1/31/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	131 STONY CIR	1600	SANTA ROSA	CA	95401	9520	00	06000	38.439477	-122.7451095	Sonoma County
310335	Non-Physician Medical Practitioner	None	1275869703	0	0	LEGISLADOR, MELOCOTON J	8/10/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	50 BELLEFONTAINE ST	SUITE 201	PASADENA	CA	91105	3132	00	06000	34.13155953	-118.1517525	Los Angeles County
310348	Non-Physician Medical Practitioner	None	1558742171	0	0	LOUIE, DONNA L	9/15/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2849 PARKWAY DR	None	MARTINEZ	CA	94553	3484	00	06000	38.00462207	-122.112248	Contra Costa County
310358	Non-Physician Medical Practitioner	None	1619544046	0	0	LE, CHRISTINE T PA	11/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	00	06000	33.93112671	-118.2035532	Los Angeles County
310419	Non-Physician Medical Practitioner	None	1316135460	0	0	LOPEZ, AMY R PA	10/20/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1918 LAKESHORE AVE	UNIT 52	OAKLAND	CA	94606	1178	00	06000	37.8029955	-122.2536453	Alameda County
310444	Non-Physician Medical Practitioner	None	1790210540	0	0	LUCE, DAMARA K PA-C	9/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	925 CORPORATE CENTER	SUITE A	SANTA ROSA	CA	95407	5453	00	06000	38.425383	-122.7536235	Sonoma County
310477	Non-Physician Medical Practitioner	None	1285142125	0	0	LAVERTY, LISSANDE M PA-C	12/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2375 S MELROSE DR	None	VISTA	CA	92081	8788	00	06000	33.14409946	-117.2417711	San Diego County
310480	Non-Physician Medical Practitioner	None	1700832128	0	0	LANDRETH, CURTIS D	9/20/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 W FERN AVE	None	REDLANDS	CA	92373	5916	00	06000	34.05016907	-117.1793443	San Bernardino County
310490	Non-Physician Medical Practitioner	None	1457883068	0	0	LEDBETTER, LOGAN N PA-C	1/21/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	00	06000	38.76566391	-121.2457432	Placer County
310491	Non-Physician Medical Practitioner	None	1457599631	0	0	LOS ANGELES CHRISTIAN HEALTH CENTERS	12/3/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1625 E 4TH STREET	None	LOS ANGELES	CA	90033	0000	00	06000	34.04297786	-118.2220181	Los Angeles County
310505	Non-Physician Medical Practitioner	None	1538775093	0	0	LEE, DAVID S NP	11/24/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 STEIN PLZ	420	LOS ANGELES	CA	90095	0001	00	06000	34.06482846	-118.4443432	Los Angeles County
310515	Non-Physician Medical Practitioner	None	1104006741	0	0	LOVE, JUSTIN D PA-C	3/4/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15651 IMPERIAL HWY STE 1	None	LA MIRADA	CA	90638	1600	00	06000	33.91736136	-117.9972197	Los Angeles County
310527	Non-Physician Medical Practitioner	None	1497471320	0	0	LAYTON, LUKE PA	9/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14117 LIMONITE AVE	BUILDING 2, SUITE 300	EASTVALE	CA	92880	3864	00	06000	33.97532151	-117.5914845	Riverside County
310531	Non-Physician Medical Practitioner	None	1194373514	0	0	LINDEMANN, CHRISTINA R PA	7/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
310537	Non-Physician Medical Practitioner	None	1144313420	0	0	LAIRD, LESLEY A PA-C	4/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1295 HAMNER AVE	STE C	NORCO	CA	92860	3161	00	06000	33.90023607	-117.5624777	Riverside County
310572	Non-Physician Medical Practitioner	None	1952851727	0	0	LAWRENCE, KENDRA D NP	4/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3551 Q ST	None	BAKERSFIELD	CA	93301	1657	00	06000	35.392059	-119.010556	Kern County
310578	Non-Physician Medical Practitioner	None	1477884294	0	0	LEAHY, JULIE A NP	4/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2853 CHIOS ROAD	None	COSTA MESA	CA	92626	3523	00	06000	33.67582271	-117.9394694	Orange County
310580	Non-Physician Medical Practitioner	None	1851998165	0	0	LO, MIRANDA	1/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	33494 OAK GLEN RD	None	YUCAIPA	CA	92399	2057	00	06000	34.03255442	-117.0737219	San Bernardino County
310609	Non-Physician Medical Practitioner	None	1437486073	0	0	LAIRD, JASON P	3/21/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2584 SUTTER CT	None	TUSTIN	CA	92782	9050	00	06000	33.73050625	-117.7953137	Orange County
310624	Non-Physician Medical Practitioner	None	1376191718	0	0	LARRIVA, SOPHIA PA-C	1/29/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	00	06000	34.12811155	-118.2577764	Los Angeles County
310634	Non-Physician Medical Practitioner	None	1407224157	0	0	LONGBARDO, FRANCESCA A	1/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2915 CANTO DE LOS CIERVO	None	SAN CLEMENTE	CA	92673	6423	00	06000	33.46100694	-117.6154847	Orange County
310671	Non-Physician Medical Practitioner	None	1851692511	0	0	LE, PHUONG KIM	4/5/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
310677	Non-Physician Medical Practitioner	None	1659324564	0	0	LILAK, DONALD P	7/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	828 RUBY DR	None	VACAVILLE	CA	95687	7880	00	06000	38.31931499	-121.9554805	Solano County
310680	Non-Physician Medical Practitioner	None	1750420196	0	0	LOVELL, JENNIFER GAYLE	11/27/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3001 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	1114	00	06000	42.25288307	-121.7896138	Klamath County
310725	Non-Physician Medical Practitioner	None	1942621362	0	0	LO, TRACY T PA	6/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	00	06000	34.09817553	-118.293237	Los Angeles County
310728	Non-Physician Medical Practitioner	None	1962169011	0	0	LACKEY, ROY PA-C	10/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28062 BAXTER RD	None	MURRIETA	CA	92563	1401	00	06000	33.61350847	-117.1691225	Riverside County
310739	Non-Physician Medical Practitioner	None	1487889846	0	0	LIEBER, CAROL L NP	10/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
310772	Non-Physician Medical Practitioner	None	1609948660	0	0	LEWANDOWSKI, SEAN ANDREW	5/3/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
310799	Non-Physician Medical Practitioner	None	1841495140	0	0	LYONS, JENNIFER L	10/7/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	610 W BLUFF CT	None	ENCINITAS	CA	92024	5836	00	06000	33.05165047	-117.271288	San Diego County
310802	Non-Physician Medical Practitioner	None	1093182859	0	0	LEE-RAMOS, STEVEN R NP	4/27/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2710 DOLBEER ST	None	EUREKA	CA	95501	4736	00	06000	40.78449066	-124.1414748	Humboldt County
310809	Non-Physician Medical Practitioner	None	1255779120	0	0	LANGLEY, LESLIE A NP	2/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7451 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91605	2803	00	06000	34.20616081	-118.3878161	Los Angeles County
310811	Non-Physician Medical Practitioner	None	1801007158	0	0	LEBOUVIER, TERESA M NP	2/13/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9781 EMMONS CIR	None	FOUNTAIN VALLEY	CA	92708	2925	00	06000	33.71753094	-117.9583065	Orange County
310821	Non-Physician Medical Practitioner	None	1831713833	0	0	LESCANO, DIEGO A PA-C	10/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	00	06000	37.744011	-121.4349725	San Joaquin County
310828	Non-Physician Medical Practitioner	None	1689103749	0	0	LUU, JACKIE	8/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11852 MT VERNON AVE	APT 601	GRAND TERRACE	CA	92313	8317	00	06000	34.038036	-117.316332	San Bernardino County
310838	Non-Physician Medical Practitioner	None	1558783258	0	0	LEE, MARILYN M NP	2/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
310857	Non-Physician Medical Practitioner	None	1851593370	0	0	LARKIN, KEVIN D	10/14/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1167 IDAHO AVE	None	ESCONDIDO	CA	92027	4302	00	06000	33.11641837	-117.053973	San Diego County
310869	Non-Physician Medical Practitioner	None	1487268793	0	0	LIU, MIN YUE A NP	2/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	00	06000	34.148637	-118.4312035	Los Angeles County
310878	Non-Physician Medical Practitioner	None	1124155668	0	0	LEE, HAMMOND H	11/28/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5555 GROSSMONT CENTER DR	PRENATAL CLINIC	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
310881	Non-Physician Medical Practitioner	None	1023780822	0	0	LETSA, BERNADETTE G NP	1/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1317 OAKDALE ROAD	STE. 800	MODESTO	CA	95355	3361	00	06000	37.662489	-120.957588	Stanislaus County
310890	Non-Physician Medical Practitioner	None	1144733676	0	0	LANDIS, SARAH E PA-C	7/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
310895	Non-Physician Medical Practitioner	None	1952437709	0	0	LAMENDOLA, CYNTHIA A	12/19/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
310897	Non-Physician Medical Practitioner	None	1750835815	0	0	LIVINGSTONE, PAIGE L	12/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1026 METRO CIRCLE	None	PALO ALTO	CA	94303	3835	00	06000	37.44116701	-122.1200369	Santa Clara County
310905	Non-Physician Medical Practitioner	None	1144585837	0	0	LEPP, JONATHAN MICHAEL	8/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1194 N HOPE AVE	None	REEDLEY	CA	93654	2081	00	06000	36.60696	-119.4555415	Fresno County
310907	Non-Physician Medical Practitioner	None	1861100521	0	0	LONG, KARLEE PA	6/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2704 E WILLOW ST	None	SIGNAL HILL	CA	90755	2217	00	06000	33.80432955	-118.1594295	Los Angeles County
310928	Non-Physician Medical Practitioner	None	1245332618	0	0	LEE, SCOTT N PA-C	9/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	00	06000	34.28200485	-118.4030797	Los Angeles County
310931	Non-Physician Medical Practitioner	None	1295218097	0	0	LANG, KELLEY PA	8/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5555 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	4000	00	06000	37.69212528	-121.8803442	Alameda County
310946	Non-Physician Medical Practitioner	None	1356648968	0	0	LEPE, ERIKA	11/25/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11527 GREYFORD ST	None	WHITTIER	CA	90606	2341	00	06000	33.97196693	-118.0653471	Los Angeles County
310976	Non-Physician Medical Practitioner	None	1801069943	0	0	LOPEZ, CECILIA	9/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1247 YALE AVE	None	CLAREMONT	CA	91711	3825	00	06000	34.10622707	-117.7185574	Los Angeles County
310983	Non-Physician Medical Practitioner	None	1215539820	0	0	LY, ELLEN NP	2/11/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	289 W HUNTINGTON DR	SUITE 410	ARCADIA	CA	91007	3495	00	06000	34.13549119	-118.0419175	Los Angeles County
311026	Non-Physician Medical Practitioner	None	1417178542	0	0	LAU, CHRISTINE T NP	5/8/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7037 CROZET AVENUE	None	MOORPARK	CA	93021	5071	00	06000	34.30069853	-118.8698247	Ventura County
311055	Non-Physician Medical Practitioner	None	1871641712	0	0	LEWIS, KATHERINE R	3/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27285 OCEAN DUNES ST	None	MORENO VALLEY	CA	92555	4916	00	06000	33.89165003	-117.1864831	Riverside County
311089	Non-Physician Medical Practitioner	None	1497153282	0	0	LIN, YUNG HUI	11/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1513 2ND AVE	None	SAN MATEO	CA	94401	2107	00	06000	37.57451315	-122.3127742	San Mateo County
311100	Non-Physician Medical Practitioner	None	1235991019	0	0	LYON, IAN M PA	10/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	00	06000	38.12188356	-121.285872	San Joaquin County
311105	Non-Physician Medical Practitioner	None	1932708229	0	0	LEE, MINKYUNG NP	9/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
311127	Non-Physician Medical Practitioner	None	1245833623	0	0	LEE, AARON PA	4/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
311139	Non-Physician Medical Practitioner	None	1801362140	0	0	LEISER, LINDA	7/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
311170	Non-Physician Medical Practitioner	None	1316928484	0	0	LOPEZ, LEOPOLDO L	7/22/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	152 REDWOOD CIRCLE	None	VENTURA	CA	93003	3671	00	06000	34.27247589	-119.2409732	Ventura County
311227	Non-Physician Medical Practitioner	None	1588237580	0	0	LARINO, LEONARD NP	12/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	625 S FAIR OAKS AVE	STE 215	PASADENA	CA	91105	2613	00	06000	34.134894	-118.1504155	Los Angeles County
311246	Non-Physician Medical Practitioner	None	1790453926	0	0	LOWE, MATTHEW G PA-C	3/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4700 SOQUEL DR	None	SOQUEL	CA	95073	2427	00	06000	36.98815433	-121.9571695	Santa Cruz County
311247	Non-Physician Medical Practitioner	None	1750592424	0	0	LYNES, BILLIE A NP	8/14/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1333 RUTH WAY	None	UPLAND	CA	91784	1562	00	06000	34.13101874	-117.6735942	San Bernardino County
311249	Non-Physician Medical Practitioner	None	1962092502	0	0	LADD, ERIN PA	4/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7257 FRESNO	FIRST FLOOR	FRESNO	CA	93720	2950	00	06000	36.84225164	-119.7833937	Fresno County
311250	Non-Physician Medical Practitioner	None	1932646932	0	0	LAM, HIU Y	11/3/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1016 S OLIVE AVE	None	ALHAMBRA	CA	91803	2205	00	06000	34.08069432	-118.1354089	Los Angeles County
311276	Non-Physician Medical Practitioner	None	1679944565	0	0	LERCH, CINDY N PA	9/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	00	06000	34.049547	-117.264078	San Bernardino County
311298	Non-Physician Medical Practitioner	None	1710280383	0	0	LEE, CHRISTEN R PA-C	11/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1407 FOOTHILL BLVD	25	LA VERNE	CA	91750	3451	00	06000	34.11734305	-117.7767279	Los Angeles County
311304	Non-Physician Medical Practitioner	None	1760254296	0	0	LOPEZ, GERARDO CNP	4/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	81767 DR CARREON BLVD	STE 201	INDIO	CA	92201	5599	00	06000	33.70738112	-116.237755	Riverside County
311307	Non-Physician Medical Practitioner	None	1376931295	0	0	LIFELONG MEDICAL CARE	11/8/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	386 14TH ST	None	OAKLAND	CA	94612	3211	00	06000	37.80371572	-122.2696209	Alameda County
311324	Non-Physician Medical Practitioner	None	1710905195	0	0	LARSON, MICHAEL L	10/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	42575 WASHINGTON ST	None	PALM DESERT	CA	92211	8850	00	06000	33.739767	-116.3039465	Riverside County
311332	Non-Physician Medical Practitioner	None	1073165320	0	0	LUONG, MINH-ANH N PA	11/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	00	06000	34.04805253	-117.249534	San Bernardino County
311346	Non-Physician Medical Practitioner	None	1679978522	0	0	LEON, MICHAEL	8/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
311349	Non-Physician Medical Practitioner	None	1811475528	0	0	LEE, CATHY NP	10/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	902 CIRBY WAY	None	ROSEVILLE	CA	95661	4420	00	06000	38.7294585	-121.2763095	Placer County
311389	Non-Physician Medical Practitioner	None	1407301989	0	0	LAMA, TENZIN D NP	11/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3512 PARK RIDGE DR	None	RICHMOND	CA	94806	5824	00	06000	37.985688	-122.3431215	Contra Costa County
311411	Non-Physician Medical Practitioner	None	1730348087	0	0	LOPEZ, ERIC N PA-C	1/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41880 KALMIA ST	SUITE 100	MURRIETA	CA	92562	8835	00	06000	33.55740114	-117.2157733	Riverside County
311423	Non-Physician Medical Practitioner	None	1780785923	0	0	LUCCO, JOETTE L NP	10/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 29TH ST	STE 301	OAKLAND	CA	94609	3522	00	06000	37.81784861	-122.2652263	Alameda County
311449	Non-Physician Medical Practitioner	None	1558664169	0	0	LIAO, ALICE J NP	6/20/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1550 PERSHING DR	APT C	SAN FRANCISCO	CA	94129	1228	00	06000	37.79290602	-122.4775882	San Francisco County
311467	Non-Physician Medical Practitioner	None	1770257586	0	0	LE, NELSON	11/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18145 US HIGHWAY 18	SUITE D	APPLE VALLEY	CA	92307	2210	00	06000	34.5404119	-117.2678454	San Bernardino County
311519	Non-Physician Medical Practitioner	None	1154839645	0	0	LUONG, TONG M NP	4/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	00	06000	33.84718298	-117.933758	Orange County
311531	Non-Physician Medical Practitioner	None	1689824310	0	0	LEON, MICHELLE M NP	4/14/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1480 COLE LANE	None	UPLAND	CA	91784	8066	00	06000	34.12581663	-117.6284757	San Bernardino County
311542	Non-Physician Medical Practitioner	None	1134590086	0	0	LA MAESTRA FAMILY CLINIC INC	6/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1032 BROADWAY	None	EL CAJON	CA	92021	4911	00	06000	32.80772446	-116.946612	San Diego County
311558	Non-Physician Medical Practitioner	None	1881615524	0	0	LORD, CAROL A	11/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	9567 E CREEK VISTA PLACE	None	TUCSON	AZ	85749	7924	00	06000	32.250771	-110.7884295	Pima County
311564	Non-Physician Medical Practitioner	None	1447627658	0	0	LOPEZ, CORINA E	11/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1785 MARLYN WAY	None	SAN JOSE	CA	95125	3427	00	06000	37.294951	-121.8974808	Santa Clara County
311602	Non-Physician Medical Practitioner	None	1548926132	0	0	LEE, SEO YOUNG NP	8/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2151 HARBOR BLVD	STE 3100	FULLERTON	CA	92835	3820	00	06000	33.89443025	-117.9288328	Orange County
311611	Non-Physician Medical Practitioner	None	1710652904	0	0	LEE, JONATHAN W PA-C	11/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18145 US HIGHWAY 18	STE D	APPLE VALLEY	CA	92307	2210	00	06000	34.5404119	-117.2678454	San Bernardino County
311623	Non-Physician Medical Practitioner	None	1245863737	0	0	LAM, DAVINA PA	8/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	00	06000	32.83133206	-117.1252363	San Diego County
311630	Non-Physician Medical Practitioner	None	1982954913	0	0	LY, DAVID C PA	6/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
311632	Non-Physician Medical Practitioner	None	1013046911	0	0	LEE, YUKFUNG	2/14/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	535 ARASTRADERO ROAD	APT 211	PALO ALTO	CA	94306	4316	00	06000	37.40927283	-122.1241101	Santa Clara County
311642	Non-Physician Medical Practitioner	None	1134765738	0	0	LETKO, CHELSY R PA	2/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
311650	Non-Physician Medical Practitioner	None	1851312664	0	0	LEE, TAMMY K	1/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3854 RADBURN DR	None	SOUTH SAN FRANCIS	CA	94080	4027	00	06000	37.64947644	-122.4566868	San Mateo County
311703	Non-Physician Medical Practitioner	None	1972251163	0	0	LEE, TERESA C PA	1/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
311704	Non-Physician Medical Practitioner	None	1356779656	0	0	LUCERO, CHRISTIANNE J	1/13/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5843 VIA FIORI	None	GOLETA	CA	93117	1838	00	06000	34.44922614	-119.828208	Santa Barbara County
311705	Non-Physician Medical Practitioner	None	1275988537	0	0	LOUQUE, BETHANY NP	1/29/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	00	06000	39.13306148	-121.6140103	Sutter County
311715	Non-Physician Medical Practitioner	None	1750792149	0	0	LEHMAN, IRIS M	7/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4228 POCONO CT	None	FAIR OAKS	CA	95628	6445	00	06000	38.643228	-121.232286	Sacramento County
311732	Non-Physician Medical Practitioner	None	1811296635	0	0	LE-MAHON, CHRISTIANE M	2/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3474 NOBLE AVE	None	SAN JOSE	CA	95132	3132	00	06000	37.3944021	-121.8355071	Santa Clara County
311735	Non-Physician Medical Practitioner	None	1487095865	0	0	LONGDON, TINA NP	10/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15408 ROCHELLE ST	None	FONTANA	CA	92336	1040	00	06000	34.14276595	-117.4686244	San Bernardino County
311743	Non-Physician Medical Practitioner	None	1467679688	0	0	LIGONDE, ADELINE	7/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1939 ACADEMY AVE	None	SANGER	CA	93657	3737	00	06000	36.68936951	-119.5550306	Fresno County
311753	Non-Physician Medical Practitioner	None	1164241824	0	0	LAL, MELISSA NP	10/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	729 SUNRISE AVE	SUITE 602	ROSEVILLE	CA	95661	4542	00	06000	38.73444822	-121.2720033	Placer County
311754	Non-Physician Medical Practitioner	None	1275974701	0	0	LANDO, GLENDA NP	6/16/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7001 RAWLEY WAY	None	ELK GROVE	CA	95757	4039	00	06000	38.406375	-121.42179	Sacramento County
311769	Non-Physician Medical Practitioner	None	1710346937	0	0	LEE, DENISE M NP	12/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1085 TASMAN DRIVE	SPACE 281	SUNNYVALE	CA	94089	5380	00	06000	37.40347474	-121.9995782	Santa Clara County
311778	Non-Physician Medical Practitioner	None	1457907982	0	0	LAMBERSON, COLLEEN M PA	12/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
311787	Non-Physician Medical Practitioner	None	1316183452	0	0	LE, WILLIAM	4/2/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9143 VALLEY BLVD STE 101	None	ROSEMEAD	CA	91770	1993	00	06000	34.08096534	-118.0700742	Los Angeles County
311797	Non-Physician Medical Practitioner	None	1043887474	0	0	LEGASPI, ELAINE MARIE N PA-C	4/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
311799	Non-Physician Medical Practitioner	None	1437644556	0	0	LUIZ, BRITTANY G NP	8/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15 SOUTH ORANGE AVE	None	LODI	CA	95240	2834	00	06000	38.1337527	-121.2853757	San Joaquin County
311808	Non-Physician Medical Practitioner	None	1538759451	0	0	LEPP, KIRSTEN M NP	5/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
311809	Non-Physician Medical Practitioner	None	1275109787	0	0	LIU, KEVIN E PA-C	9/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10441 LAKEWOOD BLVD	E	DOWNEY	CA	90241	2744	00	06000	33.94358034	-118.1193714	Los Angeles County
311812	Non-Physician Medical Practitioner	None	1114514122	0	0	LOW, ALEXANDRA CNM	1/14/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	00	06000	37.78594176	-122.421322	San Francisco County
311821	Non-Physician Medical Practitioner	None	1669072328	0	0	LEWIS, IRMARITA NP	4/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2521 SEMINARY AVE	SUITE 1	OAKLAND	CA	94605	1307	00	06000	37.77104396	-122.1912093	Alameda County
311860	Non-Physician Medical Practitioner	None	1649296997	0	0	LEE, SOO-MIN S	1/1/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	0000	00	06000	34.06373445	-118.443537	Los Angeles County
311880	Non-Physician Medical Practitioner	None	1932392529	0	0	LUPTRAWAN, ANNE	10/12/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8631 W 3RD ST	800E	LOS ANGELES	CA	90048	5901	00	06000	34.07361928	-118.3803143	Los Angeles County
311926	Non-Physician Medical Practitioner	None	1508261686	0	0	LIONG, MAE C Y NP	1/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10002 TUNGSTEN ST	None	BAKERSFIELD	CA	93311	9517	00	06000	35.30400767	-119.1132248	Kern County
311930	Non-Physician Medical Practitioner	None	1477074904	0	0	LIERAS, VINCENT M	9/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30300 ANTELOPE ROAD	APT 1826	MENIFEE	CA	92584	9568	00	06000	33.67928525	-117.1701778	Riverside County
311937	Non-Physician Medical Practitioner	None	1669493367	0	0	LALONDE, LOUISE C NP	8/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	625 S FAIR OAKS AVE	STE 215	PASADENA	CA	91105	2613	00	06000	34.134894	-118.1504155	Los Angeles County
311961	Non-Physician Medical Practitioner	None	1477263184	0	0	LENG, GRACE PA	4/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	00	06000	38.38851772	-121.9382798	Solano County
311984	Non-Physician Medical Practitioner	None	1447247655	0	0	LEE, LINDA	11/20/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	19021 US HIGHWAY 285	None	LA JARA	CO	81140	9410	00	06000	37.26266338	-105.9644393	Conejos County
311992	Non-Physician Medical Practitioner	None	1265161699	0	0	LUNDGREN, MADELINE H PA	8/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	00	06000	38.12188356	-121.285872	San Joaquin County
311993	Non-Physician Medical Practitioner	None	1598012908	0	0	LI, XIAOLING PA-C	3/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1561 CREEKSIDE DRIVE	180	FOLSOM	CA	95630	3492	00	06000	38.668032	-121.150188	Sacramento County
312007	Non-Physician Medical Practitioner	None	1659556389	0	0	LAM, SOPHIA BAO TRAN	8/27/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	SUITE 4300	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
312036	Non-Physician Medical Practitioner	None	1851432470	0	0	LLOYD, TASONA S PA	5/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	00	06000	33.78673844	-118.2965289	Los Angeles County
312039	Non-Physician Medical Practitioner	None	1366631954	0	0	LOWE, JACKLYN JEANNE	11/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3325 BEVIS ST	None	SAN DIEGO	CA	92111	5017	00	06000	32.804487	-117.159053	San Diego County
312048	Non-Physician Medical Practitioner	None	1619639093	0	0	LAMM, ZACHARY L PA-C	2/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1668 DOMINICAN WAY	None	SANTA CRUZ	CA	95065	1522	00	06000	36.99025828	-121.9810944	Santa Cruz County
312059	Non-Physician Medical Practitioner	None	1376947762	0	0	LIU, SANDY C	10/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	303 W ATARA ST	None	MONROVIA	CA	91016	4718	00	06000	34.12568845	-118.0081305	Los Angeles County
312069	Non-Physician Medical Practitioner	None	1649210048	0	0	LADWIG, MICHELLE MONETTE	4/27/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2101 TENAYA DR	None	MODESTO	CA	95354	3930	00	06000	37.6324545	-120.956463	Stanislaus County
312071	Non-Physician Medical Practitioner	None	1770242190	0	0	LAM, HIEN PA-C	3/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	33560 ALVARADO NILES	None	UNION CITY	CA	94587	3111	00	06000	37.59123987	-122.0355648	Alameda County
312076	Non-Physician Medical Practitioner	None	1154948164	0	0	LAWSON, SEAN M PA-C	1/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 W STEWART DR	None	ORANGE	CA	92868	3849	00	06000	33.78236558	-117.8648414	Orange County
312087	Non-Physician Medical Practitioner	None	1609370659	0	0	LEE, KRISTINE NP	6/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	00	06000	34.065126	-118.446237	Los Angeles County
312101	Non-Physician Medical Practitioner	None	1538617691	0	0	LOW, CHEN DER	1/3/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
312128	Non-Physician Medical Practitioner	None	1588168330	0	0	LEE, JANE Y	12/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1131 HAWKSHEAD CIR	None	SAN RAMON	CA	94583	6004	00	06000	37.73991185	-121.9859776	Contra Costa County
312157	Non-Physician Medical Practitioner	None	1871239699	0	0	LAL, NELU N NP	6/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1317 OAKDALE RD	SUITE 440	MODESTO	CA	95355	3364	00	06000	37.662489	-120.957588	Stanislaus County
312165	Non-Physician Medical Practitioner	None	1972139079	0	0	LEE, KAREN	8/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	280 SIERRA COLLEGE DR	STE 120	GRASS VALLEY	CA	95945	5763	00	06000	39.23410746	-121.0515391	Nevada County
312170	Non-Physician Medical Practitioner	None	1427541085	0	0	LEUNG, ABRAHAM W	6/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4108 EDISON AVE	SUITE 112	CHINO	CA	91710	8418	00	06000	33.9972783	-117.7147771	San Bernardino County
312175	Non-Physician Medical Practitioner	None	1356969901	0	0	LAVI, EMILY PA	5/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 W 5TH ST	STE 209	SAN PEDRO	CA	90731	2752	00	06000	33.73971779	-118.2852574	Los Angeles County
312181	Non-Physician Medical Practitioner	None	1194055632	0	0	LIKOU, TINA M PA-C	4/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2675 HARRIS ST	None	EUREKA	CA	95503	4806	00	06000	40.78053022	-124.1369379	Humboldt County
312182	Non-Physician Medical Practitioner	None	1740789106	0	0	LOWERY, BRENTTON T	8/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9201 W SUNSET BLVD	SUITE 812	WEST HOLLYWOOD	CA	90069	3709	00	06000	34.09054375	-118.392295	Los Angeles County
312194	Non-Physician Medical Practitioner	None	1619571742	0	0	LE, VINCE V PA-C	1/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11190 WARNER AVE	408	FOUNTAIN VALLEY	CA	92708	4047	00	06000	33.714	-117.9333585	Orange County
312201	Non-Physician Medical Practitioner	None	1497283717	0	0	LECHICH, KIRSTIE M	11/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	470 DEL MEDIO AVENUE	APT 8	MOUNTAIN VIEW	CA	94040	1122	00	06000	37.40499773	-122.1154772	Santa Clara County
312209	Non-Physician Medical Practitioner	None	1518063478	0	0	LEE, MAYRE TAMARA	5/18/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	00	06000	38.26109552	-122.0470245	Solano County
312211	Non-Physician Medical Practitioner	None	1710473640	0	0	LE, VICTORIA H PA	8/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	00	06000	33.93112671	-118.2035532	Los Angeles County
312212	Non-Physician Medical Practitioner	None	1942817267	0	0	LEE, EDWIN K PA	12/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 W FERN AVE	None	REDLANDS	CA	92373	5916	00	06000	34.05016907	-117.1793443	San Bernardino County
312224	Non-Physician Medical Practitioner	None	1144996745	0	0	LEE, PAUL PA-C	12/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9850 GENESEE AVE	SUITE 440	SAN DIEGO	CA	92037	1212	00	06000	32.882913	-117.226341	San Diego County
312276	Non-Physician Medical Practitioner	None	1659541027	0	0	LEEDY, BROOKE CAROLINE	3/8/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 W LEGION RD	None	BRAWLEY	CA	92227	7732	00	06000	32.95996012	-115.5538196	Imperial County
312299	Non-Physician Medical Practitioner	None	1477937563	0	0	LEE, THANIA I NP	8/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	899 VALENCIA ST	GROUND FLOOR	SAN FRANCISCO	CA	94110	1736	00	06000	37.75867161	-122.4212468	San Francisco County
312359	Non-Physician Medical Practitioner	None	1538780218	0	0	LEE, LAIN L NP	3/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8135 S PAINTER AVENUE	SUITE 103	WHITTIER	CA	90602	3171	00	06000	33.965829	-118.032738	Los Angeles County
312390	Non-Physician Medical Practitioner	None	1164784849	0	0	LEE, HELEN NP	6/16/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5344 VILLAGE CIRCLE DR	None	TEPMPLE CITY	CA	91780	3360	00	06000	34.09823716	-118.0490597	Los Angeles County
312443	Non-Physician Medical Practitioner	None	1790818557	0	0	LUNG, SHELLEY M	12/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 COFFEE RD	None	MODESTO	CA	95355	2803	00	06000	37.668645	-120.9756715	Stanislaus County
312462	Non-Physician Medical Practitioner	None	1730643925	0	0	LAW, VINNIE NP	9/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	00	06000	33.83760674	-118.3572569	Los Angeles County
312467	Non-Physician Medical Practitioner	None	1780622084	0	0	LAI, NGA TU	6/22/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39233 LIBERTY ST	None	FREMONT	CA	94538	1501	00	06000	37.55061601	-121.9816447	Alameda County
312471	Non-Physician Medical Practitioner	None	1356458137	0	0	LANDA, BETH A	5/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	246 N MOUNTAIN AVE	APT D	MONROVIA	CA	91016	2474	00	06000	34.15537588	-117.9880313	Los Angeles County
312494	Non-Physician Medical Practitioner	None	1508268996	0	0	LONDON, CHRISTINE A	7/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10511 CUSHDON AVENUE	None	LOS ANGELES	CA	90064	3336	00	06000	34.04278819	-118.4177962	Los Angeles County
312496	Non-Physician Medical Practitioner	None	1447698477	0	0	LINAREZ, MARIE R NP	4/8/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11149 ALLERTON ST	None	WHITTIER	CA	90606	1801	00	06000	33.9780255	-118.0680512	Los Angeles County
312504	Non-Physician Medical Practitioner	None	1396217220	0	0	LIU, DANIELLE K PA	8/22/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	00	06000	36.68590557	-121.8010492	Monterey County
312523	Non-Physician Medical Practitioner	None	1396395950	0	0	LEE, HYO J NP	2/19/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8631 W THIRD STREET	None	LOS ANGELES	CA	90048	5901	00	06000	34.07361928	-118.3803143	Los Angeles County
312545	Non-Physician Medical Practitioner	None	1235791674	0	0	LORETO, JOHN-JOHN NP	4/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	47111 MONROE ST	None	INDIO	CA	92201	6739	00	06000	33.70620698	-116.2339008	Riverside County
312547	Non-Physician Medical Practitioner	None	1528681202	0	0	LAMASTERS, JORDAN D PA-C	9/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1675 ALHAMBRA	STE B	SACRAMENTO	CA	95816	7047	00	06000	38.563983	-121.4679915	Sacramento County
312567	Non-Physician Medical Practitioner	None	1235174780	0	0	LUARCA, CARLOS	7/15/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	316 E LAS TUNAS DR	101	SAN GABRIEL	CA	91776	1535	00	06000	34.10314065	-118.096387	Los Angeles County
312580	Non-Physician Medical Practitioner	None	1851401319	0	0	LUNDE, DANA J NP	1/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3345 TURTLE HEAD PEAK DR	None	LAS VEGAS	NV	89135	1677	00	06000	36.12929753	-115.3422609	Clark County
312624	Non-Physician Medical Practitioner	None	1235897190	0	0	LUONG, JENNIFER NP	10/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	435 ARDEN AVE	460	GLENDALE	CA	91203	1130	00	06000	34.15848148	-118.2628845	Los Angeles County
312628	Non-Physician Medical Practitioner	None	1174054076	0	0	LEAL, ELEANOR NP	5/30/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12716 SABLE POINT DRIVE	None	BAKERSFIELD	CA	93312	6816	00	06000	35.42447667	-119.1440497	Kern County
312629	Non-Physician Medical Practitioner	None	1336926260	0	0	LO, HEATHER PA-C	4/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	832 S GREVILLEA AVE	None	INGLEWOOD	CA	90301	3312	00	06000	33.9529004	-118.3548473	Los Angeles County
312631	Non-Physician Medical Practitioner	None	1427373521	0	0	LALAND, ISIS A	5/17/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1083 VINE ST	STE #352	HEALDSBURG	CA	95448	4830	00	06000	38.60916261	-122.8717947	Sonoma County
312634	Non-Physician Medical Practitioner	None	1518209444	0	0	LEHMAN, FAITH R NP	4/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7660 HILL ROAD	None	GRANITE BAY	CA	95746	9505	00	06000	38.74039227	-121.1579832	Placer County
312635	Non-Physician Medical Practitioner	None	1639218878	0	0	LEE, KELVIN CHUA	1/22/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	00	06000	37.78305866	-122.4421313	San Francisco County
312717	Non-Physician Medical Practitioner	None	1487218723	0	0	LUNDGREN, ALICIA K PA	5/18/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	00	06000	37.70453535	-121.8586496	Alameda County
312723	Non-Physician Medical Practitioner	None	1477787521	0	0	LOWENSTEIN-MOFFETT, FELICIA ANTOINETTE	9/28/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	975 RYLAND ST	STE 100	RENO	NV	89502	1667	00	06000	39.52386346	-119.7990902	Washoe County
312729	Non-Physician Medical Practitioner	None	1487721452	0	0	LIGAYO, LLOYD A NP	11/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	00	06000	34.13101049	-118.151532	Los Angeles County
312740	Non-Physician Medical Practitioner	None	1154609949	0	0	LABBE, SUSANNAH R NP	9/19/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1979 N BURGAN AVE	None	CLOVIS	CA	93619	2864	00	06000	36.86584027	-119.6800929	Fresno County
312760	Non-Physician Medical Practitioner	None	1295779387	0	0	LIEBELT, STACIE NOEL	2/27/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2603 PATTERSON RD	SUITE 2	RIVERBANK	CA	95367	3407	00	06000	37.73272653	-120.949119	Stanislaus County
312762	Non-Physician Medical Practitioner	None	1144788357	0	0	LILJESTROM, CHRISTINA L PA	4/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
312764	Non-Physician Medical Practitioner	None	1174192561	0	0	LAVERDE, ALEJANDRA PA	9/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 CANAL ST	None	KING CITY	CA	93930	3432	00	06000	36.20731142	-121.1325532	Monterey County
312783	Non-Physician Medical Practitioner	None	1558853820	0	0	LUK, WENDY PA	5/24/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
312788	Non-Physician Medical Practitioner	None	1639571482	0	0	LAGUILLES, THERESA	11/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
312811	Non-Physician Medical Practitioner	None	1467783167	0	0	LEE, ESTHER CHA	6/7/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10000 LAKEWOOD BLVD	None	DOWNEY	CA	90240	4020	00	06000	33.94833058	-118.1166411	Los Angeles County
312835	Non-Physician Medical Practitioner	None	1871662213	0	0	LUDINGTON, JOHN K	12/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	567 N DEL MAR AVE	None	SAN GABRIEL	CA	91775	2225	00	06000	34.113294	-118.0998195	Los Angeles County
312858	Non-Physician Medical Practitioner	None	1669575957	0	0	LAM, CAROL	10/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7569 VISTA RIO	None	HIGHLAND	CA	92346	5954	00	06000	34.11630607	-117.1423953	San Bernardino County
312919	Non-Physician Medical Practitioner	None	1093093791	0	0	LINDSAY, SHELA N	8/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	00	06000	37.78475261	-122.43973	San Francisco County
312929	Non-Physician Medical Practitioner	None	1134784200	0	0	LEE, SEAN NP	6/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	123 ATLANTIC AVENUE	None	LONG BEACH	CA	90802	5121	00	06000	33.7685184	-118.1850803	Los Angeles County
312954	Non-Physician Medical Practitioner	None	1972730323	0	0	LADA, JANA NICOLE	12/5/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2141 N HARBOR BLVD	SUITE 35000	FULLERTON	CA	92835	3827	00	06000	33.89443025	-117.9288328	Orange County
312956	Non-Physician Medical Practitioner	None	1265068050	0	0	LEU, KATHERINE S NP	8/18/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
312959	Non-Physician Medical Practitioner	None	1336834480	0	0	LO, KEVIN	6/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	236 SAN JOSE	None	SALINAS	CA	93901	3901	00	06000	36.6582359	-121.6463252	Monterey County
312978	Non-Physician Medical Practitioner	None	1982279972	0	0	LANDY, SARAH PA	3/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	00	06000	37.89281357	-122.0598728	Contra Costa County
312985	Non-Physician Medical Practitioner	None	1750413233	0	0	LAWRENCE, ANTHONY	12/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	365 SUNSWEPT STREET	None	SAN DIEGO	CA	92114	7145	00	06000	32.69485967	-117.0387278	San Diego County
312999	Non-Physician Medical Practitioner	None	1457758724	0	0	LIFELONG MEDICAL CARE	4/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3075 ADELINE ST STE 280	None	BERKELEY	CA	94703	2580	00	06000	37.85258905	-122.2697614	Alameda County
313033	Non-Physician Medical Practitioner	None	1356962211	0	0	LY, TRACEY PA-C	11/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1212 S MAIN ST	None	SALINAS	CA	93901	2260	00	06000	36.65759539	-121.6594973	Monterey County
313058	Non-Physician Medical Practitioner	None	1114115565	0	0	LANGE, SARAH A NP	8/5/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	380 TOMPKINS AVE	None	SAN FRANCISCO	CA	94110	6040	00	06000	37.73709832	-122.4142736	San Francisco County
313078	Non-Physician Medical Practitioner	None	1851953970	0	0	LUU, AMY	2/2/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5602 UNIVERSITY AVE	None	SAN DIEGO	CA	92105	2308	00	06000	32.7481088	-117.0743149	San Diego County
313087	Non-Physician Medical Practitioner	None	1225053028	0	0	LUMAN, BENJAMIN R	11/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	724 ORPHEUS AVE	None	ENCINITAS	CA	92024	2155	00	06000	33.06228197	-117.2939504	San Diego County
313097	Non-Physician Medical Practitioner	None	1023089729	0	0	LENNON, MARLENE P NP	4/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11597 GREEN VALLEY RD	None	SEBASTOPOL	CA	95473	9713	00	06000	38.44429981	-122.9137144	Sonoma County
313116	Non-Physician Medical Practitioner	None	1033573084	0	0	LEE, PATTI D NP	3/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 CANAL ST	None	KING CITY	CA	93930	3432	00	06000	36.20731142	-121.1325532	Monterey County
313125	Non-Physician Medical Practitioner	None	1730430380	0	0	LYSTAD, ERIN M PA	9/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	00	06000	33.74496	-117.818857	Orange County
313149	Non-Physician Medical Practitioner	None	1104985829	0	0	LAM, CHRIS V	3/13/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6737 PALO VERDE PL	None	RANCHO CUCAMONGA	CA	91739	1562	00	06000	34.13162866	-117.5360089	San Bernardino County
313151	Non-Physician Medical Practitioner	None	1922625375	0	0	LIU, TAMMIE NP	12/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1211 W LA PALMA AVE	STE 207	ANAHEIM	CA	92801	2139	00	06000	33.84718298	-117.933758	Orange County
313154	Non-Physician Medical Practitioner	None	1366474371	0	0	LANCASTER, PAMELA A	2/22/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3213 PANORAMA DR	None	BAKERSFIELD	CA	93306	1142	00	06000	35.41179581	-118.9564116	Kern County
313157	Non-Physician Medical Practitioner	None	1386033967	0	0	LAS, HOSHMAND PA-C	8/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
313168	Non-Physician Medical Practitioner	None	1528664760	0	0	LUNA, JOSE	11/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1020 29TH ST	STE 120	SACRAMENTO	CA	95816	5173	00	06000	38.572803	-121.4685	Sacramento County
313186	Non-Physician Medical Practitioner	None	1225285695	0	0	LODI MEMORIAL HOSPITAL ASSOCIATION, INC	5/7/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1235 W VINE ST	SUITE 22	LODI	CA	95240	5109	00	06000	38.12279179	-121.2879362	San Joaquin County
313205	Non-Physician Medical Practitioner	None	1356026405	0	0	LEE, TIMOTHY NP	9/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 E HIGHLAND AVE	# 551	SAN BERNARDINO	CA	92404	3861	00	06000	34.1358627	-117.2757778	San Bernardino County
313227	Non-Physician Medical Practitioner	None	1285796458	0	0	LAKHANPAL, SONIA	4/12/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9000	00	06000	32.7537975	-117.1658298	San Diego County
313239	Non-Physician Medical Practitioner	None	1275063687	0	0	LI, JENNIFER R NP	5/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2601 ALAMEDA AVE	412	BURBANK	CA	91505	4800	00	06000	34.15783817	-118.3293969	Los Angeles County
313248	Non-Physician Medical Practitioner	None	1609443589	0	0	LAKEY, DREW E PA	3/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	00	06000	35.356203	-119.0612695	Kern County
313249	Non-Physician Medical Practitioner	None	1922480599	0	0	LILES, TIFFANY NP	10/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4600 BOHANNON DR	STE 100	MENLO PARK	CA	90245	1037	00	06000	37.479573	-122.1755445	San Mateo County
313252	Non-Physician Medical Practitioner	None	1861746612	0	0	LOS ANGELES CHRISTIAN HEALTH CENTERS	8/6/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 ST PAUL AVE STE 100	None	LOS ANGELES	CA	90017	5658	00	06000	34.05324991	-118.2609994	Los Angeles County
313260	Non-Physician Medical Practitioner	None	1922596899	0	0	LENDARIS, MARIA E NP	9/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1575 SOQUEL DRIVE	SUITE C	SANTA CRUZ	CA	95065	1700	00	06000	36.98861921	-121.9831127	Santa Cruz County
313268	Non-Physician Medical Practitioner	None	1467726364	0	0	LINCOLN, JENNIFER REBECCA	8/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	558 SAINT CHARLES DR	SUITE 110	THOUSAND OAKS	CA	91360	3903	00	06000	34.18553108	-118.8779244	Ventura County
313286	Non-Physician Medical Practitioner	None	1508002528	0	0	LAMMERS, TRACY M NP	11/26/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3499 HONEYSUCKLE	None	CHINO HILLS	CA	91709	1824	00	06000	33.98837946	-117.7282888	San Bernardino County
313287	Non-Physician Medical Practitioner	None	1316493406	0	0	LIMON, SANDRA NP	10/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12021 JACARANDA AVE	SUITE 101	HESPERIA	CA	92345	4978	00	06000	34.46963618	-117.263267	San Bernardino County
313300	Non-Physician Medical Practitioner	None	1245418730	0	0	LURIE, TERESA L NP	8/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	905 EAST WASHINGTON ST	None	PETALUMA	CA	94952	3385	00	06000	38.24451673	-122.6303052	Sonoma County
313340	Non-Physician Medical Practitioner	None	1134870728	0	0	LANE, SCOTT NP	8/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 VICTORIA STREET	None	COSTA MESA	CA	92627	1995	00	06000	33.65258952	-117.9121545	Orange County
313360	Non-Physician Medical Practitioner	None	1326890864	0	0	LOWRY, DAVID NP	11/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30589 TEMECULA PKWY	None	TEMECULA	CA	92592	2840	00	06000	33.47579179	-117.127031	Riverside County
313366	Non-Physician Medical Practitioner	None	1629581657	0	0	LUONG, KATHY L NP	7/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	06000	29.70724683	-95.4026169	Harris County
313396	Non-Physician Medical Practitioner	None	1770898397	0	0	LACAYO, CLAUDIA M NP	11/21/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6555 COYLE AVE	SUITE 190	CARMICHAEL	CA	95608	0302	00	06000	38.66859	-121.3118055	Sacramento County
313464	Non-Physician Medical Practitioner	None	1710671193	0	0	LE, VICTORIA K NP	9/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1071 BLOSSOM HILL RD	None	SAN JOSE	CA	95123	1103	00	06000	37.2509447	-121.8743507	Santa Clara County
313468	Non-Physician Medical Practitioner	None	1942577051	0	0	LEWIS, MICHAEL D JR	4/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	142 GRANADA AVE	None	LONG BEACH	CA	90803	3256	00	06000	33.75901707	-118.1370068	Los Angeles County
313491	Non-Physician Medical Practitioner	None	1962737460	0	0	LESS, MARITES	7/5/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	220 HOSPITAL DR	None	VALLEJO	CA	94589	2517	00	06000	38.13109785	-122.238998	Solano County
313497	Non-Physician Medical Practitioner	None	1679050280	0	0	LY, CYNTHIA T PA-C	4/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 S GRANDE AVE	None	LOS ANGELES	CA	90015	3010	00	06000	34.03719097	-118.2654105	Los Angeles County
313501	Non-Physician Medical Practitioner	None	1922168004	0	0	LEHMAN, DWAYNE PA-C	9/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3634 ELIZABETH ST	None	RIVERSIDE	CA	92506	2506	00	06000	33.95782448	-117.3904065	Riverside County
313529	Non-Physician Medical Practitioner	None	1679646277	0	0	LAKAMP, MARIANNE	4/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
313537	Non-Physician Medical Practitioner	None	1710222070	0	0	LEVITAN, SARAH H CNM	2/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	411 OLIVE ST	None	SANTA CRUZ	CA	95060	2422	00	06000	36.96711451	-122.044672	Santa Cruz County
313556	Non-Physician Medical Practitioner	None	1659935989	0	0	LIANG, WILSON PA-C	9/9/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
313559	Non-Physician Medical Practitioner	None	1437598695	0	0	LEE, JESSICA COT YEE	7/18/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9300 CAMPUS POINT DR	MAIL CODE #7411	LA JOLLA	CA	92037	1300	00	06000	32.877999	-117.225891	San Diego County
313563	Non-Physician Medical Practitioner	None	1184192411	0	0	LOPEZ, ADRIANA V NP	2/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
313566	Non-Physician Medical Practitioner	None	1215142385	0	0	LEE, CHERYL A NP	10/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4 CLARK DRIVE	None	LADERA RANCH	CA	92694	1334	00	06000	33.53944502	-117.6418234	Orange County
313577	Non-Physician Medical Practitioner	None	1043511900	0	0	LAPADAT, CONNIE NP	6/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9808 VENICE BLVD	100	CULVER CITY	CA	90232	2732	00	06000	34.0236396	-118.3980847	Los Angeles County
313624	Non-Physician Medical Practitioner	None	1730709775	0	0	LUMMIS, MADELINE E PA-C	7/15/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6403 COYLE AVE	STE 170	CARMICHAEL	CA	95608	0363	00	06000	38.668347	-121.3148745	Sacramento County
313627	Non-Physician Medical Practitioner	None	1881755411	0	0	LOUISE, TAYLOR H	1/9/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1433 N. HOLLENBECK AVENU	SUITE 200	COVINA	CA	91722	0000	00	06000	34.105518	-117.8989985	Los Angeles County
313652	Non-Physician Medical Practitioner	None	1457135493	0	0	LONEY, DONICA PA-C	10/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	00	06000	33.49890392	-117.1612965	Riverside County
313668	Non-Physician Medical Practitioner	None	1003512427	0	0	LLAGUNO, BRYLLE PA	12/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
313683	Non-Physician Medical Practitioner	None	1578920955	0	0	LADEGAST, SHERRIE NP	1/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1679 E MONTE VISTA AVE	STE. 140	VACAVILLE	CA	95688	3122	00	06000	38.36981273	-121.9599958	Solano County
313708	Non-Physician Medical Practitioner	None	1215702121	0	0	LEW, ROXANNE I NP	4/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	201 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6385	00	06000	37.36812305	-122.0312314	Santa Clara County
313747	Non-Physician Medical Practitioner	None	1871875534	0	0	LOCHRIDGE, KYLE C PA-C	3/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	00	06000	33.93112671	-118.2035532	Los Angeles County
313756	Non-Physician Medical Practitioner	None	1952642514	0	0	LACLERGUE, SARAH M NP	1/6/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9 ACACIA WAY	None	SANTA CRUZ	CA	95062	1313	00	06000	36.98427759	-121.9970247	Santa Cruz County
313765	Non-Physician Medical Practitioner	None	1003582354	0	0	LUU, ANGELA PA	6/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	729 SUNRISE AVE	SUITE 602	ROSEVILLE	CA	95661	4542	00	06000	38.73444822	-121.2720033	Placer County
313775	Non-Physician Medical Practitioner	None	1992386312	0	0	LE, TIFFANY	12/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2077 HARBOR BLVD	A	COSTA MESA	CA	92627	9384	00	06000	33.64990963	-117.9190918	Orange County
313808	Non-Physician Medical Practitioner	None	1609417914	0	0	LEFORT, CAITLIN PA-C	12/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12665 GARDEN GROVE BLVD	STE 601	GARDEN GROVE	CA	92843	1920	00	06000	33.77450141	-117.9123364	Orange County
313809	Non-Physician Medical Practitioner	None	1386177624	0	0	LUTES, GARRET W NP	8/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	00	06000	33.82736911	-116.5109632	Riverside County
313830	Non-Physician Medical Practitioner	None	1841709276	0	0	LUSINYAN, TAMARA M	12/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	742 CAVANAGH ROAD	None	GLENDALE	CA	91207	1412	00	06000	34.16650693	-118.2472958	Los Angeles County
313852	Non-Physician Medical Practitioner	None	1114111374	0	0	LIERMAN, ANGELA M NP	1/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
313860	Non-Physician Medical Practitioner	None	1518596568	0	0	LE, JENNY T PA-C	2/27/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26024 ACERO	None	MISSION VIEJO	CA	92691	2768	00	06000	33.61784172	-117.6769661	Orange County
313866	Non-Physician Medical Practitioner	None	1750055885	0	0	LINLO-SYRIOTIS, ASHLEY NP	1/7/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1809 W. REDLANDS BLVD	# 234	REDLANDS	CA	92373	8054	00	06000	34.06288379	-117.2156673	San Bernardino County
313889	Non-Physician Medical Practitioner	None	1134356280	0	0	LEE, JONG-MI	10/30/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
313901	Non-Physician Medical Practitioner	None	1316422876	0	0	LUCAS, BRENDAN K PA-C	1/7/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1981 N BROADWAY	STE 190	WALNUT CREEK	CA	94596	3671	00	06000	37.90582392	-122.0613697	Contra Costa County
313904	Non-Physician Medical Practitioner	None	1730269564	0	0	LE, TRI T	1/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1149 W 190TH ST	None	TORRANCE	CA	90248	4321	00	06000	33.85834052	-118.2958065	Los Angeles County
313916	Non-Physician Medical Practitioner	None	1902489297	0	0	LE, VIET Q PA	11/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2488 N CALIFORNIA ST	None	STOCKTON	CA	95204	3494	00	06000	37.97587328	-121.2911856	San Joaquin County
313950	Non-Physician Medical Practitioner	None	1396137329	0	0	LAIDLAW, GALE E NP	5/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	834 SOUTH CALMGROVE AVE	None	GLENDORA	CA	91740	4822	00	06000	34.12414491	-117.8653527	Los Angeles County
313960	Non-Physician Medical Practitioner	None	1194706770	0	0	LOPEZ, MARIA DANETTE INFANTE	8/13/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7373 WEST LN	None	STOCKTON	CA	95210	3377	00	06000	38.017701	-121.297869	San Joaquin County
313972	Non-Physician Medical Practitioner	None	1871005850	0	0	LUU, HELEN PA	8/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14443 CULVER DR	14443-A	IRVINE	CA	92604	0343	00	06000	33.70541708	-117.7871432	Orange County
313984	Non-Physician Medical Practitioner	None	1104138114	0	0	LAO, ROBYN H NP	8/5/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	740 TREEHOUSE LANE	None	SACRAMENTO	CA	95864	5360	00	06000	38.579247	-121.365108	Sacramento County
313986	Non-Physician Medical Practitioner	None	1851327886	0	0	LOREE, SHANNON DAY	3/15/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1055 N 500 W	SUITE 202	PROVO	UT	84604	3305	00	06000	40.24851337	-111.6674438	Utah County
313997	Non-Physician Medical Practitioner	None	1316220809	0	0	LIM, RUTH SHIEUN	8/2/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
314005	Non-Physician Medical Practitioner	None	1194316604	0	0	LEE, JASON PA	9/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14117 LIMONITE AVE	BUILDING 2, SUITE 300	EASTVALE	CA	92880	3864	00	06000	33.97532151	-117.5914845	Riverside County
314022	Non-Physician Medical Practitioner	None	1447529573	0	0	LEAVITT, SHARON	4/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	00	06000	38.571084	-121.471074	Sacramento County
314023	Non-Physician Medical Practitioner	None	1760092126	0	0	LIANG, MEILIN PA	12/7/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
314071	Non-Physician Medical Practitioner	None	1518373505	0	0	LE, CINDY C NP	7/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	00	06000	34.06544724	-118.4459249	Los Angeles County
314073	Non-Physician Medical Practitioner	None	1306889621	0	0	LI, LAWRENCE D	4/25/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	877 E. SECOND STREET	None	POMONA	CA	91766	2009	00	06000	34.05812348	-117.7398525	Los Angeles County
314086	Non-Physician Medical Practitioner	None	1245579481	0	0	LO, LYNN F	3/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16323 CLARK AVE.	None	BELL FLOWER	CA	90706	0000	00	06000	33.885693	-118.1339975	Los Angeles County
314098	Non-Physician Medical Practitioner	None	1841623238	0	0	LOZANO, JONATHAN A	11/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7716 NORWALK BLVD	None	WHITTIER	CA	90606	2157	00	06000	33.97537167	-118.0752075	Los Angeles County
314117	Non-Physician Medical Practitioner	None	1518396894	0	0	LUU, LILY NP	6/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
314127	Non-Physician Medical Practitioner	None	1477074094	0	0	LIERAS, VINCENT M	11/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30300 ANTELOPE RD	#1826	MENIFEE	CA	92584	9568	00	06000	33.67928525	-117.1701778	Riverside County
314134	Non-Physician Medical Practitioner	None	1417417627	0	0	LEE, DANIEL PA-C	12/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	160 E ARTESIA STREET	SUITE 310	POMONA	CA	91767	2922	00	06000	34.07556833	-117.7507835	Los Angeles County
314138	Non-Physician Medical Practitioner	None	1639876410	0	0	LIRA, SHANNON NP	8/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31625 DE PORTOLA RD	SUITE 101	TEMECULA	CA	92592	2770	00	06000	33.48359715	-117.1048345	Riverside County
314163	Non-Physician Medical Practitioner	None	1669582557	0	0	LEATHERBARROW, KATHLEEN	10/30/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	800 SCENIC DR	BLDG 4	MODESTO	CA	95350	6131	00	06000	37.64722447	-120.9836925	Stanislaus County
314171	Non-Physician Medical Practitioner	None	1114253457	0	0	LIU, EDWARD NP	6/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	47 PEARL ST	None	SAN FRANCISCO	CA	94103	1176	00	06000	37.77065053	-122.4238804	San Francisco County
314177	Non-Physician Medical Practitioner	None	1346656576	0	0	LAM, LILY NP	10/5/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	375 NIAGARA AVENUE	None	SAN FRANCISCO	CA	94112	3340	00	06000	37.71924412	-122.4470713	San Francisco County
314228	Non-Physician Medical Practitioner	None	1881248003	0	0	LAM, KIT NP	10/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	00	06000	37.36797679	-122.0297112	Santa Clara County
314230	Non-Physician Medical Practitioner	None	1861890030	0	0	LAKIN, LYNSEY L NP	4/3/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12822 SEAHORSE DR	None	RANCHO CUCAMONGA	CA	91739	2625	00	06000	34.16331246	-117.5251619	San Bernardino County
314245	Non-Physician Medical Practitioner	None	1285782136	0	0	LAPORTE-HAUENSTEIN, LARUE	3/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	45939 CORTE MISLANCA	None	TEMECULA	CA	92592	3395	00	06000	33.46026782	-117.0838765	Riverside County
314272	Non-Physician Medical Practitioner	None	1730315508	0	0	LOGUE, ELIZABETH HELEN	9/2/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3805 SAN DIMAS ST STE B	None	BAKERSFIELD	CA	93301	5725	00	06000	35.39508529	-119.0082516	Kern County
314328	Non-Physician Medical Practitioner	None	1710654587	0	0	LEE, JI EUN PA	1/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
314340	Non-Physician Medical Practitioner	None	1770533887	0	0	LYONS, JENNIFER L	7/30/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	980 NINA DRIVE	None	BOULDER CREEK	CA	95006	9436	00	06000	37.12070953	-122.1059314	Santa Cruz County
314372	Non-Physician Medical Practitioner	None	1578037859	0	0	LUTZ, KATIE E NP	2/15/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	00	06000	36.68590557	-121.8010492	Monterey County
314378	Non-Physician Medical Practitioner	None	1770340515	0	0	LOPEZ, JAVIER NP	2/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	222 E COLE BLVD	STE C	CALEXICO	CA	92231	3211	00	06000	32.69391949	-115.495038	Imperial County
314411	Non-Physician Medical Practitioner	None	1962803692	0	0	LEMUS, GUADALUPE NP	9/24/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
314423	Non-Physician Medical Practitioner	None	1750724928	0	0	LIBORO, JOYCE M NP	8/22/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1730 SAWTELLE BLVD	APT 206	LOS ANGELES	CA	90025	6175	00	06000	34.04444023	-118.4466206	Los Angeles County
314439	Non-Physician Medical Practitioner	None	1841672102	0	0	LINARES, DAISY	9/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11908 FAIRFORD AVE	None	NORWALK	CA	90650	7746	00	06000	33.92356055	-118.0954902	Los Angeles County
314451	Non-Physician Medical Practitioner	None	1770039646	0	0	LUCERO-JACKSON, SABRINA M NP	11/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2110 S NANCY LANE	None	GILBERT	AZ	85295	0031	00	06000	33.312366	-111.7122345	Maricopa County
314486	Non-Physician Medical Practitioner	None	1619150893	0	0	LY, THANH-LAN T NP	1/30/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9340 LARKSPUR DR	None	WESTMINSTER	CA	92683	7413	00	06000	33.73313696	-117.9665871	Orange County
314519	Non-Physician Medical Practitioner	None	1275156184	0	0	LEE, SOO YOUNG PA-C	12/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 S. ANAHEIM BLVD	SUITE 250	ANAHEIM	CA	92805	9280	00	06000	33.83528856	-117.913627	Orange County
314538	Non-Physician Medical Practitioner	None	1649078577	0	0	LO, SOPHEA NP	3/19/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
314540	Non-Physician Medical Practitioner	None	1598844003	0	0	LIGGINS, MELISSA L NP	4/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
314549	Non-Physician Medical Practitioner	None	1639921232	0	0	LAZABAL SCHAEFER, LIZETTE NP	7/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	43839 15TH ST W	None	LANCASTER	CA	93534	4756	00	06000	34.678791	-118.156867	Los Angeles County
314583	Non-Physician Medical Practitioner	None	1235657354	0	0	LADZEKPO, DELALI A NP	2/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14860 ROSCOE BLVD	#200	PANORAMA CITY	CA	91402	4683	00	06000	34.2214515	-118.4573205	Los Angeles County
314590	Non-Physician Medical Practitioner	None	1538413877	0	0	LYONS, KELLY LEA	1/18/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	00	06000	34.47092468	-117.2977236	San Bernardino County
314604	Non-Physician Medical Practitioner	None	1821506775	0	0	LIM, SOHYUN PA-C	8/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4200 CHINO HILLS PKWY	STE 800	CHINO HILLS	CA	91709	3785	00	06000	33.98274451	-117.7129305	San Bernardino County
314633	Non-Physician Medical Practitioner	None	1124088893	0	0	LEE, MOONNY	2/20/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4055 COWELL BOULEVARD	None	DAVIS	CA	95618	6013	00	06000	38.5482993	-121.7019896	Yolo County
314634	Non-Physician Medical Practitioner	None	1083262232	0	0	LEIBOVICH, TAMARA PA-C	3/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
314655	Non-Physician Medical Practitioner	None	1275270449	0	0	LEE, JESSICA PA	12/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	00	06000	38.12188356	-121.285872	San Joaquin County
314657	Non-Physician Medical Practitioner	None	1770672974	0	0	LESNICK, DIANE A NP	4/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	285 CARBONERA AVE	None	SUNNYVALE	CA	94086	7005	00	06000	37.37910259	-122.0527817	Santa Clara County
314664	Non-Physician Medical Practitioner	None	1467484139	0	0	LEWIS, CARRIE	9/22/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	235 W 6TH ST	None	RENO	NV	89503	4548	00	06000	39.53165987	-119.8181899	Washoe County
314666	Non-Physician Medical Practitioner	None	1669910428	0	0	LEE, CINDY NP	12/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19682 HESPERIAN BLVD	STE 101	HAYWARD	CA	94541	4752	00	06000	37.66812177	-122.1194688	Alameda County
314671	Non-Physician Medical Practitioner	None	1699759134	0	0	LOVE, VICKI L NP	6/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
314686	Non-Physician Medical Practitioner	None	1710309695	0	0	LEE, PATRICIA Y	8/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4280 CORTE FAMOSA	None	SAN DIEGO	CA	92130	2180	00	06000	32.95138787	-117.2221712	San Diego County
314742	Non-Physician Medical Practitioner	None	1790168870	0	0	LOPER, NICHOLAS E NP	1/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	264 LINDERO AVE	None	LONG BEACH	CA	90803	5724	00	06000	33.76771108	-118.1627815	Los Angeles County
314754	Non-Physician Medical Practitioner	None	1053970327	0	0	LORENZO-TRUJILLO, LORISSA J PA-C	8/27/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4715 VALLEY EAST BLVD	STE. 3	ARCATA	CA	95521	3586	00	06000	40.90112023	-124.0814061	Humboldt County
314762	Non-Physician Medical Practitioner	None	1174237127	0	0	LEE, MAY NP	3/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1498 SOUTHGATE AVE	STE 102	DALY CITY	CA	94015	4015	00	06000	37.67558947	-122.4761175	San Mateo County
314768	Non-Physician Medical Practitioner	None	1093244246	0	0	LE, DIEM-THUY T	3/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3107 HAGA DR	None	SAN JOSE	CA	95111	2228	00	06000	37.29212154	-121.8384159	Santa Clara County
314796	Non-Physician Medical Practitioner	None	1780361493	0	0	LY, AN PA	10/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	00	06000	34.19395645	-118.463265	Los Angeles County
314803	Non-Physician Medical Practitioner	None	1215495635	0	0	LONDON, MELISSA J PA-C	10/26/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 N CALIFORNIA ST	None	STOCKTON	CA	95204	6005	00	06000	37.97165921	-121.2895813	San Joaquin County
314835	Non-Physician Medical Practitioner	None	1710673108	0	0	LENG, BRIAN	1/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5725 S SOTO ST	None	HUNTINGTON PARK	CA	90255	9993	00	06000	33.990444	-118.2193965	Los Angeles County
314846	Non-Physician Medical Practitioner	None	1063840460	0	0	LAU, YUFEI	3/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15890 GOLDEN STAR AVE	None	RIVERSIDE	CA	92506	5712	00	06000	33.88976012	-117.3690858	Riverside County
314848	Non-Physician Medical Practitioner	None	1275308744	0	0	LAYMAN, AMANDA NP	1/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3625 E THOUSAND OAKS BLV	SUITE #232	WESTLAKE VILLAGE	CA	91362	6932	00	06000	34.16480359	-118.8299997	Ventura County
314913	Non-Physician Medical Practitioner	None	1225123177	0	0	LACHICA, SHEILA MAE	7/20/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2760 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5747	00	06000	33.97370839	-118.2207184	Los Angeles County
314918	Non-Physician Medical Practitioner	None	1487995684	0	0	LOUIE, LUNG S NP	4/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
314919	Non-Physician Medical Practitioner	None	1043931629	0	0	LARA, JETTELE JOY D	12/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1135 S SUNSET AVENUE	SUITE 401	WEST COVINA	CA	91790	3921	00	06000	34.06215064	-117.9453997	Los Angeles County
314964	Non-Physician Medical Practitioner	None	1396380796	0	0	LIU, ANNIE PA	8/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18220 YORBA LINDA BLVD	301	YORBA LINDA	CA	92886	4057	00	06000	33.88842824	-117.8154698	Orange County
314968	Non-Physician Medical Practitioner	None	1932122009	0	0	LIMOGES-GONZALEZ, MICHELE FRANCES	4/19/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	271 TURN PIKE DR	None	FOLSOM	CA	95630	8098	00	06000	38.65509	-121.170042	Sacramento County
315003	Non-Physician Medical Practitioner	None	1740491521	0	0	LIU, ESTHER	4/2/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	SUMC - PEDS PHYSICIAN BI	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
315025	Non-Physician Medical Practitioner	None	1639510332	0	0	LU, HELEN NP	5/22/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	106 LADYBUG LANE	None	MARTINEZ	CA	94553	9665	00	06000	38.00326627	-122.0826726	Contra Costa County
315058	Non-Physician Medical Practitioner	None	1568929438	0	0	LAL, RETA	3/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	447 W EATON AVE	None	TRACY	CA	95376	3420	00	06000	37.74338833	-121.432305	San Joaquin County
315065	Non-Physician Medical Practitioner	None	1255793840	0	0	LAI, THAO T NP	7/18/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	140 S HIDDEN PATH	None	ANAHEIM	CA	92801	5149	00	06000	33.83145523	-117.9650984	Orange County
315073	Non-Physician Medical Practitioner	None	1225660939	0	0	LUU, JULIE L NP	4/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 S VINCENT AVE	SUITE 205	WEST COVINA	CA	91790	6712	00	06000	34.0662144	-117.9274205	Los Angeles County
315078	Non-Physician Medical Practitioner	None	1588172217	0	0	LIM, VICTORIA CNP	1/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5755 E KINGS CANYON RD	STE 104	FRESNO	CA	93727	4744	00	06000	36.7362951	-119.6933795	Fresno County
315089	Non-Physician Medical Practitioner	None	1548557309	0	0	LOYA, ESTHER PA	8/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	00	06000	34.072245	-117.4319685	San Bernardino County
315120	Non-Physician Medical Practitioner	None	1689810632	0	0	LITTLE, CYNTHIANN A	6/29/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	990 CAUGHLIN XING	None	RENO	NV	89519	0631	00	06000	39.50134061	-119.8595718	Washoe County
315128	Non-Physician Medical Practitioner	None	1558696328	0	0	LAMBERT, PAMELA A PA-C	10/20/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	30 SHELBURNE RD	None	STAMFORD	CT	06902	3628	00	06000	41.054958	-73.55391404	Western Connecticut Planning Region
315141	Non-Physician Medical Practitioner	None	1497714828	0	0	LEBOWITZ, STEVEN PA-C	6/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
315161	Non-Physician Medical Practitioner	None	1932569357	0	0	LIZARRAGA-DAVIS, OSKAR A PA-C	6/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 MAIN ST	None	SOLEDAD	CA	93960	2533	00	06000	36.43281182	-121.3243597	Monterey County
315216	Non-Physician Medical Practitioner	None	1487700563	0	0	LOWE, WILLIAM JAME	3/11/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
315268	Non-Physician Medical Practitioner	None	1073779609	0	0	LYNCH, ELIZABETH M PA-C	4/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	325 GELLERT BLVD	None	DALY CITY	CA	94015	2613	00	06000	37.66753085	-122.4686194	San Mateo County
315303	Non-Physician Medical Practitioner	None	1972122018	0	0	LEE, RITA J PA	9/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
315309	Non-Physician Medical Practitioner	None	1487764064	0	0	LAST FRONTIER HEALTHCARE DISTRICT	8/8/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	229 WEST MCDOWELL AVENUE	None	ALTURAS	CA	96101	3933	00	06000	41.47992829	-120.5440782	Modoc County
315327	Non-Physician Medical Practitioner	None	1366105777	0	0	LAYFIELD, JACOB L PA-C	2/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	115 MALL DRIVE	None	HANFORD	CA	93230	5786	00	06000	36.32396253	-119.6688834	Kings County
315368	Non-Physician Medical Practitioner	None	1437821261	0	0	LEVY, SARA PA	1/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3838 CALIFORNIA ST	STE 801	SAN FRANCISCO	CA	94118	1522	00	06000	37.78591809	-122.4575439	San Francisco County
315375	Non-Physician Medical Practitioner	None	1659774966	0	0	LEONE, MARGARET C	4/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4830 DEPEW ST	None	DENVER	CO	80212	2717	00	06000	39.78441	-105.0578815	Denver County
315387	Non-Physician Medical Practitioner	None	1942547732	0	0	LE, BENJAMIN T	1/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39435 BLUE FIN WAY	None	FREMONT	CA	94538	1816	00	06000	37.52998641	-121.9954075	Alameda County
315389	Non-Physician Medical Practitioner	None	1184213647	0	0	LUONG, VICKI PA-C	4/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	00	06000	34.06287152	-118.2029433	Los Angeles County
315427	Non-Physician Medical Practitioner	None	1235866690	0	0	LIU, WENDY	10/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	615 OCEAN ST	None	SANTA CRUZ	CA	95060	4005	00	06000	36.97734512	-122.0204895	Santa Cruz County
315449	Non-Physician Medical Practitioner	None	1992331094	0	0	LIBRADO, RUSSFIR PA-C	4/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1740 ROSECRANS ST	None	SAN DIEGO	CA	92106	1928	00	06000	32.72903913	-117.2254885	San Diego County
315504	Non-Physician Medical Practitioner	None	1235737867	0	0	LEE, LINDA PA-C	12/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8635 W 3RD ST	STE 485W	LOS ANGELES	CA	90048	6121	00	06000	34.07361928	-118.3803143	Los Angeles County
315513	Non-Physician Medical Practitioner	None	1326556382	0	0	LINARES, KAREN	8/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
315520	Non-Physician Medical Practitioner	None	1619443108	0	0	LEE, YONG K	2/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	36125 CREIGHTON AVE	STE 3104	MURRIETA	CA	92562	5989	00	06000	33.595533	-117.173718	Riverside County
315526	Non-Physician Medical Practitioner	None	1780840447	0	0	LI, CARRIE M NP	5/15/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 SHARON PARK DR	APT E18	MENLO PARK	CA	94025	6849	00	06000	37.42436917	-122.1980721	San Mateo County
315572	Non-Physician Medical Practitioner	None	1720292485	0	0	LIGON, DEBORAH C NP	4/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5144 CARTWRIGHT AVE	None	NORTH HOLLYWOOD	CA	91601	1209	00	06000	34.163955	-118.3636925	Los Angeles County
315599	Non-Physician Medical Practitioner	None	1760963763	0	0	LINDHOLM, CHRISTINE N NP	3/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4663 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3943	00	06000	37.04973619	-122.0157773	Santa Cruz County
315603	Non-Physician Medical Practitioner	None	1093891061	0	0	LE, TIFFANY M	5/16/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20001 N NEW BRITAIN LN	None	HUNTINGT0N BEACH	CA	92646	4422	00	06000	33.671925	-117.983548	Orange County
315612	Non-Physician Medical Practitioner	None	1336486968	0	0	LEE, SAMANN	3/4/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 ARC WAY	306	BURLINGAME	CA	94010	5050	00	06000	37.57967908	-122.3592037	San Mateo County
315632	Non-Physician Medical Practitioner	None	1245576891	0	0	LEITCH, KRISTY L NP	9/17/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12206 HIGH COUNTRY DR	None	BAKERSFIELD	CA	93312	6841	00	06000	35.42353848	-119.1375495	Kern County
315643	Non-Physician Medical Practitioner	None	1215130356	0	0	LAURY, MELISSA N	2/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4112 ARBOR ROAD	None	LAKEWOOD	CA	90712	3503	00	06000	33.84306968	-118.1433898	Los Angeles County
315651	Non-Physician Medical Practitioner	None	1801949185	0	0	LUMBRERAS, LESLIE-JEAN PRESA	3/23/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1809 NATIONAL AVENUE	LOGAN HEIGHTS FAMILY HEA	SAN DIEGO	CA	92113	2196	00	06000	32.70162897	-117.1465065	San Diego County
315663	Non-Physician Medical Practitioner	None	1043392897	0	0	LUKE, ELIZABETH A NP	10/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
315681	Non-Physician Medical Practitioner	None	1376732685	0	0	LEBLANC, ALLYN E NP	7/12/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4308 U STREET	None	SACRAMENTO	CA	95817	1435	00	06000	38.556369	-121.4545635	Sacramento County
315712	Non-Physician Medical Practitioner	None	1528411071	0	0	LEE, JOHN A NP	1/28/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3104 VILLAGE PLAZA DR	None	ROSEVILLE	CA	95747	9009	00	06000	38.77219911	-121.3668844	Placer County
315717	Non-Physician Medical Practitioner	None	1861913113	0	0	LIU, JENNIFER	2/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	816 W SHORB ST	None	ALHAMBRA	CA	91801	4651	00	06000	34.079413	-118.1325194	Los Angeles County
315718	Non-Physician Medical Practitioner	None	1083236244	0	0	LECHUGA, JANET PA-C	7/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5945 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0610	00	06000	35.36322921	-119.0706029	Kern County
315736	Non-Physician Medical Practitioner	None	1073168282	0	0	LIN, JENNY PA	1/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	0000	00	06000	34.158213	-118.328112	Los Angeles County
315743	Non-Physician Medical Practitioner	None	1225662398	0	0	LOZA, ANGELIE	11/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4139 BALL RD	None	CYPRESS	CA	90630	3465	00	06000	33.81766548	-118.060362	Orange County
315750	Non-Physician Medical Practitioner	None	1184994378	0	0	LAU, SHARON	1/11/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	MC 5553	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
315761	Non-Physician Medical Practitioner	None	1952661985	0	0	LOWENBERG-LIN, IRIS REBECCA	9/4/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1828 EL CAMINO REAL	SUITE 706	BURLINGAME	CA	94010	3103	00	06000	37.59552262	-122.3838771	San Mateo County
315826	Non-Physician Medical Practitioner	None	1205043346	0	0	LOZANI, RANA	3/7/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
315836	Non-Physician Medical Practitioner	None	1447393129	0	0	LINDSAY, CAROL H NP	3/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14800 HANSEL AVE	None	TRUCKEE	CA	96161	6363	00	06000	39.35789589	-120.2355103	Nevada County
315853	Non-Physician Medical Practitioner	None	1063674992	0	0	LEWIS, STEVEN E	8/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2105 MANZANITA LN	None	MANHATTAN BEACH	CA	90266	4134	00	06000	33.89310059	-118.3817631	Los Angeles County
315875	Non-Physician Medical Practitioner	None	1114628740	0	0	LEFEVRE, LINDSAY NP	3/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 UPPER RAGSDALE DR	STE B-210	MONTEREY	CA	93940	7851	00	06000	36.57940327	-121.8142876	Monterey County
315931	Non-Physician Medical Practitioner	None	1861156192	0	0	LANSANG, KRISTINA NP	12/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	00	06000	34.06704253	-118.3835029	Los Angeles County
315958	Non-Physician Medical Practitioner	None	1033824776	0	0	LOCKETT, BRIANA PA	4/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
315970	Non-Physician Medical Practitioner	None	1598033508	0	0	LEBER, AMY PA	11/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	525 3RD AVE	None	CHULA VISTA	CA	91910	5696	00	06000	32.63367609	-117.0769202	San Diego County
315996	Non-Physician Medical Practitioner	None	1831215086	0	0	LUCIENE, JASON M	2/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3010 LOMINA AVE	None	LONG BEACH	CA	90808	3705	00	06000	33.81106061	-118.119831	Los Angeles County
315997	Non-Physician Medical Practitioner	None	1437489507	0	0	LEON, NANCY PA-C	6/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	00	06000	34.13502	-117.2758635	San Bernardino County
316021	Non-Physician Medical Practitioner	None	1316252356	0	0	LOBODA, NIKOLAY N	6/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1842 MERIDIAN ST	None	SAN JACINTO	CA	92583	2010	00	06000	33.76889731	-116.9321264	Riverside County
316074	Ordering, Referring, Prescribing	N/A	1003052168	0	0	LIVINGSTONE, ROBERT V LCSW	6/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS11087	N/A	N/A	N/A	N/A	N/A	205 E 3RD AVE	None	SAN MATEO	CA	94401	4051	00	06000	37.565161	-122.3229376	San Mateo County
316082	Ordering, Referring, Prescribing	N/A	1003082512	0	0	LEE, CONNIE M MD	5/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110042	N/A	N/A	N/A	N/A	N/A	1525 SILVER AVE	2ND FLOOR	SAN FRANCISCO	CA	94134	1229	00	06000	37.73224392	-122.4063707	San Francisco County
316123	Ordering, Referring, Prescribing	N/A	1003145749	0	0	LEE, JEE Y LMFT	6/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84359	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE	300	MOORPARK	CA	95128	1004	00	06000	37.3160785	-121.937121	Santa Clara County
316137	Ordering, Referring, Prescribing	N/A	1003168071	0	0	LOEBNER, JAIME R NP	12/9/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013381	N/A	N/A	N/A	N/A	N/A	2180 HARVARD ST	210	SACRAMENTO	CA	95815	3317	00	06000	38.60568	-121.4345385	Sacramento County
316147	Ordering, Referring, Prescribing	N/A	1003182825	0	0	LANE, KEIRA PHARMD	1/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53457	N/A	N/A	N/A	N/A	N/A	8920 FLETCHER PKWY	None	LA MESA	CA	91942	3231	00	06000	32.78544347	-117.0051058	San Diego County
316190	Ordering, Referring, Prescribing	N/A	1003236415	0	0	LIM, FRANCIS MD	3/15/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146548	N/A	N/A	N/A	N/A	N/A	1670 E 120TH ST	None	LOS ANGELES	CA	90059	3026	00	06000	33.92456051	-118.2417525	Los Angeles County
316209	Ordering, Referring, Prescribing	N/A	1003262866	0	0	LAM, AARON N MD	4/9/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154227	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
316211	Ordering, Referring, Prescribing	N/A	1003262478	0	0	LO GIUDICE, PABLO LPCC	3/8/2024	Taxonomy not applicable	NA	n/a	000	Unknown	15994	N/A	N/A	N/A	N/A	N/A	995 PORTRERO AVE	None	SAN FRANCISCO	CA	94110	2859	00	06000	37.75729541	-122.4066641	San Francisco County
316227	Ordering, Referring, Prescribing	N/A	1003285107	0	0	LOPEZ, LESLIE M LCSW	12/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88479	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE	3RD FLOOR	LONG BEACH	CA	90806	0000	00	06000	33.806097	-118.151378	Los Angeles County
316257	Ordering, Referring, Prescribing	N/A	1003329137	0	0	LAM, TRACY DC	1/27/2018	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC34065	N/A	N/A	N/A	N/A	N/A	650 ROOSEVELT	#2F	IRVINE	CA	92620	3621	00	06000	33.69504926	-117.7671222	Orange County
316267	Ordering, Referring, Prescribing	N/A	1003345737	0	0	LE, STEPHANIE T MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158529	N/A	N/A	N/A	N/A	N/A	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
316279	Ordering, Referring, Prescribing	N/A	1003361221	0	0	LINDEN, VEL E LCSW	6/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94455	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	STE 210	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
316280	Ordering, Referring, Prescribing	N/A	1003357781	0	0	LEE, KIA NP	11/22/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019222	N/A	N/A	N/A	N/A	N/A	1908 N BEALE RD	None	MARYSVILLE	CA	95901	6937	00	06000	39.1278388	-121.5457994	Yuba County
316298	Ordering, Referring, Prescribing	N/A	1003390519	0	0	LE, JENNIFER NP	11/30/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95010516	N/A	N/A	N/A	N/A	N/A	4575 COLLEGE AVE	None	SAN DIEGO	CA	92115	4011	00	06000	32.76023438	-117.0667611	San Diego County
316315	Ordering, Referring, Prescribing	N/A	1003413055	0	0	LISTA, ANTHONY NP	6/28/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019937	N/A	N/A	N/A	N/A	N/A	8627 ATLANTIC AVE	None	SOUTH GATE	CA	90280	3501	00	06000	33.95462085	-118.1838426	Los Angeles County
316353	Ordering, Referring, Prescribing	N/A	1003461484	0	0	LE, GRACE PHARMD	3/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80855	N/A	N/A	N/A	N/A	N/A	6670 EMERGENT WAY	UNIT 332	SAN JOSE	CA	95119	1785	00	06000	37.24085749	-121.7879952	Santa Clara County
316367	Ordering, Referring, Prescribing	N/A	1003488651	0	0	LOWRY, JUSTINE LPCC	11/14/2023	Taxonomy not applicable	NA	n/a	000	Unknown	15121	N/A	N/A	N/A	N/A	N/A	2598 MAIN ST	None	MORRO BAY	CA	93442	1553	00	06000	35.38830586	-120.8582467	San Luis Obispo County
316369	Ordering, Referring, Prescribing	N/A	1003492828	0	0	LIU, NINA MD	10/3/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182645	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
316389	Ordering, Referring, Prescribing	N/A	1003534132	0	0	LEE, SHULAMI	2/8/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021436	N/A	N/A	N/A	N/A	N/A	728 E VALLEY PKWY	None	ESCONDIDO	CA	92025	3052	00	06000	33.12769389	-117.0730873	San Diego County
316391	Ordering, Referring, Prescribing	N/A	1003545583	0	0	LEECH, JENNA M PA-C	5/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61158	N/A	N/A	N/A	N/A	N/A	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	00	06000	39.3245308	-120.2013097	Nevada County
316392	Ordering, Referring, Prescribing	N/A	1003553223	0	0	LOONEY, TAYLERE LMFT	1/30/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	152346	N/A	N/A	N/A	N/A	N/A	540 N CALIFORNIA ST	None	STOCKTON	CA	95202	2117	00	06000	37.95929627	-121.2861102	San Joaquin County
316397	Ordering, Referring, Prescribing	N/A	1003559972	0	0	LUONG, KEVIN A PHARMD	3/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	85939	N/A	N/A	N/A	N/A	N/A	795 E FOOTHILL BLVD	None	POMONA	CA	91767	1223	00	06000	34.10721485	-117.7372912	Los Angeles County
316420	Ordering, Referring, Prescribing	N/A	1003817883	0	0	LEVY, SUSAN MD	9/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G29332	N/A	N/A	N/A	N/A	N/A	23413 LYONS AVE	None	SANTA CLARITA	CA	91355	3028	00	06000	34.37974287	-118.5428596	Los Angeles County
316436	Ordering, Referring, Prescribing	N/A	1003906389	0	0	LI, HEUMIN	8/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	44901	N/A	N/A	N/A	N/A	N/A	2811 MIDDLEFIELD RD	None	PALO ALTO	CA	94306	2522	00	06000	37.43244792	-122.1277424	Santa Clara County
316439	Ordering, Referring, Prescribing	N/A	1003923368	0	0	LOVELL, ALLISON A MD	4/7/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A45444	N/A	N/A	N/A	N/A	N/A	1328 SOUTH MISSION ROAD	None	FALLBROOK	CA	92028	4006	00	06000	33.36868654	-117.2507699	San Diego County
316456	Ordering, Referring, Prescribing	N/A	1003945932	0	0	LESSER, MARCIE T LMFT	7/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46638	N/A	N/A	N/A	N/A	N/A	3628 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2153	00	06000	35.35426453	-119.045007	Kern County
316468	Ordering, Referring, Prescribing	N/A	1003962564	0	0	LEWELLYN, RENE LMFT	8/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42173	N/A	N/A	N/A	N/A	N/A	1210 CENTRAL BLVD	122	BRENTWOOD	CA	94513	2242	00	06000	37.93851243	-121.6981458	Contra Costa County
316473	Ordering, Referring, Prescribing	N/A	1003947227	0	0	LEVI, TRACI P LCSW	10/26/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	19797	N/A	N/A	N/A	N/A	N/A	3200 SOUTH MOTOR AVE	None	LOS ANGELES	CA	90034	0000	00	06000	34.03321301	-118.4109122	Los Angeles County
316477	Ordering, Referring, Prescribing	N/A	1003985185	0	0	LIAO, MAGGIE M PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH50340	N/A	N/A	N/A	N/A	N/A	4900 RIVERGRADE RD	C110	IRWINDALE	CA	91706	1401	00	06000	34.10201565	-117.9802967	Los Angeles County
316489	Ordering, Referring, Prescribing	N/A	1013014794	0	0	LY, MICHAEL M OD	3/29/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	11700	N/A	N/A	N/A	N/A	N/A	2447 WEST VALLEY BLVD	None	ALHAMBRA	CA	91803	1933	00	06000	34.07703515	-118.1505746	Los Angeles County
316528	Ordering, Referring, Prescribing	N/A	1013080431	0	0	LOUIE, RONALD L PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	27296	N/A	N/A	N/A	N/A	N/A	1101 O. ST	None	FIREBAUGH	CA	93622	0000	00	06000	36.85875277	-120.4562709	Fresno County
316532	Ordering, Referring, Prescribing	N/A	1013085638	0	0	LA PLANT JR, LLOYD P	1/23/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D22243	N/A	N/A	N/A	N/A	N/A	2630 1ST AVE	None	SAN DIEGO	CA	92103	6599	00	06000	32.73288727	-117.1639712	San Diego County
316556	Ordering, Referring, Prescribing	N/A	1013140029	0	0	LAU, WINNIE	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62599	N/A	N/A	N/A	N/A	N/A	1200 EL CAMINO REAL	None	SOUTH SAN FRANCIS	CA	94080	3208	00	06000	37.65894608	-122.440161	San Mateo County
316560	Ordering, Referring, Prescribing	N/A	1013154970	0	0	LIGHTELL, JEREMY LCSW	3/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93817	N/A	N/A	N/A	N/A	N/A	2000 EMBARCADERO COVE	SUITE 400	OAKLAND	CA	94606	5334	00	06000	37.78179304	-122.2428136	Alameda County
316581	Ordering, Referring, Prescribing	N/A	1013188150	0	0	LEONARD, RUTH A LMFT	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105953	N/A	N/A	N/A	N/A	N/A	355 TUOLUMNE STREET	ROOM 3407	VALLEJO	CA	94590	5700	00	06000	38.10261225	-122.2382555	Solano County
316596	Ordering, Referring, Prescribing	N/A	1013209907	0	0	LAMBERT, KRISTA G LMFT	12/23/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103635	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
316648	Ordering, Referring, Prescribing	N/A	1013293307	0	0	LEE, KAINI PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60227	N/A	N/A	N/A	N/A	N/A	3320 CHINO HILLS PKWY	None	CHINO HILLS	CA	91709	4228	00	06000	33.9825291	-117.7318314	San Bernardino County
316649	Ordering, Referring, Prescribing	N/A	1013299551	0	0	LE, NANCY PHARMD	7/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60470	N/A	N/A	N/A	N/A	N/A	7878 CRESCENT AVE	None	BUENA PARK	CA	90620	3950	00	06000	33.83935387	-117.9959161	Orange County
316689	Ordering, Referring, Prescribing	N/A	1013351550	0	0	LUCKETT, ANDREW MD	10/10/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137210	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
316692	Ordering, Referring, Prescribing	N/A	1013360437	0	0	LITTLE, CATHERINE LMFT	2/12/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT153170	N/A	N/A	N/A	N/A	N/A	6001 CLARA STREET	None	BELL GARDENS	CA	90201	4723	00	06000	33.96259296	-118.1593487	Los Angeles County
316701	Ordering, Referring, Prescribing	N/A	1013368273	0	0	LOPEZ, PAMELA	4/19/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101113	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL ST	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
316732	Ordering, Referring, Prescribing	N/A	1013422864	0	0	LEBEAU, SEBASTIAN LCSW	6/9/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75370	N/A	N/A	N/A	N/A	N/A	5580 CALLE REAL	None	SANTA BARBARA	CA	93111	1646	00	06000	34.44131559	-119.8184752	Santa Barbara County
316733	Ordering, Referring, Prescribing	N/A	1013404912	0	0	LEE, SANDY DO	10/23/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17623	N/A	N/A	N/A	N/A	N/A	3415 MARTIN LUTHER KING	None	SACRAMENTO	CA	95817	3648	00	06000	38.54376	-121.4644095	Sacramento County
316766	Ordering, Referring, Prescribing	N/A	1013467836	0	0	LAM, AMANDA S PHARMD	7/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75315	N/A	N/A	N/A	N/A	N/A	30251 MURRIETA RD	None	MENIFEE	CA	92584	8385	00	06000	33.684399	-117.2060495	Riverside County
316767	Ordering, Referring, Prescribing	N/A	1013478569	0	0	LARIE, SHAYE B CNP	10/27/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013824	N/A	N/A	N/A	N/A	N/A	925 BEVINS CT	None	LAKEPORT	CA	95453	9754	00	06000	39.03772106	-122.9223338	Lake County
316777	Ordering, Referring, Prescribing	N/A	1013487289	0	0	LESLIE, TRICIA R	12/18/2017	Taxonomy not applicable	NA	n/a	000	Unknown	533302	N/A	N/A	N/A	N/A	N/A	600 N CHERRY	None	TULARE	CA	93274	8758	00	06000	36.21679761	-119.3375929	Tulare County
316780	Ordering, Referring, Prescribing	N/A	1013493956	0	0	LEE, NA YOUNG PHARMD	2/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH77869	N/A	N/A	N/A	N/A	N/A	525 5TH	B	EUREKA	CA	95501	1032	00	06000	40.8020516	-124.1653625	Humboldt County
316784	Ordering, Referring, Prescribing	N/A	1013486026	0	0	LI, ZHAOYU	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79704	N/A	N/A	N/A	N/A	N/A	5300 3RD ST	None	SAN FRANCISCO	CA	94124	2604	00	06000	37.72884002	-122.3929237	San Francisco County
316787	Ordering, Referring, Prescribing	N/A	1013513522	0	0	LOGAN, SHAWNTEL NP	11/24/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016075	N/A	N/A	N/A	N/A	N/A	13010 HESPERIA RD	500	VICTORVILLE	CA	92395	5837	00	06000	34.48843676	-117.2909745	San Bernardino County
316804	Ordering, Referring, Prescribing	N/A	1013547264	0	0	LOUIE, SIRENA O PHARMD	3/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81468	N/A	N/A	N/A	N/A	N/A	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	00	06000	37.23948065	-121.8005798	Santa Clara County
316841	Ordering, Referring, Prescribing	N/A	1013739705	0	0	LONG, DANIELLE D NP	8/9/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031614	N/A	N/A	N/A	N/A	N/A	5580 CALLE REAL	None	GOLETA	CA	93111	0000	00	06000	34.44131559	-119.8184752	Santa Barbara County
316876	Ordering, Referring, Prescribing	N/A	1023037199	0	0	LOMIS, THOMAS J MD	1/23/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G83600	N/A	N/A	N/A	N/A	N/A	15211 VANOWEN ST	208	VAN NUYS	CA	91405	3623	00	06000	34.19395411	-118.4642527	Los Angeles County
316898	Ordering, Referring, Prescribing	N/A	1023107174	0	0	LEINER, STEVEN NP	8/31/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	409463	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL	None	SAN FRANCISCO	CA	94110	1390	00	06000	37.76460716	-122.416335	San Francisco County
316903	Ordering, Referring, Prescribing	N/A	1023132362	0	0	LE, DUNG LCSW	11/18/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29842	N/A	N/A	N/A	N/A	N/A	1414 NORTH CALIFORNIA ST	SUITE #A, B, C	STOCKTON	CA	95202	1515	00	06000	37.96761084	-121.2883234	San Joaquin County
316923	Ordering, Referring, Prescribing	N/A	1023154721	0	0	LYNCH, KELLY S PHD	5/26/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	23774	N/A	N/A	N/A	N/A	N/A	1503 GRANT RD	SUITE 110	MOUNTAIN VIEW	CA	94040	3292	00	06000	37.37672165	-122.0757295	Santa Clara County
316959	Ordering, Referring, Prescribing	N/A	1023241957	0	0	LE, MYAN PSYD	11/30/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28154	N/A	N/A	N/A	N/A	N/A	4510 E PACIFIC COAST HWY	600	LONG BEACH	CA	90804	3279	00	06000	33.78815204	-118.1400821	Los Angeles County
316971	Ordering, Referring, Prescribing	N/A	1023273638	0	0	LINN, ERIN S PHD	6/16/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26805	N/A	N/A	N/A	N/A	N/A	4025 W 226TH ST	None	TORRANCE	CA	90505	2340	00	06000	33.82360754	-118.3560922	Los Angeles County
316983	Ordering, Referring, Prescribing	N/A	1023292026	0	0	LIU, KAREN	7/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH70794	N/A	N/A	N/A	N/A	N/A	12001 S EUCLID ST	None	GARDEN GROVE	CA	92840	3332	00	06000	33.78758768	-117.941271	Orange County
316987	Ordering, Referring, Prescribing	N/A	1023303922	0	0	LYLES MCKELVY, STARLA N DO	2/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14833	N/A	N/A	N/A	N/A	N/A	12625 HESPERIA RD	None	VICTORVILLE	CA	92395	7720	00	06000	34.48058899	-117.2907353	San Bernardino County
316997	Ordering, Referring, Prescribing	N/A	1023340585	0	0	LIVINGSTON QUINN, DOUGLAS T LMFT	11/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45338	N/A	N/A	N/A	N/A	N/A	202 GLACIER DRIVE	None	MARTINEZ	CA	94553	4826	00	06000	37.988865	-122.087427	Contra Costa County
317017	Ordering, Referring, Prescribing	N/A	1023379401	0	0	LONG, CODY J	12/1/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	528	N/A	N/A	N/A	N/A	N/A	3220 W SEPULVEDA BLVD	103	TORRANCE	CA	90505	8160	00	06000	33.82490043	-118.3436029	Los Angeles County
317046	Ordering, Referring, Prescribing	N/A	1023419371	0	0	LI, AIMEE PHARMD	6/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71087	N/A	N/A	N/A	N/A	N/A	2306 PLATEAU DR	None	SAN JOSE	CA	95125	6620	00	06000	37.29634943	-121.8673347	Santa Clara County
317060	Ordering, Referring, Prescribing	N/A	1023434768	0	0	LA, TUAN N PHARMD	9/23/2020	Taxonomy not applicable	NA	n/a	000	Unknown	RPH69401	N/A	N/A	N/A	N/A	N/A	10596 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1163	00	06000	33.7739907	-117.9476369	Orange County
317068	Ordering, Referring, Prescribing	N/A	1023448222	0	0	LOBO, MICHELLE LMFT	12/7/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	101253	N/A	N/A	N/A	N/A	N/A	4701 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90022	1209	00	06000	34.04062547	-118.1643975	Los Angeles County
317087	Ordering, Referring, Prescribing	N/A	1023486909	0	0	LAGUNAS, BIVIANA C LCSW	10/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97595	N/A	N/A	N/A	N/A	N/A	4402 E COMPTON BLVD	104	COMPTON	CA	90221	3667	00	06000	33.8960937	-118.1944727	Los Angeles County
317094	Ordering, Referring, Prescribing	N/A	1023494077	0	0	LEE, CONNIE C PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71231	N/A	N/A	N/A	N/A	N/A	11080 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	00	06000	33.90402176	-117.4750005	Riverside County
317118	Ordering, Referring, Prescribing	N/A	1023523008	0	0	LARSEN, CORY J PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77400	N/A	N/A	N/A	N/A	N/A	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
317127	Ordering, Referring, Prescribing	N/A	1023549433	0	0	LA, DAVID T DO	11/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16726	N/A	N/A	N/A	N/A	N/A	1530 HILLHURST AVE	None	LOS ANGELES	CA	90027	5516	00	06000	34.098921	-118.287374	Los Angeles County
317128	Ordering, Referring, Prescribing	N/A	1023551462	0	0	LIEW, LI L LPCC	1/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	9158	N/A	N/A	N/A	N/A	N/A	9353 VALLEY BLVD	None	ROSEMEAD	CA	91770	1923	00	06000	34.08115618	-118.0651957	Los Angeles County
317136	Ordering, Referring, Prescribing	N/A	1023563848	0	0	LOPEZ ZAMORA, LIZETH LCSW	3/16/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100543	N/A	N/A	N/A	N/A	N/A	950 S GRAND AVE	FL 2	LOS ANGELES	CA	90015	3999	00	06000	34.04362303	-118.2600164	Los Angeles County
317144	Ordering, Referring, Prescribing	N/A	1023565595	0	0	LUA, SERGIO A LMFT	5/31/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132989	N/A	N/A	N/A	N/A	N/A	225 CABRILLO HWY S	200A	HALF MOON BAY	CA	94019	8200	00	06000	37.46542425	-122.4337617	San Mateo County
317158	Ordering, Referring, Prescribing	N/A	1023594892	0	0	LEON, KIMBERLIN LCSW	2/6/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	120914	N/A	N/A	N/A	N/A	N/A	1303 SAN CARLOS AVE	None	SAN CARLOS	CA	94070	2317	00	06000	37.50572931	-122.2621879	San Mateo County
317162	Ordering, Referring, Prescribing	N/A	1023605201	0	0	LOPEZ, STEVEN D MSW LCSW	6/9/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101914	N/A	N/A	N/A	N/A	N/A	8927 CURBARIL AVE.	None	ATASCADERO	CA	93422	5252	00	06000	35.4804193	-120.6541913	San Luis Obispo County
317175	Ordering, Referring, Prescribing	N/A	1023646999	0	0	LIU, CONAN S MD	3/3/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176715	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2282	00	06000	38.555181	-121.4566785	Sacramento County
317177	Ordering, Referring, Prescribing	N/A	1023647765	0	0	LUCILA, MARIANNE R CNP	10/10/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015652	N/A	N/A	N/A	N/A	N/A	30257 SAN MARTINEZ RD	None	CASTAIC	CA	91384	2472	00	06000	34.44738769	-118.6644399	Los Angeles County
317193	Ordering, Referring, Prescribing	N/A	1023676079	0	0	LABRIERE, SADIE J LCSW	6/17/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87447	N/A	N/A	N/A	N/A	N/A	228 W MCDOWELL AVE	None	ALTURAS	CA	96101	3981	00	06000	41.48004239	-120.5440923	Modoc County
317200	Ordering, Referring, Prescribing	N/A	1023692415	0	0	LOPEZ MENDOZA, MIGUEL DO	8/31/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21895	N/A	N/A	N/A	N/A	N/A	1430 FREEDOM BLVD	D	WATSONVILLE	CA	95076	2752	00	06000	36.92713051	-121.7652145	Santa Cruz County
317230	Ordering, Referring, Prescribing	N/A	1023784774	0	0	LEE, BRITTNEY C LCSW	6/6/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	123017	N/A	N/A	N/A	N/A	N/A	831 E. ARROW HWY	None	POMONA	CA	91767	2535	00	06000	34.09030767	-117.7353578	Los Angeles County
317232	Ordering, Referring, Prescribing	N/A	1023843000	0	0	LEACHMAN, NICOLAS PA-C	10/4/2024	Taxonomy not applicable	NA	n/a	000	Unknown	65169	N/A	N/A	N/A	N/A	N/A	6501 GARFIELD AVE	None	BELL GARDENS	CA	90201	1805	00	06000	33.97292523	-118.1475473	Los Angeles County
317270	Ordering, Referring, Prescribing	N/A	1033201678	0	0	LE, GRACE H PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53083	N/A	N/A	N/A	N/A	N/A	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	00	06000	38.38851772	-121.9382798	Solano County
317318	Ordering, Referring, Prescribing	N/A	1033285051	0	0	LE, VINH M	9/9/1999	Taxonomy not applicable	NA	n/a	099	DENTIST	D46402	N/A	N/A	N/A	N/A	N/A	1400 N MAIN ST	None	SANTA ANA	CA	92701	2304	00	06000	33.75688822	-117.8676134	Orange County
317323	Ordering, Referring, Prescribing	N/A	1033301247	0	0	LIU, BETTY D MD	10/9/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A102490	N/A	N/A	N/A	N/A	N/A	2220 CLARK AVE	UNIT A	LONG BEACH	CA	90815	2521	00	06000	33.79772674	-118.1338339	Los Angeles County
317324	Ordering, Referring, Prescribing	N/A	1033303672	0	0	LOPEZ, MONICA D LCSW	8/29/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW22436	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
317334	Ordering, Referring, Prescribing	N/A	1033310966	0	0	LORENZ, PHYLLIS F LMFT	7/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38363	N/A	N/A	N/A	N/A	N/A	22320 FOOTHILL BLVD	400	HAYWARD	CA	94541	2704	00	06000	37.67836576	-122.0838763	Alameda County
317360	Ordering, Referring, Prescribing	N/A	1033368600	0	0	LEE, YU-CHING K NP	4/22/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	19477	N/A	N/A	N/A	N/A	N/A	600 N GARFIELD AVE STE 1	STE 100	MONTEREY PARK	CA	91754	1167	00	06000	34.06820797	-118.1228835	Los Angeles County
317365	Ordering, Referring, Prescribing	N/A	1033375050	0	0	LUCAS, LESLIE K LMFT	1/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106163	N/A	N/A	N/A	N/A	N/A	3576 ARLINGTON AVE	106	RIVERSIDE	CA	92506	3907	00	06000	33.94625192	-117.3913739	Riverside County
317397	Ordering, Referring, Prescribing	N/A	1033430822	0	0	LARSON, KIMBERLY LCSW	7/9/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW109051	N/A	N/A	N/A	N/A	N/A	2686 SPRING ST	None	REDWOOD CITY	CA	94063	3522	00	06000	37.48231745	-122.2081659	San Mateo County
317430	Ordering, Referring, Prescribing	N/A	1033473962	0	0	LIEU, PHONG PHARMD	12/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH76315	N/A	N/A	N/A	N/A	N/A	4521 S 263RD ST	None	KENT	WA	98032	7607	00	06000	47.36536314	-122.2766666	King County
317440	Ordering, Referring, Prescribing	N/A	1033487004	0	0	LE, TIFFANY D PHARMD	12/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56629	N/A	N/A	N/A	N/A	N/A	5839 WESTMISTER BLVD	A	WESTMINSTER	CA	92683	9107	00	06000	33.75910437	-118.0272372	Orange County
317447	Ordering, Referring, Prescribing	N/A	1033487657	0	0	LE, PHUONG-THAO D PHARMD	7/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	48252	N/A	N/A	N/A	N/A	N/A	30592 SANTA MARGARITA PK	None	RANCHO SANTA MARG	CA	92688	5802	00	06000	33.64345316	-117.597728	Orange County
317449	Ordering, Referring, Prescribing	N/A	1033496187	0	0	LEE, ANABEL F LMFT	12/23/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT94175	N/A	N/A	N/A	N/A	N/A	2810 E. DEL MAR BLVD	SUITE 5	PASADENA	CA	91107	0000	00	06000	34.14212984	-118.092328	Los Angeles County
317458	Ordering, Referring, Prescribing	N/A	1033507009	0	0	LOMBOY, CLARK B NP	8/14/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	789909	N/A	N/A	N/A	N/A	N/A	729 SUNRISE AVE	STE 900	ROSEVILLE	CA	95661	4565	00	06000	38.73444822	-121.2720033	Placer County
317465	Ordering, Referring, Prescribing	N/A	1033511142	0	0	LUONG, TINH MD	4/28/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A129979	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
317490	Ordering, Referring, Prescribing	N/A	1033554480	0	0	LOPEZ, MARYALICE MD	7/3/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133468	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
317511	Ordering, Referring, Prescribing	N/A	1033585088	0	0	LOPEZ, ALEXIS C LCSW	12/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99298	N/A	N/A	N/A	N/A	N/A	1227 E LOS ANGELES AVE	None	SIMI VALLEY	CA	93065	2871	00	06000	34.27181352	-118.7762625	Ventura County
317550	Ordering, Referring, Prescribing	N/A	1033646542	0	0	LEVITT, FREDI-RUTH LCSW	9/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW126221	N/A	N/A	N/A	N/A	N/A	58383 29 PALMS HWY	101	YUCCA VALLEY	CA	92284	5891	00	06000	34.13159539	-116.3901072	San Bernardino County
317558	Ordering, Referring, Prescribing	N/A	1033658596	0	0	LOOYZADEH, LADAN PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH66456	N/A	N/A	N/A	N/A	N/A	10955 MAGNOLIA BLVD	None	NORTH HOLLYWOOD	CA	91601	3907	00	06000	34.16490852	-118.3694715	Los Angeles County
317580	Ordering, Referring, Prescribing	N/A	1033685318	0	0	LE, VY PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78903	N/A	N/A	N/A	N/A	N/A	4165 TIMBERLINE DRIVE	None	SAN JOSE	CA	95121	4031	00	06000	37.30394921	-121.7796692	Santa Clara County
317603	Ordering, Referring, Prescribing	N/A	1033731930	0	0	LAKHANI, NAASIR MD	1/18/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A193069	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	None	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
317606	Ordering, Referring, Prescribing	N/A	1033743778	0	0	LOPEZ, ANGELLA CCC-SLP	1/29/2021	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	31304	N/A	N/A	N/A	N/A	N/A	1901 N RICE AVE	SUITE 170-180	OXNARD	CA	93030	7912	00	06000	34.21960355	-119.1421345	Ventura County
317609	Ordering, Referring, Prescribing	N/A	1033746326	0	0	LUNA, RUBI E MD	11/18/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL4741	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
317621	Ordering, Referring, Prescribing	N/A	1033779012	0	0	LEUNG, STEPHEN PHARMD	10/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	77654	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
317629	Ordering, Referring, Prescribing	N/A	1033798467	0	0	LI, WENLI NP	4/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95018467	N/A	N/A	N/A	N/A	N/A	1401 ANAHEIM BLVD	None	ANAHEIM	CA	92805	0000	00	06000	33.81367377	-117.9065536	Orange County
317643	Ordering, Referring, Prescribing	N/A	1033854492	0	0	LE, MICHELLE P PHARMD	4/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86044	N/A	N/A	N/A	N/A	N/A	1500 E GAGE AVE	None	COMMERCE	CA	90022	0000	00	06000	33.98202771	-118.2473747	Los Angeles County
317646	Ordering, Referring, Prescribing	N/A	1033884499	0	0	LE, MINH PHARMD	7/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84576	N/A	N/A	N/A	N/A	N/A	1001 SNEATH LN	204,	SAN BRUNO	CA	94066	2349	00	06000	37.63462925	-122.4259247	San Mateo County
317668	Ordering, Referring, Prescribing	N/A	1043061161	0	0	LEE, MAYGE PA-C	6/20/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64684	N/A	N/A	N/A	N/A	N/A	30300 CAMINO CAPISTRANO	None	SAN JUAN CAPISTRA	CA	92675	1304	00	06000	33.5230101	-117.6683028	Orange County
317669	Ordering, Referring, Prescribing	N/A	1043087596	0	0	LE, DIEM T PHARMD	11/20/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH88997	N/A	N/A	N/A	N/A	N/A	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
317681	Ordering, Referring, Prescribing	N/A	1043259047	0	0	LEON, VINCENT T	8/21/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G169920	N/A	N/A	N/A	N/A	N/A	818 WEST 7TH STREET	930	LOS ANGELES	CA	90017	3476	00	06000	34.04892591	-118.259182	Los Angeles County
317725	Ordering, Referring, Prescribing	N/A	1043378466	0	0	LACHAPELLE, TOM LMFT	2/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	37694	N/A	N/A	N/A	N/A	N/A	1086 EAST GRAND AVE	None	ARROYO GRANDE	CA	93420	2505	00	06000	35.11933967	-120.5958538	San Luis Obispo County
317754	Ordering, Referring, Prescribing	N/A	1043428378	0	0	LANCASTER, CYNTHIA L LMFT	7/12/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50200	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95127	1439	00	06000	37.34293689	-121.9270392	Santa Clara County
317767	Ordering, Referring, Prescribing	N/A	1043467202	0	0	LIU, JASON DDS	7/16/2023	Taxonomy not applicable	NA	n/a	000	Unknown	58007	N/A	N/A	N/A	N/A	N/A	50100 GOLSH RD	None	VALLEY CENTER	CA	92082	5338	00	06000	33.27715948	-116.9618201	San Diego County
317789	Ordering, Referring, Prescribing	N/A	1043511546	0	0	LINDER, BRITTANI LCSW	10/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97596	N/A	N/A	N/A	N/A	N/A	921 E COMPTON BLVD	None	COMPTON	CA	90221	3303	00	06000	33.89604551	-118.213137	Los Angeles County
317795	Ordering, Referring, Prescribing	N/A	1043529720	0	0	LYON, MATTHEW E LCSW	7/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81868	N/A	N/A	N/A	N/A	N/A	3850 CRENSHAW BLVD	None	LOS ANGELES	CA	90008	1821	00	06000	34.01581788	-118.3348506	Los Angeles County
317799	Ordering, Referring, Prescribing	N/A	1043543507	0	0	LAWTON, MELISSA A LMFT	6/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT87273	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
317826	Ordering, Referring, Prescribing	N/A	1043592793	0	0	LIPPITT, LAURA PHARMD	3/23/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH52814	N/A	N/A	N/A	N/A	N/A	2250 OTAY LAKES RD.	None	CHULA VISTA	CA	91915	1000	00	06000	32.645754	-116.9664165	San Diego County
317827	Ordering, Referring, Prescribing	N/A	1043596232	0	0	LATIF, SUZANNE A PHARMD	8/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	41112	N/A	N/A	N/A	N/A	N/A	11604 WHITTIER BLVD	None	WHITTIER	CA	90601	1234	00	06000	33.98243673	-118.0530955	Los Angeles County
317836	Ordering, Referring, Prescribing	N/A	1043611700	0	0	LE-NGUYEN, HOANG LMFT	3/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105944	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	100	GILROY	CA	95020	3673	00	06000	37.03080985	-121.5741639	Santa Clara County
317837	Ordering, Referring, Prescribing	N/A	1043611346	0	0	LOUIE, VINCENT PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71287	N/A	N/A	N/A	N/A	N/A	275 HOSPITAL PKWY	625	SAN JOSE	CA	95119	1106	00	06000	37.23951066	-121.8013511	Santa Clara County
317845	Ordering, Referring, Prescribing	N/A	1043618937	0	0	LAGEVARDI, EMON LMFT	6/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT103059	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
317869	Ordering, Referring, Prescribing	N/A	1043655830	0	0	LEE, JANE S PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55404	N/A	N/A	N/A	N/A	N/A	16145 SIERRA LAKES PKWY	None	FONTANA	CA	92336	0000	00	06000	34.13894422	-117.452804	San Bernardino County
317894	Ordering, Referring, Prescribing	N/A	1043693120	0	0	LIU, LAUREN N LCSW	2/26/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100280	N/A	N/A	N/A	N/A	N/A	11175 SAN PABLO AVE	None	EL CERRITO	CA	94530	2157	00	06000	37.91926262	-122.31424	Contra Costa County
317895	Ordering, Referring, Prescribing	N/A	1043690696	0	0	LIEN, KELLY W	2/13/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	102219	N/A	N/A	N/A	N/A	N/A	767 N HILL ST	STE 200	LOS ANGELES	CA	90012	2365	00	06000	34.06255157	-118.2397077	Los Angeles County
317910	Ordering, Referring, Prescribing	N/A	1043712110	0	0	LAY, PAULINE	7/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78105	N/A	N/A	N/A	N/A	N/A	310 S LAKE AVE	None	PASADENA	CA	91101	9998	00	06000	34.14044971	-118.1322366	Los Angeles County
317928	Ordering, Referring, Prescribing	N/A	1043734932	0	0	LOPEZ, LIZETTE LMFT	6/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119520	N/A	N/A	N/A	N/A	N/A	1301 PINE AVE	None	LONG BEACH	CA	90813	9998	00	06000	33.782913	-118.192417	Los Angeles County
317951	Ordering, Referring, Prescribing	N/A	1043767494	0	0	LEE, EUNICE	3/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74951	N/A	N/A	N/A	N/A	N/A	25821 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	00	06000	33.78906668	-118.293942	Los Angeles County
317968	Ordering, Referring, Prescribing	N/A	1043796402	0	0	LU, JONATHAN F NP	2/12/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009811	N/A	N/A	N/A	N/A	N/A	1211 W. LA PALMA AVE.	SUITE 404	ANAHEIM	CA	92801	2806	00	06000	33.84718298	-117.933758	Orange County
317981	Ordering, Referring, Prescribing	N/A	1043828320	0	0	LA, STEVE LMFT	10/31/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	151057	N/A	N/A	N/A	N/A	N/A	15350 SHERMAN WAY	#200	VAN NUYS	CA	91406	4458	00	06000	34.20109649	-118.467432	Los Angeles County
317988	Ordering, Referring, Prescribing	N/A	1043836257	0	0	LE, JEREMY MSW LCSW	1/23/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW120621	N/A	N/A	N/A	N/A	N/A	301 VICTORIA ST	None	COSTA MESA	CA	92627	1995	00	06000	33.65258952	-117.9121545	Orange County
317989	Ordering, Referring, Prescribing	N/A	1043844889	0	0	LEE, NICOLE DDS	1/23/2024	Taxonomy not applicable	NA	n/a	000	Unknown	DDS104463	N/A	N/A	N/A	N/A	N/A	100 PHILLIPS DRIVE	None	SAUSALITO	CA	94965	1172	00	06000	37.87309986	-122.5132921	Marin County
317990	Ordering, Referring, Prescribing	N/A	1043838121	0	0	LUI, ANTHONY W	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82542	N/A	N/A	N/A	N/A	N/A	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	00	06000	37.66312028	-122.4631592	San Mateo County
318011	Ordering, Referring, Prescribing	N/A	1043873979	0	0	LOPEZ, KRISTOFER-MYLES M MD	8/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181408	N/A	N/A	N/A	N/A	N/A	2105 BEVERLY BLVD	None	LOS ANGELES	CA	90057	2262	00	06000	34.06682861	-118.2706286	Los Angeles County
318015	Ordering, Referring, Prescribing	N/A	1043867963	0	0	LEE, JISOO	11/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81661	N/A	N/A	N/A	N/A	N/A	653 S STATE ST	None	UKIAH	CA	95482	4912	00	06000	39.14431887	-123.2066078	Mendocino County
318016	Ordering, Referring, Prescribing	N/A	1043885361	0	0	LOPEZ CHAVEZ, ABRAHAM PA-C	10/28/2024	Taxonomy not applicable	NA	n/a	000	Unknown	65306	N/A	N/A	N/A	N/A	N/A	148 E KINGS ST	None	AVENAL	CA	93204	1529	00	06000	36.00249425	-120.1366109	Kings County
318068	Ordering, Referring, Prescribing	N/A	1053085712	0	0	LOPEZ-ALVAREZ, SANDY A	12/1/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	106786	N/A	N/A	N/A	N/A	N/A	3081 TEAGARDEN ST	None	SAN LEANDRO	CA	94577	5720	00	06000	37.70519163	-122.1536391	Alameda County
318081	Ordering, Referring, Prescribing	N/A	1053168476	0	0	LEE, BENJAMIN LAC	2/27/2024	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	20023	N/A	N/A	N/A	N/A	N/A	12640 HESPERIA RD	D	VICTORVILLE	CA	92395	7753	00	06000	34.48056876	-117.2907887	San Bernardino County
318107	Ordering, Referring, Prescribing	N/A	1053422360	0	0	LOEHNER, SANDRA M NP	2/8/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	4405	N/A	N/A	N/A	N/A	N/A	518 GARDEN ST	None	SANTA BARBARA	CA	93101	0000	00	06000	34.42054634	-119.6928135	Santa Barbara County
318109	Ordering, Referring, Prescribing	N/A	1053433748	0	0	LIMAS, STEPHANIE E LMFT	4/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99397	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
318115	Ordering, Referring, Prescribing	N/A	1053440552	0	0	LEVY, JAY I LCSW	12/28/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW16619	N/A	N/A	N/A	N/A	N/A	947 COLE AVE	None	LOS ANGELES	CA	90038	2610	00	06000	34.088499	-118.3299065	Los Angeles County
318134	Ordering, Referring, Prescribing	N/A	1053447870	0	0	LAJEUNESSE, STACIE J NP	4/6/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	17737	N/A	N/A	N/A	N/A	N/A	844 OLD TUNNEL ROAD	None	GRASS VALLEY	CA	95945	8524	00	06000	39.23512508	-121.0306878	Nevada County
318139	Ordering, Referring, Prescribing	N/A	1053469460	0	0	LIU, TSENG PING LMFT	1/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	43923	N/A	N/A	N/A	N/A	N/A	11050 E ARTESIA BLVD	STE F	CERRITOS	CA	90703	2542	00	06000	33.8728535	-118.097847	Los Angeles County
318141	Ordering, Referring, Prescribing	N/A	1053471045	0	0	LALLANDE, ANDRE P DO	11/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A7021	N/A	N/A	N/A	N/A	N/A	925 BEVINS CT	None	LAKEPORT	CA	95453	9754	00	06000	39.03772106	-122.9223338	Lake County
318148	Ordering, Referring, Prescribing	N/A	1053481499	0	0	LEE, ANNIE Y PHARMD	3/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	48742	N/A	N/A	N/A	N/A	N/A	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	00	06000	38.602089	-121.3925895	Sacramento County
318194	Ordering, Referring, Prescribing	N/A	1053548784	0	0	LUCAS, DARREN A MD	6/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A130342	N/A	N/A	N/A	N/A	N/A	734 10TH AVE	None	SAN DIEGO	CA	92101	6502	00	06000	32.71306718	-117.1556209	San Diego County
318197	Ordering, Referring, Prescribing	N/A	1053557306	0	0	LOSE, ALEXSANDRIA F LMFT	7/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120072	N/A	N/A	N/A	N/A	N/A	4422 N PERSHING AVE	D2	STOCKTON	CA	95207	6954	00	06000	37.98522608	-121.3202226	San Joaquin County
318206	Ordering, Referring, Prescribing	N/A	1053566505	0	0	LE, PHUONG T NP	7/13/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	18647	N/A	N/A	N/A	N/A	N/A	700 S TUSTIN ST	None	ORANGE	CA	92866	3425	00	06000	33.77685748	-117.8357804	Orange County
318207	Ordering, Referring, Prescribing	N/A	1053569434	0	0	LATERZA, CASSANDRA M MSW LCSW	12/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94080	N/A	N/A	N/A	N/A	N/A	801 GATEWAY BLVD.	4TH FLOOR	SOUTH SAN FRANCIS	CA	94080	9817	00	06000	37.65950806	-122.3969233	San Mateo County
318250	Ordering, Referring, Prescribing	N/A	1053646810	0	0	LUCATERO, ARACELI	5/15/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW122541	N/A	N/A	N/A	N/A	N/A	144 S L ST	None	DINUBA	CA	93618	2323	00	06000	36.54033313	-119.389607	Tulare County
318257	Ordering, Referring, Prescribing	N/A	1053669267	0	0	LO, KATHLEEN W PHARMD	3/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67344	N/A	N/A	N/A	N/A	N/A	3000 S ROBERTSON BLVD	None	LOS ANGELES	CA	90034	3158	00	06000	34.03262164	-118.3900457	Los Angeles County
318263	Ordering, Referring, Prescribing	N/A	1053680231	0	0	LAW, YINGXUAN	9/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022503	N/A	N/A	N/A	N/A	N/A	1801 PARKCOURT PL	BUILDING H	SANTA ANA	CA	92701	5036	00	06000	33.74986153	-117.8429355	Orange County
318273	Ordering, Referring, Prescribing	N/A	1053674432	0	0	LINKER, AMY M LCSW	12/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88772	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD., MAILS	None	LOS ANGELES	CA	90027	9998	00	06000	34.09813032	-118.2901794	Los Angeles County
318284	Ordering, Referring, Prescribing	N/A	1053706861	0	0	LAGOY, JULIAN MD	4/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A161713	N/A	N/A	N/A	N/A	N/A	1922 THE ALAMEDA	440	SAN JOSE	CA	95126	1462	00	06000	37.34128547	-121.9236047	Santa Clara County
318294	Ordering, Referring, Prescribing	N/A	1053718312	0	0	LAU, BRIAN C LCSW	6/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW84943	N/A	N/A	N/A	N/A	N/A	1266 14TH STREET	None	OAKLAND	CA	94607	2247	00	06000	37.81022696	-122.2887619	Alameda County
318315	Ordering, Referring, Prescribing	N/A	1053741223	0	0	LEONARD, JENNIFER LCSW	1/6/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75737	N/A	N/A	N/A	N/A	N/A	1401 N TUSTIN AVE	225	SANTA ANA	CA	92705	8644	00	06000	33.757254	-117.8341425	Orange County
318339	Ordering, Referring, Prescribing	N/A	1053767459	0	0	LUSCOMB, THOMAS A MD	1/7/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A168545	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
318363	Ordering, Referring, Prescribing	N/A	1053793224	0	0	LOPEZ, ALEXANDER A LMFT	1/22/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124122	N/A	N/A	N/A	N/A	N/A	1401 L ST	None	BAKERSFIELD	CA	93301	4522	00	06000	35.37071435	-119.0164657	Kern County
318380	Ordering, Referring, Prescribing	N/A	1053816496	0	0	LOUGH, MICHELLE S MD	1/16/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165872	N/A	N/A	N/A	N/A	N/A	4725 MARKET STREET	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
318402	Ordering, Referring, Prescribing	N/A	1053861773	0	0	LARA, JUNE E LMFT	8/30/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125915	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	280	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
318411	Ordering, Referring, Prescribing	N/A	1053871293	0	0	LAKE-AKINNUOYE, CRYSTAL D NP	12/3/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013402	N/A	N/A	N/A	N/A	N/A	1200 W MAIN ST	None	TURLOCK	CA	95380	5107	00	06000	37.4926695	-120.862917	Stanislaus County
318429	Ordering, Referring, Prescribing	N/A	1053900845	0	0	LAM, MICHELLE W PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH75523	N/A	N/A	N/A	N/A	N/A	210 S GRAND AVE	#116	GLENDORA	CA	91741	4205	00	06000	34.133859	-117.872523	Los Angeles County
318444	Ordering, Referring, Prescribing	N/A	1053962597	0	0	LIMQUECO, LAUDIMIR A NP	12/10/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012857	N/A	N/A	N/A	N/A	N/A	3701 BROADWAY	5TH FLOOR, SUITE 501	OAKLAND	CA	94611	5613	00	06000	37.82533768	-122.258094	Alameda County
318446	Ordering, Referring, Prescribing	N/A	1053966200	0	0	LIU, DARRYL MSW LCSW	1/24/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93319	N/A	N/A	N/A	N/A	N/A	300 BRADFORD ST	None	REDWOOD CITY	CA	94063	1530	00	06000	37.48767403	-122.2323005	San Mateo County
318463	Ordering, Referring, Prescribing	N/A	1063005981	0	0	LE, JANNEINNE T PA-C	11/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59857	N/A	N/A	N/A	N/A	N/A	1971 E 4TH ST	200	SANTA ANA	CA	92705	3917	00	06000	33.7482685	-117.83934	Orange County
318464	Ordering, Referring, Prescribing	N/A	1063016053	0	0	LINESCH, JULIA NP	9/6/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015351	N/A	N/A	N/A	N/A	N/A	12756 VAN NUYS BLVD	None	PACOIMA	CA	91331	1626	00	06000	34.27415381	-118.4110145	Los Angeles County
318542	Ordering, Referring, Prescribing	N/A	1063450500	0	0	LOVE, LYNNE A MD	5/31/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A82621	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	#207	SANTA ROSA	CA	95407	9122	00	06000	38.425266	-122.749875	Sonoma County
318567	Ordering, Referring, Prescribing	N/A	1063530087	0	0	LOCKE, SUSAN T MD	4/23/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A99212	N/A	N/A	N/A	N/A	N/A	1524 W LACEY BLVD	SUITE 103	HANFORD	CA	93230	5967	00	06000	36.32816338	-119.6690189	Kings County
318582	Ordering, Referring, Prescribing	N/A	1063543197	0	0	LOWE, EVELYN M LCSW	1/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS18085	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
318593	Ordering, Referring, Prescribing	N/A	1063550424	0	0	LIPKIND, JESSICA R PSYD	3/13/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY21623	N/A	N/A	N/A	N/A	N/A	3301 E. 12TH ST.	259	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
318611	Ordering, Referring, Prescribing	N/A	1063584142	0	0	LOPEZ, VERONICA M PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56174	N/A	N/A	N/A	N/A	N/A	573 BENT TRAIL DR	None	CHULA VISTA	CA	91914	4156	00	06000	32.66310972	-116.9624532	San Diego County
318616	Ordering, Referring, Prescribing	N/A	1063586402	0	0	LORELEI, MADELEINE PHD	6/10/2014	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	24885	N/A	N/A	N/A	N/A	N/A	1014 CALLOWAY DR	BLDG F	BAKERSFIELD	CA	93312	3509	00	06000	35.36769028	-119.1111246	Kern County
318626	Ordering, Referring, Prescribing	N/A	1063609097	0	0	LEE, SOLEDAD O MD	6/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A35051	N/A	N/A	N/A	N/A	N/A	6888 LINCOLN AVE.	M	BUENA PARK	CA	90620	4107	00	06000	33.83179254	-118.013031	Orange County
318642	Ordering, Referring, Prescribing	N/A	1063653582	0	0	LY, WILSON O PHARMD	8/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH59662	N/A	N/A	N/A	N/A	N/A	4129 18TH STREET	None	SAN FRANCISCO	CA	94114	0000	00	06000	37.7608252	-122.4356669	San Francisco County
318643	Ordering, Referring, Prescribing	N/A	1063655983	0	0	LACUESTA-AROJADO, CHARISSE R PHARMD	3/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH61983	N/A	N/A	N/A	N/A	N/A	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	7909	00	06000	37.70453535	-121.8586496	Alameda County
318664	Ordering, Referring, Prescribing	N/A	1063691970	0	0	LINSZKY, JOZSEF P	6/6/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D36392	N/A	N/A	N/A	N/A	N/A	9001 S H ST	None	BAKERSFIELD	CA	93307	5948	00	06000	35.27289	-119.0212895	Kern County
318685	Ordering, Referring, Prescribing	N/A	1063733426	0	0	LARSEN, LARISSA MD	8/11/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A118359	N/A	N/A	N/A	N/A	N/A	2438 N. PONDEROSA DR	C-105	CAMARILLO	CA	93010	2465	00	06000	34.24219545	-119.0227012	Ventura County
318699	Ordering, Referring, Prescribing	N/A	1063757771	0	0	LANDAZURI, DULCE	5/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH68153	N/A	N/A	N/A	N/A	N/A	605 CROUCH ST	BLDG C	OCEANSIDE	CA	92054	4415	00	06000	33.19619156	-117.3537219	San Diego County
318715	Ordering, Referring, Prescribing	N/A	1063776250	0	0	LOBELLO, SABRINA LMFT	3/31/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115308	N/A	N/A	N/A	N/A	N/A	4545 N. WEST AVE	None	FRESNO	CA	93705	9998	00	06000	36.799623	-119.8264355	Fresno County
318719	Ordering, Referring, Prescribing	N/A	1063778371	0	0	LIN, XIUTING A	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65555	N/A	N/A	N/A	N/A	N/A	1800 HARRISON ST	13TH FLOOR	OAKLAND	CA	94612	3466	00	06000	37.80593773	-122.2656714	Alameda County
318726	Ordering, Referring, Prescribing	N/A	1063781987	0	0	LY, TINREATH PHARMD	8/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH48161	N/A	N/A	N/A	N/A	N/A	2627 PACIFIC AVE	None	LONG BEACH	CA	90906	1712	00	06000	33.80511396	-118.1937379	Los Angeles County
318728	Ordering, Referring, Prescribing	N/A	1063789675	0	0	LAU, FERNANDO T PHARMD	7/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH59589	N/A	N/A	N/A	N/A	N/A	2647 SPRINGS ROAD	None	VALLEJO	CA	94591	5712	00	06000	38.10591447	-122.2076385	Solano County
318733	Ordering, Referring, Prescribing	N/A	1063794006	0	0	LE, TRAM ANH PHARMD	7/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH60951	N/A	N/A	N/A	N/A	N/A	4170 EL CAMINO REAL	None	PALO ALTO	CA	94306	4008	00	06000	37.41148135	-122.1243315	Santa Clara County
318746	Ordering, Referring, Prescribing	N/A	1063806529	0	0	LOPEZ, MARIA E LCSW	7/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80821	N/A	N/A	N/A	N/A	N/A	4200 ASHE ROAD	None	BAKERSFIELD	CA	93313	2029	00	06000	35.316864	-119.0744405	Kern County
318750	Ordering, Referring, Prescribing	N/A	1063812071	0	0	LEW, TIFFANY M PHARMD	3/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH71057	N/A	N/A	N/A	N/A	N/A	1800 HARRISON ST	None	OAKLAND	CA	94612	3466	00	06000	37.80593773	-122.2656714	Alameda County
318751	Ordering, Referring, Prescribing	N/A	1063812279	0	0	LOPEZ, JENNY LCSW	3/2/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95091	N/A	N/A	N/A	N/A	N/A	3255 WILSHIRE BLVD	120	LOS ANGELES	CA	90010	1404	00	06000	34.0618166	-118.2932612	Los Angeles County
318754	Ordering, Referring, Prescribing	N/A	1063814093	0	0	LI, CUI PHARMD	7/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	64456	N/A	N/A	N/A	N/A	N/A	480 N MCKINLEY ST	None	CORONA	CA	92879	1291	00	06000	33.886881	-117.5245245	Riverside County
318755	Ordering, Referring, Prescribing	N/A	1063816254	0	0	LOPEZ, LIDIA P CNP	5/20/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95014584	N/A	N/A	N/A	N/A	N/A	2020 SANTA MONICA BLVD	SUITE 600	SANTA MONICA	CA	90404	2131	00	06000	34.02901811	-118.4795396	Los Angeles County
318777	Ordering, Referring, Prescribing	N/A	1063839280	0	0	LEE, MICHELLE M LMFT	6/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101006	N/A	N/A	N/A	N/A	N/A	3133 N MILLBROOK AVE	None	FRESNO	CA	93703	1425	00	06000	36.77841	-119.7635455	Fresno County
318820	Ordering, Referring, Prescribing	N/A	1063899052	0	0	LE, LEA A MA OTR	5/6/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	15272	N/A	N/A	N/A	N/A	N/A	2686 SPRING ST	None	REDWOOD CITY	CA	94063	3522	00	06000	37.48231745	-122.2081659	San Mateo County
318857	Ordering, Referring, Prescribing	N/A	1063960763	0	0	LUJANO, JACQUELINE M LMFT	6/5/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127262	N/A	N/A	N/A	N/A	N/A	2934 N FRESNO ST	None	FRESNO	CA	93703	1123	00	06000	36.777735	-119.7815105	Fresno County
318901	Ordering, Referring, Prescribing	N/A	1073038469	0	0	LANE, BREAWNA	6/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99754	N/A	N/A	N/A	N/A	N/A	4930 NAPLES ST	None	SAN DIEGO	CA	92110	3816	00	06000	32.77013831	-117.2030986	San Diego County
318930	Ordering, Referring, Prescribing	N/A	1073080164	0	0	LIPSCHULTZ, ERICA CNP	8/15/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009717	N/A	N/A	N/A	N/A	N/A	2727 MACDONALD AVE.	None	RICHMOND	CA	94804	3006	00	06000	37.93503193	-122.3422799	Contra Costa County
318943	Ordering, Referring, Prescribing	N/A	1073100038	0	0	LE, AN T PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH83953	N/A	N/A	N/A	N/A	N/A	4815 WATT AVE	#B101	NORTH HIGHLANDS	CA	95660	5108	00	06000	38.653245	-121.3836075	Sacramento County
318960	Ordering, Referring, Prescribing	N/A	1073147047	0	0	LAM, ASHLEY PHARMD	3/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	80944	N/A	N/A	N/A	N/A	N/A	12324 HOXIE AVE	None	NORWALK	CA	90650	0000	00	06000	33.91989505	-118.1036812	Los Angeles County
318984	Ordering, Referring, Prescribing	N/A	1073195962	0	0	LOSK, AMBER	2/2/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120975	N/A	N/A	N/A	N/A	N/A	680 WILSON AVE	None	NOVATO	CA	94947	3825	00	06000	38.1040296	-122.5964315	Marin County
319021	Ordering, Referring, Prescribing	N/A	1073504262	0	0	LIM, DERRICK G OD	9/13/2021	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT10509	N/A	N/A	N/A	N/A	N/A	4455 W. 117TH ST	105	HAWTHORNE	CA	90250	2240	00	06000	33.92825048	-118.3539285	Los Angeles County
319034	Ordering, Referring, Prescribing	N/A	1073607214	0	0	LAGHAEI, FARSHID PHARMD	3/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50298	N/A	N/A	N/A	N/A	N/A	975 SERENO DRIVE	None	VALLEJO	CA	94589	0000	00	06000	38.12828446	-122.24821	Solano County
319038	Ordering, Referring, Prescribing	N/A	1073617262	0	0	LUK, SELENE M	4/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A9643	N/A	N/A	N/A	N/A	N/A	777 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1934	00	06000	37.34370033	-121.8747539	Santa Clara County
319039	Ordering, Referring, Prescribing	N/A	1073630554	0	0	LY, LYNN E LCSW	7/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25358	N/A	N/A	N/A	N/A	N/A	137 N COTTONWOOD ST	None	WOODLAND	CA	95695	6646	00	06000	38.68538399	-121.7933582	Yolo County
319071	Ordering, Referring, Prescribing	N/A	1073687554	0	0	LAM, KELLY N PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59139	N/A	N/A	N/A	N/A	N/A	23621 S MAIN ST	None	CARSON	CA	90745	9074	00	06000	33.810615	-118.2757055	Los Angeles County
319093	Ordering, Referring, Prescribing	N/A	1073745584	0	0	LEUNG, HERMAN C	10/7/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D58668	N/A	N/A	N/A	N/A	N/A	650 S ZEDIKER AVE	BLDG 3	PARLIER	CA	93648	2667	00	06000	36.60500164	-119.5210273	Fresno County
319107	Ordering, Referring, Prescribing	N/A	1073796298	0	0	LIN, STEPHANIE S	4/27/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D46871	N/A	N/A	N/A	N/A	N/A	210 N GARFIELD AVE	STE 203D	MONTEREY PARK	CA	91754	1746	00	06000	34.064181	-118.122834	Los Angeles County
319165	Ordering, Referring, Prescribing	N/A	1073911087	0	0	LUCAS, LORENZEN C PA	8/19/2018	Taxonomy not applicable	NA	n/a	000	Unknown	54129	N/A	N/A	N/A	N/A	N/A	1140 MAIN STREET	None	LIVINGSTON	CA	95334	1257	00	06000	37.37992056	-120.7234222	Merced County
319167	Ordering, Referring, Prescribing	N/A	1073911681	0	0	LAI, YIHSUAN M LCSW	1/19/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107691	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	401	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
319170	Ordering, Referring, Prescribing	N/A	1073915716	0	0	LAU, JESSICA WING YAN	3/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71469	N/A	N/A	N/A	N/A	N/A	1004 MORRELL AVE	None	BURLINGAME	CA	94010	2625	00	06000	37.58533374	-122.3540763	San Mateo County
319171	Ordering, Referring, Prescribing	N/A	1073910287	0	0	LEE, BRYANT W PHARMD	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71294	N/A	N/A	N/A	N/A	N/A	275 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1101	00	06000	37.23951066	-121.8013511	Santa Clara County
319175	Ordering, Referring, Prescribing	N/A	1073916797	0	0	LANPHEAR, CHAD LAC	2/18/2024	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC16040	N/A	N/A	N/A	N/A	N/A	995 PORTERO AVE	None	SAN FRANCISCO	CA	94110	2859	00	06000	37.75729541	-122.4066641	San Francisco County
319184	Ordering, Referring, Prescribing	N/A	1073933990	0	0	LESKO, SARAH J LMFT	4/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT104882	N/A	N/A	N/A	N/A	N/A	950 W JULIAN ST	None	SAN JOSE	CA	95126	2719	00	06000	37.33352455	-121.9089111	Santa Clara County
319192	Ordering, Referring, Prescribing	N/A	1073956199	0	0	LI, FAN LCSW	4/20/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76737	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON STREET	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
319212	Ordering, Referring, Prescribing	N/A	1073980090	0	0	LIANG, DIANE N	9/11/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D65019	N/A	N/A	N/A	N/A	N/A	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	00	06000	37.53384106	-121.9607241	Alameda County
319228	Ordering, Referring, Prescribing	N/A	1083005508	0	0	LEE, DANNY K	3/25/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64322	N/A	N/A	N/A	N/A	N/A	5205 MELROSE AVE	None	LOS ANGELES	CA	90038	3144	00	06000	34.08354051	-118.314009	Los Angeles County
319314	Ordering, Referring, Prescribing	N/A	1083116214	0	0	LAI, VICTORIA T	11/11/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	104178	N/A	N/A	N/A	N/A	N/A	55 E JULIAN ST	None	SAN JOSE	CA	95112	4007	00	06000	37.34118198	-121.8925795	Santa Clara County
319320	Ordering, Referring, Prescribing	N/A	1083126403	0	0	LIANG, GINA M PA-C	11/23/2020	Taxonomy not applicable	NA	n/a	000	Unknown	54813	N/A	N/A	N/A	N/A	N/A	420 S GLENDORA AVE	None	WEST COVINA	CA	91790	3001	00	06000	34.06750236	-117.925203	Los Angeles County
319326	Ordering, Referring, Prescribing	N/A	1083139190	0	0	LEE, EMILY A NP	9/26/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95007124	N/A	N/A	N/A	N/A	N/A	1964 VIA CTR	None	VISTA	CA	92081	6056	00	06000	33.18400138	-117.283827	San Diego County
319362	Ordering, Referring, Prescribing	N/A	1083189195	0	0	LOYA-VENZOR, DANIEL I PHARMD	9/24/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79125	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD. M	None	BOISE	ID	83706	0000	00	06000	43.59860438	-116.1806635	Ada County
319373	Ordering, Referring, Prescribing	N/A	1083219497	0	0	LIU, CHRISTINA W PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83815	N/A	N/A	N/A	N/A	N/A	22 SAN PEDRO RD	None	DALY CITY	CA	94014	2528	00	06000	37.68893852	-122.4669569	San Mateo County
319407	Ordering, Referring, Prescribing	N/A	1083277255	0	0	LAM, THY A NP	2/9/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016645	N/A	N/A	N/A	N/A	N/A	550 W VISTA WAY	STE 407	VISTA	CA	92083	5732	00	06000	33.19564771	-117.2534095	San Diego County
319436	Ordering, Referring, Prescribing	N/A	1083381982	0	0	LIN, KATHY H PHARMD	1/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH64774	N/A	N/A	N/A	N/A	N/A	1380 HOWARD STREET	STE 130	SAN FRANCISCO	CA	94103	2638	00	06000	37.77424669	-122.4141502	San Francisco County
319438	Ordering, Referring, Prescribing	N/A	1083377725	0	0	LEE, BEE NP	12/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95016873	N/A	N/A	N/A	N/A	N/A	3100 COHASSET RD	None	CHICO	CA	95973	0962	00	06000	39.77184653	-121.8436243	Butte County
319459	Ordering, Referring, Prescribing	N/A	1083616874	0	0	LEE, KELLY C PHARMD	5/31/2023	Taxonomy not applicable	NA	n/a	000	Unknown	51900	N/A	N/A	N/A	N/A	N/A	8950 VILLA LA JOLLA DR	C101	LA JOLLA	CA	92037	1714	00	06000	32.870934	-117.2338765	San Diego County
319481	Ordering, Referring, Prescribing	N/A	1083706998	0	0	LUNA-PINTO, LETICIA LMFT	3/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53181	N/A	N/A	N/A	N/A	N/A	405 W. 5TH ST.	SUITE 130	SANTA ANA	CA	92701	0700	00	06000	33.74893088	-117.8713859	Orange County
319518	Ordering, Referring, Prescribing	N/A	1083797054	0	0	LANDA, KEVIN K PHARMD	3/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH51747	N/A	N/A	N/A	N/A	N/A	13652 CANTARA ST	MOB4 AREA 105	PANORAMA CITY	CA	91402	5423	00	06000	34.21980849	-118.4301135	Los Angeles County
319531	Ordering, Referring, Prescribing	N/A	1083829691	0	0	LEE, CLIFFORD S LAC	4/29/2021	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC11744	N/A	N/A	N/A	N/A	N/A	16200 AMBER VALLEY DRIVE	None	WHITTIER	CA	90604	4051	00	06000	33.92458653	-117.9826605	Los Angeles County
319546	Ordering, Referring, Prescribing	N/A	1083873772	0	0	LO, KERAS PHARMD	2/25/2020	Taxonomy not applicable	NA	n/a	000	Unknown	60424	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
319558	Ordering, Referring, Prescribing	N/A	1083880215	0	0	LEDESMA, ANDREA N LMFT	12/21/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106918	N/A	N/A	N/A	N/A	N/A	760 MOUNTAIN VIEW ST	None	ALTADENA	CA	91001	4925	00	06000	34.19178664	-118.1657029	Los Angeles County
319594	Ordering, Referring, Prescribing	N/A	1083954994	0	0	LEE, KUANYI LCSW	1/6/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75187	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST.	None	CHATSWORTH	CA	91311	6215	00	06000	34.23182352	-118.572948	Los Angeles County
319596	Ordering, Referring, Prescribing	N/A	1083956593	0	0	LANCE, SIMONE R	5/23/2013	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	RN0781615	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
319600	Ordering, Referring, Prescribing	N/A	1083963094	0	0	LIM, SANDRA S DO	6/20/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A13075	N/A	N/A	N/A	N/A	N/A	2204 NATIONAL AVE	None	SAN DIEGO	CA	92113	3615	00	06000	32.69715769	-117.1399272	San Diego County
319601	Ordering, Referring, Prescribing	N/A	1083957393	0	0	LINGAD, ROMAR B NP	5/9/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	22964	N/A	N/A	N/A	N/A	N/A	4425 S CENTRAL AVE	None	LOS ANGELES	CA	90011	3629	00	06000	34.003116	-118.2565185	Los Angeles County
319621	Ordering, Referring, Prescribing	N/A	1083997118	0	0	LE, JANET H PHARMD	8/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59053	N/A	N/A	N/A	N/A	N/A	2600 MOWRY AVE	None	FREMONT	CA	94538	1619	00	06000	37.55561189	-121.9825927	Alameda County
319637	Ordering, Referring, Prescribing	N/A	1093002685	0	0	LEONG, JULIE S LMFT	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	85603	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
319661	Ordering, Referring, Prescribing	N/A	1093063745	0	0	LEZAMA, MATTHEW G NP	1/12/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010135	N/A	N/A	N/A	N/A	N/A	66 HURLBUT ST	None	PASADENA	CA	91105	4025	00	06000	34.12993251	-118.1516625	Los Angeles County
319663	Ordering, Referring, Prescribing	N/A	1093063729	0	0	LEE, ANGELA J LMFT	9/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT100113	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	None	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
319717	Ordering, Referring, Prescribing	N/A	1093156150	0	0	LIN, KAREN H OD	3/24/2021	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	14752	N/A	N/A	N/A	N/A	N/A	1015 S NOGALES ST	STE 109	ROWLAND HEIGHTS	CA	91748	1309	00	06000	33.99637543	-117.8884823	Los Angeles County
319718	Ordering, Referring, Prescribing	N/A	1093163289	0	0	LEE, SEMI LAC	8/8/2017	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC14618	N/A	N/A	N/A	N/A	N/A	15785 LAGUNA CANYON RD	SUITE 330	IRVINE	CA	92618	3178	00	06000	33.66542536	-117.7615537	Orange County
319732	Ordering, Referring, Prescribing	N/A	1093172439	0	0	LE, HOANGNAM M LMFT	6/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105899	N/A	N/A	N/A	N/A	N/A	2531 W WOODLAND DR	None	ANAHEIM	CA	92801	2637	00	06000	33.8492705	-117.973044	Orange County
319799	Ordering, Referring, Prescribing	N/A	1093277345	0	0	LOPEZ FLORES, FLOR D MD	7/14/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180438	N/A	N/A	N/A	N/A	N/A	12619 BENTLEY STREET	None	WATERFORD	CA	95386	9011	00	06000	37.64073442	-120.7613165	Stanislaus County
319801	Ordering, Referring, Prescribing	N/A	1093272338	0	0	LEE, EUNICE NP	6/3/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95012515	N/A	N/A	N/A	N/A	N/A	4712 ADMIRALTY WAY,	SUITE 579	MARINA DEL REY	CA	90291	0295	00	06000	33.97863547	-118.4392419	Los Angeles County
319806	Ordering, Referring, Prescribing	N/A	1093286312	0	0	LU, LOUIE LAC	12/13/2018	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC18320	N/A	N/A	N/A	N/A	N/A	5546 ROSEMEAD BLVD.	SUITE.204	TEMPLE CITY	CA	91780	1855	00	06000	34.10036598	-118.0734184	Los Angeles County
319817	Ordering, Referring, Prescribing	N/A	1093296873	0	0	LOPEZTIANA, IVANA S LPCC	12/11/2023	Taxonomy not applicable	NA	n/a	000	Unknown	12115	N/A	N/A	N/A	N/A	N/A	149 PASADENA AVENUE	SUITE A	PASADENA	CA	91030	2947	00	06000	34.11188281	-118.1734374	Los Angeles County
319841	Ordering, Referring, Prescribing	N/A	1093356966	0	0	LAPICOLA, SARA LCSW	5/1/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	115050	N/A	N/A	N/A	N/A	N/A	3478 BUSKIRK AVE	SUITE 260	PLEASANT HILL	CA	92523	4344	00	06000	37.93963113	-122.0591644	Contra Costa County
319859	Ordering, Referring, Prescribing	N/A	1093388076	0	0	LEVERONI, JOSEPHINA C	4/10/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114721	N/A	N/A	N/A	N/A	N/A	409 CAMINO DEL RIO S	None	SAN DIEGO	CA	92108	3504	00	06000	32.76105674	-117.1609032	San Diego County
319884	Ordering, Referring, Prescribing	N/A	1093554008	0	0	LEDERHOS, HEIDI NP	5/20/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030184	N/A	N/A	N/A	N/A	N/A	1045 N LAKE AVE	None	PASADENA	CA	91104	4521	00	06000	34.16394511	-118.1324885	Los Angeles County
319888	Ordering, Referring, Prescribing	N/A	1093581506	0	0	LIN, YI DDS PHD	10/12/2023	Taxonomy not applicable	NA	n/a	000	Unknown	SP310	N/A	N/A	N/A	N/A	N/A	10833 LE CONTE AVE.	CHS 20-140	LOS ANGELES	CA	90095	1668	00	06000	34.06373445	-118.443537	Los Angeles County
319890	Ordering, Referring, Prescribing	N/A	1093583981	0	0	LAO, CRYSTAL T PHARMD	10/3/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH87282	N/A	N/A	N/A	N/A	N/A	795 E. SECOND STREET	1	POMONA	CA	91766	1854	00	06000	34.05845654	-117.7423951	Los Angeles County
319909	Ordering, Referring, Prescribing	N/A	1093766834	0	0	LIM, KAREN C PSYD	1/27/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	18342	N/A	N/A	N/A	N/A	N/A	520 S LA FAYETTE PARK PL	STE 300	LOS ANGELES	CA	90057	5400	00	06000	34.06392003	-118.2826062	Los Angeles County
319929	Ordering, Referring, Prescribing	N/A	1093847337	0	0	LEWIS, KELLEY	3/10/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50297	N/A	N/A	N/A	N/A	N/A	1045 W REDONDO BEACH BLV	300	GARDENA	CA	90247	4175	00	06000	33.89247044	-118.2931941	Los Angeles County
319933	Ordering, Referring, Prescribing	N/A	1093841561	0	0	LOW, SELINA C LCSW	6/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27935	N/A	N/A	N/A	N/A	N/A	3801-3RD ST.	SUITE 400	SAN FRANCISCO	CA	94124	1409	00	06000	37.74208019	-122.3880422	San Francisco County
319958	Ordering, Referring, Prescribing	N/A	1093895823	0	0	LAM, ANGELA P PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH51089	N/A	N/A	N/A	N/A	N/A	4901 RIO HONDO AVE	None	TEMPLE CITY	CA	91780	3741	00	06000	34.09024258	-118.0646055	Los Angeles County
319966	Ordering, Referring, Prescribing	N/A	1093901688	0	0	LIUSKA, CYNTHIA LMFT	8/13/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40169	N/A	N/A	N/A	N/A	N/A	1350 SOLANO AVE.	UNIT A	ALBANY	CA	94706	1853	00	06000	37.89069464	-122.2910126	Alameda County
319982	Ordering, Referring, Prescribing	N/A	1093920340	0	0	LEE, CAROLINE J PHARMD	4/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH54725	N/A	N/A	N/A	N/A	N/A	1001 METRO CENTER BLVD	None	FOSTER CITY	CA	94404	2177	00	06000	37.56120852	-122.2739553	San Mateo County
319984	Ordering, Referring, Prescribing	N/A	1093930430	0	0	LAM, VIVIAN K PHARMD	3/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52754	N/A	N/A	N/A	N/A	N/A	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
319989	Ordering, Referring, Prescribing	N/A	1093944019	0	0	LAPIDUS, RACHEL L MD	6/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A114105	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	00	06000	37.34293689	-121.9270392	Santa Clara County
319992	Ordering, Referring, Prescribing	N/A	1093946212	0	0	LEE, JESSICA K PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62686	N/A	N/A	N/A	N/A	N/A	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	00	06000	32.79293009	-117.0952438	San Diego County
319994	Ordering, Referring, Prescribing	N/A	1093946139	0	0	LOPEZ GALLEGOS, MIRZA LCSW	2/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74959	N/A	N/A	N/A	N/A	N/A	11721 TELEGRAPH RD	None	SANTA FE SPRINGS	CA	90670	3674	00	06000	33.94629336	-118.0832752	Los Angeles County
319996	Ordering, Referring, Prescribing	N/A	1093959991	0	0	LAZAR, JANET S LMFT	1/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53954	N/A	N/A	N/A	N/A	N/A	15305 RAYEN STREET	None	NORTH HILLS	CA	91343	5117	00	06000	34.23191048	-118.4657625	Los Angeles County
319997	Ordering, Referring, Prescribing	N/A	1093950982	0	0	LEYVA, JESUS PSYD	4/2/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	32495	N/A	N/A	N/A	N/A	N/A	4025 W 226TH ST	None	TORRANCE	CA	90505	2340	00	06000	33.82360754	-118.3560922	Los Angeles County
320014	Ordering, Referring, Prescribing	N/A	1093991663	0	0	LIPPERT, HEATHER M LCSW	4/1/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW22526	N/A	N/A	N/A	N/A	N/A	2136 EL CAJON BLVD	None	SAN DIEGO	CA	92104	1102	00	06000	32.75537928	-117.1416551	San Diego County
320036	Ordering, Referring, Prescribing	N/A	1104042928	0	0	LUNN, ERIC W LCSW	1/30/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW120764	N/A	N/A	N/A	N/A	N/A	3756 SANTA ROSALIA DR	SUITE 628	LOS ANGELES	CA	90008	3606	00	06000	34.00888336	-118.3389334	Los Angeles County
320038	Ordering, Referring, Prescribing	N/A	1104034768	0	0	LOPEZ, MARCUS G LCSW	6/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW62683	N/A	N/A	N/A	N/A	N/A	2500 S C ST	C	OXNARD	CA	93033	4560	00	06000	34.17646093	-119.1812737	Ventura County
320041	Ordering, Referring, Prescribing	N/A	1104043496	0	0	LEIMBACH, MICHAEL K LMFT	10/4/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44552	N/A	N/A	N/A	N/A	N/A	108 WHISPERING PINES DR	115	SCOTTS VALLEY	CA	95066	4791	00	06000	37.04239796	-122.0275075	Santa Cruz County
320048	Ordering, Referring, Prescribing	N/A	1104055656	0	0	LI, BERYL M LCSW	2/22/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	78823	N/A	N/A	N/A	N/A	N/A	9353 E VALLEY BLVD.	None	ROSEMEAD	CA	91770	0001	00	06000	34.08115618	-118.0651957	Los Angeles County
320055	Ordering, Referring, Prescribing	N/A	1104080167	0	0	LUU, NHIEN T DDS	2/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	48826	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
320066	Ordering, Referring, Prescribing	N/A	1104106772	0	0	LEM, DAVID V PHARMD	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55803	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	362	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
320076	Ordering, Referring, Prescribing	N/A	1104126069	0	0	LA, JAMIE K PHARMD	1/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51894	N/A	N/A	N/A	N/A	N/A	3320 ARDEN WAY	None	SACRAMENTO	CA	95825	0000	00	06000	38.594439	-121.386672	Sacramento County
320079	Ordering, Referring, Prescribing	N/A	1104118298	0	0	LAU, JOHN PHARMD	8/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61766	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	None	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
320085	Ordering, Referring, Prescribing	N/A	1104151653	0	0	LEUNG, WILSON K	11/16/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D58224	N/A	N/A	N/A	N/A	N/A	1814 W LINCOLN AVE	STE B	ANAHEIM	CA	92801	6730	00	06000	33.83241852	-117.946323	Orange County
320092	Ordering, Referring, Prescribing	N/A	1104160415	0	0	LEAVITT, DANIEL MD	4/7/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C172218	N/A	N/A	N/A	N/A	N/A	2450 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	00	06000	40.14921426	-122.2216794	Tehama County
320096	Ordering, Referring, Prescribing	N/A	1104170133	0	0	LEVINE, HAL W LMFT	5/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	19873	N/A	N/A	N/A	N/A	N/A	2045 FAIRMONT DRIVE	None	SAN LEANDRO	CA	94578	1088	00	06000	37.709892	-122.118966	Alameda County
320113	Ordering, Referring, Prescribing	N/A	1104198449	0	0	LEONG, CHAO H PHARMD	7/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	47150	N/A	N/A	N/A	N/A	N/A	460 W FELICITA AVE	None	ESCONDIDO	CA	92025	6518	00	06000	33.10362671	-117.0751891	San Diego County
320114	Ordering, Referring, Prescribing	N/A	1104194968	0	0	LE, UYEN N	10/18/2018	Taxonomy not applicable	NA	n/a	000	Unknown	66248	N/A	N/A	N/A	N/A	N/A	70 W HEDDING ST	None	SAN JOSE	CA	95110	1705	00	06000	37.35249294	-121.9050815	Santa Clara County
320197	Ordering, Referring, Prescribing	N/A	1104332915	0	0	LESESNE, REBECCA LCSW	4/4/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121848	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
320199	Ordering, Referring, Prescribing	N/A	1104330919	0	0	LE, PHUNG	3/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	77502	N/A	N/A	N/A	N/A	N/A	5101 BUSINESS CENTER DR	None	FAIRFIELD	CA	94534	1624	00	06000	38.21577011	-122.1459125	Solano County
320229	Ordering, Referring, Prescribing	N/A	1104366954	0	0	LE, TRISHA B	8/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH74185	N/A	N/A	N/A	N/A	N/A	11950 VALLEY VIEW ST	None	GARDEN GROVE	CA	92845	1239	00	06000	33.7890093	-118.0283611	Orange County
320232	Ordering, Referring, Prescribing	N/A	1104371905	0	0	LOPEZ, MAYRA C LCSW	7/23/2019	Taxonomy not applicable	NA	n/a	000	Unknown	ASW78566	N/A	N/A	N/A	N/A	N/A	3430 A STREET	None	ATWATER	CA	95301	5100	00	06000	37.36706977	-120.570351	Merced County
320250	Ordering, Referring, Prescribing	N/A	1104391713	0	0	LEWIS, KAITLYN PA-C	2/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	57617	N/A	N/A	N/A	N/A	N/A	90 VIA JUANA RD	None	SANTA YNEZ	CA	93460	9679	00	06000	34.60546842	-120.0931812	Santa Barbara County
320253	Ordering, Referring, Prescribing	N/A	1104394998	0	0	LEE, RENEE LMFT	9/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122234	N/A	N/A	N/A	N/A	N/A	1540 E COLORADO ST	None	GLENDALE	CA	91205	1514	00	06000	34.1427285	-118.230039	Los Angeles County
320256	Ordering, Referring, Prescribing	N/A	1104400282	0	0	LANDA, CRISTINA V PA-C	9/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59508	N/A	N/A	N/A	N/A	N/A	1971 E 4TH ST	200	SANTA ANA	CA	92705	3917	00	06000	33.7482685	-117.83934	Orange County
320267	Ordering, Referring, Prescribing	N/A	1104426626	0	0	LY, HELLEN N PHARMD	3/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83893	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	1000	00	06000	37.33636857	-121.9958111	Santa Clara County
320275	Ordering, Referring, Prescribing	N/A	1104469535	0	0	LIMON, LETICIA I LCSW	3/7/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103482	N/A	N/A	N/A	N/A	N/A	20951 PAVILION WAY	None	LOST HILLS	CA	93249	9737	00	06000	35.61559963	-119.7027342	Kern County
320319	Ordering, Referring, Prescribing	N/A	1104681592	0	0	LUA, VERONICA RN PHN	6/6/2023	Taxonomy not applicable	NA	n/a	000	Unknown	653782	N/A	N/A	N/A	N/A	N/A	150 DISTRICT CENTER DR.	None	PALM SPRINGS	CA	92264	3626	00	06000	33.82485354	-116.4955129	Riverside County
320326	Ordering, Referring, Prescribing	N/A	1104585439	0	0	LE, MINH D PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84221	N/A	N/A	N/A	N/A	N/A	4211 S AVALON BLVD	None	LOS ANGELES	CA	90011	5622	00	06000	34.007238	-118.2653065	Los Angeles County
320345	Ordering, Referring, Prescribing	N/A	1104909969	0	0	LOZA, ANNA M LCSW	10/14/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23117	N/A	N/A	N/A	N/A	N/A	4850 PEDLEY RD	None	JURUPA VALLEY	CA	92509	3966	00	06000	34.0005919	-117.4753694	Riverside County
320351	Ordering, Referring, Prescribing	N/A	1104926732	0	0	LAPERNA, DONALD J LMFT	10/24/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT11814	N/A	N/A	N/A	N/A	N/A	6615 EAST PACIFIC COAST	SUITE 190	LONG BEACH	CA	90803	4219	00	06000	33.75463355	-118.1079597	Los Angeles County
320366	Ordering, Referring, Prescribing	N/A	1104961440	0	0	LIN, SOPHIA Y NP	2/4/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	15864	N/A	N/A	N/A	N/A	N/A	760 HARRISON ST	None	SAN FRANCISCO	CA	94107	1235	00	06000	37.78155484	-122.3987081	San Francisco County
320387	Ordering, Referring, Prescribing	N/A	1114001831	0	0	LEE, HEE SEUNG LCSW	1/31/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29615	N/A	N/A	N/A	N/A	N/A	14112 KINGSLEY DR.	None	GARDENA	CA	90249	9998	00	06000	33.902901	-118.304243	Los Angeles County
320392	Ordering, Referring, Prescribing	N/A	1114006871	0	0	LUNA, AILEEN C	11/17/2003	Taxonomy not applicable	NA	n/a	099	DENTIST	D50780	N/A	N/A	N/A	N/A	N/A	6901 S ATLANTIC BLVD	None	BELL	CA	90201	3646	00	06000	33.97291242	-118.1878808	Los Angeles County
320395	Ordering, Referring, Prescribing	N/A	1114004884	0	0	LIGASON, LIZBETH M MD	6/27/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A64827	N/A	N/A	N/A	N/A	N/A	401 THE CITY DR S	None	ORANGE	CA	92868	3303	00	06000	33.78395385	-117.8887742	Orange County
320398	Ordering, Referring, Prescribing	N/A	1114006889	0	0	LUNA, CELLINI N	6/13/1991	Taxonomy not applicable	NA	n/a	099	DENTIST	D37464	N/A	N/A	N/A	N/A	N/A	2219 E 1ST ST	None	LOS ANGELES	CA	90033	3901	00	06000	34.04452444	-118.2114844	Los Angeles County
320432	Ordering, Referring, Prescribing	N/A	1114068459	0	0	LEMUS, CARLOS LCSW	6/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW70121	N/A	N/A	N/A	N/A	N/A	1605 EASTLAKE AVE	None	LOS ANGELES	CA	90033	1009	00	06000	34.06300636	-118.2054784	Los Angeles County
320440	Ordering, Referring, Prescribing	N/A	1114101995	0	0	LIN, JONSON J MD	5/18/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A90042	N/A	N/A	N/A	N/A	N/A	2008 N GAREY AVE	None	POMONA	CA	91767	2722	00	06000	34.08295003	-117.7528173	Los Angeles County
320456	Ordering, Referring, Prescribing	N/A	1114131927	0	0	LINDNER, LORIN PHD	3/31/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY10659	N/A	N/A	N/A	N/A	N/A	3717 MT PINOS WAY	C AND D	FRAZIER PARK	CA	93225	0000	00	06000	34.82273575	-118.9474749	Kern County
320465	Ordering, Referring, Prescribing	N/A	1114144839	0	0	LAM, CHRISTOPHER M PA-C	7/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA17631	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD STE	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
320469	Ordering, Referring, Prescribing	N/A	1114156544	0	0	LARA, EDWARD S LMFT	3/2/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116687	N/A	N/A	N/A	N/A	N/A	2600 E VINEYARD AVE	None	OXNARD	CA	93036	1615	00	06000	34.23410039	-119.1715863	Ventura County
320483	Ordering, Referring, Prescribing	N/A	1114199304	0	0	LOWE, JONATHAN A	3/29/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014582	N/A	N/A	N/A	N/A	N/A	10978 DONNER PASS RD	None	TRUCKEE	CA	96161	0433	00	06000	39.32616692	-120.2026317	Nevada County
320487	Ordering, Referring, Prescribing	N/A	1114201787	0	0	LIU, WEN-HUI PHARMD	8/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH48761	N/A	N/A	N/A	N/A	N/A	456 MISSION STREET	None	SAN FRANCISCO	CA	94105	2502	00	06000	37.79028395	-122.3973981	San Francisco County
320489	Ordering, Referring, Prescribing	N/A	1114204039	0	0	LAU, ALICE M	7/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH36979	N/A	N/A	N/A	N/A	N/A	459 POWELL STREET	None	SAN FRANCISCO	CA	94102	1503	00	06000	37.78902921	-122.4085938	San Francisco County
320493	Ordering, Referring, Prescribing	N/A	1114207578	0	0	LUKAS, CARLY LMFT	5/31/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	88544	N/A	N/A	N/A	N/A	N/A	11175 SAN PABLO AVE	None	EL CERRITO	CA	94530	2157	00	06000	37.91926262	-122.31424	Contra Costa County
320501	Ordering, Referring, Prescribing	N/A	1114221306	0	0	LEE, PAULINE PHARMD	4/3/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH42449	N/A	N/A	N/A	N/A	N/A	5901 REDWOOD DR	None	ROHNERT PARK	CA	94928	2076	00	06000	38.35201427	-122.7156861	Sonoma County
320517	Ordering, Referring, Prescribing	N/A	1114250479	0	0	LINK, CHRISTOPHER J	2/2/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27069	N/A	N/A	N/A	N/A	N/A	4141 STATE ST	STE. B-6	SANTA BARBARA	CA	93110	1814	00	06000	34.4404695	-119.7612045	Santa Barbara County
320523	Ordering, Referring, Prescribing	N/A	1114267481	0	0	LEWIS, JANET LMFT	6/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112126	N/A	N/A	N/A	N/A	N/A	1297 W HOBSONWAY	None	BLYTHE	CA	92225	1423	00	06000	33.61017847	-114.611112	Riverside County
320576	Ordering, Referring, Prescribing	N/A	1114356748	0	0	LEANG, JESSICA	4/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH54993	N/A	N/A	N/A	N/A	N/A	275 HOSPITAL PKWY	625	SAN JOSE	CA	95119	1106	00	06000	37.23951066	-121.8013511	Santa Clara County
320587	Ordering, Referring, Prescribing	N/A	1114375219	0	0	LEE, LUKE V MD	8/31/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154228	N/A	N/A	N/A	N/A	N/A	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	00	06000	37.74791027	-122.4587116	San Francisco County
320629	Ordering, Referring, Prescribing	N/A	1114431012	0	0	LARA-RINCON, MILKA S LMFT	10/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122540	N/A	N/A	N/A	N/A	N/A	3715 COLUMBUS ST	None	BAKERSFIELD	CA	93306	2719	00	06000	35.39925709	-118.9522496	Kern County
320639	Ordering, Referring, Prescribing	N/A	1114456340	0	0	LEEKE, MACKENZIE R	11/28/2017	Taxonomy not applicable	NA	n/a	000	Unknown	500	N/A	N/A	N/A	N/A	N/A	406 VALLEY ST	None	NEVADA CITY	CA	95959	3014	00	06000	39.25714324	-121.0220225	Nevada County
320654	Ordering, Referring, Prescribing	N/A	1114475183	0	0	LEVI, JOANNIS NP	11/21/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004835	N/A	N/A	N/A	N/A	N/A	918 W FOOTHILL BLVD	#A	UPLAND	CA	91786	3772	00	06000	34.10676594	-117.6636152	San Bernardino County
320662	Ordering, Referring, Prescribing	N/A	1114480803	0	0	LAM, AMY PHARMD	7/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79866	N/A	N/A	N/A	N/A	N/A	5224 COLDWATER CANYON AV	None	VAN NUYS	CA	91401	6146	00	06000	34.165512	-118.4137725	Los Angeles County
320663	Ordering, Referring, Prescribing	N/A	1114488194	0	0	LAI, ERNEST MD	3/28/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL909	N/A	N/A	N/A	N/A	N/A	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
320678	Ordering, Referring, Prescribing	N/A	1114527652	0	0	LIM, LI A PA-C	9/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60013	N/A	N/A	N/A	N/A	N/A	400 WEST PUEBLO	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
320685	Ordering, Referring, Prescribing	N/A	1114532272	0	0	LANDEROS DE SANTIAGO, YADIRA PA-C	4/3/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64331	N/A	N/A	N/A	N/A	N/A	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
320686	Ordering, Referring, Prescribing	N/A	1114548047	0	0	LABASS, BRAD F LMFT	6/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53462	N/A	N/A	N/A	N/A	N/A	2255 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5423	00	06000	38.424924	-122.7512565	Sonoma County
320730	Ordering, Referring, Prescribing	N/A	1114666765	0	0	LAPIG, LANELLE N NP	5/31/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021120	N/A	N/A	N/A	N/A	N/A	7301 STATE ST	None	HUNTINGTON PARK	CA	90255	5823	00	06000	33.97149395	-118.2097278	Los Angeles County
320760	Ordering, Referring, Prescribing	N/A	1114940640	0	0	LEON, ZONIA	1/8/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G72043	N/A	N/A	N/A	N/A	N/A	8727 VAN NUYS BLVD	101 & 102	PANORAMA CITY	CA	91402	2451	00	06000	34.22817174	-118.4502885	Los Angeles County
320761	Ordering, Referring, Prescribing	N/A	1114936945	0	0	LEE, SANG J PHARMD	12/24/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH46373	N/A	N/A	N/A	N/A	N/A	266 S HARVARD BL	120	LOS ANGELES	CA	90004	4374	00	06000	34.069221	-118.3041245	Los Angeles County
320796	Ordering, Referring, Prescribing	N/A	1124110622	0	0	LEVIN, LYUBOV PHARMD	3/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53070	N/A	N/A	N/A	N/A	N/A	2350 GEARY BLVD	109	SAN FRANCISCO	CA	94115	3305	00	06000	37.78305866	-122.4421313	San Francisco County
320826	Ordering, Referring, Prescribing	N/A	1124153440	0	0	LOPEZ, AMELIA	5/23/2017	Taxonomy not applicable	NA	n/a	000	Unknown	11657	N/A	N/A	N/A	N/A	N/A	1140 MAIN ST	None	LIVINGSTON	CA	95334	1257	00	06000	37.37992056	-120.7234222	Merced County
320844	Ordering, Referring, Prescribing	N/A	1124178041	0	0	LEE, MICHELLE PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54764	N/A	N/A	N/A	N/A	N/A	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
320848	Ordering, Referring, Prescribing	N/A	1124187943	0	0	LUU, MYTHUY PHARMD	4/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50311	N/A	N/A	N/A	N/A	N/A	23621 S. MAIN ST.	None	CARSON	CA	90745	5743	00	06000	33.810615	-118.2757055	Los Angeles County
320853	Ordering, Referring, Prescribing	N/A	1124205455	0	0	LI, MIKE Y	1/7/2008	Taxonomy not applicable	NA	n/a	099	DENTIST	D52636	N/A	N/A	N/A	N/A	N/A	250 N SEE VEE LN	None	BISHOP	CA	93514	8130	00	06000	37.365066	-118.410912	Inyo County
320880	Ordering, Referring, Prescribing	N/A	1124253323	0	0	LEDEZMA, BLANCA A	3/8/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0570758	N/A	N/A	N/A	N/A	N/A	2020 SANTA MONICA BLV	STE 600	SANTA MONICA	CA	90404	2131	00	06000	34.02901811	-118.4795396	Los Angeles County
320909	Ordering, Referring, Prescribing	N/A	1124322383	0	0	LUCATERO-ACOSTA, LETICIA LMFT	4/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT87576	N/A	N/A	N/A	N/A	N/A	516 N KAWEAH AVE	None	EXETER	CA	93221	1200	00	06000	36.30416949	-119.1357315	Tulare County
320916	Ordering, Referring, Prescribing	N/A	1124326814	0	0	LOZADA, JESSICA B PHARMD	10/10/2018	Taxonomy not applicable	NA	n/a	000	Unknown	42821	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	None	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
320919	Ordering, Referring, Prescribing	N/A	1124328935	0	0	LIM, HEA-RAN	6/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	47045	N/A	N/A	N/A	N/A	N/A	774 ADMIRAL CALLAGHAN LA	None	VALLEJO	CA	94591	0000	00	06000	38.12591271	-122.2280142	Solano County
320922	Ordering, Referring, Prescribing	N/A	1124329487	0	0	LEE, YEO HOON	3/30/2018	Taxonomy not applicable	NA	n/a	000	Unknown	66453	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
320941	Ordering, Referring, Prescribing	N/A	1124376660	0	0	LONG, GREGORY G	8/26/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D21475	N/A	N/A	N/A	N/A	N/A	209 BIRCH ST	None	WESTWOOD	CA	96137	0000	00	06000	40.30154086	-121.001876	Lassen County
320949	Ordering, Referring, Prescribing	N/A	1124392766	0	0	LEVY, THOMAS A	11/9/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	D25165	N/A	N/A	N/A	N/A	N/A	66675 PIERSON BLVD	None	DSRT HOT SPGS	CA	92240	3737	00	06000	33.96138951	-116.498223	Riverside County
320950	Ordering, Referring, Prescribing	N/A	1124396866	0	0	LA, TARYN T PHARMD	7/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	48852	N/A	N/A	N/A	N/A	N/A	3237 E CHAPMAN AVE	None	ORANGE	CA	92869	3709	00	06000	33.78782753	-117.8188425	Orange County
320959	Ordering, Referring, Prescribing	N/A	1124403423	0	0	LOUIE, KURTIS J	9/14/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64794	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
320968	Ordering, Referring, Prescribing	N/A	1124412390	0	0	LOPEZ, STEPHANIE LMFT	10/3/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	141797	N/A	N/A	N/A	N/A	N/A	1600 N CUYAMACA ST	None	EL CAJON	CA	92020	1109	00	06000	32.817267	-116.979677	San Diego County
320973	Ordering, Referring, Prescribing	N/A	1124422605	0	0	LECUYER-MANGEL, ROYANNA LMFT	3/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT102660	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	100	GILROY	CA	95020	3673	00	06000	37.03080985	-121.5741639	Santa Clara County
320992	Ordering, Referring, Prescribing	N/A	1124456579	0	0	LAM, YIN YEE PHARMD	10/11/2018	Taxonomy not applicable	NA	n/a	000	Unknown	55254	N/A	N/A	N/A	N/A	N/A	751 S. BASCOM AVE.	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
321012	Ordering, Referring, Prescribing	N/A	1124480645	0	0	LEEBURG, ROBERT LCSW	11/7/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW104258	N/A	N/A	N/A	N/A	N/A	15315 MAGNOLIA BLVD	400	SHERMAN OAKS	CA	91403	1173	00	06000	34.16488161	-118.4666419	Los Angeles County
321067	Ordering, Referring, Prescribing	N/A	1124568944	0	0	LEE, JUSTIN PHARMD	7/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75312	N/A	N/A	N/A	N/A	N/A	6100 PACIFIC BLVD	None	HUNTINGTON PARK	CA	90255	2923	00	06000	33.984981	-118.2251735	Los Angeles County
321076	Ordering, Referring, Prescribing	N/A	1124575410	0	0	LE, CAM TU OD	10/11/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34429	N/A	N/A	N/A	N/A	N/A	4141 STATE STREET	SUITE B2	SANTA BARBARA	CA	93110	1810	00	06000	34.4404695	-119.7612045	Santa Barbara County
321077	Ordering, Referring, Prescribing	N/A	1124572649	0	0	LANK, TALENA M NP	8/23/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	755836	N/A	N/A	N/A	N/A	N/A	1100 FOURTH ST	BLDG A	TAFT	CA	93268	2415	00	06000	35.14905085	-119.4534352	Kern County
321081	Ordering, Referring, Prescribing	N/A	1124580956	0	0	LEONE, VIRGINIA A MD MPH	7/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180424	N/A	N/A	N/A	N/A	N/A	172 E GRANT AVE	None	WINTERS	CA	95694	1780	00	06000	38.5264496	-121.9668052	Yolo County
321121	Ordering, Referring, Prescribing	N/A	1124665286	0	0	LANSING, JEREMY O LCSW	2/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88259	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
321127	Ordering, Referring, Prescribing	N/A	1124667779	0	0	LOPEZ, RITO A NP	11/18/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013287	N/A	N/A	N/A	N/A	N/A	340 FOURTH AVE	10	CHULA VISTA	CA	91910	3813	00	06000	32.63831293	-117.0833536	San Diego County
321189	Ordering, Referring, Prescribing	N/A	1134207947	0	0	LARSEN, KIMBERLY W MD	7/6/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A85327	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
321190	Ordering, Referring, Prescribing	N/A	1134205537	0	0	LEE, FAYVEN PHARMD	4/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH52843	N/A	N/A	N/A	N/A	N/A	4900 RIVERGRADE RD	C-110	BALDWIN PARK	CA	91706	1401	00	06000	34.10201565	-117.9802967	Los Angeles County
321233	Ordering, Referring, Prescribing	N/A	1134279243	0	0	LAM, KATHERINE LCSW	3/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	65660	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	None	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
321238	Ordering, Referring, Prescribing	N/A	1134251028	0	0	LOPEZ, YOLANDA	11/21/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24791	N/A	N/A	N/A	N/A	N/A	333 S. BEAURDY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
321243	Ordering, Referring, Prescribing	N/A	1134289937	0	0	LEE, YOU SOO LAC	3/17/2024	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC8212	N/A	N/A	N/A	N/A	N/A	500 S VIRGIL AVE	302	LOS ANGELES	CA	90020	1446	00	06000	34.064964	-118.2870335	Los Angeles County
321251	Ordering, Referring, Prescribing	N/A	1134312663	0	0	LAVAEE, MARILYN PHARMD	3/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59307	N/A	N/A	N/A	N/A	N/A	6041 CADILLAC AVE	516	LOS ANGELES	CA	90034	1702	00	06000	34.03781261	-118.3755101	Los Angeles County
321266	Ordering, Referring, Prescribing	N/A	1134357270	0	0	LOTTATORE-FRENCH, LISA PSYD	6/24/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY25812	N/A	N/A	N/A	N/A	N/A	23040 SLEEPING OAK DR	None	YORBA LINDA	CA	92887	3912	00	06000	33.88521913	-117.7327317	Orange County
321267	Ordering, Referring, Prescribing	N/A	1134358401	0	0	LY, ALEX C LCSW	6/17/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102010	N/A	N/A	N/A	N/A	N/A	3030 EXPLORER DR	None	SACRAMENTO	CA	95827	2728	00	06000	38.563362	-121.332429	Sacramento County
321275	Ordering, Referring, Prescribing	N/A	1134365406	0	0	LEE, KRIS S MD	5/16/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A105009	N/A	N/A	N/A	N/A	N/A	15206 PARTHENIA ST	None	NORTH HILLS	CA	91343	5305	00	06000	34.22817313	-118.4636497	Los Angeles County
321278	Ordering, Referring, Prescribing	N/A	1134385354	0	0	LAMPA, WALTER J	11/14/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A128829	N/A	N/A	N/A	N/A	N/A	208 RICHLAND AVE	None	CERES	CA	95307	0000	00	06000	37.60456433	-120.9661617	Stanislaus County
321316	Ordering, Referring, Prescribing	N/A	1134476062	0	0	LUHRS MACDONALD, RENEE LCSW	7/17/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75169	N/A	N/A	N/A	N/A	N/A	39990 FAURE RD	None	HEMET	CA	92544	9408	00	06000	33.54540303	-116.8982524	Riverside County
321334	Ordering, Referring, Prescribing	N/A	1134495450	0	0	LIU, TIMOTHY Y MD	10/31/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A128408	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPRESSWAY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
321338	Ordering, Referring, Prescribing	N/A	1134500333	0	0	LUCERO-FUNES, CAROLINA LMFT	1/13/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT130621	N/A	N/A	N/A	N/A	N/A	200 24TH STREET	None	RICHMOND	CA	94804	1804	00	06000	37.93439778	-122.3465322	Contra Costa County
321339	Ordering, Referring, Prescribing	N/A	1134500382	0	0	LIAO, CHUNG-LING PHARMD	1/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69839	N/A	N/A	N/A	N/A	N/A	1910 N CAMPUS AVE	None	UPLAND	CA	91784	1667	00	06000	34.13230802	-117.6383398	San Bernardino County
321398	Ordering, Referring, Prescribing	N/A	1134591415	0	0	LOPEZ, THEODORE I LCSW	12/21/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88983	N/A	N/A	N/A	N/A	N/A	1533 EUCLID ST	None	SANTA MONICA	CA	90404	3306	00	06000	34.02126733	-118.4842564	Los Angeles County
321404	Ordering, Referring, Prescribing	N/A	1134596273	0	0	LEE, JOCELYN M OD	10/9/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT15331	N/A	N/A	N/A	N/A	N/A	3727 W 6TH ST.	SUITE 200	LOS ANGELES	CA	90020	5105	00	06000	34.06358655	-118.3037656	Los Angeles County
321405	Ordering, Referring, Prescribing	N/A	1134599780	0	0	LEE, JENNY PHARMD	4/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73434	N/A	N/A	N/A	N/A	N/A	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	7628	00	06000	34.17030266	-118.5881699	Los Angeles County
321432	Ordering, Referring, Prescribing	N/A	1134649742	0	0	LEE, SARAH J DO	6/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19868	N/A	N/A	N/A	N/A	N/A	555 TECHNOLOGY CT	STE 300	RIVERSIDE	CA	92507	2155	00	06000	34.00024862	-117.32403	Riverside County
321474	Ordering, Referring, Prescribing	N/A	1134720725	0	0	LE, AVA PSYD	11/18/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32161	N/A	N/A	N/A	N/A	N/A	1340 ARNOLD DR	None	MARTINEZ	CA	94553	4189	00	06000	37.99250264	-122.0983907	Contra Costa County
321481	Ordering, Referring, Prescribing	N/A	1134740194	0	0	LOGAN, HAILEY M DDS	9/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	108034	N/A	N/A	N/A	N/A	N/A	10300 COMPTON AVE	None	LOS ANGELES	CA	90002	3628	00	06000	33.94274917	-118.2461916	Los Angeles County
321485	Ordering, Referring, Prescribing	N/A	1134746936	0	0	LIU, JERRY DDS	5/11/2023	Taxonomy not applicable	NA	n/a	000	Unknown	105887	N/A	N/A	N/A	N/A	N/A	19969 GREENLEY RD	C AND D	SONORA	CA	95370	5908	00	06000	37.98497262	-120.3669198	Tuolumne County
321488	Ordering, Referring, Prescribing	N/A	1134751886	0	0	LU, TIFFANY E LMFT	1/24/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	137396	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
321513	Ordering, Referring, Prescribing	N/A	1134842479	0	0	LI, DAN YING PA	10/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61744	N/A	N/A	N/A	N/A	N/A	3431 TARAVAL ST	None	SAN FRANCISCO	CA	94116	2050	00	06000	37.74176633	-122.5030059	San Francisco County
321517	Ordering, Referring, Prescribing	N/A	1134765191	0	0	LEE, DANIEL PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80551	N/A	N/A	N/A	N/A	N/A	3201 W 6TH ST	None	LOS ANGELE	CA	90020	5001	00	06000	34.0636545	-118.2922515	Los Angeles County
321518	Ordering, Referring, Prescribing	N/A	1134842461	0	0	LEE, YENNA OD	9/5/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT35275	N/A	N/A	N/A	N/A	N/A	2581 CHINO HILLS PKWY	None	CHINO HILLS	CA	91709	5117	00	06000	33.98493569	-117.7477262	San Bernardino County
321519	Ordering, Referring, Prescribing	N/A	1134873706	0	0	LOBALBO, ASHLEIGH PA	3/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60902	N/A	N/A	N/A	N/A	N/A	303 SACRAMENTO ST	None	VALLEJO	CA	94590	5901	00	06000	38.09964602	-122.2583497	Solano County
321522	Ordering, Referring, Prescribing	N/A	1134888423	0	0	LERNER, BRIAN LCSW	11/15/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	105537	N/A	N/A	N/A	N/A	N/A	1250 MORENA BLVD	None	SAN DIEGO	CA	92110	3815	00	06000	32.76963745	-117.2036361	San Diego County
321523	Ordering, Referring, Prescribing	N/A	1134880974	0	0	LAM, JUDY T PHARMD	12/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85758	N/A	N/A	N/A	N/A	N/A	555 E CALAVERAS BLVD	None	MILPITAS	CA	95035	0000	00	06000	37.43317076	-121.8957393	Santa Clara County
321527	Ordering, Referring, Prescribing	N/A	1134953847	0	0	LI, JENNIFER JIE YING PHARMD	8/22/2024	Taxonomy not applicable	NA	n/a	000	Unknown	89933	N/A	N/A	N/A	N/A	N/A	975 SERENO DR	None	VALLEJO	CA	94589	2441	00	06000	38.12828446	-122.24821	Solano County
321539	Ordering, Referring, Prescribing	N/A	1144080946	0	0	LUNA, STACY V NP	3/14/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029456	N/A	N/A	N/A	N/A	N/A	8902 WOODMAN AVE	None	ARLETA	CA	91331	6401	00	06000	34.23141203	-118.4374526	Los Angeles County
321551	Ordering, Referring, Prescribing	N/A	1144248527	0	0	LOREDO, ABEL C	10/31/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D32482	N/A	N/A	N/A	N/A	N/A	20601 WEST PAOLI LANE	# 486	WEIMAR	CA	95736	0486	00	06000	39.03521526	-120.9755343	Placer County
321569	Ordering, Referring, Prescribing	N/A	1144303876	0	0	LEE, ANGELA Y LCSW	12/15/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26230	N/A	N/A	N/A	N/A	N/A	21081 S WESTERN AVE	SUITE 295	TORRANCE	CA	90501	0000	00	06000	33.83886841	-118.3093605	Los Angeles County
321596	Ordering, Referring, Prescribing	N/A	1144354739	0	0	LIM, ELLEN L NP	8/26/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	403391	N/A	N/A	N/A	N/A	N/A	406 S MAIN ST	None	SANTA ANA	CA	92401	5712	00	06000	33.742008	-117.8677165	Orange County
321618	Ordering, Referring, Prescribing	N/A	1144416561	0	0	LE, PAUL T PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59966	N/A	N/A	N/A	N/A	N/A	12254 BELLFLOWER BLVD	None	DOWNEY	CA	90242	2804	00	06000	33.921405	-118.125323	Los Angeles County
321621	Ordering, Referring, Prescribing	N/A	1144418567	0	0	LE, DIANNE T	10/20/1998	Taxonomy not applicable	NA	n/a	099	DENTIST	D45281	N/A	N/A	N/A	N/A	N/A	1070 E RAMSEY ST	None	BANNING	CA	92220	5924	00	06000	33.92534349	-116.8644555	Riverside County
321628	Ordering, Referring, Prescribing	N/A	1144450057	0	0	LOPEZ-GLASS, ARLENE	12/16/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA20312	N/A	N/A	N/A	N/A	N/A	10300 COMPTON AVENUE	None	LOS ANGELES	CA	90002	3628	00	06000	33.94274917	-118.2461916	Los Angeles County
321656	Ordering, Referring, Prescribing	N/A	1144507518	0	0	LAC LIU, VAN T PHARMD	3/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	58947	N/A	N/A	N/A	N/A	N/A	3150 FOSTORIA WAY	None	DANVILLE	CA	94526	5553	00	06000	37.78145555	-121.9725562	Contra Costa County
321667	Ordering, Referring, Prescribing	N/A	1144520396	0	0	LOPEZ, SARAH G MD	3/20/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A114022	N/A	N/A	N/A	N/A	N/A	214 E WALNUT ST	None	SANTA ANA	CA	92701	5896	00	06000	33.74436237	-117.8656067	Orange County
321674	Ordering, Referring, Prescribing	N/A	1144531450	0	0	LOPEZ, DANIELLE A MD	6/15/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A109895	N/A	N/A	N/A	N/A	N/A	4800 E LOS COYOTES DIAGO	None	LONG BEACH	CA	90815	2827	00	06000	33.79304077	-118.1378147	Los Angeles County
321687	Ordering, Referring, Prescribing	N/A	1144574732	0	0	LAM, LY P OD	2/26/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	33646	N/A	N/A	N/A	N/A	N/A	8190 MANGO AVE.	None	FONTANA	CA	92335	3610	00	06000	34.10497032	-117.4314648	San Bernardino County
321717	Ordering, Referring, Prescribing	N/A	1144618760	0	0	LOYA, PAUL E LMFT	4/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125363	N/A	N/A	N/A	N/A	N/A	47825 OASIS ST	None	INDIO	CA	92201	6950	00	06000	33.70112861	-116.2209066	Riverside County
321752	Ordering, Referring, Prescribing	N/A	1144667353	0	0	LIN, YI-JU LMFT	4/9/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	98570	N/A	N/A	N/A	N/A	N/A	851 FREMONT AVE	102	LOS ALTOS	CA	94024	5698	00	06000	37.35551243	-122.0908419	Santa Clara County
321765	Ordering, Referring, Prescribing	N/A	1144683269	0	0	LIN, LIU YI MD	5/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A172720	N/A	N/A	N/A	N/A	N/A	2344 SIXTH STREET	None	BERKELEY	CA	94710	2412	00	06000	37.86198466	-122.295766	Alameda County
321775	Ordering, Referring, Prescribing	N/A	1144697517	0	0	LO, LEE LCSW	12/15/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW106175	N/A	N/A	N/A	N/A	N/A	1360 E LASSEN AVE	None	CHICO	CA	95973	7823	00	06000	39.77359746	-121.8420053	Butte County
321779	Ordering, Referring, Prescribing	N/A	1144701152	0	0	LOPEZ, KARISSA LMFT	9/25/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127902	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
321783	Ordering, Referring, Prescribing	N/A	1144711490	0	0	LOPEZ GONZALEZ, ITZEL S LMFT	4/29/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125794	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVENUE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
321794	Ordering, Referring, Prescribing	N/A	1144716770	0	0	LEE, ROBI ANGELA C PHARMD	4/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	77011	N/A	N/A	N/A	N/A	N/A	480 N MCKINLEY ST	None	CORONA	CA	92879	1291	00	06000	33.886881	-117.5245245	Riverside County
321805	Ordering, Referring, Prescribing	N/A	1144733296	0	0	LESTARI, CRYSTAL PHARMD	8/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77062	N/A	N/A	N/A	N/A	N/A	82955 AVENUE 48	None	INDIO	CA	92201	6757	00	06000	33.70028627	-116.2170761	Riverside County
321811	Ordering, Referring, Prescribing	N/A	1144733676	0	0	LANDIS, SARAH E PA-C	11/6/2020	Taxonomy not applicable	NA	n/a	000	Unknown	58826	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
321812	Ordering, Referring, Prescribing	N/A	1144738212	0	0	LUONG, DAVID C PHARMD	7/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82262	N/A	N/A	N/A	N/A	N/A	2900 N. MAIN ST	None	WALNUT CREEK	CA	94597	2035	00	06000	37.92721212	-122.0621121	Contra Costa County
321839	Ordering, Referring, Prescribing	N/A	1144778838	0	0	LOPEZ, MARIA LCSW	11/7/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW103918	N/A	N/A	N/A	N/A	N/A	2008 N GAREY AVE	None	POMONA	CA	91767	2722	00	06000	34.08295003	-117.7528173	Los Angeles County
321849	Ordering, Referring, Prescribing	N/A	1144792680	0	0	LAWRENCE-FERREIRA, MEGAN R LMFT	4/26/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132506	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	207	SANTA ROSA	CA	95407	5478	00	06000	38.425266	-122.749875	Sonoma County
321854	Ordering, Referring, Prescribing	N/A	1144801440	0	0	LEHMAN, LANCE T MD	5/19/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A186392	N/A	N/A	N/A	N/A	N/A	3800 W CHAPMAN AVE	500	ORANGE	CA	92868	1638	00	06000	33.78885849	-117.8950802	Orange County
321863	Ordering, Referring, Prescribing	N/A	1144805508	0	0	LY, BAO G PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH84130	N/A	N/A	N/A	N/A	N/A	1799 MARLOW RD	None	SANTA ROSA	CA	95401	4474	00	06000	38.452095	-122.752836	Sonoma County
321867	Ordering, Referring, Prescribing	N/A	1144812124	0	0	LOPEZ, ESMERALDA P NP	9/11/2024	Taxonomy not applicable	NA	n/a	000	Unknown	95032111	N/A	N/A	N/A	N/A	N/A	1 HOPE DR	None	TUSTIN	CA	92782	0221	00	06000	33.71470753	-117.8323965	Orange County
321874	Ordering, Referring, Prescribing	N/A	1144831488	0	0	LISKOW, TAYLOR A LMFT	9/8/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134644	N/A	N/A	N/A	N/A	N/A	1231 E DYER RD	135	SANTA ANA	CA	92705	5643	00	06000	33.710643	-117.856773	Orange County
321878	Ordering, Referring, Prescribing	N/A	1144836099	0	0	LEDERACH, JOSHUA A LMFT	10/7/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT138566	N/A	N/A	N/A	N/A	N/A	700 FREDERICK ST	None	SANTA CRUZ	CA	95062	2239	00	06000	36.98031434	-122.004438	Santa Cruz County
321888	Ordering, Referring, Prescribing	N/A	1144846957	0	0	LEE, AH RIM PHARMD	8/26/2020	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81449	N/A	N/A	N/A	N/A	N/A	99 N LA CIENEGA BLVD STE	STE 200	BEVERLY HILLS	CA	90211	2285	00	06000	34.06736471	-118.3763201	Los Angeles County
321891	Ordering, Referring, Prescribing	N/A	1144856881	0	0	LE, CATHERINE	4/4/2024	Taxonomy not applicable	NA	n/a	000	Unknown	482698	N/A	N/A	N/A	N/A	N/A	6578 SANTA TERESA BLVD	None	SAN JOSE	CA	95119	1204	00	06000	37.23369777	-121.7881115	Santa Clara County
321898	Ordering, Referring, Prescribing	N/A	1144866492	0	0	LEWIS, JACLYN LMFT	9/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122094	N/A	N/A	N/A	N/A	N/A	1007 MYRTLE AVE.	None	INGLEWOOD	CA	90301	4009	00	06000	33.95067513	-118.3491758	Los Angeles County
321917	Ordering, Referring, Prescribing	N/A	1144936576	0	0	LAMBA, CHETAN NP	1/24/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024010	N/A	N/A	N/A	N/A	N/A	4151 MEXICALI DR	None	BAKERSFIELD	CA	93313	2065	00	06000	35.317233	-119.081649	Kern County
321930	Ordering, Referring, Prescribing	N/A	1144976176	0	0	LIN, LILI NP	2/22/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020088	N/A	N/A	N/A	N/A	N/A	3030 EXPLORER DRIVE	None	SACRAMENTO	CA	95827	2728	00	06000	38.563362	-121.332429	Sacramento County
321938	Ordering, Referring, Prescribing	N/A	1144984667	0	0	LUI, RANDY Y PHARMD	10/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85467	N/A	N/A	N/A	N/A	N/A	25 POINT LOBOS AVE	None	SAN FRANCISCO	CA	94121	1530	00	06000	37.77965192	-122.503515	San Francisco County
321946	Ordering, Referring, Prescribing	N/A	1154034403	0	0	LIANG, LI CNP	9/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022509	N/A	N/A	N/A	N/A	N/A	14335 PIPELINE AVE	A-1	CHINO	CA	91710	5642	00	06000	33.99328331	-117.7151702	San Bernardino County
321959	Ordering, Referring, Prescribing	N/A	1154063501	0	0	LIU, CLAIRE	11/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A191456	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	8	TORRANCE	CA	90509	7360	00	06000	33.83155851	-118.2920625	Los Angeles County
321979	Ordering, Referring, Prescribing	N/A	1154307494	0	0	LEE, WHINGMING M	5/11/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	D50158	N/A	N/A	N/A	N/A	N/A	19969 GREENLEY RD	STE BD	SONORA	CA	95370	5908	00	06000	37.98497262	-120.3669198	Tuolumne County
321983	Ordering, Referring, Prescribing	N/A	1154314037	0	0	LOFHOLM, PAUL W PHARMD	11/13/2018	Taxonomy not applicable	NA	n/a	000	Unknown	23701	N/A	N/A	N/A	N/A	N/A	8 DIGITAL DRIVE	200	NOVATO	CA	94949	8705	00	06000	38.07023457	-122.5339008	Marin County
322007	Ordering, Referring, Prescribing	N/A	1154408854	0	0	LILLY, ADRIANA LCSW	5/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	21383	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	SUITE 2	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
322010	Ordering, Referring, Prescribing	N/A	1154415495	0	0	LUBIANKER, LEON MD	1/9/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G33660	N/A	N/A	N/A	N/A	N/A	9460 N NAME UNO	210	GILROY	CA	95020	3532	00	06000	37.037781	-121.570965	Santa Clara County
322015	Ordering, Referring, Prescribing	N/A	1154427144	0	0	LOGAN, DEIRDRE D MD	5/4/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A69173	N/A	N/A	N/A	N/A	N/A	1031 W 34TH ST	None	LOS ANGELES	CA	90089	3602	00	06000	34.024005	-118.2895875	Los Angeles County
322047	Ordering, Referring, Prescribing	N/A	1154494664	0	0	LEW, LAURA L PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51075	N/A	N/A	N/A	N/A	N/A	275 HOSPITAL PKWY	625	SAN JOSE	CA	95119	1106	00	06000	37.23951066	-121.8013511	Santa Clara County
322057	Ordering, Referring, Prescribing	N/A	1154507440	0	0	LEE, ANDREW MD	12/7/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A91324	N/A	N/A	N/A	N/A	N/A	16350 FILBERT ST	None	SYLMAR	CA	91342	0000	00	06000	34.31595736	-118.4853828	Los Angeles County
322063	Ordering, Referring, Prescribing	N/A	1154518322	0	0	LEMKE, KARA PHD	12/28/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY24481	N/A	N/A	N/A	N/A	N/A	3180 CROW CANYON PLACE	SUITE 255	SAN RAMON	CA	94583	1118	00	06000	37.77546801	-121.9719489	Contra Costa County
322106	Ordering, Referring, Prescribing	N/A	1154604106	0	0	LAU, RAYMOND Y	7/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60769	N/A	N/A	N/A	N/A	N/A	1333 BROADWAY	None	OAKLAND	CA	94612	1333	00	06000	37.80397489	-122.2714485	Alameda County
322108	Ordering, Referring, Prescribing	N/A	1154606747	0	0	LEE, LINH T PHARMD	3/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	64350	N/A	N/A	N/A	N/A	N/A	2220 E WILLOW STREET	None	SIGNAL HILL	CA	90755	9075	00	06000	33.8043027	-118.164737	Los Angeles County
322114	Ordering, Referring, Prescribing	N/A	1154609949	0	0	LABBE, SUSANNAH R NP	2/25/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	20881	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
322119	Ordering, Referring, Prescribing	N/A	1154619955	0	0	LOCASCIO, TERESA	9/8/2020	Taxonomy not applicable	NA	n/a	000	Unknown	109834	N/A	N/A	N/A	N/A	N/A	2769 VALENCIA RD	None	APTOS	CA	95003	9616	00	06000	36.99342082	-121.8642485	Santa Cruz County
322132	Ordering, Referring, Prescribing	N/A	1154645059	0	0	LEE, YISHAN LAC	12/3/2018	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC12729	N/A	N/A	N/A	N/A	N/A	5925 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	8537	00	06000	37.68360997	-121.8990082	Alameda County
322146	Ordering, Referring, Prescribing	N/A	1154677516	0	0	LOGAN, MEGHAN S LMFT	4/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT98536	N/A	N/A	N/A	N/A	N/A	47825 OASIS ST	None	INDIO	CA	92201	6950	00	06000	33.70112861	-116.2209066	Riverside County
322167	Ordering, Referring, Prescribing	N/A	1154714111	0	0	LEE, CATHERINE MD	10/18/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162782	N/A	N/A	N/A	N/A	N/A	1030 W WARNER AVE	None	SANTA ANA	CA	92707	3147	00	06000	33.71597598	-117.8819134	Orange County
322173	Ordering, Referring, Prescribing	N/A	1154718781	0	0	LE, ANA R LCSW	9/25/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85993	N/A	N/A	N/A	N/A	N/A	2023 VALE ROAD	None	SAN PABLO	CA	94806	3834	00	06000	37.95369824	-122.3378493	Contra Costa County
322175	Ordering, Referring, Prescribing	N/A	1154724748	0	0	LE, STEFANIE T PHARMD	5/7/2019	Taxonomy not applicable	NA	n/a	000	Unknown	53425	N/A	N/A	N/A	N/A	N/A	8120 TIMBERLAKE WAY	108	SACRAMENTO	CA	95823	5412	00	06000	38.461023	-121.41414	Sacramento County
322180	Ordering, Referring, Prescribing	N/A	1154736809	0	0	LIU, ANNA S PHARMD	7/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	43080	N/A	N/A	N/A	N/A	N/A	9843 CORTINO WAY	None	ELK GROVE	CA	95757	3048	00	06000	38.398905	-121.4253675	Sacramento County
322200	Ordering, Referring, Prescribing	N/A	1154763209	0	0	LESKO, JILLIAN M NP	3/19/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	APRN9344038	N/A	N/A	N/A	N/A	N/A	104 1 RANCH ROAD	None	WADSWORTH	NV	89442	0000	00	06000	39.63129365	-119.2959314	Washoe County
322242	Ordering, Referring, Prescribing	N/A	1154839629	0	0	LIU, JOY LMFT	8/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120843	N/A	N/A	N/A	N/A	N/A	11429 VALLEY BLVD	None	EL MONTE	CA	91731	3229	00	06000	34.06953065	-118.0288485	Los Angeles County
322285	Ordering, Referring, Prescribing	N/A	1154897262	0	0	LENHARDT, JENA LMFT	1/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	54050	N/A	N/A	N/A	N/A	N/A	1889 LAWRENCE RD	None	SANTA CLARA	CA	95051	2162	00	06000	37.35761102	-121.9947195	Santa Clara County
322293	Ordering, Referring, Prescribing	N/A	1154938017	0	0	LOVELESS, BRIAN LMFT	12/23/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	142523	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
322337	Ordering, Referring, Prescribing	N/A	1164021481	0	0	LAFRAUGH, AUDREY L	10/20/2020	Taxonomy not applicable	NA	n/a	000	Unknown	58740	N/A	N/A	N/A	N/A	N/A	5385 FRANKLIN BLVD	SUITE A-D	SACRAMENTO	CA	95820	0000	00	06000	38.526282	-121.471398	Sacramento County
322342	Ordering, Referring, Prescribing	N/A	1164023347	0	0	LEWIS, WENDY P PA-C	3/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60956	N/A	N/A	N/A	N/A	N/A	1971 E 4TH ST	200	SANTA ANA	CA	92705	3917	00	06000	33.7482685	-117.83934	Orange County
322349	Ordering, Referring, Prescribing	N/A	1164035622	0	0	LENT, MALLORY PT	10/11/2022	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	298903	N/A	N/A	N/A	N/A	N/A	111 RALEY BLVD	140	CHICO	CA	95928	8351	00	06000	39.71601447	-121.790817	Butte County
322353	Ordering, Referring, Prescribing	N/A	1164042768	0	0	LIODAKIS, RACHEL MD	6/24/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A185896	N/A	N/A	N/A	N/A	N/A	1333 MERIDIAN AVE	None	SAN JOSE	CA	95125	5212	00	06000	37.30176	-121.9136465	Santa Clara County
322372	Ordering, Referring, Prescribing	N/A	1164076774	0	0	LEE, HYUNGWON LAC	7/18/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC18592	N/A	N/A	N/A	N/A	N/A	8352 COMMONWEALTH AVE	None	BUENA PARK	CA	90621	2526	00	06000	33.8698947	-117.9872467	Orange County
322377	Ordering, Referring, Prescribing	N/A	1164078903	0	0	LIU, JACQUELINE PHARMD	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78676	N/A	N/A	N/A	N/A	N/A	1425 SOUTH MAIN ST	None	WALNUT CREEK	CA	94596	5300	00	06000	37.89189148	-122.057999	Contra Costa County
322388	Ordering, Referring, Prescribing	N/A	1164092656	0	0	LAWAL, HALIMA A NP	4/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95017227	N/A	N/A	N/A	N/A	N/A	500 B JEFFERSON BLVD	None	W SACRAMENTO	CA	95605	2349	00	06000	38.58758543	-121.5270475	Yolo County
322390	Ordering, Referring, Prescribing	N/A	1164115960	0	0	LANG, JENNIFER	6/2/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87708	N/A	N/A	N/A	N/A	N/A	6520 S MOONEY BLVD	None	VISALIA	CA	93277	9529	00	06000	36.271125	-119.3119785	Tulare County
322395	Ordering, Referring, Prescribing	N/A	1164117917	0	0	LOPEZ, IRVING E LCSW	9/6/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW110337	N/A	N/A	N/A	N/A	N/A	250 S G ST	None	SAN BERNARDINO	CA	92410	3320	00	06000	34.09693522	-117.2986838	San Bernardino County
322397	Ordering, Referring, Prescribing	N/A	1164111340	0	0	LAU, ISABEL DMD	4/25/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108731	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
322436	Ordering, Referring, Prescribing	N/A	1164497319	0	0	LEE, JAI GOO	12/27/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	103634	N/A	N/A	N/A	N/A	N/A	925 BEVINS CT	None	LAKEPORT	CA	95453	9754	00	06000	39.03772106	-122.9223338	Lake County
322440	Ordering, Referring, Prescribing	N/A	1164505012	0	0	LUM, EVA Y PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	39136	N/A	N/A	N/A	N/A	N/A	8010 PARKWAY DR	None	LA MESA	CA	91942	2104	00	06000	32.7749024	-117.0246371	San Diego County
322458	Ordering, Referring, Prescribing	N/A	1164539151	0	0	LOWNSBERY, STEVEN P LMFT	6/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	31363	N/A	N/A	N/A	N/A	N/A	2115 THE ALAMEDA	None	SAN JOSE	CA	95126	4111	00	06000	37.34363007	-121.9292295	Santa Clara County
322478	Ordering, Referring, Prescribing	N/A	1164563755	0	0	LIM, CHRISTOPHER M	1/4/2001	Taxonomy not applicable	NA	n/a	099	DENTIST	D46638	N/A	N/A	N/A	N/A	N/A	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14893664	-122.2178101	Tehama County
322484	Ordering, Referring, Prescribing	N/A	1164575700	0	0	LEE, JAE D PHARMD	4/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51559	N/A	N/A	N/A	N/A	N/A	25821 S VERMONT AVE	4TH FLOOR	HARBOR CITY	CA	90710	3518	00	06000	33.78934581	-118.2936765	Los Angeles County
322488	Ordering, Referring, Prescribing	N/A	1164586046	0	0	LICHTENSTEIN, JONATHAN D PSYD	12/21/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	23165	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVENUE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
322499	Ordering, Referring, Prescribing	N/A	1164606117	0	0	LEWIS, CLAUDIA RDH	1/11/2023	Taxonomy not applicable	NA	n/a	000	Unknown	8874	N/A	N/A	N/A	N/A	N/A	2965 EAST ST	None	ANDERSON	CA	96007	3481	00	06000	40.45154834	-122.2986846	Shasta County
322501	Ordering, Referring, Prescribing	N/A	1164613899	0	0	LIBERSTEIN, ALLA MD	1/27/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A100462	N/A	N/A	N/A	N/A	N/A	365 N PEARSON DRIVE	SUITE 5	PORTERVILLE	CA	93257	3305	00	06000	36.07242539	-119.0276799	Tulare County
322523	Ordering, Referring, Prescribing	N/A	1164647525	0	0	LAMBERT, REKHA LMFT	4/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT103862	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95240	0000	00	06000	37.96681769	-121.2881382	San Joaquin County
322531	Ordering, Referring, Prescribing	N/A	1164670394	0	0	LLAMAS, LINDA M LMFT	4/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43892	N/A	N/A	N/A	N/A	N/A	17800 HIGHWAY 18	None	APPLE VALLEY	CA	92307	0004	00	06000	34.54007429	-117.2744761	San Bernardino County
322536	Ordering, Referring, Prescribing	N/A	1164702361	0	0	LEON, CRISTINA LCSW	2/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85822	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE.	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
322560	Ordering, Referring, Prescribing	N/A	1164716445	0	0	LINDSTROM, BRAD H	10/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH36668	N/A	N/A	N/A	N/A	N/A	20261 HWY 18	None	APPLE VALLEY	CA	92307	2953	00	06000	34.52556433	-117.2198711	San Bernardino County
322563	Ordering, Referring, Prescribing	N/A	1164723078	0	0	LEW, WILSON PHARMD	3/30/2018	Taxonomy not applicable	NA	n/a	000	Unknown	42008	N/A	N/A	N/A	N/A	N/A	550 E BASELINE RD	None	CLAREMONT	CA	91711	2236	00	06000	34.12158852	-117.7059825	Los Angeles County
322613	Ordering, Referring, Prescribing	N/A	1164821146	0	0	LOZANO, CHARISSE C PHARMD	11/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67027	N/A	N/A	N/A	N/A	N/A	5205 MELROSE AVE	None	LOS ANGELES	CA	90038	3144	00	06000	34.08354051	-118.314009	Los Angeles County
322630	Ordering, Referring, Prescribing	N/A	1164841615	0	0	LYMATH, BREANN LMFT	11/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109434	N/A	N/A	N/A	N/A	N/A	3725 TAYLOR ROAD	SUITE 1	LOOMIS	CA	95650	9283	00	06000	38.81963826	-121.1950015	Placer County
322632	Ordering, Referring, Prescribing	N/A	1164843652	0	0	LOGAN, DANIELLE R LMFT	7/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111295	N/A	N/A	N/A	N/A	N/A	300 MONTGOMERY ST	STE 204	SAN FRANCISCO	CA	94104	1902	00	06000	37.7923269	-122.4026145	San Francisco County
322634	Ordering, Referring, Prescribing	N/A	1164846689	0	0	LOCKE, JESSICA MSW LCSW	7/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW73369	N/A	N/A	N/A	N/A	N/A	2121 W TEMPLE ST	None	LOS ANGELES	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
322642	Ordering, Referring, Prescribing	N/A	1164870796	0	0	LUONG, ALEXANDER S PHARMD	4/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73163	N/A	N/A	N/A	N/A	N/A	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	00	06000	37.23948065	-121.8005798	Santa Clara County
322657	Ordering, Referring, Prescribing	N/A	1164897369	0	0	LOO, SHERWIN Y Y DC	12/12/2016	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	33421	N/A	N/A	N/A	N/A	N/A	4600 PANAMA LN	STE 102B	BAKERSFIELD	CA	93313	3509	00	06000	35.29596129	-119.0543102	Kern County
322659	Ordering, Referring, Prescribing	N/A	1164899514	0	0	LA, CINDY PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73149	N/A	N/A	N/A	N/A	N/A	1472 OLWYN DRIVE	None	TUSTIN	CA	92780	3835	00	06000	33.74235545	-117.8070312	Orange County
322681	Ordering, Referring, Prescribing	N/A	1164935086	0	0	LUNEAU, PAIGE NP	12/21/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008035	N/A	N/A	N/A	N/A	N/A	4575 COLLEGE AVENUE	None	SAN DIEGO	CA	92115	4011	00	06000	32.76023438	-117.0667611	San Diego County
322699	Ordering, Referring, Prescribing	N/A	1164963385	0	0	LOZANO, RAFAEL MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158486	N/A	N/A	N/A	N/A	N/A	2170 SOUTH AVENUE	None	SOUTH LAKE TAHOE	CA	96150	7008	00	06000	38.91229842	-119.9978133	El Dorado County
322726	Ordering, Referring, Prescribing	N/A	1164993739	0	0	LAMB, SAUNDRA L	11/30/2018	Taxonomy not applicable	NA	n/a	000	Unknown	56329	N/A	N/A	N/A	N/A	N/A	263 S WEST ST	None	TULARE	CA	93274	3411	00	06000	36.20460711	-119.3668926	Tulare County
322727	Ordering, Referring, Prescribing	N/A	1174010896	0	0	LWIN, THUTHIRI MD	2/2/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173351	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
322754	Ordering, Referring, Prescribing	N/A	1174056410	0	0	LAPONZA, JAMES PHARMD	10/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	49549	N/A	N/A	N/A	N/A	N/A	30251 MURRIETA RD	None	MENIFEE	CA	92584	8385	00	06000	33.684399	-117.2060495	Riverside County
322757	Ordering, Referring, Prescribing	N/A	1174046742	0	0	LOPEZ, SIERRA LCSW	3/24/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114537	N/A	N/A	N/A	N/A	N/A	4820 BUSINESS CENTER DR	210	SACRAMENTO	CA	94534	1696	00	06000	38.22055392	-122.1386622	Solano County
322803	Ordering, Referring, Prescribing	N/A	1174140727	0	0	LEMOS, MARILU LMFT	10/28/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	150949	N/A	N/A	N/A	N/A	N/A	520 E TULARE AVE	None	VISALIA	CA	93291	3426	00	06000	36.320679	-119.2870845	Tulare County
322817	Ordering, Referring, Prescribing	N/A	1174155170	0	0	LONG, PHILLIP B PHARMD	10/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81088	N/A	N/A	N/A	N/A	N/A	3131 W HAMMER LN	None	STOCKTON	CA	95209	2747	00	06000	38.02143649	-121.3555455	San Joaquin County
322832	Ordering, Referring, Prescribing	N/A	1174184170	0	0	LU, CHU YING	1/26/2023	Taxonomy not applicable	NA	n/a	000	Unknown	76627	N/A	N/A	N/A	N/A	N/A	1601 COLEMAN AVE	None	SANTA CLARA	CA	95050	3122	00	06000	37.35814451	-121.93908	Santa Clara County
322835	Ordering, Referring, Prescribing	N/A	1174213292	0	0	LELINA, MARISSA A	3/13/2023	Taxonomy not applicable	NA	n/a	000	Unknown	87772	N/A	N/A	N/A	N/A	N/A	1138 W TENNYSON RD	None	HAYWARD	CA	94544	4422	00	06000	37.63123947	-122.076639	Alameda County
322861	Ordering, Referring, Prescribing	N/A	1174309892	0	0	LOUIE, DANNY DC	9/13/2022	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC33976	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
322882	Ordering, Referring, Prescribing	N/A	1174602510	0	0	LUBINA, PHILLIP O PHARMD	3/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	39554	N/A	N/A	N/A	N/A	N/A	2545 MAIN ST	None	OAKLEY	CA	94561	1853	00	06000	37.99795077	-121.730618	Contra Costa County
322903	Ordering, Referring, Prescribing	N/A	1174644736	0	0	LARSON, JUSTINA LMFT	8/3/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48214	N/A	N/A	N/A	N/A	N/A	137 N COTTONWOOD ST	2500	WOODLAND	CA	95695	6646	00	06000	38.68538399	-121.7933582	Yolo County
322905	Ordering, Referring, Prescribing	N/A	1174651194	0	0	LEWIS, MARLO S LCSW	1/28/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW #76409	N/A	N/A	N/A	N/A	N/A	933 MACARTHUR BLVD	D1	SAN LEANDRO	CA	94577	3062	00	06000	37.73629529	-122.140849	Alameda County
322923	Ordering, Referring, Prescribing	N/A	1174665640	0	0	LAIRD, ALLAN DC	5/30/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	33411	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
322960	Ordering, Referring, Prescribing	N/A	1174768782	0	0	LUNDELL, CAROLYN A	9/5/2014	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	SP21933	N/A	N/A	N/A	N/A	N/A	355 REDONDO AVE	None	LONG BEACH	CA	90814	2656	00	06000	33.770079	-118.1524465	Los Angeles County
322967	Ordering, Referring, Prescribing	N/A	1174783807	0	0	LAWSON, MEGAN LMFT	6/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT79104	N/A	N/A	N/A	N/A	N/A	1250 MORENA BLVD	None	SAN DIEGO	CA	92110	3815	00	06000	32.76963745	-117.2036361	San Diego County
322990	Ordering, Referring, Prescribing	N/A	1174813364	0	0	LE, HUNG MD	9/20/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A134679	N/A	N/A	N/A	N/A	N/A	15444 BROOKHURST ST	None	WESTMINSTER	CA	92683	7057	00	06000	33.7382955	-117.9547231	Orange County
323036	Ordering, Referring, Prescribing	N/A	1174885255	0	0	LUI, PRISCILLA MD	4/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145104	N/A	N/A	N/A	N/A	N/A	1625 E 4TH ST	None	LOS ANGELES	CA	90033	4201	00	06000	34.04297786	-118.2220181	Los Angeles County
323041	Ordering, Referring, Prescribing	N/A	1174894067	0	0	LI, SAREEN J NP	2/2/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95009682	N/A	N/A	N/A	N/A	N/A	729 FILBERT STREET	None	SAN FRANCISCO	CA	94133	2760	00	06000	37.80103613	-122.4119083	San Francisco County
323071	Ordering, Referring, Prescribing	N/A	1174926083	0	0	LAWSON, MARY A LMFT	7/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT100098	N/A	N/A	N/A	N/A	N/A	864 E. SANTA CLARA STREE	None	VENTURA	CA	93001	2939	00	06000	34.27952351	-119.287537	Ventura County
323078	Ordering, Referring, Prescribing	N/A	1174932370	0	0	LUNG, CHIA SHU LMFT	12/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT129695	N/A	N/A	N/A	N/A	N/A	438 N WHITE RD	None	SAN JOSE	CA	95127	1439	00	06000	37.3776149	-121.8374887	Santa Clara County
323080	Ordering, Referring, Prescribing	N/A	1174941504	0	0	LEONG, BEATRIZ V MD	4/21/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A129189	N/A	N/A	N/A	N/A	N/A	15010 FIR ST	None	HESPERIA	CA	92345	4316	00	06000	34.39236128	-117.335741	San Bernardino County
323085	Ordering, Referring, Prescribing	N/A	1174944276	0	0	LONDON, CANDACE LMFT	6/26/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131681	N/A	N/A	N/A	N/A	N/A	8300 S VERMONT AVE	None	LOS ANGELES	CA	90044	3493	00	06000	33.963021	-118.291474	Los Angeles County
323086	Ordering, Referring, Prescribing	N/A	1174947006	0	0	LE, DIEM H PHARMD	7/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69488	N/A	N/A	N/A	N/A	N/A	1726 SUPERIOR AVE	None	COSTA MESA	CA	92627	3615	00	06000	33.63718326	-117.9226045	Orange County
323114	Ordering, Referring, Prescribing	N/A	1174983027	0	0	LHEUREUX, APRIL LMFT	8/27/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	28536	N/A	N/A	N/A	N/A	N/A	12835 POINTE DEL MAR WAY	1	DEL MAR	CA	92014	3846	00	06000	32.93216216	-117.2433492	San Diego County
323128	Ordering, Referring, Prescribing	N/A	1174995583	0	0	LONG, CHANNARY PHARMD	2/7/2019	Taxonomy not applicable	NA	n/a	000	Unknown	73690	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	None	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
323130	Ordering, Referring, Prescribing	N/A	1174999171	0	0	LOYOLA, ELIZABETH S PSYD	11/17/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	29471	N/A	N/A	N/A	N/A	N/A	3331 POWER INN ROAD	SUITE 140	SACRAMENTO	CA	95826	3889	00	06000	38.543391	-121.4077095	Sacramento County
323138	Ordering, Referring, Prescribing	N/A	1184006587	0	0	LARRIMORE, AYANNA Z LPCC	3/31/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC6654	N/A	N/A	N/A	N/A	N/A	8750 MOUNTAIN BLVD	None	OAKLAND	CA	94605	4500	00	06000	37.76618305	-122.1517347	Alameda County
323141	Ordering, Referring, Prescribing	N/A	1184016180	0	0	LAZAROVITS, ROSA MARIA LMFT	2/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103853	N/A	N/A	N/A	N/A	N/A	1100 W GONZALES RD	None	OXNARD	CA	93036	3336	00	06000	34.21910048	-119.1907575	Ventura County
323158	Ordering, Referring, Prescribing	N/A	1184034654	0	0	LEONARD, ADAM J CNP	9/17/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000965	N/A	N/A	N/A	N/A	N/A	134 GOLDEN GATE AVE	None	SAN FRANCISCO	CA	94102	3810	00	06000	37.78204768	-122.4129337	San Francisco County
323185	Ordering, Referring, Prescribing	N/A	1184074114	0	0	LONG-CHAN, SAMANTHA N LCSW	12/3/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	105917	N/A	N/A	N/A	N/A	N/A	9412 BIG HORN BLVD	6	ELK GROVE	CA	95758	1101	00	06000	38.415861	-121.407957	Sacramento County
323192	Ordering, Referring, Prescribing	N/A	1184085243	0	0	LEVY, JARED N LMFT	5/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52577	N/A	N/A	N/A	N/A	N/A	1731 PRINCE ST	None	BERKELEY	CA	94703	2464	00	06000	37.85215034	-122.2737934	Alameda County
323203	Ordering, Referring, Prescribing	N/A	1184095564	0	0	LUTHER, JOSEPH B PHARMD	2/20/2023	Taxonomy not applicable	NA	n/a	000	Unknown	64113	N/A	N/A	N/A	N/A	N/A	652 PETALUMA AVE	SUITE I1	SEBASTOPOL	CA	95472	4256	00	06000	38.39662494	-122.8201368	Sonoma County
323205	Ordering, Referring, Prescribing	N/A	1184096620	0	0	LARSON, DARREL P CRNA	5/14/2019	Taxonomy not applicable	NA	n/a	018	NURSE ANESTHETISTS	95001164	N/A	N/A	N/A	N/A	N/A	136 S ASPEN CT	None	VISALIA	CA	93291	5175	00	06000	36.32887484	-119.3528574	Tulare County
323209	Ordering, Referring, Prescribing	N/A	1184095531	0	0	LONG, TESI	12/15/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110038	N/A	N/A	N/A	N/A	N/A	33100 COUNTY ROAD 31	None	DAVIS	CA	95616	9523	00	06000	38.562426	-121.893282	Yolo County
323217	Ordering, Referring, Prescribing	N/A	1184112864	0	0	LE, DIANA T DPM	11/22/2022	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5734	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
323238	Ordering, Referring, Prescribing	N/A	1184151367	0	0	LATOUR, AUTUMN M LMFT	5/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126135	N/A	N/A	N/A	N/A	N/A	11565 LAUREL CANYON BLVD	SUITE 118	SAN FERNANDO	CA	91340	4168	00	06000	34.28018218	-118.4549135	Los Angeles County
323265	Ordering, Referring, Prescribing	N/A	1184185043	0	0	LI, SHANPENG MD	3/4/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182410	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
323271	Ordering, Referring, Prescribing	N/A	1184196487	0	0	LEE, HYUNG MIN PHARMD	12/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80100	N/A	N/A	N/A	N/A	N/A	7095 MARKET PLACE DR	None	GOLETA	CA	93117	5905	00	06000	34.42799696	-119.873532	Santa Barbara County
323278	Ordering, Referring, Prescribing	N/A	1184221483	0	0	LAMMERS, ALICIA L LCSW	11/16/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82304	N/A	N/A	N/A	N/A	N/A	11429 VALLEY BLVD	None	EL MONTE	CA	91731	0000	00	06000	34.06953065	-118.0288485	Los Angeles County
323279	Ordering, Referring, Prescribing	N/A	1184215030	0	0	LEE, HANNAH C LCSW	10/22/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW126880	N/A	N/A	N/A	N/A	N/A	820 E GILBERT ST	None	SAN BERNARDINO	CA	92415	0928	00	06000	34.1268333	-117.2687417	San Bernardino County
323297	Ordering, Referring, Prescribing	N/A	1184254856	0	0	LA, JENNIFER H PHARMD	6/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81925	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
323299	Ordering, Referring, Prescribing	N/A	1184253940	0	0	LAM, ALDA	3/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL3997	N/A	N/A	N/A	N/A	N/A	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
323302	Ordering, Referring, Prescribing	N/A	1184266389	0	0	LEMOS, CYNTHIA R OT	12/1/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	11095	N/A	N/A	N/A	N/A	N/A	1524 MCHENRY AVE	330	MODESTO	CA	95350	4500	00	06000	37.666233	-120.993933	Stanislaus County
323321	Ordering, Referring, Prescribing	N/A	1184307076	0	0	LUTHER, MICHELLE A PT	8/4/2023	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	304503	N/A	N/A	N/A	N/A	N/A	10431 COMMERCE ST	STE A	REDLANDS	CA	92374	0110	00	06000	34.06427678	-117.2416506	San Bernardino County
323326	Ordering, Referring, Prescribing	N/A	1184333197	0	0	LAU, TRACY	4/15/2022	Taxonomy not applicable	NA	n/a	000	Unknown	81172	N/A	N/A	N/A	N/A	N/A	12155 TECH CENTER DR	None	POWAY	CA	92064	7156	00	06000	32.937048	-117.032895	San Diego County
323361	Ordering, Referring, Prescribing	N/A	1184443491	0	0	LORD, MADISON NP	7/25/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031324	N/A	N/A	N/A	N/A	N/A	3861 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4605	00	06000	34.01133074	-118.4159833	Los Angeles County
323364	Ordering, Referring, Prescribing	N/A	1184456576	0	0	LEE, YING H NP	6/10/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030457	N/A	N/A	N/A	N/A	N/A	1120 E CHURCH AVE	None	FRESNO	CA	93706	5435	00	06000	36.7140837	-119.7975576	Fresno County
323378	Ordering, Referring, Prescribing	N/A	1184629859	0	0	LEVY, BARBARA S MD	1/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G43461	N/A	N/A	N/A	N/A	N/A	1075 CAMINO DEL RIO S	None	SAN DIEGO	CA	92108	3538	00	06000	32.76444721	-117.1537188	San Diego County
323386	Ordering, Referring, Prescribing	N/A	1184684417	0	0	LEE, BRIAN S LAC	8/7/2017	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC8718	N/A	N/A	N/A	N/A	N/A	15785 LAGUNA CANYON ROAD	SUITE 330	IRVINE	CA	92618	3178	00	06000	33.66542536	-117.7615537	Orange County
323419	Ordering, Referring, Prescribing	N/A	1184759326	0	0	LIU, KAI M	1/14/2004	Taxonomy not applicable	NA	n/a	099	DENTIST	D51102	N/A	N/A	N/A	N/A	N/A	4305 UNIVERSITY AVE	STE 150	SAN DIEGO	CA	92105	1690	00	06000	32.74957853	-117.101439	San Diego County
323446	Ordering, Referring, Prescribing	N/A	1184824013	0	0	LUVIANO, GEORGINA A LMFT	12/28/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101984	N/A	N/A	N/A	N/A	N/A	2750 SUTTERVILLE RD	None	SACRAMENTO	CA	95820	1024	00	06000	38.540124	-121.4786745	Sacramento County
323454	Ordering, Referring, Prescribing	N/A	1184840472	0	0	LANDRY, KAREN	5/1/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0238231	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
323457	Ordering, Referring, Prescribing	N/A	1184848020	0	0	LENCHES, JENNIFER L LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45082	N/A	N/A	N/A	N/A	N/A	8755 AERO DR,	None	SAN DIEGO	CA	92123	0000	00	06000	32.80965252	-117.139383	San Diego County
323469	Ordering, Referring, Prescribing	N/A	1184872509	0	0	LARGE, BARBARA G LCSW	12/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS13833	N/A	N/A	N/A	N/A	N/A	501 KEARNEY ST	None	EL CERRITO	CA	94530	3520	00	06000	37.90264358	-122.3024948	Contra Costa County
323471	Ordering, Referring, Prescribing	N/A	1184871154	0	0	LYNN, RENEA PSYD	4/13/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27270	N/A	N/A	N/A	N/A	N/A	24301 SOUTHLAND DR	None	HAYWARD	CA	94545	1542	00	06000	37.65344508	-122.1045736	Alameda County
323490	Ordering, Referring, Prescribing	N/A	1184901845	0	0	LAU, JEANNETTE J	1/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	46876	N/A	N/A	N/A	N/A	N/A	2800 INDEPENDENCE DR	None	LIVERMORE	CA	94551	7628	00	06000	37.70342494	-121.8115224	Alameda County
323493	Ordering, Referring, Prescribing	N/A	1184902900	0	0	LE, DUY-PHUONG L NP	2/14/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN751472	N/A	N/A	N/A	N/A	N/A	1125 TENTH STREET	None	SACRAMENTO	CA	95814	3503	00	06000	38.57890563	-121.4939739	Sacramento County
323501	Ordering, Referring, Prescribing	N/A	1184905580	0	0	LOPEZ-SMITH, ALANA P LCSW	7/17/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	116569	N/A	N/A	N/A	N/A	N/A	485 N 1ST ST	None	SAN JOSE	CA	95112	4041	00	06000	37.34444033	-121.8968517	Santa Clara County
323533	Ordering, Referring, Prescribing	N/A	1184973067	0	0	LOCKETT, TIFFANY N PHD	10/6/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115982	N/A	N/A	N/A	N/A	N/A	1255 ALLSTON WAY	None	BERKELEY	CA	94702	1833	00	06000	37.86702492	-122.2865918	Alameda County
323553	Ordering, Referring, Prescribing	N/A	1184997462	0	0	LANE-POMPA, CINDI J LMFT	7/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115635	N/A	N/A	N/A	N/A	N/A	3628 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2153	00	06000	35.35426453	-119.045007	Kern County
323589	Ordering, Referring, Prescribing	N/A	1194068494	0	0	LANDERS, SCOTT A PHARMD	12/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH56273	N/A	N/A	N/A	N/A	N/A	1540 FROOM RANCH WAY	None	SAN LUIS OBISPO	CA	93405	7211	00	06000	35.25089426	-120.6906169	San Luis Obispo County
323599	Ordering, Referring, Prescribing	N/A	1194091165	0	0	LEEPER, CONNIE MD	3/21/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A127011	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
323601	Ordering, Referring, Prescribing	N/A	1194096818	0	0	LEW, DEXTER	7/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50808	N/A	N/A	N/A	N/A	N/A	13052 NEWPORT AVE	None	TUSTIN	CA	92780	3536	00	06000	33.74896613	-117.8112946	Orange County
323625	Ordering, Referring, Prescribing	N/A	1194146878	0	0	LILLO, MICHELLE B LMFT	2/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	41031	N/A	N/A	N/A	N/A	N/A	9864 BALDWIN PL	None	EL MONTE	CA	91731	2202	00	06000	34.07063297	-118.054303	Los Angeles County
323628	Ordering, Referring, Prescribing	N/A	1194137513	0	0	LOUGHLIN, GLENN A PHARMD	4/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	41066	N/A	N/A	N/A	N/A	N/A	2100 DR MARTIN LUTHER KI	None	CHICO	CA	95928	4422	00	06000	39.721077	-121.811508	Butte County
323632	Ordering, Referring, Prescribing	N/A	1194152082	0	0	LOUIE, JESSICA PHD	10/19/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33715	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
323649	Ordering, Referring, Prescribing	N/A	1194178004	0	0	LAMBERT, PETER MD	12/11/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192277	N/A	N/A	N/A	N/A	N/A	1990 CONCORD AVE	None	CHICO	CA	95928	9518	00	06000	39.72768476	-121.7912855	Butte County
323658	Ordering, Referring, Prescribing	N/A	1194194910	0	0	LLAMAS, JUAN C LCSW	12/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99240	N/A	N/A	N/A	N/A	N/A	658 E BRIER DR	200	SAN BERNARDINO	CA	92408	2880	00	06000	34.07137738	-117.2702805	San Bernardino County
323677	Ordering, Referring, Prescribing	N/A	1194223750	0	0	LIEU, ELIZABETH PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77186	N/A	N/A	N/A	N/A	N/A	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
323684	Ordering, Referring, Prescribing	N/A	1194235341	0	0	LOPEZ, LORI R LMFT	6/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114916	N/A	N/A	N/A	N/A	N/A	3133 N MILLBROOK AVE	None	FRESNO	CA	93703	9999	00	06000	36.77841	-119.7635455	Fresno County
323692	Ordering, Referring, Prescribing	N/A	1194245118	0	0	LAUREANO, HADAS LMFT	3/18/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	21172	N/A	N/A	N/A	N/A	N/A	4605 LANKERSHIM BLVD	720	NORTH HOLLYWOOD	CA	91602	1878	00	06000	34.15389329	-118.3679999	Los Angeles County
323694	Ordering, Referring, Prescribing	N/A	1194248005	0	0	LUU, THANH K PHARMD	7/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76530	N/A	N/A	N/A	N/A	N/A	721 GREGORY LN	None	PLEASANT HILL	CA	94523	2763	00	06000	37.94794151	-122.0819175	Contra Costa County
323704	Ordering, Referring, Prescribing	N/A	1194258707	0	0	LEONG, JEFFREY MD	2/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158987	N/A	N/A	N/A	N/A	N/A	14140 BEACH BLVD	None	WESTMINSTER	CA	92683	4453	00	06000	33.756966	-117.9894915	Orange County
323719	Ordering, Referring, Prescribing	N/A	1194285965	0	0	LEE, SO L MD	5/8/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176429	N/A	N/A	N/A	N/A	N/A	325 E 7TH ST	None	LOS ANGELES	CA	90014	2209	00	06000	34.04209386	-118.2486813	Los Angeles County
323748	Ordering, Referring, Prescribing	N/A	1194358093	0	0	LUA, MARK IAN PHARMD	8/12/2020	Taxonomy not applicable	NA	n/a	000	Unknown	82082	N/A	N/A	N/A	N/A	N/A	99 N LA CIENEGA BLVD	200	LOS ANGELES	CA	90211	0000	00	06000	34.06736471	-118.3763201	Los Angeles
323789	Ordering, Referring, Prescribing	N/A	1194590091	0	0	LIM, STEVE S LCSW	5/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122638	N/A	N/A	N/A	N/A	N/A	460 N ELM ST	None	ESCONDIDO	CA	92025	3002	00	06000	33.12850258	-117.0729169	San Diego County
323792	Ordering, Referring, Prescribing	N/A	1194581181	0	0	LOPEZ MARTINEZ, CRISTINA NP	3/28/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029618	N/A	N/A	N/A	N/A	N/A	430 S BLOSSER RD	None	SANTA MARIA	CA	93458	4908	00	06000	34.94869196	-120.4537258	Santa Barbara County
323796	Ordering, Referring, Prescribing	N/A	1194598946	0	0	LORENZANA, LAURA PA-C	2/13/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64082	N/A	N/A	N/A	N/A	N/A	107 N MCKINLEY ST	None	CORONA	CA	92879	6561	00	06000	33.88230027	-117.5145319	Riverside County
323798	Ordering, Referring, Prescribing	N/A	1194598243	0	0	LOHNES, SUZANNE NP	9/21/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95027365	N/A	N/A	N/A	N/A	N/A	678 3RD AVE	None	CHULA VISTA	CA	91910	5736	00	06000	32.62870793	-117.0750108	San Diego County
323811	Ordering, Referring, Prescribing	N/A	1194800672	0	0	LEE, KAREN H PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH48167	N/A	N/A	N/A	N/A	N/A	27107 TOURNEY RD	None	VALENCIA	CA	91355	1860	00	06000	34.41607441	-118.5761057	Los Angeles County
323816	Ordering, Referring, Prescribing	N/A	1194810002	0	0	LEE, JANNY P PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49312	N/A	N/A	N/A	N/A	N/A	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	00	06000	37.60574038	-122.0836254	Alameda County
323836	Ordering, Referring, Prescribing	N/A	1194855064	0	0	LE, GRACE PSYD	4/23/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28187	N/A	N/A	N/A	N/A	N/A	2054 S EUCLID ST	STE H #3020	ANAHEIM	CA	92802	3136	00	06000	33.79639034	-117.9412323	Orange County
323842	Ordering, Referring, Prescribing	N/A	1194862144	0	0	LECLAIRE, ANN B LMFT	8/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40097	N/A	N/A	N/A	N/A	N/A	2400 LISA LANE	None	PLEASANT HILL	CA	94523	3902	00	06000	37.94511904	-122.0512768	Contra Costa County
323844	Ordering, Referring, Prescribing	N/A	1194864363	0	0	LE, NINA N LCSW	5/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24284	N/A	N/A	N/A	N/A	N/A	769 W. BLAINE STREET	SUITE B	RIVERSIDE	CA	92507	3970	00	06000	33.98300646	-117.327555	Riverside County
323902	Ordering, Referring, Prescribing	N/A	1194964932	0	0	LUSSIER, EILEEN C PHD	4/22/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY19249	N/A	N/A	N/A	N/A	N/A	1325 E CHURCH ST	None	SANTA MARIA	CA	93454	5909	00	06000	34.95209265	-120.4147348	Santa Barbara County
323903	Ordering, Referring, Prescribing	N/A	1194973990	0	0	LIAO, LUCY P MD	6/7/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A102540	N/A	N/A	N/A	N/A	N/A	767 N. HILL STREET	SUITE 400B	LOS ANGELES	CA	90012	2381	00	06000	34.06255157	-118.2397077	Los Angeles County
323927	Ordering, Referring, Prescribing	N/A	1205035441	0	0	LOYLES, JODI B PHARMD	2/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58545	N/A	N/A	N/A	N/A	N/A	200 MUIR ROAD	None	MARTINEZ	CA	94553	3259	00	06000	37.99430233	-122.1107194	Contra Costa County
323955	Ordering, Referring, Prescribing	N/A	1205101144	0	0	LAME-ARZANI, SHAHRZAD PHARMD	3/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	41010	N/A	N/A	N/A	N/A	N/A	1051 W BURBANK BLVD	None	BURBANK	CA	91506	1421	00	06000	34.186032	-118.324359	Los Angeles County
323958	Ordering, Referring, Prescribing	N/A	1205105038	0	0	LYUBAREV, MIKHAIL NP	9/18/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	20354	N/A	N/A	N/A	N/A	N/A	4618 FOUNTAIN AVE	None	LOS ANGELES	CA	90029	1830	00	06000	34.095582	-118.290195	Los Angeles County
323962	Ordering, Referring, Prescribing	N/A	1205110475	0	0	LATCHMAN, PUJITA J LMFT	1/30/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93278	N/A	N/A	N/A	N/A	N/A	2434 MILVIA ST	OFFICE B	BERKELEY	CA	94704	1918	00	06000	37.86415096	-122.2699204	Alameda County
323965	Ordering, Referring, Prescribing	N/A	1205111879	0	0	LAW, WING CHUEN F	7/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	44604	N/A	N/A	N/A	N/A	N/A	2420 N BLACKSTONE AVE	None	FRESNO	CA	93703	1747	00	06000	36.772776	-119.790442	Fresno County
323987	Ordering, Referring, Prescribing	N/A	1205131695	0	0	LE, OANH H PHARMD	8/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	50103	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD. M	None	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
324001	Ordering, Referring, Prescribing	N/A	1205155389	0	0	LYONS, DANIEL PHARMD	2/27/2024	Taxonomy not applicable	NA	n/a	000	Unknown	55205	N/A	N/A	N/A	N/A	N/A	642 PALOMAR ST	UNIT 410	CHULA VISTA	CA	91911	2626	00	06000	32.60345042	-117.0817809	San Diego County
324018	Ordering, Referring, Prescribing	N/A	1205215720	0	0	LITTLE, SUSAN R LMFT	12/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	101038	N/A	N/A	N/A	N/A	N/A	8233 E. STOCKTON BLVD	STE D	SACRAMENTO	CA	95828	8203	00	06000	38.459628	-121.4095815	Sacramento County
324027	Ordering, Referring, Prescribing	N/A	1205227584	0	0	LISE, CHRISTIAN T LMFT	12/20/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106757	N/A	N/A	N/A	N/A	N/A	851 N OAKLAND AVE	None	PASADENA	CA	91104	4343	00	06000	34.16031813	-118.1403347	Los Angeles County
324031	Ordering, Referring, Prescribing	N/A	1205244555	0	0	LOREDO DEL TORO, YVETTE LCSW	9/27/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103069	N/A	N/A	N/A	N/A	N/A	11100 SEPULVEDA BLVD	#8	MISSION HILLS	CA	91345	1105	00	06000	34.27255732	-118.4675155	Los Angeles County
324048	Ordering, Referring, Prescribing	N/A	1205271590	0	0	LICHTE, MELISSA L MD	2/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133585	N/A	N/A	N/A	N/A	N/A	1201 ALHAMBRA BLVD	330	SACRAMENTO	CA	95816	5242	00	06000	38.570076	-121.4657145	Sacramento County
324063	Ordering, Referring, Prescribing	N/A	1205288636	0	0	LIN, NAOMI MD	9/16/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A160223	N/A	N/A	N/A	N/A	N/A	4601 DALE RD	None	MODESTO	CA	95356	9718	00	06000	37.706508	-121.052457	Stanislaus County
324064	Ordering, Referring, Prescribing	N/A	1205297033	0	0	LAGOR, KEVIN J NP	1/31/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003917	N/A	N/A	N/A	N/A	N/A	50 IVY STREET	None	SAN FRANCISCO	CA	94102	4506	00	06000	37.77797898	-122.4185591	San Francisco County
324072	Ordering, Referring, Prescribing	N/A	1205310182	0	0	LEE, DANIEL DDS	5/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	102944	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
324074	Ordering, Referring, Prescribing	N/A	1205309366	0	0	LAMBERT, NANCY F PSYD	5/19/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY23070	N/A	N/A	N/A	N/A	N/A	1 ST VINCENTS DR	None	SAN RAFAEL	CA	94901	1001	00	06000	38.034216	-122.525199	Marin County
324085	Ordering, Referring, Prescribing	N/A	1205318920	0	0	LEE, RACHAEL O NP	8/21/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009773	N/A	N/A	N/A	N/A	N/A	1900 T STREET	None	SACRAMENTO	CA	95811	6822	00	06000	38.56595297	-121.4859736	Sacramento County
324092	Ordering, Referring, Prescribing	N/A	1205329893	0	0	LUND, ERIN R MSW LCSW	3/18/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121639	N/A	N/A	N/A	N/A	N/A	7171 BOWLING DR	300	SACRAMENTO	CA	95823	2034	00	06000	38.497527	-121.455297	Sacramento County
324094	Ordering, Referring, Prescribing	N/A	1205328184	0	0	LI, YULINGLONG LPCC	7/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	11917	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE.	SUITE 300	SAN JOSE	CA	95128	2680	00	06000	37.3160785	-121.937121	Santa Clara County
324098	Ordering, Referring, Prescribing	N/A	1205335536	0	0	LI, QIUTING LMFT	1/18/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT130670	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE	STE#300	SAN JOSE	CA	95128	2860	00	06000	37.3160785	-121.937121	Santa Clara County
324129	Ordering, Referring, Prescribing	N/A	1205380748	0	0	LA, JULIE PHARMD	3/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74831	N/A	N/A	N/A	N/A	N/A	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1700	00	06000	34.03781261	-118.3755101	Los Angeles County
324130	Ordering, Referring, Prescribing	N/A	1205378833	0	0	LOPEZ, ALEXANDRA LMFT	9/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT121969	N/A	N/A	N/A	N/A	N/A	15095 AMARGOSA RD	None	VICTORVILLE	CA	92394	1879	00	06000	34.52479785	-117.3303132	San Bernardino County
324144	Ordering, Referring, Prescribing	N/A	1205409646	0	0	LY, PHUONG T	8/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH84344	N/A	N/A	N/A	N/A	N/A	10551 MCFADDEN AVE	B	GARDEN GROVE	CA	92843	5329	00	06000	33.73796199	-117.9453037	Orange County
324182	Ordering, Referring, Prescribing	N/A	1205497104	0	0	LAM, ALEXANDER MD	3/14/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194742	N/A	N/A	N/A	N/A	N/A	350 VINTON AVE	202	POMONA	CA	91767	3000	00	06000	34.07937061	-117.746663	Los Angeles County
324189	Ordering, Referring, Prescribing	N/A	1205493426	0	0	LERMA, CLAIRE LPCC	10/17/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC14922	N/A	N/A	N/A	N/A	N/A	2828 FORD ST	None	OAKLAND	CA	94601	2114	00	06000	37.77357837	-122.2352589	Alameda County
324199	Ordering, Referring, Prescribing	N/A	1205583101	0	0	LIU, ZHULIN DC	3/9/2022	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC35128	N/A	N/A	N/A	N/A	N/A	701 S ATLANTIC BLVD	200	MONTEREY PARK	CA	91754	0000	00	06000	34.05382447	-118.1363489	Los Angeles County
324203	Ordering, Referring, Prescribing	N/A	1205574134	0	0	LEE, ELISA MD	7/12/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197713	N/A	N/A	N/A	N/A	N/A	500 W HOSPITAL RD, FRENC	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
324210	Ordering, Referring, Prescribing	N/A	1205634102	0	0	LOPEZ, JESSICA NP	2/27/2025	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95034174	N/A	N/A	N/A	N/A	N/A	455 K ST	None	CRESCENT CITY	CA	95531	4107	00	06000	41.75468313	-124.1960818	Del Norte County
324213	Ordering, Referring, Prescribing	N/A	1205677093	0	0	LUNA, PATRICIA NP	6/25/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030780	N/A	N/A	N/A	N/A	N/A	4750 GAGE AVE	None	BELL GARDENS	CA	90201	1351	00	06000	33.97730517	-118.1807015	Los Angeles County
324221	Ordering, Referring, Prescribing	N/A	1205827136	0	0	LONGEVIN, MICHAEL E MD	4/19/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C147057	N/A	N/A	N/A	N/A	N/A	1142 ROSE AVE	STE B	SELMA	CA	93662	3251	00	06000	36.56886527	-119.5983853	Fresno County
324238	Ordering, Referring, Prescribing	N/A	1205916582	0	0	LLOYD, STEVEN LMFT	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT35225	N/A	N/A	N/A	N/A	N/A	520 E TULARE AVENUE	None	VISALIA	CA	93292	3629	00	06000	36.320679	-119.2870845	Tulare County
324251	Ordering, Referring, Prescribing	N/A	1205929460	0	0	LERNER, DEBORAH ANN MD	6/11/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G69352	N/A	N/A	N/A	N/A	N/A	1530 S. OLIVE STREET	None	LOS ANGELES	CA	90015	0000	00	06000	34.03542552	-118.2652073	Los Angeles County
324260	Ordering, Referring, Prescribing	N/A	1205951845	0	0	LEON MARTINEZ, KEILA J LCSW	12/18/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79452	N/A	N/A	N/A	N/A	N/A	815 N EL CENTRO AVE	None	LOS ANGELES	CA	90038	3805	00	06000	34.08577365	-118.3244665	Los Angeles County
324264	Ordering, Referring, Prescribing	N/A	1205967650	0	0	LOPEZ, MARISSA LCSW	3/19/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28524	N/A	N/A	N/A	N/A	N/A	5021 E HUNTSMAN AVE	None	FOWLER	CA	93625	9644	00	06000	36.581796	-119.6993025	Fresno County
324276	Ordering, Referring, Prescribing	N/A	1205975729	0	0	LEE, SANDRA J MD	3/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G67878	N/A	N/A	N/A	N/A	N/A	17800 HWY 18	None	APPLE VALLEY	CA	92307	1221	00	06000	34.54007429	-117.2744761	San Bernardino County
324297	Ordering, Referring, Prescribing	N/A	1215020888	0	0	LEE, EDWARD S PHARMD	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH50853	N/A	N/A	N/A	N/A	N/A	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
324314	Ordering, Referring, Prescribing	N/A	1215054374	0	0	LAM, ADELYNE M PA-C	5/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	18399	N/A	N/A	N/A	N/A	N/A	1031 W 34TH ST	None	LOS ANGELES	CA	90089	3602	00	06000	34.024005	-118.2895875	Los Angeles County
324348	Ordering, Referring, Prescribing	N/A	1215125968	0	0	LO, GWENDOLYN V LCSW	11/12/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27906	N/A	N/A	N/A	N/A	N/A	10929 SOUTH STREET	SUITE 208B	CERRITOS	CA	90703	1000	00	06000	33.85836353	-118.101204	Los Angeles County
324351	Ordering, Referring, Prescribing	N/A	1215123997	0	0	LIMBERG, ELIZABETH M PHD	6/17/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY17418	N/A	N/A	N/A	N/A	N/A	GARDEN PARK APARTMENTS	2387 LISA LANE, OFFICE	PLEASANT HILL	CA	94523	3949	00	06000	0	0	None
324378	Ordering, Referring, Prescribing	N/A	1215202676	0	0	LUNA, MARIA G LMFT	6/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	77130	N/A	N/A	N/A	N/A	N/A	10174 OLD GROVE RD	SUITE 100	SAN DIEGO	CA	92131	1652	00	06000	32.89939989	-117.10786	San Diego County
324380	Ordering, Referring, Prescribing	N/A	1215204458	0	0	LAO, EANG	8/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60362	N/A	N/A	N/A	N/A	N/A	2680 UNION AVE	None	SAN JOSE	CA	95124	1001	00	06000	37.27315615	-121.9331705	Santa Clara County
324381	Ordering, Referring, Prescribing	N/A	1215212337	0	0	LEE, HSING WEN LIDIA	3/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH46302	N/A	N/A	N/A	N/A	N/A	1000 N RENGSTORFF AVE	None	MOUNTAIN VIEW	CA	94043	1716	00	06000	37.42125982	-122.0936833	Santa Clara County
324391	Ordering, Referring, Prescribing	N/A	1215219332	0	0	LEU, INGRID OT	9/15/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	13813	N/A	N/A	N/A	N/A	N/A	9808 VENICE BLVD	300	CULVER CITY	CA	90232	2732	00	06000	34.0236396	-118.3980847	Los Angeles County
324409	Ordering, Referring, Prescribing	N/A	1215234703	0	0	LEITMEYER, JENNIFER LMFT	4/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115433	N/A	N/A	N/A	N/A	N/A	762 W. CYPRESS ST.	None	SAN DIMAS	CA	91773	3505	00	06000	34.09577399	-117.8223776	Los Angeles County
324438	Ordering, Referring, Prescribing	N/A	1215292578	0	0	LEVERENZ, PATRICIA A LCSW	5/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22702	N/A	N/A	N/A	N/A	N/A	1421 GUERNEVILLE RD	SUITE 218	SANTA ROSA	CA	95403	7220	00	06000	38.458233	-122.7349305	Sonoma County
324441	Ordering, Referring, Prescribing	N/A	1215290622	0	0	LE, BAO GIA LMFT	3/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114470	N/A	N/A	N/A	N/A	N/A	12912 BROOKHURST ST	480	GARDEN GROVE	CA	92840	4835	00	06000	33.77487003	-117.9552276	Orange County
324455	Ordering, Referring, Prescribing	N/A	1215318134	0	0	LIM, ROBERTINO D MD	3/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144481	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
324490	Ordering, Referring, Prescribing	N/A	1215371133	0	0	LESLIE, OMAR LCSW	4/12/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28460	N/A	N/A	N/A	N/A	N/A	444 GEORGIA ST	None	VALLEJO	CA	94590	6005	00	06000	38.10111363	-122.2552224	Solano County
324499	Ordering, Referring, Prescribing	N/A	1215381215	0	0	LEONG, SHELLEY Y MD	3/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152494	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
324513	Ordering, Referring, Prescribing	N/A	1215390554	0	0	LOPEZ, SHAYNA R CNM	11/22/2016	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	832686	N/A	N/A	N/A	N/A	N/A	8520 S BROADWAY	None	LOS ANGELES	CA	90003	3335	00	06000	33.96110579	-118.2782667	Los Angeles County
324515	Ordering, Referring, Prescribing	N/A	1215394689	0	0	LEONARDO, JORDAN J NP	8/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95003353	N/A	N/A	N/A	N/A	N/A	7655 GREENLEAF AVENUE	None	WHITTIER	CA	90602	1626	00	06000	33.9719973	-118.0374206	Los Angeles County
324522	Ordering, Referring, Prescribing	N/A	1215420047	0	0	LEAL MENDOZA, JHONATAN MD	7/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173697	N/A	N/A	N/A	N/A	N/A	425 DEL SOL PKWY	None	DELANO	CA	93215	3442	00	06000	35.75415446	-119.250612	Kern County
324534	Ordering, Referring, Prescribing	N/A	1215449053	0	0	LIGGINS, KRISTEN CCC-SLP	12/27/2020	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	27707	N/A	N/A	N/A	N/A	N/A	10431 COMMERCE ST	A	REDLANDS	CA	92374	0110	00	06000	34.06427678	-117.2416506	San Bernardino County
324554	Ordering, Referring, Prescribing	N/A	1215481916	0	0	LOPEZ LEON, GEISHA Y LCSW	3/23/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100670	N/A	N/A	N/A	N/A	N/A	1965 LIVE OAK BLVD.	None	YUBA CITY	CA	95991	8850	00	06000	39.15563037	-121.620091	Sutter County
324560	Ordering, Referring, Prescribing	N/A	1215469887	0	0	LAM, MEI WAI MD MPH	11/10/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164862	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD, MS #5	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
324561	Ordering, Referring, Prescribing	N/A	1215486485	0	0	LOPEZ ZAMORA, ASHLEY LCSW	3/4/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110421	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
324564	Ordering, Referring, Prescribing	N/A	1215486956	0	0	LENKE, LAUREN LCSW	4/7/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95378	N/A	N/A	N/A	N/A	N/A	6043 HOLLYWOOD BLVD	LOS ANGELES CA 90028	LOS ANGELES	CA	90028	5411	00	06000	34.1016835	-118.321569	Los Angeles County
324569	Ordering, Referring, Prescribing	N/A	1215490156	0	0	LEONE, AUTUMN R LCSW	8/25/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	117746	N/A	N/A	N/A	N/A	N/A	485 N 1ST ST	None	SAN JOSE	CA	95112	4041	00	06000	37.34444033	-121.8968517	Santa Clara County
324591	Ordering, Referring, Prescribing	N/A	1215546767	0	0	LEE, ERIKA A CNP	4/2/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017081	N/A	N/A	N/A	N/A	N/A	3419 TYLER AVE	None	EL MONTE	CA	91731	3103	00	06000	34.07081311	-118.0360305	Los Angeles County
324596	Ordering, Referring, Prescribing	N/A	1215557491	0	0	LU, WENDY	8/25/2024	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC17242	N/A	N/A	N/A	N/A	N/A	5100 EASTERN AVE.	100	COMMERCE	CA	90040	2964	00	06000	33.98882955	-118.1615175	Los Angeles County
324600	Ordering, Referring, Prescribing	N/A	1215568167	0	0	LIEN, CHRISTY PHARMD	11/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81982	N/A	N/A	N/A	N/A	N/A	707 CONTRA COSTA BLVD	None	PLEASANT HILL	CA	94523	1516	00	06000	37.97098068	-122.0633635	Contra Costa County
324606	Ordering, Referring, Prescribing	N/A	1215575642	0	0	LE, DINH PHARMD	11/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81728	N/A	N/A	N/A	N/A	N/A	1366 EAST AVE, CHICO, CA	None	CHICO	CA	95926	1004	00	06000	39.76111951	-121.8226455	Butte County
324631	Ordering, Referring, Prescribing	N/A	1215627310	0	0	LIBLIN, PEARL H	11/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023278	N/A	N/A	N/A	N/A	N/A	410 SHORELINE HWY	4	MILL VALLEY	CA	94941	3728	00	06000	37.87974989	-122.5361565	Marin County
324636	Ordering, Referring, Prescribing	N/A	1215642947	0	0	LAFFERTY, CHRISTINE M NP	9/9/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013518	N/A	N/A	N/A	N/A	N/A	1722 S LEWIS ROAD	None	CAMARILLO	CA	93012	8520	00	06000	34.18921316	-119.0340743	Ventura County
324640	Ordering, Referring, Prescribing	N/A	1215677026	0	0	LLAMAS, MATT JASON V MD	8/27/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189578	N/A	N/A	N/A	N/A	N/A	2116 ARLINGTON AVE	SUITE 1000	LOS ANGELES	CA	90018	1336	00	06000	34.037415	-118.3176815	Los Angeles County
324649	Ordering, Referring, Prescribing	N/A	1215709233	0	0	LIU, JIALING CNP	7/23/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021991	N/A	N/A	N/A	N/A	N/A	210 N GARFIELD AVE	203	MONTEREY PARK	CA	91754	1746	00	06000	34.064181	-118.122834	Los Angeles County
324671	Ordering, Referring, Prescribing	N/A	1225008238	0	0	LEE, CHRIS I MD	3/25/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A88926	N/A	N/A	N/A	N/A	N/A	18897 COLIMA RD	SUITE B	ROWLAND HEIGHTS	CA	91748	2977	00	06000	33.98769974	-117.8912223	Los Angeles County
324689	Ordering, Referring, Prescribing	N/A	1225086481	0	0	LYNN, LAURA PT	10/17/2022	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	39004	N/A	N/A	N/A	N/A	N/A	880 3RD AVE	A	CHULA VISTA	CA	91911	1305	00	06000	32.62153846	-117.0722021	San Diego County
324711	Ordering, Referring, Prescribing	N/A	1225154776	0	0	LEE, ELIZABETH P MD	3/10/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G68037	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
324724	Ordering, Referring, Prescribing	N/A	1225163140	0	0	LASALA, SALVADOR E MD	2/25/2019	Taxonomy not applicable	NA	n/a	000	Unknown	A52616	N/A	N/A	N/A	N/A	N/A	523 E FOOTHILL BLVD	None	RIALTO	CA	92376	5223	00	06000	34.1067117	-117.360611	San Bernardino County
324770	Ordering, Referring, Prescribing	N/A	1225249501	0	0	LEWIS, MICHELLE D LCSW	5/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	62655	N/A	N/A	N/A	N/A	N/A	7200 BANCROFT AVE	SUITE 125-A	OAKLAND	CA	94605	2403	00	06000	37.768221	-122.17608	Alameda County
324776	Ordering, Referring, Prescribing	N/A	1225270184	0	0	LOPEZ-ALEKSANIAN, CYNTHIA J LCSW	9/18/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	104130	N/A	N/A	N/A	N/A	N/A	66 HURLBUT ST	None	PASADENA	CA	91105	4025	00	06000	34.12993251	-118.1516625	Los Angeles County
324788	Ordering, Referring, Prescribing	N/A	1225300668	0	0	LEE, CHRISTINE N DMD	6/11/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS61952	N/A	N/A	N/A	N/A	N/A	1276 HALYARD DR	None	WEST SACRAMENTO	CA	95691	3412	00	06000	38.573118	-121.5501275	Yolo County
324808	Ordering, Referring, Prescribing	N/A	1225333438	0	0	LACY, DEBRA D LMFT	4/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86783	N/A	N/A	N/A	N/A	N/A	31946 MISSION TRL	STE B	LAKE ELSINORE	CA	92530	4539	00	06000	33.65640803	-117.2979656	Riverside County
324816	Ordering, Referring, Prescribing	N/A	1225338858	0	0	LE, KAREN T	3/18/2018	Taxonomy not applicable	NA	n/a	000	Unknown	53611	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD. M	None	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
324866	Ordering, Referring, Prescribing	N/A	1225430978	0	0	LIU, JESSICA C PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH74107	N/A	N/A	N/A	N/A	N/A	99 MONTECILLO ROAD	MOB2	SAN RAFAEL	CA	94903	3308	00	06000	38.00450116	-122.5540001	Marin County
324897	Ordering, Referring, Prescribing	N/A	1225484066	0	0	LE, CHAU NP	5/12/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004557	N/A	N/A	N/A	N/A	N/A	3626 BALBOA STREET	None	SAN FRANCISCO	CA	94121	2604	00	06000	37.77571711	-122.4980286	San Francisco County
324942	Ordering, Referring, Prescribing	N/A	1225540818	0	0	LAIBSON, ARIELA LCSW	5/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75252	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
324946	Ordering, Referring, Prescribing	N/A	1225547375	0	0	LISTRO, TINA B LMFT	11/3/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93336	N/A	N/A	N/A	N/A	N/A	27200 TOURNEY ROAD	SUITE 175	VALENCIA	CA	91355	5902	00	06000	34.41656755	-118.5763161	Los Angeles County
324966	Ordering, Referring, Prescribing	N/A	1225564487	0	0	LIM, ATALIE M MD	12/19/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A167226	N/A	N/A	N/A	N/A	N/A	4618 FOUNTAIN AVE	None	LOS ANGELES	CA	90029	1830	00	06000	34.095582	-118.290195	Los Angeles County
324970	Ordering, Referring, Prescribing	N/A	1225571946	0	0	LEWIS, TAMIKA LCSW	4/5/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW61311	N/A	N/A	N/A	N/A	N/A	3255 WILSHIRE BLVD	SUITE 120	LOS ANGELES	CA	90010	1404	00	06000	34.0618166	-118.2932612	Los Angeles County
324999	Ordering, Referring, Prescribing	N/A	1225636657	0	0	LAM, JADE N PHARMD	11/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH83428	N/A	N/A	N/A	N/A	N/A	9831 CAMPO ROAD	None	SPRING VALLEY	CA	91977	1418	00	06000	32.74794448	-116.98407	San Diego County
325000	Ordering, Referring, Prescribing	N/A	1225610520	0	0	LIPMAN, SOPHIE OT	5/11/2022	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT23109	N/A	N/A	N/A	N/A	N/A	3250 WILSHIRE	None	LOS ANGELES	CA	90050	0010	00	06000	34.06176363	-118.2932622	Los Angeles County
325029	Ordering, Referring, Prescribing	N/A	1225731813	0	0	LI, LU MD	12/30/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A200550	N/A	N/A	N/A	N/A	N/A	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33578	-121.999329	Santa Clara County
325059	Ordering, Referring, Prescribing	N/A	1235163858	0	0	LADWIG, RUSSEL G PA-C	3/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA17196	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	GE01	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
325074	Ordering, Referring, Prescribing	N/A	1235212143	0	0	LONG, HANZHI H PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51159	N/A	N/A	N/A	N/A	N/A	41718 COVINGTON DR	None	FREMONT	CA	94539	4652	00	06000	37.54160553	-121.9389051	Alameda County
325088	Ordering, Referring, Prescribing	N/A	1235256777	0	0	LIOU, GEORGE LCSW	11/17/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26865	N/A	N/A	N/A	N/A	N/A	4510 E PACIFIC COAST HWY	600	LONG BEACH	CA	90804	3279	00	06000	33.78815204	-118.1400821	Los Angeles County
325093	Ordering, Referring, Prescribing	N/A	1235258997	0	0	LEONZO CASTILLO, KARINA LMFT	4/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52896	N/A	N/A	N/A	N/A	N/A	3300 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3137	00	06000	35.37353416	-119.0392409	Kern County
325118	Ordering, Referring, Prescribing	N/A	1235313925	0	0	LIN, CHRISTINE M	4/12/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D56624	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
325166	Ordering, Referring, Prescribing	N/A	1235407354	0	0	LIGHTFOOT, TAMARA I	7/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH45590	N/A	N/A	N/A	N/A	N/A	1189 POTRERO AVE.	None	SAN FRANCISCO	CA	94110	3520	00	06000	37.75329906	-122.4063227	San Francisco County
325177	Ordering, Referring, Prescribing	N/A	1235414632	0	0	LI, LISA Z PHARMD	2/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57157	N/A	N/A	N/A	N/A	N/A	3496 CAMINO TASSAJARA	None	DANVILLE	CA	94506	4680	00	06000	37.79801404	-121.9183152	Contra Costa County
325193	Ordering, Referring, Prescribing	N/A	1235439951	0	0	LAKSHMAN, MEYYAMMAI	8/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	CA56508	N/A	N/A	N/A	N/A	N/A	104 MID VALLEY CTR	None	CARMEL	CA	93923	8500	00	06000	36.52351083	-121.8100709	Monterey County
325240	Ordering, Referring, Prescribing	N/A	1235518689	0	0	LI, RONGLIN NP	4/23/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002423	N/A	N/A	N/A	N/A	N/A	9900 STOCKDALE HWY	STE 200	BAKERSFIELD	CA	93311	3634	00	06000	35.35412167	-119.1124089	Kern County
325289	Ordering, Referring, Prescribing	N/A	1235580689	0	0	LEE, EMILY PHARMD	7/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74377	N/A	N/A	N/A	N/A	N/A	45 S EL CAMINO REAL	None	MILLBRAE	CA	94030	3124	00	06000	37.59720935	-122.3865478	San Mateo County
325296	Ordering, Referring, Prescribing	N/A	1235605957	0	0	LUC, CHAN T NP	10/19/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95010285	N/A	N/A	N/A	N/A	N/A	6501 GARFIELD AVE	None	BELL GARDENS	CA	90201	1805	00	06000	33.97292523	-118.1475473	Los Angeles County
325300	Ordering, Referring, Prescribing	N/A	1235613068	0	0	LU, WILLIAM PHARMD	12/23/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH78938	N/A	N/A	N/A	N/A	N/A	9245 RESEDA BLVD	None	NORTHRIDGE	CA	91324	3137	00	06000	34.238583	-118.536108	Los Angeles County
325303	Ordering, Referring, Prescribing	N/A	1235617788	0	0	LIANG, CATHY YAN-FANG PHARMD	4/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77065	N/A	N/A	N/A	N/A	N/A	3240 ARDEN WAY	None	SACRAMENTO	CA	95825	2015	00	06000	38.594898	-121.3884765	Sacramento County
325322	Ordering, Referring, Prescribing	N/A	1235642356	0	0	LOOMBA, DEEPIKA PHARMD	4/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77348	N/A	N/A	N/A	N/A	N/A	507 MEADOW VALLEY CIR	None	FAIRFIELD	CA	94534	6675	00	06000	38.21747033	-122.1295711	Solano County
325326	Ordering, Referring, Prescribing	N/A	1235650581	0	0	LE, SELINA L PHARMD	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH76403	N/A	N/A	N/A	N/A	N/A	9728 WINTER GARDENS BLVD	None	LAKESIDE	CA	92040	3809	00	06000	32.854545	-116.9311485	San Diego County
325333	Ordering, Referring, Prescribing	N/A	1235656075	0	0	LE, KELLY D	5/8/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH63932	N/A	N/A	N/A	N/A	N/A	4058 WILLOWS RD	None	ALPINE	CA	91901	1668	00	06000	32.836428	-116.7257385	San Diego County
325335	Ordering, Referring, Prescribing	N/A	1235656653	0	0	LEWIS, SYLVIA A	11/5/2017	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	293633	N/A	N/A	N/A	N/A	N/A	2145 5TH AVE	None	OROVILLE	CA	95965	5870	00	06000	39.50368243	-121.5646958	Butte County
325341	Ordering, Referring, Prescribing	N/A	1235671793	0	0	LYU, KEZIAH PSYD	11/18/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	33817	N/A	N/A	N/A	N/A	N/A	2731 JUNCTION AVE	642007	SAN JOSE	CA	95134	1932	00	06000	37.3938629	-121.9240412	Santa Clara County
325350	Ordering, Referring, Prescribing	N/A	1235686981	0	0	LANDAKER, ERIN N LMFT	1/18/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130664	N/A	N/A	N/A	N/A	N/A	50 POMONA ST.	None	SAN FRANCISCO	CA	94124	2344	00	06000	37.73146726	-122.3935465	San Francisco County
325365	Ordering, Referring, Prescribing	N/A	1235738204	0	0	LY, CHHENG PA-C	10/7/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PA58645	N/A	N/A	N/A	N/A	N/A	2100 E. ANAHEIM ST.	STE B	LONG BEACH	CA	90804	3419	00	06000	33.7825725	-118.1663865	Los Angeles County
325408	Ordering, Referring, Prescribing	N/A	1235847674	0	0	LOPEZ, BIANCA Z CCC-SLP	9/13/2022	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	34065	N/A	N/A	N/A	N/A	N/A	1901 N RICE AVE	170-180	OXNARD	CA	93030	7912	00	06000	34.21960355	-119.1421345	Ventura County
325416	Ordering, Referring, Prescribing	N/A	1235882382	0	0	LAL, VIKRAM DDS	6/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	106052	N/A	N/A	N/A	N/A	N/A	250 W 5TH ST	None	HANFORD	CA	93230	5029	00	06000	36.32439821	-119.6472235	Kings County
325419	Ordering, Referring, Prescribing	N/A	1235802455	0	0	LI, SUK Y DMD MSD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	DDS106707	N/A	N/A	N/A	N/A	N/A	7821 S AVALON BLVD	None	LOS ANGELES	CA	90003	2358	00	06000	33.969393	-118.265197	Los Angeles County
325443	Ordering, Referring, Prescribing	N/A	1245216217	0	0	LADUKE, MARY A LCSW	3/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	2000175587	N/A	N/A	N/A	N/A	N/A	720 WOOD ST.	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
325451	Ordering, Referring, Prescribing	N/A	1245287960	0	0	LISSAUR, RALPH MD	6/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A88975	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	5	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
325486	Ordering, Referring, Prescribing	N/A	1245359835	0	0	LEW, NANCY OT	3/17/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT7367	N/A	N/A	N/A	N/A	N/A	825 SOUTHWOOD DRIVE	None	SOUTH SAN FRANCIS	CA	94080	3106	00	06000	37.64946358	-122.435325	San Mateo County
325495	Ordering, Referring, Prescribing	N/A	1245368349	0	0	LIN, CHRISTOPHER Y	7/6/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D52212	N/A	N/A	N/A	N/A	N/A	2950 INTERNATIONAL BLVD	None	OAKLAND	CA	94601	2228	00	06000	37.77893032	-122.2284286	Alameda County
325507	Ordering, Referring, Prescribing	N/A	1245398411	0	0	LANE, ANDREW DDS	5/24/2023	Taxonomy not applicable	NA	n/a	000	Unknown	49772	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
325531	Ordering, Referring, Prescribing	N/A	1245423458	0	0	LOPEZ, DULCE C LCSW	3/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24497	N/A	N/A	N/A	N/A	N/A	777 N. FIRST ST.	220	SAN JOSE	CA	95112	6350	00	06000	37.35064564	-121.9015633	Santa Clara County
325539	Ordering, Referring, Prescribing	N/A	1245454750	0	0	LONGO, CECILY LMFT	4/23/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT86591	N/A	N/A	N/A	N/A	N/A	315 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1001	00	06000	34.444881	-119.7793725	Santa Barbara County
325546	Ordering, Referring, Prescribing	N/A	1245465491	0	0	LO, KIMBERLY C MD	2/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A128899	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	MS #53	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
325552	Ordering, Referring, Prescribing	N/A	1245481191	0	0	LE, AMY O PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH57837	N/A	N/A	N/A	N/A	N/A	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	00	06000	37.70755227	-121.7149933	Alameda County
325571	Ordering, Referring, Prescribing	N/A	1245514405	0	0	LIU, JAMES T OD	7/27/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	14303	N/A	N/A	N/A	N/A	N/A	1333 POWELL ST	SUITE A-104	EMERYVILLE	CA	94608	2598	00	06000	37.83952648	-122.2889236	Alameda County
325576	Ordering, Referring, Prescribing	N/A	1245520238	0	0	LEE, JOHN S DMD	10/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	60069	N/A	N/A	N/A	N/A	N/A	1110 N BRAND BLVD	STE 101	GLENDALE	CA	91202	2567	00	06000	34.161876	-118.255033	Los Angeles County
325581	Ordering, Referring, Prescribing	N/A	1245528405	0	0	LEE, RODITH V PT	1/22/2019	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	36752	N/A	N/A	N/A	N/A	N/A	2145 5TH AVE	None	OROVILLE	CA	95965	5870	00	06000	39.50368243	-121.5646958	Butte County
325590	Ordering, Referring, Prescribing	N/A	1245551852	0	0	LAZAR BEGLARIAN, VERONICA LCSW	4/22/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80855	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST	None	CHATSWORTH	CA	91311	6215	00	06000	34.23182352	-118.572948	Los Angeles County
325606	Ordering, Referring, Prescribing	N/A	1245573476	0	0	LOO, DYANI MD MPH	2/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A153491	N/A	N/A	N/A	N/A	N/A	720 WOOD ST	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
325617	Ordering, Referring, Prescribing	N/A	1245597533	0	0	LORENZANA, ANTHONY PHARMD	9/29/2020	Taxonomy not applicable	NA	n/a	000	Unknown	65637	N/A	N/A	N/A	N/A	N/A	2001 N ROSE AVE	None	OXNARD	CA	93036	2681	00	06000	34.220106	-119.1608865	Ventura County
325626	Ordering, Referring, Prescribing	N/A	1245605708	0	0	LIMON, LUZ LMFT	6/13/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT130973	N/A	N/A	N/A	N/A	N/A	850 E. FOOTHILL BLVD	None	SAN BERNARDINO	CA	92376	5230	00	06000	34.10679449	-117.3542535	San Bernardino
325657	Ordering, Referring, Prescribing	N/A	1245637784	0	0	LIN, JASON H MD	8/13/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155281	N/A	N/A	N/A	N/A	N/A	1520 STOCKSTON STREET	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
325665	Ordering, Referring, Prescribing	N/A	1245666981	0	0	LANGE, DIANNA L NP	5/25/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	23653	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO STREET	698	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
325667	Ordering, Referring, Prescribing	N/A	1245664648	0	0	LEE, HELEN C PHARMD	9/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	42710	N/A	N/A	N/A	N/A	N/A	27972 CABOT RD	None	LAGUNA NIGUEL	CA	92677	1211	00	06000	33.55499737	-117.6785648	Orange County
325675	Ordering, Referring, Prescribing	N/A	1245670413	0	0	LAPINA, LORI L PA-C	5/29/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA23231	N/A	N/A	N/A	N/A	N/A	3544 30TH ST	None	SAN DIEGO	CA	92104	4120	00	06000	32.742936	-117.130118	San Diego County
325684	Ordering, Referring, Prescribing	N/A	1245693639	0	0	LAMB, MARIE CLAIRE MD	2/20/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158359	N/A	N/A	N/A	N/A	N/A	628 W MICHELTORENA ST	None	SANTA BARBARA	CA	93101	4131	00	06000	34.41910081	-119.7158618	Santa Barbara County
325687	Ordering, Referring, Prescribing	N/A	1245704865	0	0	LEE, JOHANNA I LPCC	1/23/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC13089	N/A	N/A	N/A	N/A	N/A	235 W 5TH AVE	STE. 130	ESCONDIDO	CA	92025	4804	00	06000	33.11704424	-117.0809778	San Diego County
325700	Ordering, Referring, Prescribing	N/A	1245726421	0	0	LE, BARBARA V LCSW	8/25/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	117708	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
325712	Ordering, Referring, Prescribing	N/A	1245749167	0	0	LE, NAOMI THETAM PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77411	N/A	N/A	N/A	N/A	N/A	3237 E CHAPMAN AVE	None	ORANGE	CA	92869	1222	00	06000	33.78782753	-117.8188425	Orange County
325716	Ordering, Referring, Prescribing	N/A	1245716802	0	0	LOZANO, JACQUELINE D LCSW	3/17/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100593	N/A	N/A	N/A	N/A	N/A	4211 S AVALON BLVD	None	LOS ANGELES	CA	90011	5622	00	06000	34.007238	-118.2653065	Los Angeles County
325731	Ordering, Referring, Prescribing	N/A	1245763580	0	0	LAMMING, KATIE LCSW	7/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75538	N/A	N/A	N/A	N/A	N/A	27800 MEDICAL CENTER ROA	SUITE 110	MISSION VIEJO	CA	92691	6407	00	06000	33.55952733	-117.6645199	Orange County
325751	Ordering, Referring, Prescribing	N/A	1245776244	0	0	LANE, JENNIFER L	5/11/2017	Taxonomy not applicable	NA	n/a	000	Unknown	54157	N/A	N/A	N/A	N/A	N/A	544 N GLENDALE AVE	None	GLENDALE	CA	91206	3311	00	06000	34.15454904	-118.2429872	Los Angeles County
325757	Ordering, Referring, Prescribing	N/A	1245789007	0	0	LIU, JENNIE	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71427	N/A	N/A	N/A	N/A	N/A	4932 SANTIAGO DRIVE	None	LA PALMA	CA	90623	1444	00	06000	33.85233408	-118.0472003	Orange County
325767	Ordering, Referring, Prescribing	N/A	1245788942	0	0	LABARGA, VANESSA A LMFT	9/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121508	N/A	N/A	N/A	N/A	N/A	42875 GATEWOOD ST	None	FREMONT	CA	94605	4131	00	06000	37.51965998	-121.9586413	Alameda County
325786	Ordering, Referring, Prescribing	N/A	1245843234	0	0	LARI, AFSANEH PHARMD	7/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79838	N/A	N/A	N/A	N/A	N/A	4940 VAN NUYS BLVD	STE 104	SHERMAN OAKS	CA	91403	1736	00	06000	34.160589	-118.4486715	Los Angeles County
325813	Ordering, Referring, Prescribing	N/A	1245897990	0	0	LOUIE, BRENT T MD	10/20/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176497	N/A	N/A	N/A	N/A	N/A	9808 VENICE BLVD	SUITE 700	CULVER CITY	CA	90232	6824	00	06000	34.0236396	-118.3980847	Los Angeles County
325821	Ordering, Referring, Prescribing	N/A	1245917137	0	0	LEE, SONHO DDS	8/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	107700	N/A	N/A	N/A	N/A	N/A	1750 WRIGHT ST	SUITE 1	SACRAMENTO	CA	95825	4041	00	06000	38.597742	-121.4057385	Sacramento County
325881	Ordering, Referring, Prescribing	N/A	1255162830	0	0	LUCAS, ERIN M CCC-SLP	11/22/2023	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	35337	N/A	N/A	N/A	N/A	N/A	2504 PORTOFINO DRIVE	None	MODESTO	CA	95356	8745	00	06000	37.69840928	-121.0412104	Stanislaus County
325884	Ordering, Referring, Prescribing	N/A	1255307724	0	0	LAYA, JOSEPH W OD	5/14/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT7982	N/A	N/A	N/A	N/A	N/A	1751 HARTNELL AVE	None	REDDING	CA	96002	2293	00	06000	40.56370348	-122.3388585	Shasta County
325893	Ordering, Referring, Prescribing	N/A	1255338406	0	0	LUSTER-ADALETE, RHONDA R MD	11/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G76910	N/A	N/A	N/A	N/A	N/A	121 S LONG BEACH BLVD	None	COMPTON	CA	90221	3423	00	06000	33.89475493	-118.2080292	Los Angeles County
325908	Ordering, Referring, Prescribing	N/A	1255409249	0	0	LEPE, SANDRA E LCSW	4/19/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27519	N/A	N/A	N/A	N/A	N/A	550 S VERMONT AVE	None	LOS ANGELES	CA	90020	1912	00	06000	34.064091	-118.2916225	Los Angeles County
325909	Ordering, Referring, Prescribing	N/A	1255423240	0	0	LAI, LUYEN L PHARMD	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53247	N/A	N/A	N/A	N/A	N/A	275 HOSPITAL PKWY	625	SAN JOSE	CA	95119	1106	00	06000	37.23951066	-121.8013511	Santa Clara County
325917	Ordering, Referring, Prescribing	N/A	1255441689	0	0	LOVEJOY, JOHN P DO	11/18/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A5959	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
325933	Ordering, Referring, Prescribing	N/A	1255465118	0	0	LIANG, WENDY C LCSW	6/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24044	N/A	N/A	N/A	N/A	N/A	1075 E SANTA CLARA ST	None	SAN JOSE	CA	95116	2244	00	06000	37.34630891	-121.869327	Santa Clara County
325946	Ordering, Referring, Prescribing	N/A	1255483921	0	0	LAM, KRISTIN PHARMD	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57542	N/A	N/A	N/A	N/A	N/A	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	00	06000	37.78096053	-122.4637512	San Francisco County
325949	Ordering, Referring, Prescribing	N/A	1255486171	0	0	LOHMAN-BAESEN, KELLY S	5/1/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA14952	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
325961	Ordering, Referring, Prescribing	N/A	1255526117	0	0	LOCKLEAR, ERIN I LMFT	10/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	95980	N/A	N/A	N/A	N/A	N/A	4001 MISSION OAKS BLVD	I	CAMARILLO	CA	93012	5121	00	06000	34.21641579	-119.0166203	Ventura County
325973	Ordering, Referring, Prescribing	N/A	1255538583	0	0	LIN, CHUNG CHING LPCC	2/1/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC4751	N/A	N/A	N/A	N/A	N/A	729 FILBERT ST	None	SAN FRANCISCO	CA	94133	2760	00	06000	37.80103613	-122.4119083	San Francisco County
325978	Ordering, Referring, Prescribing	N/A	1255563755	0	0	LAU, BONNIE OD	2/12/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	13812	N/A	N/A	N/A	N/A	N/A	5515 GEARY BLVD	None	SAN FRANCISCO	CA	94121	2208	00	06000	37.7802896	-122.4786835	San Francisco County
325985	Ordering, Referring, Prescribing	N/A	1255583241	0	0	LEHNHOF, MONICA C	6/11/2002	Taxonomy not applicable	NA	n/a	099	DENTIST	D49700	N/A	N/A	N/A	N/A	N/A	620 E ALVIN DR	STE G	SALINAS	CA	93906	3054	00	06000	36.70361129	-121.6321051	Monterey County
326021	Ordering, Referring, Prescribing	N/A	1255636833	0	0	LE, TUONG Q PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59281	N/A	N/A	N/A	N/A	N/A	1236 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5311	00	06000	34.122087	-117.278816	San Bernardino County
326036	Ordering, Referring, Prescribing	N/A	1255667374	0	0	LY, OLIVIA P LCSW	3/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	70123	N/A	N/A	N/A	N/A	N/A	401 W CIVIC CENTER DR	SUITE 200	SANTA ANA	CA	92701	3640	00	06000	33.75157353	-117.870921	Orange County
326044	Ordering, Referring, Prescribing	N/A	1255688214	0	0	LEE, SOONKI DDS	8/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	62164	N/A	N/A	N/A	N/A	N/A	3030 W OLYMPIC BLVD	SUITE 206	LOS ANGELES	CA	90006	6506	00	06000	34.05260995	-118.3015825	Los Angeles County
326059	Ordering, Referring, Prescribing	N/A	1255712865	0	0	LOE, JESSICA R	10/4/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	101485	N/A	N/A	N/A	N/A	N/A	355 CENTRAL AVE	None	FILLMORE	CA	93015	1920	00	06000	34.40028802	-118.9137057	Ventura County
326070	Ordering, Referring, Prescribing	N/A	1255729562	0	0	LIU, NANCY LMFT	11/30/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106059	N/A	N/A	N/A	N/A	N/A	205 PASADENA AVE	None	SOUTH PASADENA	CA	91030	2919	00	06000	34.11219143	-118.1709685	Los Angeles County
326080	Ordering, Referring, Prescribing	N/A	1255739249	0	0	LIN, KAREN PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71755	N/A	N/A	N/A	N/A	N/A	225 N HIDALGO AVE	None	ALHAMBRA	CA	91801	2637	00	06000	34.10129053	-118.1220708	Los Angeles County
326089	Ordering, Referring, Prescribing	N/A	1255750246	0	0	LAI, HANK H	3/30/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138913	N/A	N/A	N/A	N/A	N/A	1401 N TUSTIN AVE	STE 225	SANTA ANA	CA	92705	8644	00	06000	33.757254	-117.8341425	Orange County
326117	Ordering, Referring, Prescribing	N/A	1255807699	0	0	LIU, LIU PHARMD	10/19/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79772	N/A	N/A	N/A	N/A	N/A	6951 EL CAMINO REAL	None	CARLSBAD	CA	92009	4146	00	06000	33.10361009	-117.2668384	San Diego County
326118	Ordering, Referring, Prescribing	N/A	1255811238	0	0	LUERA, JESSICA NP	3/15/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024155	N/A	N/A	N/A	N/A	N/A	303 E. VANDERBILT WAY	None	SAN BERNARDINO	CA	92415	5230	00	06000	34.06872265	-117.2775832	San Bernardino County
326124	Ordering, Referring, Prescribing	N/A	1255818597	0	0	LEIS, KYLE B	2/16/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	102774	N/A	N/A	N/A	N/A	N/A	1141 PEAR TREE LN	None	NAPA	CA	94558	6484	00	06000	38.32125908	-122.2921523	Napa County
326139	Ordering, Referring, Prescribing	N/A	1255835989	0	0	LOOMIS, KATHERINE A MD	11/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164585	N/A	N/A	N/A	N/A	N/A	245 S. FETTERLY AVE	ROOM 2280	LOS ANGELES	CA	90022	0000	00	06000	34.03404953	-118.1609476	Los Angeles County
326146	Ordering, Referring, Prescribing	N/A	1255850566	0	0	LENIHAN, MATTHEW	7/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76973	N/A	N/A	N/A	N/A	N/A	3257 FOLSOM BLVD	None	SACRAMENTO	CA	95816	0000	00	06000	38.567835	-121.4643735	Sacramento County
326173	Ordering, Referring, Prescribing	N/A	1255883633	0	0	LACHIN, SHEMERAM S	9/3/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85569	N/A	N/A	N/A	N/A	N/A	1625 N SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
326185	Ordering, Referring, Prescribing	N/A	1255893517	0	0	LEE, KATRINA MD	9/1/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179444	N/A	N/A	N/A	N/A	N/A	1200 NORTH STATE STREET	None	LOS ANGELES	CA	90033	0000	00	06000	34.05855992	-118.209755	Los Angeles County
326209	Ordering, Referring, Prescribing	N/A	1255951752	0	0	LIU, GAVIN F DO	5/15/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21129	N/A	N/A	N/A	N/A	N/A	1870 LUNDY AVE	None	SAN JOSE	CA	95131	1826	00	06000	37.39271022	-121.8903238	Santa Clara County
326229	Ordering, Referring, Prescribing	N/A	1255991683	0	0	LAROWE, ALEXISS J LAC	12/16/2019	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	18576	N/A	N/A	N/A	N/A	N/A	855 E MADISON AVE	None	EL CAJON	CA	92020	3819	00	06000	32.80046744	-116.9522315	San Diego County
326233	Ordering, Referring, Prescribing	N/A	1255992111	0	0	LA PLANTE, LAUREN A	5/11/2019	Taxonomy not applicable	NA	n/a	000	Unknown	LEP2935	N/A	N/A	N/A	N/A	N/A	2501 CHESTNUT ST.	None	OAKLAND	CA	94607	2477	00	06000	37.81801435	-122.2819338	Alameda County
326258	Ordering, Referring, Prescribing	N/A	1265046155	0	0	LOPEZ, BRITTANY PA	9/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60631	N/A	N/A	N/A	N/A	N/A	1745 N BROADWAY	STE 101	SANTA MARIA	CA	93454	1927	00	06000	34.971759	-120.4356175	Santa Barbara County
326283	Ordering, Referring, Prescribing	N/A	1265105415	0	0	LUCEY, MEGHAN F LCSW	5/6/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122372	N/A	N/A	N/A	N/A	N/A	855 E MADISON AVE	None	EL CAJON	CA	92020	3819	00	06000	32.80046744	-116.9522315	San Diego County
326285	Ordering, Referring, Prescribing	N/A	1265108963	0	0	LU, SHAWN PHARMD	8/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84793	N/A	N/A	N/A	N/A	N/A	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	00	06000	34.17030266	-118.5881699	Los Angeles County
326286	Ordering, Referring, Prescribing	N/A	1265111843	0	0	LIN, TIFFANIE H	7/23/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH86431	N/A	N/A	N/A	N/A	N/A	510 S VERMONT AVE	None	LOS ANGELES	CA	90020	1912	00	06000	34.065	-118.291631	Los Angeles County
326304	Ordering, Referring, Prescribing	N/A	1265187868	0	0	LOREDO CONTRERAS, ALAYDE R PA	1/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60655	N/A	N/A	N/A	N/A	N/A	1276 HALYARD DR	None	WEST SACRAMENTO	CA	95691	3412	00	06000	38.573118	-121.5501275	Yolo County
326327	Ordering, Referring, Prescribing	N/A	1265430144	0	0	LOPEZ, DANIEL MD	7/11/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A52410	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	105	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
326389	Ordering, Referring, Prescribing	N/A	1265595458	0	0	LEMA, MARGARITA S MD	3/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A89534	N/A	N/A	N/A	N/A	N/A	109 PARMAC RD	STE. #1	CHICO	CA	95926	2294	00	06000	39.75358764	-121.8505893	Butte County
326397	Ordering, Referring, Prescribing	N/A	1265616320	0	0	LYNN, NORA L LMFT	12/9/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT49807	N/A	N/A	N/A	N/A	N/A	1393 BAILEY DRIVE	None	HANFORD	CA	93230	5922	00	06000	36.32726257	-119.6663418	Kings County
326430	Ordering, Referring, Prescribing	N/A	1265700322	0	0	LIZAOLA CASTELLANOS, IVONNE LCSW	7/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80362	N/A	N/A	N/A	N/A	N/A	176 HOLSTON DR	None	LANCASTER	CA	93535	4531	00	06000	34.6649465	-118.1286477	Los Angeles County
326434	Ordering, Referring, Prescribing	N/A	1265705727	0	0	LOPEZ, CHRISTINA LMFT	6/27/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	140202	N/A	N/A	N/A	N/A	N/A	701 N MADISON ST	None	STOCKTON	CA	95202	1634	00	06000	37.95907454	-121.2956959	San Joaquin County
326444	Ordering, Referring, Prescribing	N/A	1265711253	0	0	LEWIS, ELIZABETH P MD	6/13/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137502	N/A	N/A	N/A	N/A	N/A	1850 SPRRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
326453	Ordering, Referring, Prescribing	N/A	1265716856	0	0	LEE, SARAH S PHARMD	7/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50054	N/A	N/A	N/A	N/A	N/A	9018 FIRESTONE BLVD	None	DOWNEY	CA	90241	5318	00	06000	33.9350898	-118.1232714	Los Angeles County
326465	Ordering, Referring, Prescribing	N/A	1265732762	0	0	LI, JENNIFER PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64670	N/A	N/A	N/A	N/A	N/A	4131 GEARY BLVD	B23	SAN FRANCISCO	CA	94118	3101	00	06000	37.78096053	-122.4637512	San Francisco County
326479	Ordering, Referring, Prescribing	N/A	1265758817	0	0	LUFT, JULIA M LMFT	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47806	N/A	N/A	N/A	N/A	N/A	6100 CHIP AVE	ROOM 3038	CYPRESS	CA	90630	5212	00	06000	33.80559647	-118.0266705	Orange County
326498	Ordering, Referring, Prescribing	N/A	1265788095	0	0	LONG, DONNA LMFT	12/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50398	N/A	N/A	N/A	N/A	N/A	4601 MANILA AVE	None	OAKLAND	CA	94609	2269	00	06000	37.8337354	-122.2560467	Alameda County
326520	Ordering, Referring, Prescribing	N/A	1265830848	0	0	LUVIANO, ASHLEIGH LMFT	6/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96333	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS,	SUITE 220	MISSION VIEJO	CA	92691	6468	00	06000	33.56536541	-117.670334	Orange County
326525	Ordering, Referring, Prescribing	N/A	1265839039	0	0	LY, TIEP	3/16/2018	Taxonomy not applicable	NA	n/a	000	Unknown	72062	N/A	N/A	N/A	N/A	N/A	602 EUCLID AVE	None	SAN DIEGO	CA	92114	2207	00	06000	32.711796	-117.0850785	San Diego County
326537	Ordering, Referring, Prescribing	N/A	1265858690	0	0	LEE, HYEONHYE NP	3/29/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010603	N/A	N/A	N/A	N/A	N/A	451 W LINCOLN AVENUE	UNIT 100	ANAHEIM	CA	92805	2912	00	06000	33.83445082	-117.9189372	Orange County
326573	Ordering, Referring, Prescribing	N/A	1265905988	0	0	LEVESQUE, GABRIELA S LMFT	8/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120722	N/A	N/A	N/A	N/A	N/A	6800 OWENSMOUTH AVE	160	CANOGA PARK	CA	91303	3159	00	06000	34.194276	-118.6014945	Los Angeles County
326598	Ordering, Referring, Prescribing	N/A	1265947360	0	0	LONG, NATY PHARMD	8/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78029	N/A	N/A	N/A	N/A	N/A	1826 W ORANGETHORPE AVE	None	FULLERTON	CA	92833	4406	00	06000	33.85917352	-117.96057	Orange County
326607	Ordering, Referring, Prescribing	N/A	1265971527	0	0	LEWIS-SMITH, ARNECIA NP	5/7/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005721	N/A	N/A	N/A	N/A	N/A	6991 NORTH STATE STREET	None	REDWOOD VALLEY	CA	95470	9629	00	06000	39.2438212	-123.207113	Mendocino County
326625	Ordering, Referring, Prescribing	N/A	1275007700	0	0	LEE, VINCENT PHARMD	4/12/2024	Taxonomy not applicable	NA	n/a	000	Unknown	75528	N/A	N/A	N/A	N/A	N/A	972 GOODRICH BLVD	None	COMMERCE	CA	90022	4114	00	06000	34.01786727	-118.1546159	Los Angeles County
326651	Ordering, Referring, Prescribing	N/A	1275055972	0	0	LEE, MICHELLE K	6/24/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	20170847	N/A	N/A	N/A	N/A	N/A	1530 S. OLIVE STREET	None	LOS ANGELES	CA	90015	0000	00	06000	34.03542552	-118.2652073	Los Angeles County
326663	Ordering, Referring, Prescribing	N/A	1275080368	0	0	LEVER, SHAINA A LCSW	11/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88617	N/A	N/A	N/A	N/A	N/A	4565 CALIFORNIA AVE	None	LONG BEACH	CA	90807	1507	00	06000	33.841926	-118.1822395	Los Angeles County
326697	Ordering, Referring, Prescribing	N/A	1275148769	0	0	LIGHTNER, SANDRA J NP	6/10/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014708	N/A	N/A	N/A	N/A	N/A	4815 WATT AVE	None	NORTH HIGHLANDS	CA	95660	5108	00	06000	38.653245	-121.3836075	Sacramento County
326701	Ordering, Referring, Prescribing	N/A	1275146771	0	0	LAVARREDA, CHARISE L NP	10/26/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015768	N/A	N/A	N/A	N/A	N/A	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
326712	Ordering, Referring, Prescribing	N/A	1275170086	0	0	LEWIS, EMILY A PA-C	2/10/2020	Taxonomy not applicable	NA	n/a	000	Unknown	57833	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DRIVE	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
326718	Ordering, Referring, Prescribing	N/A	1275192163	0	0	LE, JAMES A PHARMD	8/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80156	N/A	N/A	N/A	N/A	N/A	3752 MISSION AVE	None	OCEANSIDE	CA	92058	5000	00	06000	33.22514029	-117.3318383	San Diego County
326721	Ordering, Referring, Prescribing	N/A	1275194201	0	0	LIMANSKIY, VIKTOR MD	5/17/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178728	N/A	N/A	N/A	N/A	N/A	240 SPRUCE AVE	None	GRIDLEY	CA	95948	2216	00	06000	39.36701046	-121.6895355	Butte County
326736	Ordering, Referring, Prescribing	N/A	1275264780	0	0	LARA, EMILY C PA	6/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61310	N/A	N/A	N/A	N/A	N/A	1005 E WASHINGTON BLVD	SUITE A	LOS ANGELES	CA	90021	3082	00	06000	34.02578238	-118.2530622	Los Angeles County
326751	Ordering, Referring, Prescribing	N/A	1275342438	0	0	LAXINETA, SAMARA CNM	6/28/2024	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	236463	N/A	N/A	N/A	N/A	N/A	837 ADDISON ST	None	BERKELEY	CA	94710	2047	00	06000	37.86680859	-122.2969443	Alameda County
326759	Ordering, Referring, Prescribing	N/A	1275522518	0	0	LONDON, MARGARET CHRISTIE F NP	2/2/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	13931	N/A	N/A	N/A	N/A	N/A	1221 SOUTH AVE	None	SACRAMENTO	CA	95838	4464	00	06000	38.633418	-121.437189	Sacramento County
326772	Ordering, Referring, Prescribing	N/A	1275601213	0	0	LAM, VICKY M PHARMD	4/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH55056	N/A	N/A	N/A	N/A	N/A	9985 SIERRA AVE	None	FONTANA	CA	92335	0000	00	06000	34.07253232	-117.4356028	San Bernardino County
326798	Ordering, Referring, Prescribing	N/A	1275625535	0	0	LOVETT, DONALD F	4/17/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D17325	N/A	N/A	N/A	N/A	N/A	100 W 3RD ST	None	CLOVERDALE	CA	95425	3204	00	06000	38.80764171	-123.01919	Sonoma County
326804	Ordering, Referring, Prescribing	N/A	1275658270	0	0	LEVIN, PHILIP M PHD	1/20/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY15225	N/A	N/A	N/A	N/A	N/A	149 PASADENA AVE	SUITE A	SOUTH PASADENA	CA	91030	2947	00	06000	34.11188281	-118.1734374	Los Angeles County
326813	Ordering, Referring, Prescribing	N/A	1275664385	0	0	LOPEZ, JOANNA LMFT	6/23/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50381	N/A	N/A	N/A	N/A	N/A	1130 2ND ST	None	ENCINITAS	CA	92024	5008	00	06000	33.03747413	-117.2936839	San Diego County
326831	Ordering, Referring, Prescribing	N/A	1275694515	0	0	LIPPINCOTT, GREGORY M LMFT	12/10/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT36722	N/A	N/A	N/A	N/A	N/A	1119 E MONTE VISTA AVE	None	VACAVILLE	CA	95688	3009	00	06000	38.36024633	-121.9763983	Solano County
326861	Ordering, Referring, Prescribing	N/A	1275772188	0	0	LEE, CHRISTINE H MD	4/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A125468	N/A	N/A	N/A	N/A	N/A	529 MAPLE AVE	None	LOS ANGELES	CA	90013	1511	00	06000	34.04465262	-118.2472846	Los Angeles County
326873	Ordering, Referring, Prescribing	N/A	1275790602	0	0	LLITERAS, LISA M PSYD	4/15/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	30725	N/A	N/A	N/A	N/A	N/A	1420 S MILLIKEN AVE	None	ONTARIO	CA	91761	2336	00	06000	34.047684	-117.55872	San Bernardino County
326883	Ordering, Referring, Prescribing	N/A	1275816050	0	0	LEYDECKER, JENNIFER M LMFT	6/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	89389	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
326885	Ordering, Referring, Prescribing	N/A	1275816423	0	0	LEE, NIKI PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52968	N/A	N/A	N/A	N/A	N/A	5467 WILSHIRE BLVD	None	LOS ANGELES	CA	90036	4219	00	06000	34.06233905	-118.3479771	Los Angeles County
326944	Ordering, Referring, Prescribing	N/A	1275911893	0	0	LOR, CHEE LMFT	8/23/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT127711	N/A	N/A	N/A	N/A	N/A	9412 BIG HORN BLVD	None	ELK GROVE	CA	95758	1101	00	06000	38.415861	-121.407957	Sacramento County
326977	Ordering, Referring, Prescribing	N/A	1275964884	0	0	LEE, SHAUN H LMFT	6/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53121	N/A	N/A	N/A	N/A	N/A	500 CITY PKWY W	200	ORANGE	CA	92868	2941	00	06000	33.78299346	-117.895788	Orange County
326988	Ordering, Referring, Prescribing	N/A	1275971335	0	0	LEVEILLE, NICOLE T PHD	8/28/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	4048	N/A	N/A	N/A	N/A	N/A	97 SCHOOL ST	None	CLOVERDALE	CA	95425	3244	00	06000	38.81046557	-123.0218953	Sonoma County
327001	Ordering, Referring, Prescribing	N/A	1275993560	0	0	LEAVITT, IAN R PT	4/18/2023	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT291088	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
327027	Ordering, Referring, Prescribing	N/A	1285018150	0	0	LEE, JANICE	10/17/2018	Taxonomy not applicable	NA	n/a	000	Unknown	51115	N/A	N/A	N/A	N/A	N/A	298 E LIVE OAK AVE	None	ARCADIA	CA	91006	5629	00	06000	34.10834877	-118.0230654	Los Angeles County
327029	Ordering, Referring, Prescribing	N/A	1285025486	0	0	LESCHER, NICOLE LCSW	3/17/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107329	N/A	N/A	N/A	N/A	N/A	20601 W. PAOLI LN	None	WEIMAR	CA	95736	9629	00	06000	39.03521526	-120.9755343	Placer County
327033	Ordering, Referring, Prescribing	N/A	1285030015	0	0	LE, DANA OD	9/28/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	15151	N/A	N/A	N/A	N/A	N/A	13800 SAN ANTONIO DRIVE	None	NORWALK	CA	90650	4033	00	06000	33.9058081	-118.0785951	Los Angeles County
327068	Ordering, Referring, Prescribing	N/A	1285074807	0	0	LINDAHL, TARA A PSYD	6/6/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30931	N/A	N/A	N/A	N/A	N/A	9280 W STOCKTON BLVD	STE 230	ELK GROVE	CA	95758	8078	00	06000	38.420235	-121.394961	Sacramento County
327083	Ordering, Referring, Prescribing	N/A	1285100172	0	0	LOERA, KELLIE A CNP	2/22/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	15511	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
327091	Ordering, Referring, Prescribing	N/A	1285107797	0	0	LIANG, TING-YING	1/7/2019	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80165	N/A	N/A	N/A	N/A	N/A	2601 BALLS FERRY RD	None	ANDERSON	CA	96007	3507	00	06000	40.45353398	-122.2893192	Shasta County
327097	Ordering, Referring, Prescribing	N/A	1285121582	0	0	LIU, QIANNA DO	3/4/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18703	N/A	N/A	N/A	N/A	N/A	11888 BARTLETT AVE	None	ADELANTO	CA	92301	1709	00	06000	34.57927736	-117.4068692	San Bernardino County
327121	Ordering, Referring, Prescribing	N/A	1285155721	0	0	LEE, JUEUN L MSW LCSW	3/27/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW114570	N/A	N/A	N/A	N/A	N/A	2035 E. BALL RD.	100-C	ANAHEIM	CA	92806	5154	00	06000	33.81812448	-117.8880075	Orange County
327140	Ordering, Referring, Prescribing	N/A	1285196576	0	0	LEE, JOSEPH L PHARMD	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82085	N/A	N/A	N/A	N/A	N/A	3232 FOOTHILL BLVD	None	OAKLAND	CA	94601	3113	00	06000	37.78344416	-122.2218117	Alameda County
327173	Ordering, Referring, Prescribing	N/A	1285249276	0	0	LAVIOLETTE, LAUREN E NP	2/26/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029220	N/A	N/A	N/A	N/A	N/A	1107 O ST	None	FIREBAUGH	CA	93622	2224	00	06000	36.85875277	-120.4562709	Fresno County
327195	Ordering, Referring, Prescribing	N/A	1285287490	0	0	LOZANO ORTIZ, MARIA ALEJANDRA LMFT	3/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT131774	N/A	N/A	N/A	N/A	N/A	200 W SANTA ANA BLVD	801	SANTA ANA	CA	92701	4134	00	06000	33.74970951	-117.8691975	Orange County
327211	Ordering, Referring, Prescribing	N/A	1285348987	0	0	LEWIS, KATHY NP	2/11/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025965	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVENUE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
327239	Ordering, Referring, Prescribing	N/A	1285619130	0	0	LEON, HOLLANDA A MD	5/1/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A77124	N/A	N/A	N/A	N/A	N/A	4141 STATE STREET	SUITE B3	SANTA BARBARA	CA	93110	1814	00	06000	34.4404695	-119.7612045	Santa Barbara County
327262	Ordering, Referring, Prescribing	N/A	1285704684	0	0	LE, AMY C PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	44611	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
327280	Ordering, Referring, Prescribing	N/A	1285748988	0	0	LYONS, SIAN CCC-SLP	8/31/2022	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	26323	N/A	N/A	N/A	N/A	N/A	2240 OLD RIVER ROAD	None	UKIAH	CA	95482	7074	00	06000	39.1293897	-123.1645436	Mendocino County
327298	Ordering, Referring, Prescribing	N/A	1285781609	0	0	LANCASTER, DONNA H PHARMD	3/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51782	N/A	N/A	N/A	N/A	N/A	501 J STREET	6TH FLOOR	SACRAMENTO	CA	95814	2325	00	06000	38.582118	-121.499325	Sacramento County
327299	Ordering, Referring, Prescribing	N/A	1285772392	0	0	LEONARD, BEVERLY S NP	11/13/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP10943	N/A	N/A	N/A	N/A	N/A	8788 JAMACHA RD	None	SPRING VALLEY	CA	91977	4035	00	06000	32.71482507	-117.0098243	San Diego County
327307	Ordering, Referring, Prescribing	N/A	1285804476	0	0	LEE, VIVIAN T LCSW	12/29/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW26823	N/A	N/A	N/A	N/A	N/A	231 E THIRD STREET	G106	LOS ANGELES	CA	90013	1493	00	06000	34.04804033	-118.2438699	Los Angeles County
327309	Ordering, Referring, Prescribing	N/A	1285805317	0	0	LIM, JI IN DDS	2/28/2023	Taxonomy not applicable	NA	n/a	000	Unknown	47936	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
327320	Ordering, Referring, Prescribing	N/A	1285825117	0	0	LAM, SUSAN H LMFT	11/9/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52834	N/A	N/A	N/A	N/A	N/A	900 CORPORATE CENTER DR	350	MONTEREY PARK	CA	91754	7620	00	06000	34.05166169	-118.1621338	Los Angeles County
327322	Ordering, Referring, Prescribing	N/A	1285832121	0	0	LENTZ, ALECIA DO	5/30/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A22972	N/A	N/A	N/A	N/A	N/A	2201 COURAGE DRIVE	None	FAIRFIELD	CA	94533	6733	00	06000	38.23727106	-122.0692856	Solano County
327337	Ordering, Referring, Prescribing	N/A	1285863217	0	0	LOOMIS, BRIANA PHD	2/1/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	25637	N/A	N/A	N/A	N/A	N/A	2712 MISSION ST	None	SAN FRANCISCO	CA	94110	3104	00	06000	37.75336705	-122.4185922	San Francisco County
327344	Ordering, Referring, Prescribing	N/A	1285880013	0	0	LABASTIDA, MAYA M LMFT	2/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111545	N/A	N/A	N/A	N/A	N/A	105 N LINCOLN ST	None	SANTA MARIA	CA	93458	4319	00	06000	34.9535882	-120.4374049	Santa Barbara County
327360	Ordering, Referring, Prescribing	N/A	1285910588	0	0	LEE-CHAN, TIFFANY PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71935	N/A	N/A	N/A	N/A	N/A	3801 HOWE ST	None	OAKLAND	CA	94611	5312	00	06000	37.8242732	-122.2568561	Alameda County
327361	Ordering, Referring, Prescribing	N/A	1285911529	0	0	LE, NHI Q PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH66045	N/A	N/A	N/A	N/A	N/A	1532 N MAIN ST	None	SALINAS	CA	93906	5101	00	06000	36.71140332	-121.6541379	Monterey County
327365	Ordering, Referring, Prescribing	N/A	1285921221	0	0	LAKIN, SONIA Z LCSW	4/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92177	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
327370	Ordering, Referring, Prescribing	N/A	1285921809	0	0	LE, TINA H PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64951	N/A	N/A	N/A	N/A	N/A	22550 SAVI RANCH PKWY	None	YORBA LINDA	CA	92887	4670	00	06000	33.87448406	-117.7441707	Orange County
327379	Ordering, Referring, Prescribing	N/A	1285931782	0	0	LI, CHUNG KAY RRT	9/24/2018	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT8718	N/A	N/A	N/A	N/A	N/A	1004 14TH AVE	SUITE A	DELANO	CA	93215	2246	00	06000	35.77449518	-119.2451571	Kern County
327382	Ordering, Referring, Prescribing	N/A	1285940312	0	0	LAPIDES, JACOB E LMFT	1/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104773	N/A	N/A	N/A	N/A	N/A	3164 CONDO CT	None	SANTA ROSA	CA	95403	2557	00	06000	38.468709	-122.7425085	Sonoma County
327398	Ordering, Referring, Prescribing	N/A	1285966549	0	0	LY, SAI PHARMD	3/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55805	N/A	N/A	N/A	N/A	N/A	3100 DUBLIN BLVD.	None	DUBLIN	CA	94568	4713	00	06000	37.70453535	-121.8586496	Alameda County
327406	Ordering, Referring, Prescribing	N/A	1285984674	0	0	LEONE, JEANNEMARIE PSYD	4/13/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31763	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
327441	Ordering, Referring, Prescribing	N/A	1295046498	0	0	LEE, SOO J MD	12/11/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A123814	N/A	N/A	N/A	N/A	N/A	11731 E. TELEGRAPH ROAD	None	SANTE FE SPRINGS	CA	90670	3675	00	06000	33.94630253	-118.0832082	Los Angeles County
327451	Ordering, Referring, Prescribing	N/A	1295084689	0	0	LOWE, BRIANNA J OT	8/14/2021	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT12902	N/A	N/A	N/A	N/A	N/A	10431 COMMERCE STREET	SUITE A	REDLANDS	CA	92374	0110	00	06000	34.06427678	-117.2416506	San Bernardino County
327453	Ordering, Referring, Prescribing	N/A	1295089332	0	0	LONGACRE, BRETT A	12/12/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	771286	N/A	N/A	N/A	N/A	N/A	22675 ALESSANDRO BLVD	None	MORENO VALLEY	CA	92553	8506	00	06000	33.91695337	-117.2672536	Riverside County
327461	Ordering, Referring, Prescribing	N/A	1295098390	0	0	LEZCANO, SHEILA D MD	5/4/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A130548	N/A	N/A	N/A	N/A	N/A	1700 CESAR E CHAVEZ AVE	STE 3300	LOS ANGELES	CA	90033	2469	00	06000	34.05101259	-118.217259	Los Angeles County
327476	Ordering, Referring, Prescribing	N/A	1295130268	0	0	LANDAVERDE, VERONICA LMFT	12/4/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT77571	N/A	N/A	N/A	N/A	N/A	4701 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90022	1209	00	06000	34.04062547	-118.1643975	Los Angeles County
327484	Ordering, Referring, Prescribing	N/A	1295142149	0	0	LEE, KYUNG WOON NP	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95006454	N/A	N/A	N/A	N/A	N/A	37491 ENTERPRISE DRIVE	None	BURNEY	CA	96013	4380	00	06000	40.88784451	-121.6526265	Shasta County
327490	Ordering, Referring, Prescribing	N/A	1295149888	0	0	LAI, BENJAMIN PHARMD	6/20/2023	Taxonomy not applicable	NA	n/a	000	Unknown	72491	N/A	N/A	N/A	N/A	N/A	3208 SANTA ANITA AVE	100	EL MONTE	CA	91733	1304	00	06000	34.06628897	-118.0425098	Los Angeles County
327496	Ordering, Referring, Prescribing	N/A	1295162394	0	0	LOPEZ, VIOLETA M PA-C	5/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA19502	N/A	N/A	N/A	N/A	N/A	1031 W. 34TH ST	104	LOS ANGELES	CA	90089	3602	00	06000	34.024005	-118.2895875	Los Angeles County
327521	Ordering, Referring, Prescribing	N/A	1295213916	0	0	LIU, YING WU PHARMD	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76741	N/A	N/A	N/A	N/A	N/A	4131 GEARY BLVD	FL 4	SAN FRANCISCO	CA	94118	3101	00	06000	37.78096053	-122.4637512	San Francisco County
327525	Ordering, Referring, Prescribing	N/A	1295217131	0	0	LE, ALLEN	3/13/2018	Taxonomy not applicable	NA	n/a	000	Unknown	77700	N/A	N/A	N/A	N/A	N/A	1500 SOLANO AVE	None	ALBANY	CA	94707	2107	00	06000	37.89091938	-122.2869615	Alameda County
327544	Ordering, Referring, Prescribing	N/A	1295246692	0	0	LOPEZ, JACKELINE PA-C	6/29/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA62965	N/A	N/A	N/A	N/A	N/A	16465 SIERRA LAKES PKWY	300	FONTANA	CA	92336	1242	00	06000	34.13805177	-117.4457839	San Bernardino County
327578	Ordering, Referring, Prescribing	N/A	1295289312	0	0	LYNCH, SIENNA LCSW	8/9/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW102992	N/A	N/A	N/A	N/A	N/A	1812 W. PARK AVE	None	REDLANDS	CA	92373	0000	00	06000	34.05931058	-117.216243	San Bernardino County
327584	Ordering, Referring, Prescribing	N/A	1295303428	0	0	LAI, RYAN CHUN WAI	8/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH84275	N/A	N/A	N/A	N/A	N/A	3005 MIDWAY DR	None	SAN DIEGO	CA	92110	4502	00	06000	32.74999864	-117.2067973	San Diego County
327593	Ordering, Referring, Prescribing	N/A	1295316768	0	0	LEVENSON-PALMER, ROSE L MD	12/13/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183991	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
327595	Ordering, Referring, Prescribing	N/A	1295319291	0	0	LAURENTY-ELLIOTT, KRISTIN LMFT	6/7/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139867	N/A	N/A	N/A	N/A	N/A	9343 TECH CENTER DR	None	SACRAMENTO	CA	95826	2563	00	06000	38.564091	-121.3509285	Sacramento County
327597	Ordering, Referring, Prescribing	N/A	1295322147	0	0	LEE, RACHEL J	4/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	83613	N/A	N/A	N/A	N/A	N/A	900 S HARBOR BLVD	None	FULLERTON	CA	92832	3025	00	06000	33.862491	-117.921951	Orange County
327615	Ordering, Referring, Prescribing	N/A	1295364750	0	0	LIN, CARRIE MD	8/30/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189721	N/A	N/A	N/A	N/A	N/A	3250 WILSHIRE BLVD	SUITE 320	LOS ANGELES	CA	90010	1577	00	06000	34.06176363	-118.2932622	Los Angeles County
327670	Ordering, Referring, Prescribing	N/A	1295745354	0	0	LEE, TONY S LMFT	6/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT91075	N/A	N/A	N/A	N/A	N/A	9343 TECH CENTER DR	None	SACRAMENTO	CA	95826	2563	00	06000	38.564091	-121.3509285	Sacramento County
327677	Ordering, Referring, Prescribing	N/A	1295775401	0	0	LIBBEY, VICTOR B	7/7/2017	Taxonomy not applicable	NA	n/a	000	Unknown	15176	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
327706	Ordering, Referring, Prescribing	N/A	1295858959	0	0	LEMUS, NANCY LCSW	11/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98843	N/A	N/A	N/A	N/A	N/A	26137 LA PAZ RD	None	MISSION VIEJO	CA	92691	5319	00	06000	33.60038172	-117.6735855	Orange County
327711	Ordering, Referring, Prescribing	N/A	1295861730	0	0	LARA, JULIA P PHD	3/4/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PSY29134	N/A	N/A	N/A	N/A	N/A	429 N SAN ANTONIO RD	None	SANTA BARBARA	CA	93110	1399	00	06000	34.44573228	-119.7804008	Santa Barbara County
327776	Ordering, Referring, Prescribing	N/A	1306007042	0	0	LARA, ISSADORA MD	7/29/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A109540	N/A	N/A	N/A	N/A	N/A	223 W COLE BLVD	None	CALEXICO	CA	92231	9722	00	06000	32.69401949	-115.5029355	Imperial County
327787	Ordering, Referring, Prescribing	N/A	1306030028	0	0	LEE, JERRICA L PHARMD	3/20/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH55355	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC2-B	BOISE	ID	83706	0000	00	06000	43.59860438	-116.1806635	Ada County
327796	Ordering, Referring, Prescribing	N/A	1306053186	0	0	LEVINSON, SIMONE PSYD	8/28/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26212	N/A	N/A	N/A	N/A	N/A	1470 MARIA LANE	SUITE 200	WALNUT CREEK	CA	94596	5365	00	06000	37.892501	-122.0566177	Contra Costa County
327798	Ordering, Referring, Prescribing	N/A	1306053947	0	0	LEWIS, BARBARA LMFT	2/28/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41794	N/A	N/A	N/A	N/A	N/A	1290 GROVE STREET	APT. 302	SAN FRANCISCO	CA	94117	1536	00	06000	37.77598634	-122.4377464	San Francisco County
327808	Ordering, Referring, Prescribing	N/A	1306078068	0	0	LALLANDE, BEVERLY J MD	12/18/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A113039	N/A	N/A	N/A	N/A	N/A	4300 LONG BEACH BLVD	100	LONG BEACH	CA	90807	2011	00	06000	33.83662572	-118.1900605	Los Angeles County
327814	Ordering, Referring, Prescribing	N/A	1306096706	0	0	LAMAS, PERLA R LCSW	8/10/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26847	N/A	N/A	N/A	N/A	N/A	3303 N BROADWAY	400	LOS ANGELES	CA	90031	2803	00	06000	34.07380397	-118.20586	Los Angeles County
327818	Ordering, Referring, Prescribing	N/A	1306113311	0	0	LEE, ANDREW C PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50259	N/A	N/A	N/A	N/A	N/A	2976 SEPULVEDA BLVD	None	TORRANCE	CA	90505	2804	00	06000	33.82402224	-118.3392271	Los Angeles County
327831	Ordering, Referring, Prescribing	N/A	1306124268	0	0	LOZANO, EILEEN LMFT	1/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84912	N/A	N/A	N/A	N/A	N/A	1812 W PARK AVE	None	REDLANDS	CA	92373	8014	00	06000	34.05931058	-117.216243	San Bernardino County
327836	Ordering, Referring, Prescribing	N/A	1306128988	0	0	LAM, LINH	7/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH52755	N/A	N/A	N/A	N/A	N/A	41400 BLACOW RD	None	FREMONT	CA	94538	3387	00	06000	37.5225065	-121.9708497	Alameda County
327844	Ordering, Referring, Prescribing	N/A	1306146998	0	0	LUU, KELLY NHUNG T PHARMD	10/1/2018	Taxonomy not applicable	NA	n/a	000	Unknown	48052	N/A	N/A	N/A	N/A	N/A	369 MAGNOLIA AVE	None	CORONA	CA	92879	3300	00	06000	33.85312751	-117.5653159	Riverside County
327863	Ordering, Referring, Prescribing	N/A	1306173109	0	0	LUONG, LINDA LMFT	3/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT83778	N/A	N/A	N/A	N/A	N/A	1521 UNIVERSITY AVE	None	BERKELEY	CA	94703	1422	00	06000	37.87060038	-122.2812128	Alameda County
327874	Ordering, Referring, Prescribing	N/A	1306185293	0	0	LUNDEN, KALLE E	12/5/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0675150	N/A	N/A	N/A	N/A	N/A	2017 1ST AVENUE	SUITE 301	SAN DIEGO	CA	92101	2033	00	06000	32.72646147	-117.1638767	San Diego County
327889	Ordering, Referring, Prescribing	N/A	1306209796	0	0	LUTTRELL, JOHN T MD	4/8/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154344	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
327894	Ordering, Referring, Prescribing	N/A	1306220157	0	0	LACY, KIMBERLY A LMFT	11/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123204	N/A	N/A	N/A	N/A	N/A	101 WIKIUP DR.	SUITE B	SANTA ROSA	CA	95403	1375	00	06000	38.50788547	-122.7587646	Sonoma County
327989	Ordering, Referring, Prescribing	N/A	1306372834	0	0	LEE, MICHAEL J MD	3/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158112	N/A	N/A	N/A	N/A	N/A	375 89TH ST	None	DALY CITY	CA	94015	1802	00	06000	37.69175212	-122.474006	San Mateo County
327991	Ordering, Referring, Prescribing	N/A	1306374236	0	0	LIEWEN, ALISON P MD	10/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170692	N/A	N/A	N/A	N/A	N/A	610 WEST 3RD STREET	None	DORRIS	CA	96023	0170	00	06000	41.9642673	-121.9241778	Siskiyou County
327996	Ordering, Referring, Prescribing	N/A	1306405030	0	0	LEE, KEVIN PA-C	8/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63162	N/A	N/A	N/A	N/A	N/A	114 E ROMIE LN	None	SALINAS	CA	93901	3126	00	06000	36.66186399	-121.6545765	Monterey County
328011	Ordering, Referring, Prescribing	N/A	1306434899	0	0	LAVIN, BETH	10/14/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33694	N/A	N/A	N/A	N/A	N/A	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	00	06000	39.3245308	-120.2013097	Nevada County
328022	Ordering, Referring, Prescribing	N/A	1306454939	0	0	LEZAMA, YALIN LMFT	4/1/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	154344	N/A	N/A	N/A	N/A	N/A	18350 MOUNT LANGLEY ST	220	FOUNTAIN VALLEY	CA	92708	6900	00	06000	33.69633523	-117.9420534	Orange County
328026	Ordering, Referring, Prescribing	N/A	1306473376	0	0	LAM, YAT-YEE PHARMD	7/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72331	N/A	N/A	N/A	N/A	N/A	1532 N MAIN ST	None	SALINAS	CA	93901	1001	00	06000	36.71140332	-121.6541379	Monterey County
328041	Ordering, Referring, Prescribing	N/A	1306496369	0	0	LEE, MIN JIN	6/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH51504	N/A	N/A	N/A	N/A	N/A	21337 COLD SPRING LN	None	DIAMOND BAR	CA	91765	3443	00	06000	33.9733362	-117.8400213	Los Angeles County
328072	Ordering, Referring, Prescribing	N/A	1306579172	0	0	LE, MINH NP	1/11/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021575	N/A	N/A	N/A	N/A	N/A	9862 CHAPMAN AVE	None	GARDEN GROVE	CA	92841	2711	00	06000	33.78849558	-117.9607338	Orange County
328080	Ordering, Referring, Prescribing	N/A	1306621552	0	0	LOJPUR, TOMISLAV PA	1/8/2024	Taxonomy not applicable	NA	n/a	000	Unknown	63901	N/A	N/A	N/A	N/A	N/A	2800 RIVERSIDE AVE	None	PASO ROBLES	CA	93446	1311	00	06000	35.64351546	-120.6888699	San Luis Obispo County
328093	Ordering, Referring, Prescribing	N/A	1306847181	0	0	LEVGUR-FIELDS, HADAR Z	10/31/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A86281	N/A	N/A	N/A	N/A	N/A	7138 VAN NUYS BLVD	None	VAN NUYS	CA	91405	3005	00	06000	34.200464	-118.4487407	Los Angeles County
328099	Ordering, Referring, Prescribing	N/A	1306852561	0	0	LEE, CHARLES C MD	11/10/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A73537	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90509	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
328102	Ordering, Referring, Prescribing	N/A	1306874532	0	0	LAI, LAURA MD	1/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A66298	N/A	N/A	N/A	N/A	N/A	1530 HILLHURST AVE	None	LOS ANGELES	CA	90027	5516	00	06000	34.098921	-118.287374	Los Angeles County
328105	Ordering, Referring, Prescribing	N/A	1306889621	0	0	LI, LAWRENCE D PA-C	7/17/2018	Taxonomy not applicable	NA	n/a	000	Unknown	15055	N/A	N/A	N/A	N/A	N/A	1151 EAST WALNUT AVENUE	None	ONTARIO	CA	91761	6155	00	06000	34.026975	-117.6303375	San Bernardino County
328109	Ordering, Referring, Prescribing	N/A	1306891346	0	0	LEE, WINSTON J MD	6/5/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A67889	N/A	N/A	N/A	N/A	N/A	1140 WEST LA VETA	SUITE 610	ORANGE	CA	92868	0000	00	06000	33.7802984	-117.8651669	Orange County
328168	Ordering, Referring, Prescribing	N/A	1316025216	0	0	LUO, XING-XING MD	12/18/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A73788	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
328218	Ordering, Referring, Prescribing	N/A	1316120694	0	0	LERMA, LIZBETH P LMFT	4/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT49687	N/A	N/A	N/A	N/A	N/A	327 SOUTH K ST	None	TULARE	CA	93274	5416	00	06000	36.20476387	-119.3454489	Tulare County
328220	Ordering, Referring, Prescribing	N/A	1316143191	0	0	LAVERE, SUZANNE LMFT	5/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	34718	N/A	N/A	N/A	N/A	N/A	146 REDONDO DR.	None	PITTSBURG	CA	94565	5929	00	06000	37.99994404	-121.8945641	Contra Costa County
328257	Ordering, Referring, Prescribing	N/A	1316221690	0	0	LIN, CHRISTINE Y NP	3/4/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	21309	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
328274	Ordering, Referring, Prescribing	N/A	1316238280	0	0	LE, LEON C PHARMD	11/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55051	N/A	N/A	N/A	N/A	N/A	2227 S SHORE CENTER	None	ALAMEDA	CA	94501	8029	00	06000	37.75636497	-122.2516049	Alameda County
328276	Ordering, Referring, Prescribing	N/A	1316248198	0	0	LESLIE, DANIEL A PHARMD	4/11/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH58903	N/A	N/A	N/A	N/A	N/A	3610 ADAMS AVE	None	SAN DIEGO	CA	92116	2212	00	06000	32.76335447	-117.1146375	San Diego County
328282	Ordering, Referring, Prescribing	N/A	1316251531	0	0	LEVIN, IVY LCSW	2/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	68363	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
328307	Ordering, Referring, Prescribing	N/A	1316315286	0	0	LEE, MARY NP	4/14/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95010783	N/A	N/A	N/A	N/A	N/A	2727 MACDONALD AVE	None	RICHMOND	CA	94804	3006	00	06000	37.93503193	-122.3422799	Contra Costa County
328315	Ordering, Referring, Prescribing	N/A	1316318983	0	0	LUI, MARY PHARMD	4/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	43201	N/A	N/A	N/A	N/A	N/A	13550 PAXTON ST	None	PACOIMA	CA	91331	2352	00	06000	34.27263559	-118.4275767	Los Angeles County
328323	Ordering, Referring, Prescribing	N/A	1316324536	0	0	LEE, PAMELA MD	11/8/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145071	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	CARSON	CA	90502	2004	00	06000	33.8315367	-118.29243	Los Angeles County
328349	Ordering, Referring, Prescribing	N/A	1316370364	0	0	LEAL, ALEJANDRA LCSW	3/9/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100452	N/A	N/A	N/A	N/A	N/A	22978 EL TORO RD	None	LAKE FOREST	CA	92630	4961	00	06000	33.62895849	-117.6898866	Orange County
328363	Ordering, Referring, Prescribing	N/A	1316392657	0	0	LINDSTROM, SORREN MD	6/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163728	N/A	N/A	N/A	N/A	N/A	500B JEFFERSON BLVD	STE 180	DAVIS	CA	95616	9701	00	06000	0	0	None
328366	Ordering, Referring, Prescribing	N/A	1316393788	0	0	LEE, KAYAN CATHERINE LMFT	3/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	101774	N/A	N/A	N/A	N/A	N/A	1160 S GRAND AVE	None	GLENDORA	CA	91740	5000	00	06000	34.11736533	-117.8725213	Los Angeles County
328367	Ordering, Referring, Prescribing	N/A	1316396351	0	0	LOHARUKA, SHEILA DO	3/18/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18117	N/A	N/A	N/A	N/A	N/A	22675 ALESSANDRO BLVD	None	MORENO VALLEY	CA	92553	8551	00	06000	33.91695337	-117.2672536	Riverside County
328373	Ordering, Referring, Prescribing	N/A	1316397896	0	0	LETTSOME, JENNIFER NP	7/27/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005296	N/A	N/A	N/A	N/A	N/A	3743 S LA BREA AVE	None	LOS ANGELES	CA	90016	5309	00	06000	34.01991	-118.355626	Los Angeles County
328395	Ordering, Referring, Prescribing	N/A	1316433469	0	0	LEDEZMA, MARICELA	6/15/2018	Taxonomy not applicable	NA	n/a	000	Unknown	55676	N/A	N/A	N/A	N/A	N/A	1107 W POPLAR AVE	None	PORTERVILLE	CA	93257	5839	00	06000	36.05128153	-119.0422344	Tulare County
328414	Ordering, Referring, Prescribing	N/A	1316465800	0	0	LOPEZ, DALILA LCSW	4/30/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101347	N/A	N/A	N/A	N/A	N/A	19401 S. VERMONT AVE.	L102	TORRANCE	CA	90502	4459	00	06000	33.85486409	-118.2905603	Los Angeles County
328444	Ordering, Referring, Prescribing	N/A	1316495435	0	0	LE, TRI D PHARMD	8/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78350	N/A	N/A	N/A	N/A	N/A	795 EL CAMINO REAL	AB111A	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
328445	Ordering, Referring, Prescribing	N/A	1316499528	0	0	LEWIS, CAMILLE LCSW	6/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95148	N/A	N/A	N/A	N/A	N/A	158 GENTRY ST	None	POMONA	CA	91767	2100	00	06000	34.09147818	-117.7506278	Los Angeles County
328450	Ordering, Referring, Prescribing	N/A	1316503410	0	0	LUU, NICOLE L PHARMD	12/5/2019	Taxonomy not applicable	NA	n/a	000	Unknown	81089	N/A	N/A	N/A	N/A	N/A	1111 COLUMBUS ST	None	BAKERSFIELD	CA	93305	1936	00	06000	35.39744148	-118.9822815	Kern County
328461	Ordering, Referring, Prescribing	N/A	1316525587	0	0	LAW, KELLY DO	5/14/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20679	N/A	N/A	N/A	N/A	N/A	1443 OCEAN AVE	None	SAN FRANCISCO	CA	94112	1731	00	06000	37.72421849	-122.4578632	San Francisco County
328482	Ordering, Referring, Prescribing	N/A	1316564156	0	0	LARSON, EVA D PA	10/12/2020	Taxonomy not applicable	NA	n/a	000	Unknown	58681	N/A	N/A	N/A	N/A	N/A	2098 S CENTRAL AVE	None	LOS ANGELES	CA	90011	1235	00	06000	34.0227101	-118.2521314	Los Angeles County
328492	Ordering, Referring, Prescribing	N/A	1316586076	0	0	LAM, MICHAEL PHARMD	3/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81266	N/A	N/A	N/A	N/A	N/A	3701 BROADWAY	None	OAKLAND	CA	94611	0000	00	06000	37.82533768	-122.258094	Alameda County
328493	Ordering, Referring, Prescribing	N/A	1316588148	0	0	LI, SIYU PA-C	6/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA57525	N/A	N/A	N/A	N/A	N/A	451 W LINCOLN AVE	SUITE 100	ANAHEIM	CA	92805	2927	00	06000	33.83445082	-117.9189372	Orange County
328504	Ordering, Referring, Prescribing	N/A	1316602568	0	0	LIM, SHELBY PA-C	12/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	62056	N/A	N/A	N/A	N/A	N/A	2237 W BALL RD	None	ANAHEIM	CA	92804	5314	00	06000	33.817798	-117.9610599	Orange County
328545	Ordering, Referring, Prescribing	N/A	1316966971	0	0	LEE, ALBERT C MD	7/18/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G58417	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	1000	00	06000	33.83155851	-118.2920625	Los Angeles County
328558	Ordering, Referring, Prescribing	N/A	1316793003	0	0	LEE, JUNWON CNP	7/3/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95023743	N/A	N/A	N/A	N/A	N/A	3030 WEST OLYMPIC BOULEV	206	LOS ANGELES	CA	90006	6506	00	06000	34.05260995	-118.3015825	Los Angeles County
328583	Ordering, Referring, Prescribing	N/A	1326105917	0	0	LILJEDAHL, SALLY J LCSW	8/14/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW20460	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
328585	Ordering, Referring, Prescribing	N/A	1326111758	0	0	LE, DAISY ARABELLE E	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH57702	N/A	N/A	N/A	N/A	N/A	3000 LAS POSITAS RD	None	LIVERMORE	CA	94551	9627	00	06000	37.69960369	-121.7628917	Alameda County
328637	Ordering, Referring, Prescribing	N/A	1326186545	0	0	LOWDER, SALLY LCSW	6/3/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24961	N/A	N/A	N/A	N/A	N/A	200 24TH STREET	None	RICHMOND	CA	94804	1804	00	06000	37.93439778	-122.3465322	Contra Costa County
328656	Ordering, Referring, Prescribing	N/A	1326232497	0	0	LAM, KA MING LMFT	4/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52609	N/A	N/A	N/A	N/A	N/A	1290 COMMODORE DR	None	SAN BRUNO	CA	94066	2304	00	06000	37.63134914	-122.4260472	San Mateo County
328657	Ordering, Referring, Prescribing	N/A	1326231580	0	0	LEON, TRICIA	5/13/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0514108	N/A	N/A	N/A	N/A	N/A	1045 NORTH LAKE AVE	None	PASADENA	CA	91104	4521	00	06000	34.16394511	-118.1324885	Los Angeles County
328658	Ordering, Referring, Prescribing	N/A	1326242033	0	0	LONG, DANIELLE M LCSW	5/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW84763	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
328661	Ordering, Referring, Prescribing	N/A	1326242801	0	0	LIPSCOMB, ROBERT M MD	10/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G89022	N/A	N/A	N/A	N/A	N/A	721 RIVER DR	STE # B	FORT BRAGG	CA	95437	0000	00	06000	39.43204627	-123.801581	Mendocino County
328671	Ordering, Referring, Prescribing	N/A	1326259490	0	0	LAM, MARY S PHARMD	8/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58432	N/A	N/A	N/A	N/A	N/A	120 W PARKRIDGE AVE	None	CORONA	CA	92878	1450	00	06000	33.89324293	-117.5638517	Riverside County
328692	Ordering, Referring, Prescribing	N/A	1326302324	0	0	LE, HUULINH ANGELINE	1/31/2022	Taxonomy not applicable	NA	n/a	000	Unknown	56976	N/A	N/A	N/A	N/A	N/A	2299 BRONZE STAR DR	None	WOODLAND	CA	95776	5409	00	06000	38.672541	-121.7237315	Yolo County
328697	Ordering, Referring, Prescribing	N/A	1326305988	0	0	LARSON, JENNIFER L MD	3/31/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A130546	N/A	N/A	N/A	N/A	N/A	2851 MEADOW LARK DR	None	SAN DIEGO	CA	92123	2709	00	06000	32.794542	-117.154293	San Diego County
328721	Ordering, Referring, Prescribing	N/A	1326328519	0	0	LA, VINH T PHARMD	10/15/2018	Taxonomy not applicable	NA	n/a	000	Unknown	65834	N/A	N/A	N/A	N/A	N/A	5760 COTTLE RD	None	SAN JOSE	CA	95123	3624	00	06000	37.24641	-121.803852	Santa Clara County
328725	Ordering, Referring, Prescribing	N/A	1326325820	0	0	LI, ANGELA P PHARMD	7/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49587	N/A	N/A	N/A	N/A	N/A	18308 E COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	2761	00	06000	33.9883111	-117.9052922	Los Angeles County
328733	Ordering, Referring, Prescribing	N/A	1326342072	0	0	LOUIS, JUANITA T PA-C	6/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61178	N/A	N/A	N/A	N/A	N/A	5730 PACKARD AVE.	SUITE 500	MARYSVILLE	CA	95901	7118	00	06000	39.12014523	-121.5659991	Yuba County
328752	Ordering, Referring, Prescribing	N/A	1326364902	0	0	LINGAN, JAYSON VINCENT S MD	3/13/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194681	N/A	N/A	N/A	N/A	N/A	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	00	06000	40.57278686	-122.3958519	Shasta County
328786	Ordering, Referring, Prescribing	N/A	1326425570	0	0	LAMANTIA, CARLY E NP	2/14/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95011178	N/A	N/A	N/A	N/A	N/A	347 W MISSION AVE	None	ESCONDIDO	CA	92025	1729	00	06000	33.12861918	-117.0906689	San Diego County
328792	Ordering, Referring, Prescribing	N/A	1326431420	0	0	LOZANO, DANIEL LMFT	3/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113764	N/A	N/A	N/A	N/A	N/A	658 E BRIER DR	200	SAN BERNARDINO	CA	92408	2880	00	06000	34.07137738	-117.2702805	San Bernardino County
328808	Ordering, Referring, Prescribing	N/A	1326452756	0	0	LEIVENT, JACOB MD	1/9/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A149197	N/A	N/A	N/A	N/A	N/A	520 E TULARE AVE	None	TULARE	CA	93274	4221	00	06000	36.20878419	-119.3415531	Tulare County
328853	Ordering, Referring, Prescribing	N/A	1326525924	0	0	LE, BRIANA PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79155	N/A	N/A	N/A	N/A	N/A	1200 DISCOVERY DRIVE	None	BAKERSFIELD	CA	93309	7032	00	06000	35.36397746	-119.0589062	Kern County
328871	Ordering, Referring, Prescribing	N/A	1326569864	0	0	LA, CHRISTINA OD	1/22/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	33702	N/A	N/A	N/A	N/A	N/A	18601 VALLEY BLVD	None	BLOOMINGTON	CA	92316	1831	00	06000	34.07045653	-117.3982455	San Bernardino County
328882	Ordering, Referring, Prescribing	N/A	1326588450	0	0	LA FRANO, ERIKA G LCSW	9/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW70642	N/A	N/A	N/A	N/A	N/A	930 VISALIA ST	None	PISMO BEACH	CA	93449	2465	00	06000	35.1509225	-120.638755	San Luis Obispo County
328888	Ordering, Referring, Prescribing	N/A	1326593765	0	0	LANDAVERDE ALVAREZ, VICKI M LCSW	12/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99242	N/A	N/A	N/A	N/A	N/A	1887 MONTEREY HWY	205	SAN JOSE	CA	95112	6192	00	06000	37.30869336	-121.8664126	Santa Clara County
328892	Ordering, Referring, Prescribing	N/A	1326598392	0	0	LEVINE, JORDYN R LCSW	6/1/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101755	N/A	N/A	N/A	N/A	N/A	1339 20TH ST	None	SANTA MONICA	CA	90404	2033	00	06000	34.02917949	-118.4805651	Los Angeles County
328901	Ordering, Referring, Prescribing	N/A	1326601832	0	0	LE, STEPHANIE PHARMD	12/2/2020	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80228	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
328920	Ordering, Referring, Prescribing	N/A	1326667213	0	0	LARBAH, AMINA R	4/1/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL4692	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
328925	Ordering, Referring, Prescribing	N/A	1326677881	0	0	LIU, CHRISTINA OD	6/23/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34542	N/A	N/A	N/A	N/A	N/A	1724 NEW AVE	None	SAN GABRIEL	CA	91776	3734	00	06000	34.07733	-118.1082615	Los Angeles County
328927	Ordering, Referring, Prescribing	N/A	1326683046	0	0	LADSON, VANESSA OT	5/18/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	15631	N/A	N/A	N/A	N/A	N/A	185 MARTINVALE LN	None	SAN JOSE	CA	95119	1319	00	06000	37.22953469	-121.7790244	Santa Clara County
328934	Ordering, Referring, Prescribing	N/A	1326691718	0	0	LOPEZ, CHELSEA PA	6/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	56926	N/A	N/A	N/A	N/A	N/A	4402 E COMPTON BLVD	None	COMPTON	CA	90221	3667	00	06000	33.8960937	-118.1944727	Los Angeles County
328948	Ordering, Referring, Prescribing	N/A	1326708207	0	0	LACAMBRA, CHARLENE KC S NP	1/6/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019658	N/A	N/A	N/A	N/A	N/A	1080 MARINA VILLAGE PKWY	SUITE 100	ALAMEDA	CA	94501	6427	00	06000	37.78544731	-122.270323	Alameda County
328977	Ordering, Referring, Prescribing	N/A	1326821539	0	0	LASKOWICZ, NATALIE PA	12/1/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63788	N/A	N/A	N/A	N/A	N/A	7512 MORRO RD	None	ATASCADERO	CA	93422	4404	00	06000	35.47716258	-120.6674786	San Luis Obispo County
328983	Ordering, Referring, Prescribing	N/A	1326890864	0	0	LOWRY, DAVID NP	8/30/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95026960	N/A	N/A	N/A	N/A	N/A	2390 E FLORIDA AVE	101	HEMET	CA	92544	4707	00	06000	33.7477405	-116.94681	Riverside County
329015	Ordering, Referring, Prescribing	N/A	1336244458	0	0	LUND, SHEWAK R MD	1/8/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A38222	N/A	N/A	N/A	N/A	N/A	8771 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	2401	00	06000	34.229394	-118.4502665	Los Angeles County
329055	Ordering, Referring, Prescribing	N/A	1336327196	0	0	LOZANO, ALFREDO LMFT	2/12/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT100893	N/A	N/A	N/A	N/A	N/A	433 CALLAN AVE	STE 309	SAN LEANDRO	CA	94577	4641	00	06000	37.72706807	-122.1519034	Alameda County
329056	Ordering, Referring, Prescribing	N/A	1336328004	0	0	LYNCH, JEANIE LMFT	12/7/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42140	N/A	N/A	N/A	N/A	N/A	545 ESTUDILLO AVE	None	SAN LEANDRO	CA	94577	4611	00	06000	37.72679439	-122.1491972	Alameda County
329103	Ordering, Referring, Prescribing	N/A	1336418441	0	0	LEE, RICHARD H PHARMD	7/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH65808	N/A	N/A	N/A	N/A	N/A	1501 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4001	00	06000	34.01184449	-118.1170258	Los Angeles County
329105	Ordering, Referring, Prescribing	N/A	1336420868	0	0	LAU, ANDREW LCSW	12/10/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88303	N/A	N/A	N/A	N/A	N/A	515 COLUMBIA AVE	SUITE 200	LOS ANGELES	CA	90017	1209	00	06000	34.05683109	-118.265995	Los Angeles County
329107	Ordering, Referring, Prescribing	N/A	1336420447	0	0	LEONG-ABAD, JACQUELINE LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	101304	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
329109	Ordering, Referring, Prescribing	N/A	1336423094	0	0	LEUNG, YAT-MING J PHD	2/24/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28872	N/A	N/A	N/A	N/A	N/A	391 TAYLOR BLVD	100	PLEASANT HILL	CA	94523	2289	00	06000	37.96119614	-122.070409	Contra Costa County
329113	Ordering, Referring, Prescribing	N/A	1336425933	0	0	LOGSDON NEWSOME, MARGIE L PHARMD	3/17/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH39858	N/A	N/A	N/A	N/A	N/A	11800 DE PALMA RD	None	CORONA	CA	92883	8498	00	06000	33.74635292	-117.4536847	Riverside County
329115	Ordering, Referring, Prescribing	N/A	1336424613	0	0	LUOMA, JOHN LCSW	6/3/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122919	N/A	N/A	N/A	N/A	N/A	29632 HIGHWAY 299 EAST	None	ROUND MOUNTAIN	CA	96084	0000	00	06000	40.80385331	-121.9397745	Shasta County
329126	Ordering, Referring, Prescribing	N/A	1336446939	0	0	LUNA, KARINA L LMFT	4/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT110635	N/A	N/A	N/A	N/A	N/A	4441 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.738144	-119.753361	Fresno County
329138	Ordering, Referring, Prescribing	N/A	1336471689	0	0	LETHIN, CASSIE E LCSW	5/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW72049	N/A	N/A	N/A	N/A	N/A	720 WOOD ST	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
329149	Ordering, Referring, Prescribing	N/A	1336503861	0	0	LEE, JOCELYN S Y DO	3/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16063	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
329174	Ordering, Referring, Prescribing	N/A	1336529478	0	0	LEE, DAO LILY	12/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63162	N/A	N/A	N/A	N/A	N/A	1260 E ONTARIO AVE	None	CORONA	CA	92881	3600	00	06000	33.84755918	-117.5418146	Riverside County
329190	Ordering, Referring, Prescribing	N/A	1336541200	0	0	LUNA DEPAUL, ALLISON J PHARMD	11/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70743	N/A	N/A	N/A	N/A	N/A	30530 RANCHO CALIFORNIA	PHARMACY	TEMECULA	CA	92591	3277	00	06000	33.50860426	-117.1275323	Riverside County
329192	Ordering, Referring, Prescribing	N/A	1336541481	0	0	LAGEOSE, BERTHA A NP	1/13/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	424574	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD PLAZA	5447	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
329275	Ordering, Referring, Prescribing	N/A	1336670298	0	0	LI, ZHUO PHARMD	12/9/2019	Taxonomy not applicable	NA	n/a	000	Unknown	73429	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
329289	Ordering, Referring, Prescribing	N/A	1336692086	0	0	LEE, JANET	7/12/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	15425	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL STREET	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
329300	Ordering, Referring, Prescribing	N/A	1336701150	0	0	LIAO, YU-LING B PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80000	N/A	N/A	N/A	N/A	N/A	1135 S. SAN GABRIEL BLVD	UNIT 2	SAN GABRIEL	CA	91776	3114	00	06000	34.086672	-118.0908455	Los Angeles County
329312	Ordering, Referring, Prescribing	N/A	1336732163	0	0	LE, PHONG T PHARMD	8/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	84016	N/A	N/A	N/A	N/A	N/A	1080 PLEASANT GROVE BLVD	None	ROSEVILLE	CA	95678	0000	00	06000	38.77629256	-121.2910739	Placer County
329324	Ordering, Referring, Prescribing	N/A	1336762376	0	0	LAVERNE, ALYSE LMFT	12/17/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT135953	N/A	N/A	N/A	N/A	N/A	991 10TH ST	None	ARCATA	CA	95521	6114	00	06000	40.87025254	-124.0884044	Humboldt County
329328	Ordering, Referring, Prescribing	N/A	1336769728	0	0	LONGURYAN, ANNA NP	1/22/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016479	N/A	N/A	N/A	N/A	N/A	2928 E CESAR E CHAVEZ AV	SUITE 280	LOS ANGELES	CA	90033	3110	00	06000	34.04364362	-118.2006515	Los Angeles County
329375	Ordering, Referring, Prescribing	N/A	1336981356	0	0	LYONS, MARIAH NP	6/10/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030440	N/A	N/A	N/A	N/A	N/A	4425 S CENTRAL AVE	None	LOS ANGELES	CA	90011	3629	00	06000	34.003116	-118.2565185	Los Angeles County
329386	Ordering, Referring, Prescribing	N/A	1346083599	0	0	LORENZINI, TAYLOR	6/14/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030584	N/A	N/A	N/A	N/A	N/A	2450 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	00	06000	40.14921426	-122.2216794	Tehama County
329422	Ordering, Referring, Prescribing	N/A	1346327541	0	0	LIU, YIN-MING MD	12/10/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A41789	N/A	N/A	N/A	N/A	N/A	1725 W 17TH ST	102F	SANTA ANA	CA	92706	2316	00	06000	33.75999552	-117.892593	Orange County
329433	Ordering, Referring, Prescribing	N/A	1346341070	0	0	LOPEZ, LUIS E MD	6/11/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G37689	N/A	N/A	N/A	N/A	N/A	1530 S. OLIVE ST	None	LOS ANGELES	CA	90015	3023	00	06000	34.03542552	-118.2652073	Los Angeles County
329451	Ordering, Referring, Prescribing	N/A	1346381423	0	0	LODA, KIMBERLY MD	6/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A98606	N/A	N/A	N/A	N/A	N/A	700 ADELINE ST.	None	OAKLAND	CA	94607	2608	00	06000	37.80430011	-122.2879962	Alameda County
329499	Ordering, Referring, Prescribing	N/A	1346473204	0	0	LUDWIG, CONNIE H PHD	2/10/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	29653	N/A	N/A	N/A	N/A	N/A	2712 MISSION STREET	None	SAN FRANCISCO	CA	94110	3104	00	06000	37.75336705	-122.4185922	San Francisco County
329512	Ordering, Referring, Prescribing	N/A	1346510575	0	0	LIU, LUCY H MD	7/18/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A134583	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
329554	Ordering, Referring, Prescribing	N/A	1346571643	0	0	LILLY, MATTHEW N MD	1/14/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A127216	N/A	N/A	N/A	N/A	N/A	18217 HALE AVE	None	MORGAN HILL	CA	95037	0000	00	06000	37.13761496	-121.6664813	Santa Clara County
329564	Ordering, Referring, Prescribing	N/A	1346593241	0	0	LOPEZ, CASSONDRA R	2/26/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0759206	N/A	N/A	N/A	N/A	N/A	1833 FILLMORE ST	None	SAN FRANCISCO	CA	94115	3180	00	06000	37.78652252	-122.4333821	San Francisco County
329573	Ordering, Referring, Prescribing	N/A	1346594165	0	0	LAFAYETTE, RICHARD NP	12/18/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016427	N/A	N/A	N/A	N/A	N/A	316 S STRATFORD AVE	STE B	SANTA MARIA	CA	93454	0001	00	06000	34.95019447	-120.4147816	Santa Barbara County
329611	Ordering, Referring, Prescribing	N/A	1346656550	0	0	LANCASTER, LUISA M LMFT	5/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126158	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
329636	Ordering, Referring, Prescribing	N/A	1346695715	0	0	LAU, BONNIE S PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72842	N/A	N/A	N/A	N/A	N/A	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
329678	Ordering, Referring, Prescribing	N/A	1346751302	0	0	LEE, DIANNE PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77555	N/A	N/A	N/A	N/A	N/A	111 S MAIN ST ORANGE CA	None	ORANGE	CA	92868	2428	00	06000	33.787512	-117.867272	Orange County
329706	Ordering, Referring, Prescribing	N/A	1346807831	0	0	LU, MARY J LMFT	6/6/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT131766	N/A	N/A	N/A	N/A	N/A	12912 BROOKHURST ST	#420	GARDEN GROVE	CA	92840	4835	00	06000	33.77487003	-117.9552276	Orange County
329713	Ordering, Referring, Prescribing	N/A	1346827102	0	0	LOPEZ, GABRIELA MD	3/22/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194953	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
329720	Ordering, Referring, Prescribing	N/A	1346851078	0	0	LIN, ALICE	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83005	N/A	N/A	N/A	N/A	N/A	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	00	06000	37.33773494	-122.0043395	Santa Clara County
329755	Ordering, Referring, Prescribing	N/A	1346917416	0	0	LIU, FANGBING NP	8/17/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018125	N/A	N/A	N/A	N/A	N/A	5 MEDICAL PLAZA	STE 170	ROSEVILLE	CA	95661	2867	00	06000	38.76604411	-121.2466761	Placer County
329794	Ordering, Referring, Prescribing	N/A	1356082150	0	0	LUU, ANDREW MD	1/29/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A191550	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
329799	Ordering, Referring, Prescribing	N/A	1356020689	0	0	LEE, MINHA MD	7/21/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188090	N/A	N/A	N/A	N/A	N/A	200 MEDICAL PLAZA	#530	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
329824	Ordering, Referring, Prescribing	N/A	1356347959	0	0	LEMAY, DANIEL R MD	7/31/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G74285	N/A	N/A	N/A	N/A	N/A	8043 2ND ST.	105	DOWNEY	CA	90241	3621	00	06000	33.94296553	-118.1360957	Los Angeles County
329862	Ordering, Referring, Prescribing	N/A	1356470181	0	0	LOCKHART, ELIZABETH LMFT	11/20/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT36817	N/A	N/A	N/A	N/A	N/A	1400 S GRAND AVE	None	LOS ANGELES	CA	90015	3048	00	06000	34.03692236	-118.2655238	Los Angeles County
329864	Ordering, Referring, Prescribing	N/A	1356481527	0	0	LEMELLE-LOVE, SHEILA A	2/2/2012	Taxonomy not applicable	NA	n/a	099	DENTIST	D38076	N/A	N/A	N/A	N/A	N/A	15706 POMERADO RD	SUITE 205	POWAY	CA	92064	2067	00	06000	32.99909223	-117.0579393	San Diego County
329875	Ordering, Referring, Prescribing	N/A	1356503916	0	0	LYNN, AARON K MD	1/28/2015	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A116699	N/A	N/A	N/A	N/A	N/A	1530 HILLHURST AVENUE	None	LOS ANGELES	CA	90027	5516	00	06000	34.098921	-118.287374	Los Angeles County
329901	Ordering, Referring, Prescribing	N/A	1356576748	0	0	LEE, JENNY J LMFT	12/20/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97445	N/A	N/A	N/A	N/A	N/A	1001 SNEATH LN	STE 200	SAN BRUNO	CA	94066	2349	00	06000	37.63462925	-122.4259247	San Mateo County
329921	Ordering, Referring, Prescribing	N/A	1356614762	0	0	LOELIGER, CHRISTINA NP	2/13/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	350757	N/A	N/A	N/A	N/A	N/A	243 GEORGIA STREET	SUITE B	VALLEJO	CA	94590	5905	00	06000	38.10111026	-122.2588175	Solano County
329943	Ordering, Referring, Prescribing	N/A	1356637383	0	0	LOPEZ, ARMANDO LMFT	7/18/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105272	N/A	N/A	N/A	N/A	N/A	2827 CONCORD BLVD	None	CONCORD	CA	94519	2608	00	06000	37.97746145	-122.0253615	Contra Costa County
329947	Ordering, Referring, Prescribing	N/A	1356641401	0	0	LIM, HWEE	10/2/2018	Taxonomy not applicable	NA	n/a	000	Unknown	44255	N/A	N/A	N/A	N/A	N/A	785 E EL CAMINO REAL	None	SUNNYVALE	CA	94087	2919	00	06000	37.35662376	-122.0186086	Santa Clara County
329954	Ordering, Referring, Prescribing	N/A	1356654347	0	0	LARSEN, JARY PHD	12/28/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	15816	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
329972	Ordering, Referring, Prescribing	N/A	1356693246	0	0	LY, ALLISON LCSW	7/25/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82395	N/A	N/A	N/A	N/A	N/A	1515 W MISSION RD	None	ALHAMBRA	CA	91803	1618	00	06000	34.08224297	-118.1404375	Los Angeles County
330001	Ordering, Referring, Prescribing	N/A	1356724819	0	0	LINHARES, GERALDINE L LMFT	8/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120904	N/A	N/A	N/A	N/A	N/A	290 IOOF AVE	None	GILROY	CA	95020	5204	00	06000	37.01377513	-121.5685719	Santa Clara County
330041	Ordering, Referring, Prescribing	N/A	1356778393	0	0	LARSEN, YURI PHARMD	8/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80706	N/A	N/A	N/A	N/A	N/A	60 N HIGHLAND SPRINGS AV	None	BANNING	CA	92220	3048	00	06000	33.92988307	-116.9468586	Riverside County
330044	Ordering, Referring, Prescribing	N/A	1356791859	0	0	LARA, JAQUELINE D LMFT	5/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123749	N/A	N/A	N/A	N/A	N/A	2026 W BEACON AVE	None	ANAHEIM	CA	92804	4406	00	06000	33.82030486	-117.9539867	Orange County
330071	Ordering, Referring, Prescribing	N/A	1356831093	0	0	LACY, LANESHA R LCSW	3/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80361	N/A	N/A	N/A	N/A	N/A	3133 N MILLBROOK AVE	None	FRESNO	CA	93703	1425	00	06000	36.77841	-119.7635455	Fresno County
330077	Ordering, Referring, Prescribing	N/A	1356849442	0	0	LEE, RIKKI PHARMD	3/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74754	N/A	N/A	N/A	N/A	N/A	1941 TARAVAL ST.	None	SAN FRANCISCO	CA	94116	2215	00	06000	37.74254823	-122.4866868	San Francisco County
330095	Ordering, Referring, Prescribing	N/A	1356883953	0	0	LAIL, AMINDEEP MD	5/25/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169486	N/A	N/A	N/A	N/A	N/A	50249 CESAR CHAVEZ ST	STE K	COACHELLA	CA	92236	1530	00	06000	33.68245553	-116.1816607	Riverside County
330103	Ordering, Referring, Prescribing	N/A	1356885651	0	0	LAWSON, LAUREN PHARMD	8/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	67349	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
330117	Ordering, Referring, Prescribing	N/A	1356921936	0	0	LEE, YOONGUN K LAC	10/16/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	19047	N/A	N/A	N/A	N/A	N/A	36101 BOB HOPE DRIVE	A1	RANCHO MIRAGE	CA	92270	2002	00	06000	33.786126	-116.406086	Riverside County
330141	Ordering, Referring, Prescribing	N/A	1356968796	0	0	LOHR-POOT, DAWN M NP	6/9/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014702	N/A	N/A	N/A	N/A	N/A	2240 W. MONTE VISTA AVE.	None	TURLOCK	CA	95382	9667	00	06000	37.52173653	-120.8741705	Stanislaus County
330147	Ordering, Referring, Prescribing	N/A	1356977797	0	0	LOGA, MAURICE	10/20/2020	Taxonomy not applicable	NA	n/a	000	Unknown	81846	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD, M	None	BOISE	ID	83706	1000	00	06000	43.59860438	-116.1806635	Ada County
330155	Ordering, Referring, Prescribing	N/A	1366002016	0	0	LE, LAN-ANH CHRISTINA T PHARMD	6/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH67732	N/A	N/A	N/A	N/A	N/A	1339 N. DAVIS RD	None	SALINAS	CA	93907	0000	00	06000	36.70358481	-121.6669768	Monterey County
330161	Ordering, Referring, Prescribing	N/A	1366010597	0	0	LEE, SHERLYNN	7/31/2023	Taxonomy not applicable	NA	n/a	000	Unknown	60301	N/A	N/A	N/A	N/A	N/A	3601 W SUNFLOWER AVE	STE 100	SANTA ANA	CA	92704	7916	00	06000	33.69568151	-117.918072	Orange County
330172	Ordering, Referring, Prescribing	N/A	1366044604	0	0	LAN, ANN PHARMD	3/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	83663	N/A	N/A	N/A	N/A	N/A	13111 PEYTON DR	None	CHINO HILLS	CA	91709	6002	00	06000	34.014636	-117.741339	San Bernardino County
330176	Ordering, Referring, Prescribing	N/A	1366058158	0	0	LEONG, JONATHAN PA	1/15/2024	Taxonomy not applicable	NA	n/a	000	Unknown	57762	N/A	N/A	N/A	N/A	N/A	850 WEST OLIVE AVE	STE A	MERCED	CA	95348	2427	00	06000	37.31843749	-120.4834376	Merced County
330188	Ordering, Referring, Prescribing	N/A	1366072043	0	0	LAPETINO, LINDA LMFT	10/1/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	150254	N/A	N/A	N/A	N/A	N/A	3751 MOTOR AVE.	341552	LOS ANGELES	CA	90034	8076	00	06000	34.0215466	-118.4048043	Los Angeles County
330193	Ordering, Referring, Prescribing	N/A	1366076259	0	0	LEE, CYNTHIA PHARMD	7/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	78439	N/A	N/A	N/A	N/A	N/A	1451 9TH ST	None	BERKELEY	CA	94710	1525	00	06000	37.87671582	-122.2969799	Alameda County
330198	Ordering, Referring, Prescribing	N/A	1366086472	0	0	LIBORIO-LULO, JANNETH	5/1/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW122282	N/A	N/A	N/A	N/A	N/A	500 JEFFERSON BLVD STE B	STE B180	WEST SACRAMENTO	CA	95605	2394	00	06000	38.58786311	-121.5270236	Yolo County
330199	Ordering, Referring, Prescribing	N/A	1366090631	0	0	LOMELI, HECTOR LMFT	4/10/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146321	N/A	N/A	N/A	N/A	N/A	555 N. PERRIS BLVD.	None	PERRIS	CA	92571	2811	00	06000	33.79131	-117.226053	Riverside County
330244	Ordering, Referring, Prescribing	N/A	1366299315	0	0	LUNA, ABIGAIL F NP	2/26/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029227	N/A	N/A	N/A	N/A	N/A	1016 OUTER RD	None	SAN DIEGO	CA	92154	1351	00	06000	32.57795659	-117.0825179	San Diego County
330255	Ordering, Referring, Prescribing	N/A	1366465759	0	0	LANDETA, EDERLINA P NP	6/2/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	343438	N/A	N/A	N/A	N/A	N/A	18111 NORDHOFF	None	NORTHRIDGE	CA	91330	8270	00	06000	34.239213	-118.527768	Los Angeles County
330256	Ordering, Referring, Prescribing	N/A	1366480188	0	0	LE, TIM T DO	11/17/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A5595	N/A	N/A	N/A	N/A	N/A	22675 ALESSANDRO BLVD	None	MORENO VALLEY	CA	92553	8551	00	06000	33.91695337	-117.2672536	Riverside County
330261	Ordering, Referring, Prescribing	N/A	1366512451	0	0	LUJAN, MARICELA M MD	10/7/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G72526	N/A	N/A	N/A	N/A	N/A	455 W BAKER AVE	None	FULLERTON	CA	92832	3269	00	06000	33.85701143	-117.9320745	Orange County
330278	Ordering, Referring, Prescribing	N/A	1366562969	0	0	LARREA, MELISSA M LMFT	6/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	101177	N/A	N/A	N/A	N/A	N/A	500 DAVIS ST	120	SAN LEANDRO	CA	94577	2759	00	06000	37.72421526	-122.1607105	Alameda County
330300	Ordering, Referring, Prescribing	N/A	1366603573	0	0	LANSEN, HONORE N MD	10/2/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C165848	N/A	N/A	N/A	N/A	N/A	319 LAFAYETTE STREET	#151	NEW YORK	NY	10012	2711	00	06000	40.725333	-73.9949445	New York County
330301	Ordering, Referring, Prescribing	N/A	1366598773	0	0	LUCIER, PAULETTE M LMFT	7/24/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFC38010	N/A	N/A	N/A	N/A	N/A	204 PROVIDENCE MINE RD.	SUITE 111	NEVADA CITY	CA	95959	2954	00	06000	39.25014736	-121.0297624	Nevada County
330309	Ordering, Referring, Prescribing	N/A	1366627168	0	0	LUI, LINA CA	3/8/2020	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC7351	N/A	N/A	N/A	N/A	N/A	812 E CHAPMAN AVE	None	FULLERTON	CA	92831	3808	00	06000	33.87401654	-117.9112455	Orange County
330324	Ordering, Referring, Prescribing	N/A	1366647463	0	0	LAMPE-STRANG, STEFAN M MD	1/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G63813	N/A	N/A	N/A	N/A	N/A	2180 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4558	00	06000	35.27488974	-120.6468257	San Luis Obispo County
330335	Ordering, Referring, Prescribing	N/A	1366687469	0	0	LOVE, LESTER E MD	2/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A70095	N/A	N/A	N/A	N/A	N/A	520 E TULARE AVE	None	VISALIA	CA	93292	3629	00	06000	36.320679	-119.2870845	Tulare County
330346	Ordering, Referring, Prescribing	N/A	1366719049	0	0	LEPE, MARISOL V	1/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62192	N/A	N/A	N/A	N/A	N/A	1380 HOWARD ST.	130	SAN FRANCISCO	CA	94103	2638	00	06000	37.77424669	-122.4141502	San Francisco County
330349	Ordering, Referring, Prescribing	N/A	1366719197	0	0	LOMAMI, MWINGI I NP	9/15/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027234	N/A	N/A	N/A	N/A	N/A	1425 MONTGOMERY RD	None	RED BLUFF	CA	96080	4605	00	06000	40.157883	-122.2250685	Tehama County
330362	Ordering, Referring, Prescribing	N/A	1366743700	0	0	LE, THAO-HUONG N PHARMD	3/31/2018	Taxonomy not applicable	NA	n/a	000	Unknown	56275	N/A	N/A	N/A	N/A	N/A	7788 REGENTS RD	None	SAN DIEGO	CA	92122	1938	00	06000	32.86252402	-117.2228415	San Diego County
330369	Ordering, Referring, Prescribing	N/A	1366755993	0	0	LYCAN, NATHAN S	5/13/2023	Taxonomy not applicable	NA	n/a	000	Unknown	54202	N/A	N/A	N/A	N/A	N/A	1907 BORDER AVE	None	TORRANCE	CA	90501	3606	00	06000	33.828615	-118.3130985	Los Angeles County
330381	Ordering, Referring, Prescribing	N/A	1366776874	0	0	LY, BRIGITTE J LCSW	8/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	77077	N/A	N/A	N/A	N/A	N/A	16580 HARBOR BLVD	STE. M	FOUNTAIN VALLEY	CA	92708	1386	00	06000	33.72282	-117.9197845	Orange County
330434	Ordering, Referring, Prescribing	N/A	1366856304	0	0	LOPEZ, MARCO OLIVER D NP	6/4/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000854	N/A	N/A	N/A	N/A	N/A	52 DORE STREET	None	SAN FRANCISCO	CA	94103	3828	00	06000	37.7737782	-122.412854	San Francisco County
330438	Ordering, Referring, Prescribing	N/A	1366859209	0	0	LEE, MAYNONG LPCC	11/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC12713	N/A	N/A	N/A	N/A	N/A	4447 E. KINGS CANYON RD	UNIT E	FRESNO	CA	93702	2977	00	06000	36.7359873	-119.7510282	Fresno County
330445	Ordering, Referring, Prescribing	N/A	1366874422	0	0	LAU, CLIFFORD S MD	1/9/2015	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A126564	N/A	N/A	N/A	N/A	N/A	7601 HOSPITAL DRIVE	103	SACRAMENTO	CA	95823	5408	00	06000	38.464794	-121.415571	Sacramento County
330446	Ordering, Referring, Prescribing	N/A	1366873879	0	0	LACROIX, CATHERINE LMFT	12/4/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103063	N/A	N/A	N/A	N/A	N/A	25 N.14TH STREET	SUITE 400	SAN JOSE	CA	95112	6204	00	06000	37.34293357	-121.8775187	Santa Clara County
330448	Ordering, Referring, Prescribing	N/A	1366876773	0	0	LOISEAUX, RELYN LMFT	10/9/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99016	N/A	N/A	N/A	N/A	N/A	7165 BURTON AVE	None	ROHNERT PARK	CA	94928	3316	00	06000	38.33819105	-122.6990157	Sonoma County
330449	Ordering, Referring, Prescribing	N/A	1366871329	0	0	LUONG, THIEN T PHARMD	6/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69640	N/A	N/A	N/A	N/A	N/A	37160 47TH ST E	None	PALMDALE	CA	93552	4450	00	06000	34.557426	-118.0452945	Los Angeles County
330463	Ordering, Referring, Prescribing	N/A	1366899940	0	0	LARA, NATHANIEL E PA-C	4/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53394	N/A	N/A	N/A	N/A	N/A	344 E. SIXTH STREET	None	MADERA	CA	93638	3631	00	06000	36.96288964	-120.0556279	Madera County
330489	Ordering, Referring, Prescribing	N/A	1366947905	0	0	LUCE, MARIE S MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164095	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
330507	Ordering, Referring, Prescribing	N/A	1366972358	0	0	LAYEDRA, ALICIA D LCSW	11/22/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	105692	N/A	N/A	N/A	N/A	N/A	7365 CARNELIAN ST	STE #231	RANCHO CUCAMONGA	CA	91730	1158	00	06000	34.12038413	-117.6160525	San Bernardino County
330520	Ordering, Referring, Prescribing	N/A	1366995433	0	0	LOCHER, MICHAEL R MD	2/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A147992	N/A	N/A	N/A	N/A	N/A	720 WOOD ST	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
330558	Ordering, Referring, Prescribing	N/A	1376057513	0	0	LOOKOFSKY, TAYLOR S LMFT	4/26/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132512	N/A	N/A	N/A	N/A	N/A	8550 BALBOA BLVD	150	CHATSWORTH	CA	91325	3553	00	06000	34.225713	-118.5026045	Los Angeles County
330571	Ordering, Referring, Prescribing	N/A	1376086207	0	0	LOPEZ-JUAREZ, CAROLINA	1/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	75853	N/A	N/A	N/A	N/A	N/A	5030 HAMNER AVE	None	EASTVALE	CA	91752	1009	00	06000	33.996744	-117.555534	Riverside County
330632	Ordering, Referring, Prescribing	N/A	1376215970	0	0	LOPEZ, JESSICA N LPCC	6/23/2024	Taxonomy not applicable	NA	n/a	000	Unknown	16823	N/A	N/A	N/A	N/A	N/A	101 CIRBY HILLS DRIVE	None	ROSEVILLE	CA	95678	4360	00	06000	38.7303989	-121.2872592	Placer County
330638	Ordering, Referring, Prescribing	N/A	1376254656	0	0	LAKRITZ, JANE K PHARMD	11/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	87437	N/A	N/A	N/A	N/A	N/A	37160 47TH ST E	None	PALMDALE	CA	93552	4450	00	06000	34.557426	-118.0452945	Los Angeles County
330655	Ordering, Referring, Prescribing	N/A	1376266320	0	0	LE, NHI T PHARMD	9/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86930	N/A	N/A	N/A	N/A	N/A	5100 BROADWAY	None	OAKLAND	CA	94611	4620	00	06000	37.83541836	-122.2516416	Alameda County
330669	Ordering, Referring, Prescribing	N/A	1376566299	0	0	LAWSON, AMY L MD	8/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C55268	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	138	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
330686	Ordering, Referring, Prescribing	N/A	1376631291	0	0	LILLEHOFF, PIPER C MD	1/10/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A68923	N/A	N/A	N/A	N/A	N/A	3115 RED HILL AVE	None	COSTA MESA	CA	92626	4517	00	06000	33.6763772	-117.8776418	Orange County
330694	Ordering, Referring, Prescribing	N/A	1376645150	0	0	LEVIN, JONATHAN MD	3/12/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A60920	N/A	N/A	N/A	N/A	N/A	7855 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90046	5344	00	06000	34.0908873	-118.36044	Los Angeles County
330712	Ordering, Referring, Prescribing	N/A	1376674085	0	0	LANE, JENNIFER E	11/11/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23507	N/A	N/A	N/A	N/A	N/A	43520 DIVISION ST	None	LANCASTER	CA	93535	4089	00	06000	34.673445	-118.130143	Los Angeles County
330713	Ordering, Referring, Prescribing	N/A	1376674325	0	0	LEGGIO, GINA M LMFT	11/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFC39099	N/A	N/A	N/A	N/A	N/A	6957 N FIGUEROA ST	None	LOS ANGELES	CA	90042	1245	00	06000	34.12873587	-118.18774	Los Angeles County
330715	Ordering, Referring, Prescribing	N/A	1376675116	0	0	LEE, ADAM M LMFT	3/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53965	N/A	N/A	N/A	N/A	N/A	2621 OSWELL ST	119	BAKERSFIELD	CA	93306	3172	00	06000	35.393283	-118.9496505	Kern County
330720	Ordering, Referring, Prescribing	N/A	1376682583	0	0	LICHTY II, GUY C	12/21/1985	Taxonomy not applicable	NA	n/a	099	DENTIST	D27644	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
330738	Ordering, Referring, Prescribing	N/A	1376722017	0	0	LO, EDDIE Y MD	1/7/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A102816	N/A	N/A	N/A	N/A	N/A	2171 JUNIPER SERRA BLVD	SUITE 388	DALY CITY	CA	94014	1985	00	06000	37.69836798	-122.4706688	San Mateo County
330747	Ordering, Referring, Prescribing	N/A	1376758128	0	0	LUCAS, DEBORAH K	9/9/2015	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A8556	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	#5	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
330750	Ordering, Referring, Prescribing	N/A	1376766741	0	0	LAZARO, VANESSA	8/24/2017	Taxonomy not applicable	NA	n/a	000	Unknown	18249	N/A	N/A	N/A	N/A	N/A	2017 FIRST AVE	SUITE 301	SAN DIEGO	CA	92101	2033	00	06000	32.72646147	-117.1638767	San Diego County
330752	Ordering, Referring, Prescribing	N/A	1376770297	0	0	LEON, NANCY LCSW	3/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	65009	N/A	N/A	N/A	N/A	N/A	3300 TRUXTUN AVE	312	BAKERSFIELD	CA	93301	3137	00	06000	35.37353416	-119.0392409	Kern County
330759	Ordering, Referring, Prescribing	N/A	1376775429	0	0	LINDER, JACAIRA C LCSW	9/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96937	N/A	N/A	N/A	N/A	N/A	550 S VERMONT AVE.	None	LOS ANGELES	CA	90020	0000	00	06000	34.064091	-118.2916225	Los Angeles County
330777	Ordering, Referring, Prescribing	N/A	1376822783	0	0	LOW-BLUNT, CHRISTINE PHARMD	3/14/2018	Taxonomy not applicable	NA	n/a	000	Unknown	47198	N/A	N/A	N/A	N/A	N/A	2090 HARBISON DR	None	VACAVILLE	CA	95687	3902	00	06000	38.36230294	-121.9634742	Solano County
330784	Ordering, Referring, Prescribing	N/A	1376827212	0	0	LE, HIEN T PHARMD	8/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH62143	N/A	N/A	N/A	N/A	N/A	4495 MACK RD	None	SACRAMENTO	CA	95823	4545	00	06000	38.474874	-121.451292	Sacramento County
330878	Ordering, Referring, Prescribing	N/A	1376979989	0	0	LEE, ERIC A LMFT	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT96389	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVENUE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
330911	Ordering, Referring, Prescribing	N/A	1386022655	0	0	LEE, KAMILAH	7/3/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146617	N/A	N/A	N/A	N/A	N/A	1530 S. OLIVE STREET	None	LOS ANGELES	CA	90015	0000	00	06000	34.03542552	-118.2652073	Los Angeles County
330957	Ordering, Referring, Prescribing	N/A	1386088599	0	0	LONG, SUSAN DO	9/29/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16648	N/A	N/A	N/A	N/A	N/A	1333 MERIDIAN AVE	None	SAN JOSE	CA	95125	0001	00	06000	37.30176	-121.9136465	Santa Clara County
330996	Ordering, Referring, Prescribing	N/A	1386149912	0	0	LUSK, CALEB M MD	2/2/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165385	N/A	N/A	N/A	N/A	N/A	593 W 6TH ST	None	SAN PEDRO	CA	90731	2521	00	06000	33.73875253	-118.2899475	Los Angeles County
331002	Ordering, Referring, Prescribing	N/A	1386165868	0	0	LAU, SIRENA	3/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75357	N/A	N/A	N/A	N/A	N/A	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94063	0000	00	06000	37.48948529	-122.2232468	San Mateo County
331016	Ordering, Referring, Prescribing	N/A	1386174282	0	0	LEE, GLORIA K PHARMD	11/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	73306	N/A	N/A	N/A	N/A	N/A	1071 EL CAMINO REAL	None	REDWOOD CITY	CA	94063	5001	00	06000	37.48446	-122.230134	San Mateo County
331021	Ordering, Referring, Prescribing	N/A	1386177707	0	0	LIU, SERENA M MD	2/23/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A171675	N/A	N/A	N/A	N/A	N/A	1691 THE ALAMEDA	None	SAN JOSE	CA	95126	2203	00	06000	37.3373761	-121.9192532	Santa Clara County
331031	Ordering, Referring, Prescribing	N/A	1386194116	0	0	LEE, SOOIN	1/24/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010304	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
331055	Ordering, Referring, Prescribing	N/A	1386245181	0	0	LIN, MARISSA A PHARMD	9/18/2020	Taxonomy not applicable	NA	n/a	000	Unknown	83332	N/A	N/A	N/A	N/A	N/A	525 EL CAMINO REAL	None	MENLO PARK	CA	94025	4026	00	06000	37.451159	-122.1785406	San Mateo County
331057	Ordering, Referring, Prescribing	N/A	1386252120	0	0	LASZKIEWICZ, EMELYN LCSW	5/17/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW115176	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS	None	MISSION VIEJO	CA	92691	6441	00	06000	33.56536541	-117.670334	Orange County
331075	Ordering, Referring, Prescribing	N/A	1386283554	0	0	LE, AN V PHARMD	11/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81273	N/A	N/A	N/A	N/A	N/A	1120 E CLARK AVE	None	SANTA MARIA	CA	93455	5123	00	06000	34.86500248	-120.417299	Santa Barbara County
331082	Ordering, Referring, Prescribing	N/A	1386297323	0	0	LAW, JENICA PA-C	10/29/2020	Taxonomy not applicable	NA	n/a	000	Unknown	58798	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK ROAD	None	MAMMOTH LAKES	CA	93546	0100	00	06000	37.64575895	-118.9638914	Mono County
331104	Ordering, Referring, Prescribing	N/A	1386374692	0	0	LEE, JIYOON CNP	6/9/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021214	N/A	N/A	N/A	N/A	N/A	10423 OLD PLACERVILLE RD	STE A	SACRAMENTO	CA	95827	2540	00	06000	38.570382	-121.3075395	Sacramento County
331113	Ordering, Referring, Prescribing	N/A	1386390136	0	0	LY, JANICE PHARMD	7/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH84674	N/A	N/A	N/A	N/A	N/A	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	00	06000	37.78368811	-122.4218578	San Francisco County
331128	Ordering, Referring, Prescribing	N/A	1386488393	0	0	LIU, JAY	4/10/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95029768	N/A	N/A	N/A	N/A	N/A	226 E CHERRY AVE	None	MONROVIA	CA	91016	0001	00	06000	34.13849477	-117.9973065	Los Angeles County
331143	Ordering, Referring, Prescribing	N/A	1386652600	0	0	LEWIS, GRACIA C MD	12/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A38978	N/A	N/A	N/A	N/A	N/A	2010 WILSHIRE BLVD	FLOOR 2	LOS ANGELES	CA	90057	3507	00	06000	34.05748989	-118.2750432	Los Angeles County
331146	Ordering, Referring, Prescribing	N/A	1386660447	0	0	LIM, EDWARD M MD	4/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A74054	N/A	N/A	N/A	N/A	N/A	390 40TH STREET	None	OAKLAND	CA	94609	2633	00	06000	37.82836982	-122.2593946	Alameda County
331149	Ordering, Referring, Prescribing	N/A	1386682763	0	0	LIFLYANDSKY, OLEG MD	4/7/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A63656	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD	200	PACOIMA	CA	91331	1391	00	06000	34.27894489	-118.4044363	Los Angeles County
331187	Ordering, Referring, Prescribing	N/A	1386773182	0	0	LEIZEROWITZ, LINDA C LMFT	12/30/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47509	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
331194	Ordering, Referring, Prescribing	N/A	1386776011	0	0	LOWE, DANIELLE LCSW	9/26/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110706	N/A	N/A	N/A	N/A	N/A	11601 S WESTERN AVE	None	LOS ANGELES	CA	90047	5006	00	06000	33.92826552	-118.3092091	Los Angeles County
331197	Ordering, Referring, Prescribing	N/A	1386778777	0	0	LYLES, EMILY R LCSW	3/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74073	N/A	N/A	N/A	N/A	N/A	2151 COLLEGE AVE	None	BAKERSFIELD	CA	93305	4113	00	06000	35.3830369	-118.9680991	Kern County
331198	Ordering, Referring, Prescribing	N/A	1386776839	0	0	LEE, LINDA H	9/17/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	A96160	N/A	N/A	N/A	N/A	N/A	2710 MIDDLEFIELD RD	None	REDWOOD CITY	CA	94063	3404	00	06000	37.47644946	-122.2110919	San Mateo County
331212	Ordering, Referring, Prescribing	N/A	1386800191	0	0	LOEFFLER, NATALIE J LMFT	7/30/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52437	N/A	N/A	N/A	N/A	N/A	8801 FOLSOM BLVD.	SUITE 265	SACRAMENTO	CA	95826	3250	00	06000	38.553381	-121.376421	Sacramento County
331266	Ordering, Referring, Prescribing	N/A	1386926269	0	0	LAU, CELINE PHARMD	8/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH59148	N/A	N/A	N/A	N/A	N/A	15500 WASHINGTON AVE	None	SAN LEANDRO	CA	94579	1839	00	06000	37.68575579	-122.1388804	Alameda County
331269	Ordering, Referring, Prescribing	N/A	1386926673	0	0	LEONG, DARRYL T	7/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	46728	N/A	N/A	N/A	N/A	N/A	300 MONTGOMERY STREET	None	SAN FRANCISCO	CA	94104	1902	00	06000	37.7923269	-122.4026145	San Francisco County
331279	Ordering, Referring, Prescribing	N/A	1386945822	0	0	LINDAUER, KELLEE F PHARMD	3/23/2018	Taxonomy not applicable	NA	n/a	000	Unknown	59218	N/A	N/A	N/A	N/A	N/A	2938 TAPO CANYON RD	None	SIMI VALLEY	CA	93063	2171	00	06000	34.287723	-118.715364	Ventura County
331291	Ordering, Referring, Prescribing	N/A	1386983708	0	0	LUTZ, JUSTIN C PSYD	8/11/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	31972	N/A	N/A	N/A	N/A	N/A	63 CARRIAGE HILL LN	None	LAGUNA HILLS	CA	92653	6039	00	06000	33.59102965	-117.706934	Orange County
331294	Ordering, Referring, Prescribing	N/A	1386985844	0	0	LAM, TUYET PHARMD	7/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58528	N/A	N/A	N/A	N/A	N/A	640 UNIVERSITY AVE	None	SAN DIEGO	CA	92103	3213	00	06000	32.74837353	-117.15894	San Diego County
331295	Ordering, Referring, Prescribing	N/A	1386987600	0	0	LUCERO, ANNE S DO	7/18/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A13578	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPWY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
331318	Ordering, Referring, Prescribing	N/A	1396014809	0	0	LIM, EUNICE S LMFT	3/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT98854	N/A	N/A	N/A	N/A	N/A	2035 E BALL RD	#200	ANAHEIM	CA	92806	5159	00	06000	33.81812448	-117.8880075	Orange County
331336	Ordering, Referring, Prescribing	N/A	1396040267	0	0	LAUBER, AMANDA CCC-SLP	6/30/2019	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	15784	N/A	N/A	N/A	N/A	N/A	1901 N RICE AVE STE 170-	STE 170-180	OXNARD	CA	93030	7912	00	06000	34.21960355	-119.1421345	Ventura County
331347	Ordering, Referring, Prescribing	N/A	1396080826	0	0	LOPEZ, PATRICIA A PHARMD	3/25/2018	Taxonomy not applicable	NA	n/a	000	Unknown	64930	N/A	N/A	N/A	N/A	N/A	4155 TWEEDY BLVD	None	SOUTH GATE	CA	90280	6158	00	06000	33.94348229	-118.1987755	Los Angeles County
331360	Ordering, Referring, Prescribing	N/A	1396104220	0	0	LIN, JEREMY D DDS	6/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS100619	N/A	N/A	N/A	N/A	N/A	923 N MILPAS ST	None	SANTA BARBARA	CA	93103	2331	00	06000	34.43047465	-119.6910698	Santa Barbara County
331361	Ordering, Referring, Prescribing	N/A	1396107132	0	0	LUXENBERG, ADAM A MD	3/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A153981	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
331364	Ordering, Referring, Prescribing	N/A	1396110748	0	0	LAPRISE, STEPHANIE LCSW	10/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97905	N/A	N/A	N/A	N/A	N/A	2640 BRESLAUER WAY	None	REDDING	CA	96001	4246	00	06000	40.5496754	-122.3791396	Shasta County
331377	Ordering, Referring, Prescribing	N/A	1396112249	0	0	LU, LILY L	9/15/2015	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	71623	N/A	N/A	N/A	N/A	N/A	4211 S AVALON BLVD	None	LOS ANGELES	CA	90011	5622	00	06000	34.007238	-118.2653065	Los Angeles County
331382	Ordering, Referring, Prescribing	N/A	1396129342	0	0	LE, DUSTIN Q DDS	5/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS64602	N/A	N/A	N/A	N/A	N/A	1325 N ANAHEIM BLVD	SUITE 200	ANAHEIM	CA	92801	1202	00	06000	33.85331047	-117.9199617	Orange County
331408	Ordering, Referring, Prescribing	N/A	1396170296	0	0	LOPEZ, CESAR M LCSW	5/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92905	N/A	N/A	N/A	N/A	N/A	370 E. CRENSHAW BLVD	E100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
331425	Ordering, Referring, Prescribing	N/A	1396187746	0	0	LANE, PATRICE G	9/15/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D62660	N/A	N/A	N/A	N/A	N/A	441 DIAZ AVE	None	DELANO	CA	93215	4121	00	06000	35.75593981	-119.2499764	Kern County
331433	Ordering, Referring, Prescribing	N/A	1396197786	0	0	LASLEY, MATTHEW R LMFT	3/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT109610	N/A	N/A	N/A	N/A	N/A	509 W 10TH ST	None	ANTIOCH	CA	94509	1653	00	06000	38.01116769	-121.8130914	Contra Costa County
331464	Ordering, Referring, Prescribing	N/A	1396254439	0	0	LAFRANCE, CYNTHIA LMFT	6/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119523	N/A	N/A	N/A	N/A	N/A	2540 W SHAW LN	107	FRESNO	CA	93711	2700	00	06000	36.80923946	-119.8386	Fresno County
331467	Ordering, Referring, Prescribing	N/A	1396257499	0	0	LEON, LUIS A JR NP	1/11/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	818012	N/A	N/A	N/A	N/A	N/A	1450 E HOLT AVE	None	POMONA	CA	91767	5822	00	06000	34.06299829	-117.7215562	Los Angeles County
331482	Ordering, Referring, Prescribing	N/A	1396277836	0	0	LEE, DANIEL H MD	3/11/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A171922	N/A	N/A	N/A	N/A	N/A	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2180	00	06000	32.75034388	-117.161023	San Diego County
331484	Ordering, Referring, Prescribing	N/A	1396279774	0	0	LARUE, KATELIN J LMFT	3/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115416	N/A	N/A	N/A	N/A	N/A	109 PARMAC RD	2	CHICO	CA	95926	2294	00	06000	39.75358764	-121.8505893	Butte County
331488	Ordering, Referring, Prescribing	N/A	1396295416	0	0	LE, CAMTRANG T	4/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	49163	N/A	N/A	N/A	N/A	N/A	1006 W WABASH AVE	None	EUREKA	CA	95501	2121	00	06000	40.79158228	-124.1830134	Humboldt County
331496	Ordering, Referring, Prescribing	N/A	1396297081	0	0	LOPEZ, TIFFANY LMFT	10/22/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130002	N/A	N/A	N/A	N/A	N/A	1202 MORENA BLVD	None	SAN DIEGO	CA	92108	4711	00	06000	32.77025942	-117.2017196	San Diego County
331539	Ordering, Referring, Prescribing	N/A	1396373619	0	0	LOZANO, JUAN CARLOS MD	2/3/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184062	N/A	N/A	N/A	N/A	N/A	1637 3RD AVE	None	CHULA VISTA	CA	91911	5823	00	06000	32.59656	-117.0644835	San Diego County
331553	Ordering, Referring, Prescribing	N/A	1396391470	0	0	LUCASAN, ROMULO A NP	8/7/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95012368	N/A	N/A	N/A	N/A	N/A	16127 FOOTHILL BLVD	None	FONTANA	CA	92335	3374	00	06000	34.10650281	-117.4531156	San Bernardino County
331555	Ordering, Referring, Prescribing	N/A	1396403473	0	0	LEE, JANE LMFT	7/30/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	148459	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE.	FLOOR 6	LONG BEACH	CA	90806	2325	00	06000	33.806097	-118.151378	Los Angeles County
331562	Ordering, Referring, Prescribing	N/A	1396413738	0	0	LINARES, SARITA E NP	11/7/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018219	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
331575	Ordering, Referring, Prescribing	N/A	1396478400	0	0	LE, TAYLOR PA-C	6/7/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62845	N/A	N/A	N/A	N/A	N/A	855 E MADISON AVE	None	EL CAJON	CA	92020	3819	00	06000	32.80046744	-116.9522315	San Diego County
331591	Ordering, Referring, Prescribing	N/A	1396574067	0	0	LEMUS, ESTELA NP	6/11/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030502	N/A	N/A	N/A	N/A	N/A	6601 RUGBY AVE STE 300	STE 300	HUNTINGTON PARK	CA	90255	4046	00	06000	33.979113	-118.2265595	Los Angeles County
331592	Ordering, Referring, Prescribing	N/A	1396541801	0	0	LEE, MIEL DDS	8/30/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110681	N/A	N/A	N/A	N/A	N/A	1101 N CHERRY ST	None	TULARE	CA	93274	2231	00	06000	36.22333808	-119.337575	Tulare County
331597	Ordering, Referring, Prescribing	N/A	1396528014	0	0	LAGATTUTA, NORMA PA	11/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63675	N/A	N/A	N/A	N/A	N/A	316 S STRATFORD AVE	STE B	SANTA MARIA	CA	93454	0001	00	06000	34.95019447	-120.4147816	Santa Barbara County
331608	Ordering, Referring, Prescribing	N/A	1396764999	0	0	LEONARD, JOANNA M NP	1/9/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	15578	N/A	N/A	N/A	N/A	N/A	134 GOLDEN GATE AVENUE	None	SAN FRANCISCO	CA	94102	3810	00	06000	37.78204768	-122.4129337	San Francisco County
331629	Ordering, Referring, Prescribing	N/A	1396829784	0	0	LININGER, TRISHANNE B LMFT	6/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	43691	N/A	N/A	N/A	N/A	N/A	130 YELLOWSTONE DRIVE	SUITE 100	CHICO	CA	95973	5884	00	06000	39.7697419	-121.8758344	Butte County
331631	Ordering, Referring, Prescribing	N/A	1396834578	0	0	LEE, ANN M NP	4/10/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	12612	N/A	N/A	N/A	N/A	N/A	5100 SIERRA COLLEGE BLVD	None	ROCKLIN	CA	95677	3855	00	06000	38.790306	-121.214862	Placer County
331633	Ordering, Referring, Prescribing	N/A	1396837019	0	0	LAI, ERIC PHARMD	3/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH49629	N/A	N/A	N/A	N/A	N/A	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	00	06000	37.78096053	-122.4637512	San Francisco County
331652	Ordering, Referring, Prescribing	N/A	1396869038	0	0	LANG, ANNIE LCSW	1/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28207	N/A	N/A	N/A	N/A	N/A	23501 CINEMA DR	None	VALENCIA	CA	91355	5428	00	06000	34.42039699	-118.5463513	Los Angeles County
331660	Ordering, Referring, Prescribing	N/A	1396876363	0	0	LOTAN, SHULI L LCSW	6/4/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24071	N/A	N/A	N/A	N/A	N/A	601 PICO BLVD	None	SANTA MONICA	CA	90405	1224	00	06000	34.01131392	-118.4850334	Los Angeles County
331661	Ordering, Referring, Prescribing	N/A	1396876652	0	0	LENDO, JULISA LMFT	12/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42964	N/A	N/A	N/A	N/A	N/A	1200 WILSHIRE BLVD	400	LOS ANGELES	CA	90017	1908	00	06000	34.05307427	-118.2651099	Los Angeles County
331665	Ordering, Referring, Prescribing	N/A	1396879334	0	0	LIAO, HSIUCHEN	12/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT49320	N/A	N/A	N/A	N/A	N/A	275 BECK AVE	MS 5-250	FAIRFIELD	CA	94533	6804	00	06000	38.23532718	-122.0663968	Solano County
331717	Ordering, Referring, Prescribing	N/A	1396987020	0	0	LADNER-PACE, NICOLE LCSW	11/21/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80028	N/A	N/A	N/A	N/A	N/A	1340 ARNOLD DR	#225	MARTINEZ	CA	94553	4189	00	06000	37.99250264	-122.0983907	Contra Costa County
331748	Ordering, Referring, Prescribing	N/A	1407061575	0	0	LEYVA, CHRISTINA M LMFT	2/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46777	N/A	N/A	N/A	N/A	N/A	790 E BONITA AVE	None	POMONA	CA	91767	1906	00	06000	34.09621447	-117.737406	Los Angeles County
331752	Ordering, Referring, Prescribing	N/A	1407067325	0	0	LANDAYAN, MARIA C	10/23/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D52416	N/A	N/A	N/A	N/A	N/A	45 NEILSON ST	None	WATSONVILLE	CA	95076	2468	00	06000	36.92823955	-121.792905	Santa Cruz County
331765	Ordering, Referring, Prescribing	N/A	1407093123	0	0	LEE, ROSETTE K PSYD	11/25/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32250	N/A	N/A	N/A	N/A	N/A	2121 W TEMPLE ST	220	LOS ANGELES	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
331775	Ordering, Referring, Prescribing	N/A	1407117039	0	0	LYONS, JANE MD	12/5/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A126810	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
331794	Ordering, Referring, Prescribing	N/A	1407168164	0	0	LAO, AARON V PHARMD	4/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51672	N/A	N/A	N/A	N/A	N/A	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
331823	Ordering, Referring, Prescribing	N/A	1407219330	0	0	LY, STANFORD MD	8/28/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158084	N/A	N/A	N/A	N/A	N/A	1500 21ST AVE	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
331833	Ordering, Referring, Prescribing	N/A	1407242001	0	0	LAZO, ANDREW LCSW	9/14/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	104009	N/A	N/A	N/A	N/A	N/A	11499 BARTLETT AVE	None	ADELANTO	CA	92301	1902	00	06000	34.57915154	-117.414216	San Bernardino County
331838	Ordering, Referring, Prescribing	N/A	1407243538	0	0	LU, JOSEPH C DO	8/3/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15283	N/A	N/A	N/A	N/A	N/A	207 S. SANTA ANITA ST.	320	SAN GABRIEL	CA	91776	1154	00	06000	34.10072807	-118.1066296	Los Angeles County
331875	Ordering, Referring, Prescribing	N/A	1407306996	0	0	LEVENBACH, GIDON CA	1/16/2019	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC16831	N/A	N/A	N/A	N/A	N/A	1557 HEALDSBURG AVE	15 & 16	HEALDSBURG	CA	95448	3260	00	06000	38.63308509	-122.8734119	Sonoma County
331880	Ordering, Referring, Prescribing	N/A	1407311004	0	0	LUU, KIEU-YEN MD	12/20/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192397	N/A	N/A	N/A	N/A	N/A	1000 W. CARSON ST.	N-26	TORRANCE	CA	90502	0104	00	06000	33.83155851	-118.2920625	Los Angeles County
331895	Ordering, Referring, Prescribing	N/A	1407338601	0	0	LYU, XIN	4/29/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33304	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE.	SUITE 300	SAN JOSE	CA	95128	2680	00	06000	37.3160785	-121.937121	Santa Clara County
331906	Ordering, Referring, Prescribing	N/A	1407351364	0	0	LYONS, KENYA MD	9/3/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180198	N/A	N/A	N/A	N/A	N/A	5400 RALSTON ST	None	VENTURA	CA	93003	6002	00	06000	34.25974984	-119.2179337	Ventura County
331914	Ordering, Referring, Prescribing	N/A	1407355126	0	0	LEAL, THERESA G LCSW	3/15/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23219	N/A	N/A	N/A	N/A	N/A	20601 W PAOLI LN	None	COLFAX	CA	95736	0486	00	06000	39.03521526	-120.9755343	Placer County
331928	Ordering, Referring, Prescribing	N/A	1407366495	0	0	LUCERO, JONATHAN E LMFT	11/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112931	N/A	N/A	N/A	N/A	N/A	23161 MILL CREEK DR	201	LAGUNA HILLS	CA	92653	7908	00	06000	33.62655796	-117.7352122	Orange County
331943	Ordering, Referring, Prescribing	N/A	1407404247	0	0	LEUNG, JOANA PHARMD	7/20/2023	Taxonomy not applicable	NA	n/a	000	Unknown	88114	N/A	N/A	N/A	N/A	N/A	3066 ARGUELLO DR	None	BURLINGAME	CA	94010	5804	00	06000	37.57746851	-122.3966701	San Mateo County
331954	Ordering, Referring, Prescribing	N/A	1407430333	0	0	LIN, YIQI MD	7/1/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197221	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
332013	Ordering, Referring, Prescribing	N/A	1407636046	0	0	LAI, SABRINA	10/24/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027154	N/A	N/A	N/A	N/A	N/A	767 N. HILL ST.	200	LOS ANGELES	CA	90012	2343	00	06000	34.06255157	-118.2397077	Los Angeles County
332044	Ordering, Referring, Prescribing	N/A	1407927064	0	0	LEHMAN, TINA L LMFT	1/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49767	N/A	N/A	N/A	N/A	N/A	6850 MORRO RD	None	ATASCADERO	CA	93422	4123	00	06000	35.48202343	-120.6660628	San Luis Obispo County
332052	Ordering, Referring, Prescribing	N/A	1407943996	0	0	LYON, ERIK LMFT	12/7/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45226	N/A	N/A	N/A	N/A	N/A	2145 FIFTH AVE	None	OROVILLE	CA	95965	5870	00	06000	39.50368243	-121.5646958	Butte County
332060	Ordering, Referring, Prescribing	N/A	1407956329	0	0	LONGO, BRETT	11/10/2022	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT20230	N/A	N/A	N/A	N/A	N/A	50100 GOLSH ROAD	None	VALLEY CENTER	CA	92082	5338	00	06000	33.27715948	-116.9618201	San Diego County
332061	Ordering, Referring, Prescribing	N/A	1407968068	0	0	LEE, RICHARD J MD	6/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A72701	N/A	N/A	N/A	N/A	N/A	3125 MYERS ST	None	RIVERSIDE	CA	92503	5527	00	06000	33.90932558	-117.4428095	Riverside County
332063	Ordering, Referring, Prescribing	N/A	1407974280	0	0	LEE, JASON E LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46402	N/A	N/A	N/A	N/A	N/A	5740 RALSTON ST	201	VENTURA	CA	93003	6051	00	06000	34.26070802	-119.213699	Ventura County
332092	Ordering, Referring, Prescribing	N/A	1417016155	0	0	LAGUNDA, JOSE E MD	10/30/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C51020	N/A	N/A	N/A	N/A	N/A	1100 FOURTH ST	BLDG A	TAFT	CA	93268	2415	00	06000	35.14905085	-119.4534352	Kern County
332093	Ordering, Referring, Prescribing	N/A	1417024019	0	0	LINDO, MICHAEL D LCSW	8/8/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24150	N/A	N/A	N/A	N/A	N/A	20101 HAMILTON AVE	155	TORRANCE	CA	90502	1314	00	06000	33.84828383	-118.2860386	Los Angeles County
332122	Ordering, Referring, Prescribing	N/A	1417080656	0	0	LUCAS, DIANE L LCSW	12/15/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22016	N/A	N/A	N/A	N/A	N/A	101 CIRBY HILLS DR	None	ROSEVILLE	CA	95678	4360	00	06000	38.7303989	-121.2872592	Placer County
332145	Ordering, Referring, Prescribing	N/A	1417110891	0	0	LEE, SUN HYUNG LCSW	3/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25213	N/A	N/A	N/A	N/A	N/A	2000 EMBARCADERO COVE	SUITE 400	OAKLAND	CA	94606	5300	00	06000	37.78179304	-122.2428136	Alameda County
332171	Ordering, Referring, Prescribing	N/A	1417160961	0	0	LEVY, TARA L	12/10/2014	Taxonomy not applicable	NA	n/a	000	Unknown	18	N/A	N/A	N/A	N/A	N/A	3186 OLD TUNNEL RD	None	LAFAYETTE	CA	94549	4133	00	06000	37.89569649	-122.093953	Contra Costa County
332189	Ordering, Referring, Prescribing	N/A	1417210550	0	0	LIU, REGINA E PHARMD	2/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH65751	N/A	N/A	N/A	N/A	N/A	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	00	06000	37.78305866	-122.4421313	San Francisco County
332213	Ordering, Referring, Prescribing	N/A	1417257833	0	0	LUI-JACKSON, AUDREY PHARMD	11/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50687	N/A	N/A	N/A	N/A	N/A	1500 SOLANO AVE	None	ALBANY	CA	94707	2107	00	06000	37.89091938	-122.2869615	Alameda County
332223	Ordering, Referring, Prescribing	N/A	1417269879	0	0	LIEBMAN, RACHEL E LCSW	4/26/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107831	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	200	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
332224	Ordering, Referring, Prescribing	N/A	1417282187	0	0	LAU, MATTHEW J	7/29/2010	Taxonomy not applicable	NA	n/a	099	DENTIST	D58875	N/A	N/A	N/A	N/A	N/A	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	00	06000	37.53039072	-122.2987772	San Mateo County
332228	Ordering, Referring, Prescribing	N/A	1417239542	0	0	LEUNG, PHILLIP PHARMD	8/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54360	N/A	N/A	N/A	N/A	N/A	5913 CARSON ST	None	LAKEWOOD	CA	90713	3104	00	06000	33.83235946	-118.1158965	Los Angeles County
332229	Ordering, Referring, Prescribing	N/A	1417287210	0	0	LUNDBERG, EMILY A LCSW	12/4/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69992	N/A	N/A	N/A	N/A	N/A	905 E 8TH ST	None	LOS ANGELES	CA	90021	1848	00	06000	34.03639545	-118.2465917	Los Angeles County
332245	Ordering, Referring, Prescribing	N/A	1417314741	0	0	LEFLORE, NOELE A NP	2/3/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006515	N/A	N/A	N/A	N/A	N/A	121 S. LONG BEACH BLVD.	None	COMPTON	CA	90221	3423	00	06000	33.89475493	-118.2080292	Los Angeles County
332262	Ordering, Referring, Prescribing	N/A	1417328006	0	0	LY, SANNE PHARMD	3/17/2018	Taxonomy not applicable	NA	n/a	000	Unknown	75364	N/A	N/A	N/A	N/A	N/A	40101 MONTEREY AVE	None	RANCHO MIRAGE	CA	92270	3261	00	06000	33.75635374	-116.3913147	Riverside County
332294	Ordering, Referring, Prescribing	N/A	1417384801	0	0	LE, SANDY	2/22/2016	Taxonomy not applicable	NA	n/a	000	Unknown	750	N/A	N/A	N/A	N/A	N/A	11724 VENTURA BLVD	None	STUDIO CITY	CA	91604	2621	00	06000	34.14161869	-118.3885541	Los Angeles County
332296	Ordering, Referring, Prescribing	N/A	1417387564	0	0	LOPEZ, IRIS B LMFT	3/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106128	N/A	N/A	N/A	N/A	N/A	1290 COMMODORE DR	None	SAN BRUNO	CA	94066	2304	00	06000	37.63134914	-122.4260472	San Mateo County
332297	Ordering, Referring, Prescribing	N/A	1417387051	0	0	LIN, JENNIFER LCSW	2/6/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81609	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
332318	Ordering, Referring, Prescribing	N/A	1417428103	0	0	LOPEZ-ESCALERA, ERIKA LMFT	8/24/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	149109	N/A	N/A	N/A	N/A	N/A	290 IOOF AVE	None	GILROY	CA	95020	6412	00	06000	37.01377513	-121.5685719	Santa Clara County
332333	Ordering, Referring, Prescribing	N/A	1417447756	0	0	LAZO CALLES, CINTHIA V NP	2/1/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008377	N/A	N/A	N/A	N/A	N/A	1200 W MAIN STREET	None	TURLOCK	CA	95380	5107	00	06000	37.4926695	-120.862917	Stanislaus County
332356	Ordering, Referring, Prescribing	N/A	1417480948	0	0	LEE, JOSEPH Y MD	9/15/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164201	N/A	N/A	N/A	N/A	N/A	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14893664	-122.2178101	Tehama County
332365	Ordering, Referring, Prescribing	N/A	1417498676	0	0	LE, AMY MD	7/24/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157346	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
332373	Ordering, Referring, Prescribing	N/A	1417513961	0	0	LIANG, JOSEPH OT	11/30/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT17877	N/A	N/A	N/A	N/A	N/A	2633 E 27TH STREET	None	OAKLAND	CA	94601	1912	00	06000	37.79111794	-122.2219009	Alameda County
332384	Ordering, Referring, Prescribing	N/A	1417527102	0	0	LALAPPAN PADMAVATHY, SREELEKHA NP	6/24/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	722024	N/A	N/A	N/A	N/A	N/A	8305 BRIMHALL ROAD	SUITE 1601	BAKERSFIELD	CA	93312	2174	00	06000	35.36876049	-119.0948805	Kern County
332389	Ordering, Referring, Prescribing	N/A	1417549874	0	0	LIZARDO-GONZALEZ, IVETT LCSW	9/19/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW126147	N/A	N/A	N/A	N/A	N/A	23311 DRACAEA AVE	None	MORENO VALLEY	CA	92553	3201	00	06000	33.92807348	-117.258489	Riverside County
332397	Ordering, Referring, Prescribing	N/A	1417569575	0	0	LAZAR, BREANNA M NP	8/12/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015119	N/A	N/A	N/A	N/A	N/A	1035 PLACER ST	None	REDDING	CA	96001	1170	00	06000	40.58349378	-122.3853903	Shasta County
332399	Ordering, Referring, Prescribing	N/A	1417573676	0	0	LICON, CHLOE I LMFT	8/5/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134163	N/A	N/A	N/A	N/A	N/A	555 N PERRIS BLVD	D	PERRIS	CA	92571	2811	00	06000	33.79131	-117.226053	Riverside County
332413	Ordering, Referring, Prescribing	N/A	1417587304	0	0	LOPEZ, DEANNA C PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81606	N/A	N/A	N/A	N/A	N/A	1145 S MAIN ST	None	RED BLUFF	CA	96080	4357	00	06000	40.16094613	-122.2271642	Tehama County
332430	Ordering, Referring, Prescribing	N/A	1417625716	0	0	LEUNG, ALVIN PHARMD	10/24/2023	Taxonomy not applicable	NA	n/a	000	Unknown	84468	N/A	N/A	N/A	N/A	N/A	333 9TH ST	None	OAKLAND	CA	94607	4211	00	06000	37.79968404	-122.2703884	Alameda County
332460	Ordering, Referring, Prescribing	N/A	1417787680	0	0	LEE, BO BAE PA-C	6/13/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64638	N/A	N/A	N/A	N/A	N/A	6001 E WASHINGTON BLVD	None	COMMERCE	CA	90040	2451	00	06000	33.99703164	-118.1499826	Los Angeles County
332482	Ordering, Referring, Prescribing	N/A	1427041235	0	0	LE, FRANK DDS	6/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	53081	N/A	N/A	N/A	N/A	N/A	1550 SUPERIOR AVENUE	None	COSTA MESA	CA	92627	3653	00	06000	33.63305341	-117.9266303	Orange County
332511	Ordering, Referring, Prescribing	N/A	1427115591	0	0	LYONS, PATRICIA E LMFT	6/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT34536	N/A	N/A	N/A	N/A	N/A	1 6TH STREET	None	POINT REYES STATI	CA	94956	0331	00	06000	38.06956123	-122.8082445	Marin County
332518	Ordering, Referring, Prescribing	N/A	1427134733	0	0	LEW, WEI M PHD	5/2/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY4074	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON STREET	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
332527	Ordering, Referring, Prescribing	N/A	1427148733	0	0	LAWRENCE, MEG D MD	8/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C50118	N/A	N/A	N/A	N/A	N/A	6160 MISSION GORGE RD	STE 100	SAN DIEGO	CA	92120	3410	00	06000	32.7868143	-117.0977635	San Diego County
332582	Ordering, Referring, Prescribing	N/A	1427285089	0	0	LLAMAS, LILIANA E LCSW	6/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76814	N/A	N/A	N/A	N/A	N/A	2813 MAIN STREET	2ND FLOOR	CORONA	CA	92882	5422	00	06000	33.84741266	-117.570694	Riverside County
332586	Ordering, Referring, Prescribing	N/A	1427288216	0	0	LU, DEBBIE H PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61473	N/A	N/A	N/A	N/A	N/A	3240 ARDEN WAY	None	SACRAMENTO	CA	95825	2015	00	06000	38.594898	-121.3884765	Sacramento County
332614	Ordering, Referring, Prescribing	N/A	1427338037	0	0	LAU, TONY PHARMD	7/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH51962	N/A	N/A	N/A	N/A	N/A	3571 N. 1ST ST	SUITE 201	SAN JOSE	CA	95134	1803	00	06000	37.40770226	-121.9439259	Santa Clara County
332649	Ordering, Referring, Prescribing	N/A	1427416395	0	0	LEE, ANN DDS	6/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	100631	N/A	N/A	N/A	N/A	N/A	164 KINMAN AVE	None	GOLETA	CA	93117	3481	00	06000	34.436277	-119.8222815	Santa Barbara County
332657	Ordering, Referring, Prescribing	N/A	1427427293	0	0	LIM, ALICE PSYD	1/7/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31581	N/A	N/A	N/A	N/A	N/A	2727 MACDONALD AVE	None	RICHMOND	CA	94804	3006	00	06000	37.93503193	-122.3422799	Contra Costa County
332659	Ordering, Referring, Prescribing	N/A	1427425826	0	0	LAMAS, MARIA LCSW	7/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95905	N/A	N/A	N/A	N/A	N/A	370 W CRENSHAW BLVD E-10	100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
332666	Ordering, Referring, Prescribing	N/A	1427439090	0	0	LIU, SINDY Y PHARMD	3/22/2018	Taxonomy not applicable	NA	n/a	000	Unknown	66455	N/A	N/A	N/A	N/A	N/A	28047 SCOTT RD.	None	MURRIETA	CA	92562	7428	00	06000	33.639318	-117.169812	Riverside County
332679	Ordering, Referring, Prescribing	N/A	1427463710	0	0	LOUIE, LINSEY A PHARMD	5/12/2023	Taxonomy not applicable	NA	n/a	000	Unknown	70291	N/A	N/A	N/A	N/A	N/A	7 PENINSULA CENTER	None	ROLLING HILLS	CA	90274	3506	00	06000	33.77513263	-118.3757485	Los Angeles County
332687	Ordering, Referring, Prescribing	N/A	1427466952	0	0	LUCAS, MARIA	5/24/2022	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	4080	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
332695	Ordering, Referring, Prescribing	N/A	1427483254	0	0	LAMBERTHALL, CALVIN E	7/13/2015	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A126710	N/A	N/A	N/A	N/A	N/A	9380 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3749	00	06000	33.9215355	-117.4442978	Riverside County
332708	Ordering, Referring, Prescribing	N/A	1427493758	0	0	LEWIS, LAUREN M LMFT	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106473	N/A	N/A	N/A	N/A	N/A	5054 S VERMONT AVE	None	LOS ANGELES	CA	90037	2946	00	06000	33.996681	-118.291502	Los Angeles County
332739	Ordering, Referring, Prescribing	N/A	1427550102	0	0	LOVIE, MACKENZIE L LCSW	9/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96944	N/A	N/A	N/A	N/A	N/A	1272 HAYES ST	None	NAPA	CA	94559	1711	00	06000	38.30442969	-122.2936442	Napa County
332740	Ordering, Referring, Prescribing	N/A	1427549633	0	0	LUCAS, CHRISTINE A PHARMD	4/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	69924	N/A	N/A	N/A	N/A	N/A	725 CENTER DR	None	SAN MARCOS	CA	92069	3536	00	06000	33.13491593	-117.1248872	San Diego County
332741	Ordering, Referring, Prescribing	N/A	1427553221	0	0	LEVIN, CAROLYN C MD	6/13/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165719	N/A	N/A	N/A	N/A	N/A	611 S KINGSLEY DR	None	LOS ANGELES	CA	90005	2319	00	06000	34.06305793	-118.3028813	Los Angeles County
332758	Ordering, Referring, Prescribing	N/A	1427578624	0	0	LEAL, REBECCA N LMFT	11/12/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80428	N/A	N/A	N/A	N/A	N/A	1411 N GRAND AVE	None	COVINA	CA	91724	1001	00	06000	34.105149	-117.87435	Los Angeles County
332768	Ordering, Referring, Prescribing	N/A	1427588672	0	0	LUA, CYNTHIA G LMFT	4/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125350	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVE.	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
332840	Ordering, Referring, Prescribing	N/A	1427793389	0	0	LUSIGNAN, JESSICA L NP	12/20/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019513	N/A	N/A	N/A	N/A	N/A	844 OLD TUNNEL ROAD	None	GRASS VALLEY	CA	95945	8524	00	06000	39.23512508	-121.0306878	Nevada County
332847	Ordering, Referring, Prescribing	N/A	1427824564	0	0	LABIO, EZRIEL Z PT	5/30/2023	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT303816	N/A	N/A	N/A	N/A	N/A	3420 COLLEGE AVE	None	SAN DIEGO	CA	92115	7134	00	06000	32.74405281	-117.0538025	San Diego County
332859	Ordering, Referring, Prescribing	N/A	1437130655	0	0	LALLISS, STEVEN J MD	7/22/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C142801	N/A	N/A	N/A	N/A	N/A	721 RIVER DRIVE	STE B	FORT BRAGG	CA	95437	0000	00	06000	39.43204627	-123.801581	Mendocino County
332864	Ordering, Referring, Prescribing	N/A	1437184660	0	0	LUTHER, PAUL K MD	11/19/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A30758	N/A	N/A	N/A	N/A	N/A	1663 DOMINICAN WAY	214	SANTA CRUZ	CA	95065	1556	00	06000	36.99029729	-121.9809324	Santa Cruz County
332867	Ordering, Referring, Prescribing	N/A	1437204377	0	0	LAM, GORDON B DC	6/12/2019	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	27795	N/A	N/A	N/A	N/A	N/A	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
332880	Ordering, Referring, Prescribing	N/A	1437225505	0	0	LEAL-OLMOS, ARLYN R LCSW	3/29/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25623	N/A	N/A	N/A	N/A	N/A	6386 ALVARADO CT	SUITE 310	SAN DIEGO	CA	92120	4905	00	06000	32.77666838	-117.0614255	San Diego County
332888	Ordering, Referring, Prescribing	N/A	1437240041	0	0	LOPEZ, LIZ H LCSW	6/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW26182	N/A	N/A	N/A	N/A	N/A	5 MAREBLU	None	ALISO VIEJO	CA	92656	3014	00	06000	33.57250566	-117.7027366	Orange County
332890	Ordering, Referring, Prescribing	N/A	1437238920	0	0	LUNDEN, LORRAINE PA	2/1/2018	Taxonomy not applicable	NA	n/a	000	Unknown	11540	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
332907	Ordering, Referring, Prescribing	N/A	1437281425	0	0	LARA, MONICA E LCSW	1/6/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS24771	N/A	N/A	N/A	N/A	N/A	333 SOUTH BEAUDRY AVENUE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
332930	Ordering, Referring, Prescribing	N/A	1437307204	0	0	LIVINGSTON, ALISON M LMFT	1/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT77141	N/A	N/A	N/A	N/A	N/A	982 MISSION ST	None	SAN FRANCISCO	CA	94103	2911	00	06000	37.7813638	-122.4082438	San Francisco County
332946	Ordering, Referring, Prescribing	N/A	1437337391	0	0	LAMBERT, JOHN M	3/31/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C137096	N/A	N/A	N/A	N/A	N/A	1580 VALENCIA ST	STE 701	SAN FRANCISCO	CA	94110	4421	00	06000	37.74746923	-122.4202583	San Francisco County
332957	Ordering, Referring, Prescribing	N/A	1437357951	0	0	LEVINE, MARK D MD	12/12/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G34333	N/A	N/A	N/A	N/A	N/A	2180 HARVARD STREET	210	SACRAMENTO	CA	95815	3318	00	06000	38.60568	-121.4345385	Sacramento County
332964	Ordering, Referring, Prescribing	N/A	1437371960	0	0	LONDON, DEBRA S MD	6/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G88823	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	STE. 210	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
332967	Ordering, Referring, Prescribing	N/A	1437377819	0	0	LEE LACKNER, KATHERINE S	2/24/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D53531	N/A	N/A	N/A	N/A	N/A	425 N DATE ST	None	ESCONDIDO	CA	92025	3413	00	06000	33.1292461	-117.0716509	San Diego County
332993	Ordering, Referring, Prescribing	N/A	1437427275	0	0	LY, LIEN T PHARMD	7/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56594	N/A	N/A	N/A	N/A	N/A	6325 ROSEMEAD BLVD	None	SAN GABRIEL	CA	91775	1933	00	06000	34.11410169	-118.0737024	Los Angeles County
333006	Ordering, Referring, Prescribing	N/A	1437433026	0	0	LU, QUYEN PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	47344	N/A	N/A	N/A	N/A	N/A	17170 COLIMA RD #F	None	HACIENDA HEIGHTS	CA	91745	6771	00	06000	33.9907128	-117.9325812	Los Angeles County
333017	Ordering, Referring, Prescribing	N/A	1437444569	0	0	LIEU, LOAN H	8/28/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D60236	N/A	N/A	N/A	N/A	N/A	2710 MIDDLEFIELD RD	None	REDWOOD CITY	CA	94063	3404	00	06000	37.47644946	-122.2110919	San Mateo County
333046	Ordering, Referring, Prescribing	N/A	1437503844	0	0	LOCKETT, DARLYNN LCSW	2/12/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99992	N/A	N/A	N/A	N/A	N/A	3000 COLBY ST	202	BERKELEY	CA	94705	2083	00	06000	37.85473248	-122.2575793	Alameda County
333050	Ordering, Referring, Prescribing	N/A	1437507134	0	0	LOPEZ, ALAN S LMFT	5/22/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147046	N/A	N/A	N/A	N/A	N/A	21545 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	2947	00	06000	34.413021	-118.514534	Los Angeles County
333059	Ordering, Referring, Prescribing	N/A	1437522091	0	0	LOWRIE, CHRISTINA LMFT	6/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107630	N/A	N/A	N/A	N/A	N/A	5225 N LAKE BLVD	None	CARNELIAN BAY	CA	96140	0000	00	06000	39.22688547	-120.078288	Placer County
333097	Ordering, Referring, Prescribing	N/A	1437580040	0	0	LEO, HEATHER DDS	7/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	103578	N/A	N/A	N/A	N/A	N/A	4815 WATT AVE	None	NORTH HIGHLANDS	CA	95660	5108	00	06000	38.653245	-121.3836075	Sacramento County
333115	Ordering, Referring, Prescribing	N/A	1437596277	0	0	LUKAS, ALISSA M PSYD	6/24/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30195	N/A	N/A	N/A	N/A	N/A	200 W SANTA ANA BLVD	801	SANTA ANA	CA	92701	4134	00	06000	33.74970951	-117.8691975	Orange County
333117	Ordering, Referring, Prescribing	N/A	1437597952	0	0	LUPO, NATHAN LMFT	3/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT81410	N/A	N/A	N/A	N/A	N/A	295 FELL ST	SUITE A	SAN FRANCISCO	CA	94102	5147	00	06000	37.77591387	-122.4225651	San Francisco County
333121	Ordering, Referring, Prescribing	N/A	1437604196	0	0	LOERA, ANDREA LMFT	8/17/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127575	N/A	N/A	N/A	N/A	N/A	150 DISTRICT CENTER DR	None	PALM SPRINGS	CA	92264	3626	00	06000	33.82485354	-116.4955129	Riverside County
333129	Ordering, Referring, Prescribing	N/A	1437619533	0	0	LICATA, CHRISTINE J MD	2/15/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176389	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1460	00	06000	38.555181	-121.4566785	Sacramento County
333143	Ordering, Referring, Prescribing	N/A	1437629094	0	0	LEE, SO YEUN DDS	10/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS104491	N/A	N/A	N/A	N/A	N/A	1200 NORTH STATE STREET	None	LOS ANGELES	CA	90033	0000	00	06000	34.05855992	-118.209755	Los Angeles County
333175	Ordering, Referring, Prescribing	N/A	1437680378	0	0	LACHARITE, JAIME MD	3/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A172122	N/A	N/A	N/A	N/A	N/A	8405 BEVERLY BLVD, LOS A	None	LOS ANGELES	CA	90048	3401	00	06000	34.07607952	-118.373418	Los Angeles County
333178	Ordering, Referring, Prescribing	N/A	1437676368	0	0	LOVATO, VANESA NP	9/27/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014177	N/A	N/A	N/A	N/A	N/A	4425 S CENTRAL AVE	None	LOS ANGELES	CA	90011	3629	00	06000	34.003116	-118.2565185	Los Angeles County
333219	Ordering, Referring, Prescribing	N/A	1437766292	0	0	LEE, DENISE J PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83146	N/A	N/A	N/A	N/A	N/A	498 CASTRO ST	None	SAN FRANCISCO	CA	94114	2020	00	06000	37.76111969	-122.4350504	San Francisco County
333237	Ordering, Referring, Prescribing	N/A	1437796547	0	0	LUNDBERG, BRITANY R MD	8/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181383	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95871	2201	00	06000	38.555181	-121.4566785	Sacramento County
333245	Ordering, Referring, Prescribing	N/A	1437814100	0	0	LE, ZOEY C PHARMD	9/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85224	N/A	N/A	N/A	N/A	N/A	10810 WARNER AVE	3	FOUNTAIN VALLEY	CA	92708	3848	00	06000	33.71627054	-117.940176	Orange County
333249	Ordering, Referring, Prescribing	N/A	1437820388	0	0	LE, VU VY N PHARMD	9/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85223	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
333250	Ordering, Referring, Prescribing	N/A	1437826831	0	0	LI, CYNTHIA S PHARMD	4/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH83748	N/A	N/A	N/A	N/A	N/A	2000 ARDENT WAY	UNIT 312	ALAMEDA	CA	94501	7643	00	06000	37.78102824	-122.2960128	Alameda County
333347	Ordering, Referring, Prescribing	N/A	1447371224	0	0	LIN, MICHAEL MD	11/5/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A84329	N/A	N/A	N/A	N/A	N/A	500 CROWN POINT CIRCLE	STE 120	GRASS VALLEY	CA	95945	9561	00	06000	39.22028885	-121.0316663	Nevada County
333360	Ordering, Referring, Prescribing	N/A	1447394762	0	0	LUBRANO, ARCANGELO A MD	3/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A30734	N/A	N/A	N/A	N/A	N/A	320 CHURCH STREET	None	SALINAS	CA	93901	2612	00	06000	36.6724643	-121.6577947	Monterey County
333384	Ordering, Referring, Prescribing	N/A	1447460399	0	0	LEE, VINITA LCSW	2/24/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27516	N/A	N/A	N/A	N/A	N/A	2644 SOMERSET AVE	None	CASTRO VALLEY	CA	94546	4016	00	06000	37.69997108	-122.0934241	Alameda County
333408	Ordering, Referring, Prescribing	N/A	1447492657	0	0	LE, VANDAI X MD	1/16/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A125427	N/A	N/A	N/A	N/A	N/A	792 W TOWN AND COUNTRY R	BLDG E	ORANGE	CA	92868	4710	00	06000	33.77649954	-117.860409	Orange County
333439	Ordering, Referring, Prescribing	N/A	1447566294	0	0	LARSEN, STACEY N LMFT	1/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84599	N/A	N/A	N/A	N/A	N/A	4444 CALLE REAL	None	SANTA BARBARA	CA	93110	1002	00	06000	34.44240122	-119.7765542	Santa Barbara County
333454	Ordering, Referring, Prescribing	N/A	1447607189	0	0	LI, WEILIN LCSW	3/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW91980	N/A	N/A	N/A	N/A	N/A	3626 BALBOA ST	None	SAN FRANCISCO	CA	94121	2604	00	06000	37.77571711	-122.4980286	San Francisco County
333455	Ordering, Referring, Prescribing	N/A	1447602826	0	0	LUND, ALEIA	3/1/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW87977	N/A	N/A	N/A	N/A	N/A	1010 WHEATLAND ROAD	None	WHEATLAND	CA	95692	9798	00	06000	39.00756737	-121.4313596	Yuba County
333459	Ordering, Referring, Prescribing	N/A	1447623467	0	0	LOWY, JORDAN LAC	8/9/2017	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	16426	N/A	N/A	N/A	N/A	N/A	1563 MISSION ST	None	SAN FRANCISCO	CA	94103	2543	00	06000	37.77327874	-122.4183559	San Francisco County
333462	Ordering, Referring, Prescribing	N/A	1447629704	0	0	LEI, CHIO LEONG PHARMD	3/16/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH72857	N/A	N/A	N/A	N/A	N/A	850 LA PLAYA ST	None	SAN FRANCISCO	CA	94121	3219	00	06000	37.77251021	-122.5099565	San Francisco County
333469	Ordering, Referring, Prescribing	N/A	1447637939	0	0	LOMBARDI, DANIELLE LMFT	6/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT107522	N/A	N/A	N/A	N/A	N/A	25910 ACERO	SUITE 160	MISSION VIEJO	CA	92691	2790	00	06000	33.61712389	-117.6780482	Orange County
333471	Ordering, Referring, Prescribing	N/A	1447639331	0	0	LANE, WENDY M NP	1/29/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	835647	N/A	N/A	N/A	N/A	N/A	11110 ALONDRA BLVD	None	NORWALK	CA	90218	4113	00	06000	33.885675	-118.097631	Los Angeles County
333473	Ordering, Referring, Prescribing	N/A	1447633664	0	0	LEE, KENNY PHARMD	3/29/2018	Taxonomy not applicable	NA	n/a	000	Unknown	56841	N/A	N/A	N/A	N/A	N/A	18579 BROOKHURST ST.	None	FOUNTAIN VALLEY	CA	92708	3759	00	06000	33.69313539	-117.9542897	Orange County
333484	Ordering, Referring, Prescribing	N/A	1447651609	0	0	LOCKHART, LALHING PSYD	11/30/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	28997	N/A	N/A	N/A	N/A	N/A	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	00	06000	36.33611794	-119.6460191	Kings County
333486	Ordering, Referring, Prescribing	N/A	1447656343	0	0	LEE, DIANE J LMFT	4/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	29423	N/A	N/A	N/A	N/A	N/A	676 PISMO ST	None	SAN LUIS OBISPO	CA	93401	3945	00	06000	35.27640631	-120.6628883	San Luis Obispo County
333491	Ordering, Referring, Prescribing	N/A	1447664131	0	0	LEE PARK, JOANNA PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69693	N/A	N/A	N/A	N/A	N/A	7007 ROMAINE ST	None	WEST HOLLYWOOD	CA	90038	2438	00	06000	34.0889433	-118.3418281	Los Angeles County
333506	Ordering, Referring, Prescribing	N/A	1447682836	0	0	LOPEZ ASAAH, VANESSA LCSW	5/16/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW109057	N/A	N/A	N/A	N/A	N/A	917 OAKDALE RD	None	MODESTO	CA	95355	4593	00	06000	37.656045	-120.957496	Stanislaus County
333519	Ordering, Referring, Prescribing	N/A	1447698477	0	0	LINAREZ, MARIE R	6/17/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0792236	N/A	N/A	N/A	N/A	N/A	533 E PALMDALE BLVD	STE A-1	PALMDALE	CA	93550	2375	00	06000	34.5796702	-118.1198284	Los Angeles County
333529	Ordering, Referring, Prescribing	N/A	1447707542	0	0	LEE, MICHELLE LCSW	5/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94825	N/A	N/A	N/A	N/A	N/A	2311 W EL SEGUNDO BLVD	None	HAWTHORNE	CA	90250	3315	00	06000	33.91647947	-118.3189815	Los Angeles County
333535	Ordering, Referring, Prescribing	N/A	1447720305	0	0	LE, NINA PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78510	N/A	N/A	N/A	N/A	N/A	1826 W ORANGETHORPE AVE	None	FULLERTON	CA	92833	4406	00	06000	33.85917352	-117.96057	Orange County
333536	Ordering, Referring, Prescribing	N/A	1447720834	0	0	LEE, HYUNGSUK J PHARMD	7/28/2019	Taxonomy not applicable	NA	n/a	000	Unknown	76269	N/A	N/A	N/A	N/A	N/A	7140 W PERSHING CT	None	VISALIA	CA	93291	7941	00	06000	36.339669	-119.370834	Tulare County
333540	Ordering, Referring, Prescribing	N/A	1447723499	0	0	LY, HOA H PHARMD	12/15/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80031	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD MS	None	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
333558	Ordering, Referring, Prescribing	N/A	1447765698	0	0	LE, MAE JENNIFER NP	5/4/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008071	N/A	N/A	N/A	N/A	N/A	2344 SIXTH ST	None	BERKELEY	CA	94712	2247	00	06000	37.86198466	-122.295766	Alameda County
333565	Ordering, Referring, Prescribing	N/A	1447776133	0	0	LOPEZ, MICHELLE E LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119288	N/A	N/A	N/A	N/A	N/A	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4231	00	06000	33.78029455	-117.864369	Orange County
333580	Ordering, Referring, Prescribing	N/A	1447796701	0	0	LEHN, KRISTIANA MD	8/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181529	N/A	N/A	N/A	N/A	N/A	4301 X ST	None	SACRAMENTO	CA	95817	2214	00	06000	38.5536003	-121.455135	Sacramento County
333586	Ordering, Referring, Prescribing	N/A	1447810106	0	0	LOERA, NATALIE LCSW	3/7/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107211	N/A	N/A	N/A	N/A	N/A	902 S MYRTLE AVE	None	MONROVIA	CA	91016	3427	00	06000	34.14233552	-118.0008646	Los Angeles County
333594	Ordering, Referring, Prescribing	N/A	1447829858	0	0	LEE, JURI H PHARMD	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83029	N/A	N/A	N/A	N/A	N/A	615 WEST AVE L	None	LANCASTER	CA	93534	7211	00	06000	34.6603515	-118.1419695	Los Angeles County
333623	Ordering, Referring, Prescribing	N/A	1447909254	0	0	LEE, DEBBY MD	7/6/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187707	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
333635	Ordering, Referring, Prescribing	N/A	1447940127	0	0	LAWSON, BRYN	11/18/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA65264	N/A	N/A	N/A	N/A	N/A	4212 MISSOURI FLAT RD	None	PLACERVILLE	CA	95667	6269	00	06000	38.706228	-120.834891	El Dorado County
333636	Ordering, Referring, Prescribing	N/A	1447954334	0	0	LIN, KUAN-TUNG MD	5/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL11480	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
333644	Ordering, Referring, Prescribing	N/A	1447987466	0	0	LEE, YEE MEI DDS	8/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	107703	N/A	N/A	N/A	N/A	N/A	1133 W POPLAR AVE	None	PORTERVILLE	CA	93257	5839	00	06000	36.05124618	-119.0425626	Tulare County
333645	Ordering, Referring, Prescribing	N/A	1447882717	0	0	LOWE, ASHLEY R PA	11/8/2019	Taxonomy not applicable	NA	n/a	000	Unknown	57484	N/A	N/A	N/A	N/A	N/A	8520 S BROADWAY AVENUE	None	LOS ANGELES	CA	90003	3335	00	06000	33.96110579	-118.2782667	Los Angeles County
333654	Ordering, Referring, Prescribing	N/A	1457029316	0	0	LI, IRENE L PHARMD	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83614	N/A	N/A	N/A	N/A	N/A	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
333657	Ordering, Referring, Prescribing	N/A	1457053761	0	0	LUH, THOMAS M	7/1/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197213	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
333676	Ordering, Referring, Prescribing	N/A	1457158503	0	0	LAWSON, KERIANNE E LCSW	2/26/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23312	N/A	N/A	N/A	N/A	N/A	1200 DEL AMO ST.	None	REDONDO BEACH	CA	90277	3050	00	06000	33.8481509	-118.3798326	Los Angeles County
333695	Ordering, Referring, Prescribing	N/A	1457361230	0	0	LOPEZ, ROBERTO R LCSW	8/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	20218	N/A	N/A	N/A	N/A	N/A	58471 29 PALMS HWY	102	YUCCA VALLEY	CA	92284	5818	00	06000	34.13270029	-116.3881647	San Bernardino County
333698	Ordering, Referring, Prescribing	N/A	1457366130	0	0	LANG, LESLIE A NP	12/5/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0568144	N/A	N/A	N/A	N/A	N/A	1820 MARRON ROAD	SUITE 101	CARLSBAD	CA	92008	1177	00	06000	33.17711559	-117.3396763	San Diego County
333737	Ordering, Referring, Prescribing	N/A	1457491144	0	0	LOUIS, MARIAN MD	12/31/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G140111	N/A	N/A	N/A	N/A	N/A	650 HOWE AVENUE	BLDG 400-A	SACRAMENTO	CA	95825	4659	00	06000	38.577294	-121.4146395	Sacramento County
333799	Ordering, Referring, Prescribing	N/A	1457628620	0	0	LUCERO-SANCHEZ, MARIA E PHARMD	7/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61852	N/A	N/A	N/A	N/A	N/A	12275 PERRIS BLVD	None	MORENO VALLEY	CA	92557	7432	00	06000	33.942231	-117.226418	Riverside County
333809	Ordering, Referring, Prescribing	N/A	1457634859	0	0	LAM, MAINA M PHARMD	7/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54664	N/A	N/A	N/A	N/A	N/A	3250 LAKESHORE AVE	None	OAKLAND	CA	94610	2720	00	06000	37.81051525	-122.2446621	Alameda County
333812	Ordering, Referring, Prescribing	N/A	1457640997	0	0	LEI, STEPHANIE	1/12/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A123048	N/A	N/A	N/A	N/A	N/A	1030 W WARNER AVE	None	SANTA ANA	CA	92707	3147	00	06000	33.71597598	-117.8819134	Orange County
333820	Ordering, Referring, Prescribing	N/A	1457634073	0	0	LO, YVETTE PHARMD	8/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH53152	N/A	N/A	N/A	N/A	N/A	550 16TH ST	None	SAN FRANCISCO	CA	94143	2549	00	06000	37.769553	-122.390109	San Francisco County
333828	Ordering, Referring, Prescribing	N/A	1457667016	0	0	LASALA-WOOD, SUSAN	9/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	AP3846	N/A	N/A	N/A	N/A	N/A	1600 WEEOT WAY	None	ARCATA	CA	95521	4734	00	06000	40.89808837	-124.0923819	Humboldt County
333834	Ordering, Referring, Prescribing	N/A	1457670465	0	0	LEE, CONNIE MD	10/24/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A147250	N/A	N/A	N/A	N/A	N/A	2700 CHESTER AVE	None	BAKERSFIELD	CA	93301	2017	00	06000	35.384175	-119.0186805	Kern County
333862	Ordering, Referring, Prescribing	N/A	1457727216	0	0	LEE, JESSICA K LCSW	11/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88522	N/A	N/A	N/A	N/A	N/A	520 S LA FAYETTE PARK PL	3RD FLOOR	LOS ANGELES	CA	90057	1607	00	06000	34.06392003	-118.2826062	Los Angeles County
333872	Ordering, Referring, Prescribing	N/A	1457734832	0	0	LEE, KARENA LMFT	12/4/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT107334	N/A	N/A	N/A	N/A	N/A	815 N EL CENTRO AVE	None	LOS ANGELES	CA	90038	3805	00	06000	34.08577365	-118.3244665	Los Angeles County
333876	Ordering, Referring, Prescribing	N/A	1457749244	0	0	LONDON, TYLER C LMFT	2/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	114478	N/A	N/A	N/A	N/A	N/A	15305 RAYEN ST	None	NORTH HILLS	CA	91343	5117	00	06000	34.23191048	-118.4657625	Los Angeles County
333897	Ordering, Referring, Prescribing	N/A	1457778201	0	0	LE, LINDA N PHARMD	5/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	68992	N/A	N/A	N/A	N/A	N/A	11260 WHITE ROCK RD	None	RANCHO CORDOVA	CA	95742	6571	00	06000	38.587968	-121.2636915	Sacramento County
333918	Ordering, Referring, Prescribing	N/A	1457800096	0	0	LARIOS, ERIKA LMFT	10/18/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT128732	N/A	N/A	N/A	N/A	N/A	7365 CARNELAIN ST	None	RANCHO CUCAMONGA	CA	91730	1136	00	06000	34.12038413	-117.6160525	San Bernardino County
333934	Ordering, Referring, Prescribing	N/A	1457825812	0	0	LINK, DANIEL J PHARMD	11/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71474	N/A	N/A	N/A	N/A	N/A	7815 N LAKE BLVD	None	KINGS BEACH	CA	96143	0000	00	06000	39.23820667	-120.0335811	Placer County
333939	Ordering, Referring, Prescribing	N/A	1457828691	0	0	LUCAS, MARY J LMFT	3/30/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT118130	N/A	N/A	N/A	N/A	N/A	3105 WILSON RD	None	BAKERSFIELD	CA	93304	5319	00	06000	35.33217634	-119.037921	Kern County
333942	Ordering, Referring, Prescribing	N/A	1457834806	0	0	LEWIS, BREEANN M RN BS	11/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	813938	N/A	N/A	N/A	N/A	N/A	5 POWELL AVENUE	None	LEMOORE	CA	93245	2856	00	06000	36.29847307	-119.7796946	Kings County
333957	Ordering, Referring, Prescribing	N/A	1457842494	0	0	LEDEZMA, KRISTIE J	1/14/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	105581	N/A	N/A	N/A	N/A	N/A	124 N A ST	None	MADERA	CA	93638	3210	00	06000	36.96543674	-120.0560542	Madera County
333963	Ordering, Referring, Prescribing	N/A	1457862567	0	0	LUNA, JENNIFER K	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75443	N/A	N/A	N/A	N/A	N/A	1500 SUNRISE LANE	None	FULLERTON	CA	92833	1717	00	06000	33.88862845	-117.961311	Orange County
333968	Ordering, Referring, Prescribing	N/A	1457869778	0	0	LE, SOPHIE HIEN PHARMD	3/6/2024	Taxonomy not applicable	NA	n/a	000	Unknown	77756	N/A	N/A	N/A	N/A	N/A	6670 ALTON PKWY	None	IRVINE	CA	92618	3734	00	06000	33.65837833	-117.7727118	Orange County
333971	Ordering, Referring, Prescribing	N/A	1457874182	0	0	LAITY, LARA C	6/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125458	N/A	N/A	N/A	N/A	N/A	5575 HOSPITAL DRIVE	None	ATASCADERO	CA	93422	0000	00	06000	35.49162766	-120.6627516	San Luis Obispo County
333976	Ordering, Referring, Prescribing	N/A	1457879132	0	0	LU, TAMMY C NP	11/17/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95007253	N/A	N/A	N/A	N/A	N/A	1111 W CHASE AVE	None	EL CAJON	CA	92020	5710	00	06000	32.78161035	-116.9764603	San Diego County
334005	Ordering, Referring, Prescribing	N/A	1457914954	0	0	LUONG, SERENA S	5/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19646	N/A	N/A	N/A	N/A	N/A	26600 CACTUS AVE	300	MORENO VALLEY	CA	92553	3901	00	06000	33.91013953	-117.193383	Riverside County
334043	Ordering, Referring, Prescribing	N/A	1467002535	0	0	LOPEZ, VANESSA PHARMD	8/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79960	N/A	N/A	N/A	N/A	N/A	8044 LIMONITE AVE	None	RIVERSIDE	CA	92509	6107	00	06000	33.97764677	-117.4608873	Riverside County
334049	Ordering, Referring, Prescribing	N/A	1467013490	0	0	LE, ANDY PHARMD	4/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH49262	N/A	N/A	N/A	N/A	N/A	22555 MISSION BLVD	None	HAYWARD	CA	94541	5115	00	06000	37.671939	-122.0860215	Alameda County
334065	Ordering, Referring, Prescribing	N/A	1467061630	0	0	LY, JIMMY	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH82639	N/A	N/A	N/A	N/A	N/A	1301 PINOLE VALLEY ROAD	None	PINOLE	CA	94564	1384	00	06000	37.9991883	-122.2867117	Contra Costa County
334094	Ordering, Referring, Prescribing	N/A	1467120444	0	0	LOPEZ, JOCELYNE	7/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	ASW102749	N/A	N/A	N/A	N/A	N/A	540 N. MONTEBELLO BLVD	SUITE D	MONTEBELLO	CA	90640	9997	00	06000	34.01856818	-118.105579	Los Angeles County
334097	Ordering, Referring, Prescribing	N/A	1467121418	0	0	LUONG, JESSIE PHARMD	9/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85062	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
334125	Ordering, Referring, Prescribing	N/A	1467290403	0	0	LE, LUAN D NP	5/6/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029262	N/A	N/A	N/A	N/A	N/A	2776 PACIFIC AVE	None	LONG BEACH	CA	90806	2613	00	06000	33.80692698	-118.1936915	Los Angeles County
334142	Ordering, Referring, Prescribing	N/A	1467468488	0	0	LEE, STEPHEN MD	1/12/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A65674	N/A	N/A	N/A	N/A	N/A	21508 NORWALK BLVD	None	HAWAIIAN GARDENS	CA	90716	1122	00	06000	33.833862	-118.072013	Los Angeles County
334150	Ordering, Referring, Prescribing	N/A	1467504258	0	0	LEVIN, ROBERT DDS	10/14/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS34368	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK ROAD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
334159	Ordering, Referring, Prescribing	N/A	1467544031	0	0	LEE, ADAM S PHARMD	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	45392	N/A	N/A	N/A	N/A	N/A	4141 GEARY BLVD	207	SAN FRANCISCO	CA	94118	3109	00	06000	37.78096053	-122.4637512	San Francisco County
334165	Ordering, Referring, Prescribing	N/A	1467563759	0	0	LE, MAISA	2/7/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0579168	N/A	N/A	N/A	N/A	N/A	14372 BEACH BLVD	None	WESTMINSTER	CA	92683	4578	00	06000	33.75341465	-117.989413	Orange County
334185	Ordering, Referring, Prescribing	N/A	1467581298	0	0	LIPPINCOTT, CATHERINE A PSYD	6/28/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY23316	N/A	N/A	N/A	N/A	N/A	1000 VETERAN AVE	None	LOS ANGELES	CA	90095	7142	00	06000	34.0605595	-118.4499527	Los Angeles County
334215	Ordering, Referring, Prescribing	N/A	1467658781	0	0	LEE, TERRY E	9/9/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	23354	N/A	N/A	N/A	N/A	N/A	1415 CALIFORNIA ST	None	HOUSTON	TX	77006	2602	00	06000	29.74516212	-95.39422933	Harris County
334217	Ordering, Referring, Prescribing	N/A	1467679688	0	0	LIGONDE, ADELINE NP	8/17/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	507686	N/A	N/A	N/A	N/A	N/A	1939 ACADEMY AVE	None	SANGER	CA	93657	3737	00	06000	36.68936951	-119.5550306	Fresno County
334234	Ordering, Referring, Prescribing	N/A	1467701458	0	0	LAMBERT, DAISIE LCSW	4/23/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75350	N/A	N/A	N/A	N/A	N/A	17800 CA HWY 18	None	APPLE VALLEY	CA	92307	9988	00	06000	34.54007429	-117.2744761	San Bernardino County
334242	Ordering, Referring, Prescribing	N/A	1467720003	0	0	LI, MIN H PHARMD	8/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79957	N/A	N/A	N/A	N/A	N/A	14280 SAN PABLO BLVD.	None	SAN PABLO	CA	94806	0000	00	06000	37.96470576	-122.3451289	Contra Costa County
334243	Ordering, Referring, Prescribing	N/A	1467720482	0	0	LEE, SHARON PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63094	N/A	N/A	N/A	N/A	N/A	160 E ARTESIA ST	SUITE #135	POMONA	CA	91792	1536	00	06000	34.07556833	-117.7507835	Los Angeles County
334252	Ordering, Referring, Prescribing	N/A	1467735894	0	0	LEE, LYDIA M PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH47921	N/A	N/A	N/A	N/A	N/A	1344 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3356	00	06000	33.89151984	-118.299757	Los Angeles County
334255	Ordering, Referring, Prescribing	N/A	1467739045	0	0	LOUIE, CHARLEEN S PHARMD	3/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57082	N/A	N/A	N/A	N/A	N/A	1011 SNEATH LN	None	SAN BRUNO	CA	94066	2311	00	06000	37.63437084	-122.4264474	San Mateo County
334264	Ordering, Referring, Prescribing	N/A	1467751123	0	0	LELAND, CHRISTIAN LCSW	11/21/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100450	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
334309	Ordering, Referring, Prescribing	N/A	1467821413	0	0	LIM, WILLIAM PHARMD	7/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73311	N/A	N/A	N/A	N/A	N/A	191 E 3RD AVE	None	SAN MATEO	CA	94401	4012	00	06000	37.56505473	-122.3231627	San Mateo County
334330	Ordering, Referring, Prescribing	N/A	1467840900	0	0	LE, AMY PHARMD	12/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH62543	N/A	N/A	N/A	N/A	N/A	650 GATEWAY CENTER DR	None	SAN DIEGO	CA	92102	4530	00	06000	32.71403658	-117.1158307	San Diego County
334357	Ordering, Referring, Prescribing	N/A	1467888404	0	0	LABAU, CHRISTIAN DC	4/19/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC32708	N/A	N/A	N/A	N/A	N/A	7912 WEST LN	SUITE #22	STOCKTON	CA	95210	3161	00	06000	38.02030226	-121.2946839	San Joaquin County
334359	Ordering, Referring, Prescribing	N/A	1467889410	0	0	LARIOS-GARCIA, GUADALUPE	3/1/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79094	N/A	N/A	N/A	N/A	N/A	250 NORTHGATE DRIVE	None	MANTECA	CA	95336	3161	00	06000	37.81869269	-121.2190817	San Joaquin County
334390	Ordering, Referring, Prescribing	N/A	1467940643	0	0	LEVY, GREGORY PHARMD	1/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69781	N/A	N/A	N/A	N/A	N/A	16251 MAIN ST	None	GUERNEVILLE	CA	95446	8300	00	06000	38.50196181	-122.9981182	Sonoma County
334391	Ordering, Referring, Prescribing	N/A	1467941401	0	0	LEE, JAEWON NP	5/15/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008747	N/A	N/A	N/A	N/A	N/A	7212 ORANGETHORPE AVE	9A	BUENA PARK	CA	90621	3341	00	06000	33.85890953	-118.007244	Orange County
334410	Ordering, Referring, Prescribing	N/A	1467961565	0	0	LAM, GEORGE	12/11/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007421	N/A	N/A	N/A	N/A	N/A	66 HURLBUT ST	None	PASADENA	CA	91105	4025	00	06000	34.12993251	-118.1516625	Los Angeles County
334455	Ordering, Referring, Prescribing	N/A	1477037414	0	0	LYNCH, MOLLY A OT	12/10/2019	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	18992	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
334487	Ordering, Referring, Prescribing	N/A	1477092633	0	0	LE, ROSA K DDS	10/5/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS105045	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
334489	Ordering, Referring, Prescribing	N/A	1477095990	0	0	LIN, MICHELLE PHARMD	3/15/2018	Taxonomy not applicable	NA	n/a	000	Unknown	75722	N/A	N/A	N/A	N/A	N/A	6688 ALHAMBRA AVE	None	MARTINEZ	CA	94553	6105	00	06000	37.95842069	-122.0930882	Contra Costa County
334490	Ordering, Referring, Prescribing	N/A	1477094795	0	0	LEE, BRIAN P	8/10/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	101822	N/A	N/A	N/A	N/A	N/A	420 S GLENDORA AVE	None	WEST COVINA	CA	91790	3001	00	06000	34.06750236	-117.925203	Los Angeles County
334496	Ordering, Referring, Prescribing	N/A	1477105138	0	0	LEHMANN, JOHN	7/15/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	30881	N/A	N/A	N/A	N/A	N/A	600 WEST GRAND	None	PORTERVILLE	CA	93257	8964	00	06000	36.0768899	-119.0306019	Tulare County
334505	Ordering, Referring, Prescribing	N/A	1477129310	0	0	LYNCH, KYLE PT	2/2/2023	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT301737	N/A	N/A	N/A	N/A	N/A	7826 BROADWAY	None	LEMON GROVE	CA	91945	1801	00	06000	32.74280549	-117.029889	San Diego County
334508	Ordering, Referring, Prescribing	N/A	1477125789	0	0	LIGHT, JAMIE PHARMD	3/27/2023	Taxonomy not applicable	NA	n/a	000	Unknown	86998	N/A	N/A	N/A	N/A	N/A	5755 COTTLE ROAD	None	SAN JOSE	CA	95132	2223	00	06000	37.246896	-121.8040865	Santa Clara County
334511	Ordering, Referring, Prescribing	N/A	1477131803	0	0	LOJA YI, BLANCA MD	2/25/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192381	N/A	N/A	N/A	N/A	N/A	123 S ALVARADO ST.	None	LOS ANGELES	CA	90057	2201	00	06000	34.06593048	-118.2708351	Los Angeles County
334547	Ordering, Referring, Prescribing	N/A	1477209260	0	0	LAU, MICHEL LAC	7/29/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	19193	N/A	N/A	N/A	N/A	N/A	3850 17TH ST	None	SAN FRANCISCO	CA	94114	2031	00	06000	37.76272129	-122.4318522	San Francisco County
334552	Ordering, Referring, Prescribing	N/A	1477263911	0	0	LUTZ, EMMA L NP	8/2/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022110	N/A	N/A	N/A	N/A	N/A	16 RITTER ST	None	SAN RAFAEL	CA	94901	3323	00	06000	37.97151013	-122.5251246	Marin County
334577	Ordering, Referring, Prescribing	N/A	1477523264	0	0	LAM, DING S MD FAAP	2/14/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A32527	N/A	N/A	N/A	N/A	N/A	600 N.GARFIELD AVENUE	#101	MONTEREY PARK	CA	91754	1167	00	06000	34.06820797	-118.1228835	Los Angeles County
334598	Ordering, Referring, Prescribing	N/A	1477581783	0	0	LIN, MEI-LING NP	12/7/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP15338	N/A	N/A	N/A	N/A	N/A	15730 PARAMOUNT BLVD	None	PARAMOUNT	CA	90723	4333	00	06000	33.8902084	-118.1600082	Los Angeles County
334603	Ordering, Referring, Prescribing	N/A	1477601862	0	0	LAM, DIANA MSW LCSW	9/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW125912	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	None	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
334604	Ordering, Referring, Prescribing	N/A	1477603249	0	0	LORENZ, ARTHUR J LMFT	3/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45350	N/A	N/A	N/A	N/A	N/A	4545 GEORGETOWN PLACE	D	STOCKTON	CA	95207	6628	00	06000	37.98906659	-121.3134248	San Joaquin County
334609	Ordering, Referring, Prescribing	N/A	1477611630	0	0	LEE, KANG H	8/18/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D26460	N/A	N/A	N/A	N/A	N/A	201 S HARBOR BLVD	None	LA HABRA	CA	90631	5654	00	06000	33.93029897	-117.9331306	Orange County
334643	Ordering, Referring, Prescribing	N/A	1477673127	0	0	LO, ANNA MSW LCSW	8/3/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22685	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
334694	Ordering, Referring, Prescribing	N/A	1477788495	0	0	LORENTE, SOPHIA LMFT	2/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	101018	N/A	N/A	N/A	N/A	N/A	6736 LAUREL CANYON BLVD	STE 200	NORTH HOLLYWOOD	CA	91606	1576	00	06000	34.193493	-118.3964925	Los Angeles County
334709	Ordering, Referring, Prescribing	N/A	1477810174	0	0	LIN, HANNAH PHARMD	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71450	N/A	N/A	N/A	N/A	N/A	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	0000	00	06000	37.98739901	-121.7808007	Contra Costa County
334779	Ordering, Referring, Prescribing	N/A	1477925014	0	0	LEE, ANASTASHA ( LPCC	6/27/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC3589	N/A	N/A	N/A	N/A	N/A	2829 WATT AVE	200	SACRAMENTO	CA	95821	6200	00	06000	38.615247	-121.383558	Sacramento County
334841	Ordering, Referring, Prescribing	N/A	1487017224	0	0	LAVALLEY, CLAYTON K MD	7/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173945	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
334847	Ordering, Referring, Prescribing	N/A	1487020293	0	0	LAREZ, ANINA A	9/28/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64838	N/A	N/A	N/A	N/A	N/A	8316 FOOTHILL BLVD	None	SUNLAND	CA	91040	2850	00	06000	34.25966652	-118.314342	Los Angeles County
334867	Ordering, Referring, Prescribing	N/A	1487051249	0	0	LAM, MINTRA C PHARMD	3/31/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH71298	N/A	N/A	N/A	N/A	N/A	14501 HINDRY AVE	None	HAWTHORNE	CA	90250	6748	00	06000	33.89988119	-118.3721861	Los Angeles County
334882	Ordering, Referring, Prescribing	N/A	1487062717	0	0	LIN, STEPHANIE A PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70150	N/A	N/A	N/A	N/A	N/A	11541 SASSARI LN	None	PORTER RANCH	CA	91326	4402	00	06000	34.28146787	-118.583523	Los Angeles County
334942	Ordering, Referring, Prescribing	N/A	1487147062	0	0	LINDERMAN, KAREN LCSW	2/7/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	105103	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
334950	Ordering, Referring, Prescribing	N/A	1487161055	0	0	LEITZ, SARAH LMFT	6/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT126474	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD	SUITE 100	PACOIMA	CA	91331	1391	00	06000	34.27894489	-118.4044363	Los Angeles County
334966	Ordering, Referring, Prescribing	N/A	1487185328	0	0	LARNER, KARLA M LCSW	2/1/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99850	N/A	N/A	N/A	N/A	N/A	14600 SHERMAN WAY	100D	VAN NUYS	CA	91405	2283	00	06000	34.20025916	-118.4500763	Los Angeles County
334970	Ordering, Referring, Prescribing	N/A	1487193546	0	0	LIBERTONE, EVE M LMFT	12/28/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT136860	N/A	N/A	N/A	N/A	N/A	2940 SUMMIT STREET	2D	OAKLAND	CA	94609	3416	00	06000	37.81849213	-122.2647718	Alameda County
334976	Ordering, Referring, Prescribing	N/A	1487193959	0	0	LORGE, LAUREN LCSW	12/6/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	105956	N/A	N/A	N/A	N/A	N/A	5445 LAUREL HILLS DR.	None	SACRAMENTO	CA	95841	3105	00	06000	38.662227	-121.3378965	Sacramento County
334977	Ordering, Referring, Prescribing	N/A	1487196820	0	0	LENTZOU, MARIA	3/29/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125237	N/A	N/A	N/A	N/A	N/A	3720 SUNSET LANE	SUITE D	ANTIOCH	CA	94509	6133	00	06000	37.98416157	-121.804246	Contra Costa County
334990	Ordering, Referring, Prescribing	N/A	1487218640	0	0	LE, ANNIE P	2/14/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176379	N/A	N/A	N/A	N/A	N/A	651 NORTH STATE STREET,	None	SAN JACINTO	CA	92583	6574	00	06000	33.79510156	-116.9715082	Riverside County
335009	Ordering, Referring, Prescribing	N/A	1487266920	0	0	LAM, CINDY S OD	8/13/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34637	N/A	N/A	N/A	N/A	N/A	2401 15TH STREET	None	SACRAMENTO	CA	95818	2238	00	06000	38.562687	-121.4931195	Sacramento County
335015	Ordering, Referring, Prescribing	N/A	1487273918	0	0	LOWRY, ADAM DO	7/23/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A23180	N/A	N/A	N/A	N/A	N/A	2751 NAPA VALLEY CORPORA	None	NAPA	CA	94558	6216	00	06000	38.24829023	-122.2745626	Napa County
335032	Ordering, Referring, Prescribing	N/A	1487307369	0	0	LLOYD, MATTHEW G PA-C	5/19/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA62752	N/A	N/A	N/A	N/A	N/A	1550 BROADWAY	None	SAN DIEGO	CA	92101	5713	00	06000	32.71579987	-117.1499238	San Diego County
335068	Ordering, Referring, Prescribing	N/A	1487429783	0	0	LIN, RYAN	11/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	88967	N/A	N/A	N/A	N/A	N/A	555 E CALAVERAS BLVD	None	MILPITAS	CA	95035	7704	00	06000	37.43317076	-121.8957393	Santa Clara County
335076	Ordering, Referring, Prescribing	N/A	1487633616	0	0	LAMPHERE SULLIVAN, GEORGINA PHD	1/28/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY10649	N/A	N/A	N/A	N/A	N/A	954 W FOOTHILL BLVD	STE A	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
335085	Ordering, Referring, Prescribing	N/A	1487664868	0	0	LOVE-CLARK, KRISTEN M LCSW	12/15/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW26760	N/A	N/A	N/A	N/A	N/A	101 CIRBY HILLS DR	None	ROSEVILLE	CA	95678	4360	00	06000	38.7303989	-121.2872592	Placer County
335109	Ordering, Referring, Prescribing	N/A	1487733945	0	0	LEE, KAREN A MD	10/28/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A50463	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE	3RD FLOOR	LONG BEACH	CA	90806	2325	00	06000	33.806097	-118.151378	Los Angeles County
335112	Ordering, Referring, Prescribing	N/A	1487732095	0	0	LARACH, JUAN C MD	9/7/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G60426	N/A	N/A	N/A	N/A	N/A	4434 MISSION STREET	None	SAN FRANCISCO	CA	94112	1927	00	06000	37.72675413	-122.4332747	San Francisco County
335156	Ordering, Referring, Prescribing	N/A	1487805131	0	0	LOVELUND, ADRIENNE A PSYD	5/13/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY23936	N/A	N/A	N/A	N/A	N/A	1930 MARKET STREET	None	SAN FRANCISCO	CA	94102	6228	00	06000	37.77037155	-122.4255051	San Francisco County
335161	Ordering, Referring, Prescribing	N/A	1487818803	0	0	LANCASTER, JAMES LMFT	4/1/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT132092	N/A	N/A	N/A	N/A	N/A	1430 WILLOW PASS RD	None	CONCORD	CA	94520	7928	00	06000	37.97055112	-122.0492933	Contra Costa County
335204	Ordering, Referring, Prescribing	N/A	1487932372	0	0	LEUNG, HOBART	6/4/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138293	N/A	N/A	N/A	N/A	N/A	767 N HILL ST	200	LOS ANGELES	CA	90012	2343	00	06000	34.06255157	-118.2397077	Los Angeles County
335211	Ordering, Referring, Prescribing	N/A	1487947958	0	0	LINDO, JOHN D MD	5/14/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A142898	N/A	N/A	N/A	N/A	N/A	1105 E FLORIDA AVE	None	HEMET	CA	92543	4512	00	06000	33.74750951	-116.960463	Riverside County
335213	Ordering, Referring, Prescribing	N/A	1487954558	0	0	LEE, BETTY N PHARMD	3/29/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH61252	N/A	N/A	N/A	N/A	N/A	8925 MADISON AVE	None	FAIR OAKS	CA	95628	6605	00	06000	38.665152	-121.224105	Sacramento County
335218	Ordering, Referring, Prescribing	N/A	1487954897	0	0	LUCKY, VIKRAMJEET PHARMD	10/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	56802	N/A	N/A	N/A	N/A	N/A	5638 E KINGS CANYON RD	None	FRESNO	CA	93727	4627	00	06000	36.73578229	-119.6985397	Fresno County
335232	Ordering, Referring, Prescribing	N/A	1487967337	0	0	LOPEZ, NANCY M LCSW	12/9/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	72687	N/A	N/A	N/A	N/A	N/A	1933 S. BROADWAY	6TH FL.	LOS ANGELES	CA	90007	4501	00	06000	34.03102377	-118.2660738	Los Angeles County
335280	Ordering, Referring, Prescribing	N/A	1497048045	0	0	LIM, NANCY	4/30/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH62786	N/A	N/A	N/A	N/A	N/A	3020 SATURN ST	SUITE 100	BREA	CA	92821	6262	00	06000	33.9089406	-117.857311	Orange County
335317	Ordering, Referring, Prescribing	N/A	1497113302	0	0	LONGO, NANCY L LCSW	12/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99279	N/A	N/A	N/A	N/A	N/A	1420 S. MILLIKEN AVE.	SUITE 508	ONTARIO	CA	91761	2337	00	06000	34.047684	-117.55872	San Bernardino County
335321	Ordering, Referring, Prescribing	N/A	1497119929	0	0	LIN, LIHONG NP	5/8/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	672333	N/A	N/A	N/A	N/A	N/A	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	00	06000	36.33611794	-119.6460191	Kings County
335328	Ordering, Referring, Prescribing	N/A	1497134688	0	0	LEWIS, TASHANA NP	6/5/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014686	N/A	N/A	N/A	N/A	N/A	954 W. FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
335392	Ordering, Referring, Prescribing	N/A	1497223986	0	0	LEON-GONZALEZ, IRAIS LCSW	10/7/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW110925	N/A	N/A	N/A	N/A	N/A	105 N LINCOLN ST	None	SANTA MARIA	CA	93458	4319	00	06000	34.9535882	-120.4374049	Santa Barbara County
335403	Ordering, Referring, Prescribing	N/A	1497250815	0	0	LUTZ, MARIE MD	6/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165436	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
335405	Ordering, Referring, Prescribing	N/A	1497252324	0	0	LEON, WILLIAM E MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164603	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
335416	Ordering, Referring, Prescribing	N/A	1497274302	0	0	LEI, SHUANG MD	3/3/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159635	N/A	N/A	N/A	N/A	N/A	23501 CINEMA DR	STE. 200 & 210	VALENCIA	CA	91355	5428	00	06000	34.42039699	-118.5463513	Los Angeles County
335417	Ordering, Referring, Prescribing	N/A	1497275705	0	0	LEE, HEE JIN NP	2/4/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006499	N/A	N/A	N/A	N/A	N/A	3939 J STREET	SUITE 360	SACRAMENTO	CA	95819	0001	00	06000	38.570211	-121.45374	Sacramento County
335425	Ordering, Referring, Prescribing	N/A	1497290035	0	0	LEDFORD, CLARISSA J NP	6/16/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011875	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
335426	Ordering, Referring, Prescribing	N/A	1497291710	0	0	LEGHARI, SANNA LMFT	10/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122586	N/A	N/A	N/A	N/A	N/A	1955 FREMONT AVE.	None	SOUTH PASADENA	CA	91030	4507	00	06000	34.10208473	-118.1522053	Los Angeles County
335445	Ordering, Referring, Prescribing	N/A	1497318109	0	0	LEE, JI YOUNG NP	4/2/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011530	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
335449	Ordering, Referring, Prescribing	N/A	1497336085	0	0	LEE, REGINA J MD	11/1/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	7985	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
335469	Ordering, Referring, Prescribing	N/A	1497386544	0	0	LOPAPA, FABIANA E NP	1/6/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016342	N/A	N/A	N/A	N/A	N/A	2208 W 7TH STREET	None	LOS ANGELES	CA	90057	4002	00	06000	34.05710805	-118.2782502	Los Angeles County
335480	Ordering, Referring, Prescribing	N/A	1497401715	0	0	LIN, AARON J	12/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85709	N/A	N/A	N/A	N/A	N/A	2400 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2914	00	06000	33.89386589	-118.3959255	Los Angeles County
335491	Ordering, Referring, Prescribing	N/A	1497419543	0	0	LAGMAN, JACQUELINE M NP	10/21/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018924	N/A	N/A	N/A	N/A	N/A	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	00	06000	37.53384106	-121.9607241	Alameda County
335499	Ordering, Referring, Prescribing	N/A	1497434146	0	0	LANGIE, NATHALIE NP	7/10/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95025899	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
335534	Ordering, Referring, Prescribing	N/A	1497799092	0	0	LEON, JOSUE MD	10/13/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A80635	N/A	N/A	N/A	N/A	N/A	1000 VALE TERRACE	None	VISTA	CA	92084	5218	00	06000	33.20904502	-117.2286439	San Diego County
335538	Ordering, Referring, Prescribing	N/A	1497802821	0	0	LEE, LINDA J LCSW	11/17/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW26587	N/A	N/A	N/A	N/A	N/A	14112 S. KINGSLEY DRIVE	None	GARDENA	CA	90249	3018	00	06000	33.902901	-118.304243	Los Angeles County
335549	Ordering, Referring, Prescribing	N/A	1497818025	0	0	LEE, CHONG S MD	4/14/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G88058	N/A	N/A	N/A	N/A	N/A	1345 A PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3159	00	06000	40.43531297	-120.6557201	Lassen County
335551	Ordering, Referring, Prescribing	N/A	1497814370	0	0	LAM, SIN H PHARMD	3/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49359	N/A	N/A	N/A	N/A	N/A	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	00	06000	37.94947636	-121.7752571	Contra Costa County
335569	Ordering, Referring, Prescribing	N/A	1497883136	0	0	LAM, SAMSON W	6/7/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D56732	N/A	N/A	N/A	N/A	N/A	8841 GARVEY AVE	None	ROSEMEAD	CA	91770	3358	00	06000	34.06276591	-118.07587	Los Angeles County
335582	Ordering, Referring, Prescribing	N/A	1497888044	0	0	LINSCHEID, LAURIE J LMFT	6/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT38863	N/A	N/A	N/A	N/A	N/A	39155 LIBERTY ST	SUITE E500	FREMONT	CA	94537	5006	00	06000	37.55123907	-121.9828956	Alameda County
335584	Ordering, Referring, Prescribing	N/A	1497895544	0	0	LESEUR, HARRY D PHARD	11/22/2020	Taxonomy not applicable	NA	n/a	000	Unknown	43447	N/A	N/A	N/A	N/A	N/A	271 MAIN ST	SUITE A	CHESTER	CA	96020	9602	00	06000	40.3078407	-121.2307857	Plumas County
335589	Ordering, Referring, Prescribing	N/A	1497897615	0	0	LIBERTY, JAIMIE L LMFT	2/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT40291	N/A	N/A	N/A	N/A	N/A	1160 S GRAND AVE	None	GLENDORA	CA	91740	5000	00	06000	34.11736533	-117.8725213	Los Angeles County
335595	Ordering, Referring, Prescribing	N/A	1497909113	0	0	LY, JULIE M PA-C	5/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	20056	N/A	N/A	N/A	N/A	N/A	1421 EAST 17TH STREET	None	SANTA ANA	CA	92705	8505	00	06000	33.75994564	-117.847815	Orange County
335618	Ordering, Referring, Prescribing	N/A	1497981849	0	0	LAWSON, SHELLY L LMFT	7/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT40227	N/A	N/A	N/A	N/A	N/A	1940 E DEERE AVE	None	SANTA ANA	CA	92705	5718	00	06000	33.70430421	-117.8482556	Orange County
335673	Ordering, Referring, Prescribing	N/A	1508122755	0	0	LAGANA, JACQUELINE	5/26/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009305	N/A	N/A	N/A	N/A	N/A	518 GARDEN STREET	None	SANTA BARBARA	CA	93101	1606	00	06000	34.42054634	-119.6928135	Santa Barbara County
335699	Ordering, Referring, Prescribing	N/A	1508152406	0	0	LEE, JOHN W PHARMD	3/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	62052	N/A	N/A	N/A	N/A	N/A	2000 MARKET PLACE DR	None	MONTEREY PARK	CA	91755	7402	00	06000	34.03672674	-118.1057236	Los Angeles County
335721	Ordering, Referring, Prescribing	N/A	1508187063	0	0	LOGAN, YEWAH J	1/12/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A13987	N/A	N/A	N/A	N/A	N/A	5500 CAMPANILE DR	None	SAN DIEGO	CA	92182	0001	00	06000	32.77590585	-117.0722922	San Diego County
335735	Ordering, Referring, Prescribing	N/A	1508211269	0	0	LASITER, JOSHUA D LMFT	2/22/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT145254	N/A	N/A	N/A	N/A	N/A	7001 EAST PKWY	700	SACRAMENTO	CA	95823	2501	00	06000	38.497293	-121.4504235	Sacramento County
335765	Ordering, Referring, Prescribing	N/A	1508265349	0	0	LOPEZ, MARIA LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111514	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS	220	MISSION VIEJO	CA	92691	6468	00	06000	33.56536541	-117.670334	Orange County
335775	Ordering, Referring, Prescribing	N/A	1508276908	0	0	LEONG, NANCY	10/2/2018	Taxonomy not applicable	NA	n/a	000	Unknown	51364	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE, STE 1	None	SAN JOSE	CA	95128	2631	00	06000	37.3160785	-121.937121	Santa Clara County
335798	Ordering, Referring, Prescribing	N/A	1508280637	0	0	LUNA TORRES, DAISY LMFT	7/19/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127024	N/A	N/A	N/A	N/A	N/A	6043 HOLLYWOOD BLVD	LOS ANGELES CA 90028	LOS ANGELES	CA	90048	3401	00	06000	34.1016835	-118.321569	Los Angeles County
335820	Ordering, Referring, Prescribing	N/A	1508357914	0	0	LA PLACETTE, SUZANNE M LMFT	4/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	27310	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	None	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
335825	Ordering, Referring, Prescribing	N/A	1508360090	0	0	LIFLAND, BROOKE MD	11/26/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178028	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST.	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
335839	Ordering, Referring, Prescribing	N/A	1508389032	0	0	LABA, ALINA V OD	11/8/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	33773	N/A	N/A	N/A	N/A	N/A	1500 21ST STREET	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
335860	Ordering, Referring, Prescribing	N/A	1508413022	0	0	LANSILL, HEATHER M NP	4/19/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011302	N/A	N/A	N/A	N/A	N/A	1550 N GAREY AVE	None	POMONA	CA	91767	3826	00	06000	34.07356342	-117.7522392	Los Angeles County
335862	Ordering, Referring, Prescribing	N/A	1508433285	0	0	LIN, CHIA-JUNG LAC	7/2/2020	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC17031	N/A	N/A	N/A	N/A	N/A	19742 MACARTHUR BLVD	250	IRVINE	CA	92612	0000	00	06000	33.65738766	-117.8625556	Orange County
335869	Ordering, Referring, Prescribing	N/A	1508440736	0	0	LECLAIR, KARISSA MD	12/29/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192494	N/A	N/A	N/A	N/A	N/A	1430 FREEDOM BLVD	None	WATSONVILLE	CA	95076	2780	00	06000	36.92713051	-121.7652145	Santa Cruz County
335871	Ordering, Referring, Prescribing	N/A	1508441312	0	0	LECROIX, REBECCA PHD	9/26/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	32449	N/A	N/A	N/A	N/A	N/A	4605 LANKERSHIM BLVD	STE 545	NORTH HOLLYWOOD	CA	91602	1892	00	06000	34.15389329	-118.3679999	Los Angeles County
335886	Ordering, Referring, Prescribing	N/A	1508490939	0	0	LEE, JENNIFER PHARMD	7/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81949	N/A	N/A	N/A	N/A	N/A	11800 ARTESIA BLVD	None	ARTESIA	CA	90701	4003	00	06000	33.87293272	-118.0818003	Los Angeles County
335889	Ordering, Referring, Prescribing	N/A	1508473521	0	0	LI, CHIEH PA-C	10/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA60278	N/A	N/A	N/A	N/A	N/A	263 S WEST ST	None	TULARE	CA	93274	3411	00	06000	36.20460711	-119.3668926	Tulare County
335901	Ordering, Referring, Prescribing	N/A	1508519265	0	0	LAIM, JANIE	1/25/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62247	N/A	N/A	N/A	N/A	N/A	2550 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2837	00	06000	33.98915101	-118.2261679	Los Angeles County
335945	Ordering, Referring, Prescribing	N/A	1508583782	0	0	LAM, JONATHAN PHARMD	9/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	88455	N/A	N/A	N/A	N/A	N/A	510 S VERMONT AVE FL 21	None	LOS ANGELES	CA	90012	3927	00	06000	34.065	-118.291631	Los Angeles County
335961	Ordering, Referring, Prescribing	N/A	1508878596	0	0	LABINGER, JEFF DC	7/16/2019	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	14961	N/A	N/A	N/A	N/A	N/A	6424 WATT AVE	None	NORTH HIGHLANDS	CA	95660	3612	00	06000	38.684601	-121.382595	Sacramento County
335972	Ordering, Referring, Prescribing	N/A	1508905316	0	0	LANSING, LISA B LCSW	1/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	18041	N/A	N/A	N/A	N/A	N/A	2550 EAST FOOTHILL	None	PASADENA	CA	91107	3406	00	06000	34.14979153	-118.0979955	Los Angeles County
335980	Ordering, Referring, Prescribing	N/A	1508924036	0	0	LIOU, HANSHENG PHARMD	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55660	N/A	N/A	N/A	N/A	N/A	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	00	06000	37.89189148	-122.057999	Contra Costa County
335994	Ordering, Referring, Prescribing	N/A	1508962572	0	0	LUBIS, MURNI MD	8/1/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A79773	N/A	N/A	N/A	N/A	N/A	2350 PROFESSIONAL DR	None	SANTA ROSA	CA	95403	3018	00	06000	38.462535	-122.7244905	Sonoma County
336011	Ordering, Referring, Prescribing	N/A	1508994583	0	0	LAIDLEY, ANA CARLA G LMFT	10/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44112	N/A	N/A	N/A	N/A	N/A	8717 S 10TH AVE	None	INGLEWOOD	CA	90305	2324	00	06000	33.95830726	-118.3277029	Los Angeles County
336017	Ordering, Referring, Prescribing	N/A	1518006352	0	0	LOUPAS, CINDY LMFT	3/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40900	N/A	N/A	N/A	N/A	N/A	11731 E. TELEGRAPH RD	K	SANTA FE SPRINGS	CA	90670	6835	00	06000	33.94630253	-118.0832082	Los Angeles County
336031	Ordering, Referring, Prescribing	N/A	1518035971	0	0	LIU, YUE PHARMD	4/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58598	N/A	N/A	N/A	N/A	N/A	370 LENNON LN	2ND FLOOR PHASE	WALNUT CREEK	CA	94598	2419	00	06000	37.92786635	-122.0300899	Contra Costa County
336034	Ordering, Referring, Prescribing	N/A	1518032986	0	0	LARRIGAN, ANGELINA K LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	94194	N/A	N/A	N/A	N/A	N/A	768 PLEASANT VALLEY RD	None	DIAMOND SPRINGS	CA	95619	9260	00	06000	38.69498433	-120.8070771	El Dorado County
336041	Ordering, Referring, Prescribing	N/A	1518050897	0	0	LARSON, QUENLYN J CNP	10/18/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP19804	N/A	N/A	N/A	N/A	N/A	1 SCRIPPS DR	UNIT 107	SACRAMENTO	CA	95825	6206	00	06000	38.573181	-121.4118135	Sacramento County
336045	Ordering, Referring, Prescribing	N/A	1518063478	0	0	LEE, MAYRE T NP	4/17/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	10571	N/A	N/A	N/A	N/A	N/A	770 MASON STREET	120	VACAVILLE	CA	95688	4648	00	06000	38.35504697	-121.983852	Solano County
336051	Ordering, Referring, Prescribing	N/A	1518056456	0	0	LEE, CONNIE K PHARMD	3/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH44015	N/A	N/A	N/A	N/A	N/A	2350 GEARY STREET	None	SAN FRANCISCO	CA	94115	3305	00	06000	37.78305866	-122.4421313	San Francisco County
336056	Ordering, Referring, Prescribing	N/A	1518078849	0	0	LINDER, JUDITH A NP	2/28/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN365573	N/A	N/A	N/A	N/A	N/A	5700 WATT AVENUE	None	NORTH HIGHLANDS	CA	95660	4752	00	06000	38.670723	-121.3823745	Sacramento County
336069	Ordering, Referring, Prescribing	N/A	1518097039	0	0	LIM, JOYCE LMFT	6/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	33047	N/A	N/A	N/A	N/A	N/A	39155 LIBERTY STREET	E500	FREMONT	CA	94537	5006	00	06000	37.55123907	-121.9828956	Alameda County
336076	Ordering, Referring, Prescribing	N/A	1518119478	0	0	LEE, SUKJAE LAC	9/18/2017	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	9536	N/A	N/A	N/A	N/A	N/A	444 SANTA RITA AVE	None	LOS BANOS	CA	93635	3838	00	06000	37.06272659	-120.837364	Merced County
336086	Ordering, Referring, Prescribing	N/A	1518141241	0	0	LEWIS, ANNETTE LCSW	7/6/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102342	N/A	N/A	N/A	N/A	N/A	186 BROADWAY	None	RICHMOND	CA	94804	1443	00	06000	37.93359839	-122.344742	Contra Costa County
336105	Ordering, Referring, Prescribing	N/A	1518177443	0	0	LILLIEDOLL, TINA LCSW	10/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97349	N/A	N/A	N/A	N/A	N/A	600 A STREET	None	DAVIS	CA	95616	3648	00	06000	38.5479381	-121.7477157	Yolo County
336122	Ordering, Referring, Prescribing	N/A	1518199637	0	0	LANGFORD, JAMIE LMFT	3/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	85367	N/A	N/A	N/A	N/A	N/A	3320 E LA PALMA AVE	None	ANAHEIM	CA	92806	2814	00	06000	33.85263123	-117.8512144	Orange County
336128	Ordering, Referring, Prescribing	N/A	1518225374	0	0	LYNCH, KIRK J PHARMD	3/13/2018	Taxonomy not applicable	NA	n/a	000	Unknown	51650	N/A	N/A	N/A	N/A	N/A	4520 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6057	00	06000	34.09811411	-118.2879528	Los Angeles County
336148	Ordering, Referring, Prescribing	N/A	1518249390	0	0	LUO, JESSICA PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58727	N/A	N/A	N/A	N/A	N/A	331 N PACIFIC COAST HWY	None	EL SEGUNDO	CA	90245	4444	00	06000	33.92058735	-118.39638	Los Angeles County
336154	Ordering, Referring, Prescribing	N/A	1518267699	0	0	LEE, CHONGWON PHARMD	3/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	53082	N/A	N/A	N/A	N/A	N/A	1709 AUTOMATION PKWY	None	SAN JOSE	CA	95131	1866	00	06000	37.39119817	-121.8843339	Santa Clara County
336160	Ordering, Referring, Prescribing	N/A	1518276443	0	0	LONG, ASHLEY E LCSW	12/7/2017	Taxonomy not applicable	NA	n/a	000	Unknown	66070	N/A	N/A	N/A	N/A	N/A	2145 FIFTH AVE	None	OROVILLE	CA	95965	5870	00	06000	39.50368243	-121.5646958	Butte County
336202	Ordering, Referring, Prescribing	N/A	1518351683	0	0	LOUIE, JUSTIN S MD	7/3/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144124	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
336225	Ordering, Referring, Prescribing	N/A	1518380609	0	0	LEE, GLORIA PHARMD	3/18/2018	Taxonomy not applicable	NA	n/a	000	Unknown	69494	N/A	N/A	N/A	N/A	N/A	103 AMERICAN CANYON RD	None	AMERICAN CANYON	CA	94503	1112	00	06000	38.16553476	-122.2545326	Napa County
336242	Ordering, Referring, Prescribing	N/A	1518409440	0	0	LEE, MEERI C PA-C	7/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54910	N/A	N/A	N/A	N/A	N/A	5420 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4118	00	06000	34.10779213	-118.196385	Los Angeles County
336267	Ordering, Referring, Prescribing	N/A	1518450675	0	0	LANEY, ROQUELL MD MPH	7/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173696	N/A	N/A	N/A	N/A	N/A	501 S ATLANTIC BLVD	None	LOS ANGELES	CA	90022	2621	00	06000	34.0270205	-118.155308	Los Angeles County
336310	Ordering, Referring, Prescribing	N/A	1518538693	0	0	LEW, HUNTER R LMFT	5/30/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147136	N/A	N/A	N/A	N/A	N/A	124 RIVER RD	None	SALINAS	CA	93908	9601	00	06000	36.61705976	-121.6608103	Monterey County
336311	Ordering, Referring, Prescribing	N/A	1518524586	0	0	LU, STEPHANIE A DO	2/28/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20252	N/A	N/A	N/A	N/A	N/A	3544 30TH ST	None	SAN DIEGO	CA	92104	4120	00	06000	32.742936	-117.130118	San Diego County
336325	Ordering, Referring, Prescribing	N/A	1518581677	0	0	LAMBERT, TANA M	6/4/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	LEP3690	N/A	N/A	N/A	N/A	N/A	5340 SKYLANE BLVD	None	SANTA ROSA	CA	95403	0102	00	06000	38.51267049	-122.7993208	Sonoma County
336372	Ordering, Referring, Prescribing	N/A	1518963321	0	0	LEE, JAY K MD	2/7/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A85767	N/A	N/A	N/A	N/A	N/A	22675 ALESSANDRO BLVD	None	MORENO VALLEY	CA	92553	8551	00	06000	33.91695337	-117.2672536	Riverside County
336386	Ordering, Referring, Prescribing	N/A	1528049251	0	0	LERNER, STUART A MD	1/29/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C32444	N/A	N/A	N/A	N/A	N/A	3721 OCEANHILL WAY	OCEANHILL WAY	MALIBU	CA	90265	5639	00	06000	34.04524254	-118.5722369	Los Angeles County
336387	Ordering, Referring, Prescribing	N/A	1528061298	0	0	LABERTEAUXMEDINA, JULIE M	9/18/2017	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	445428	N/A	N/A	N/A	N/A	N/A	925 G ST	None	REEDLEY	CA	93654	2626	00	06000	36.59806483	-119.4526979	Fresno County
336405	Ordering, Referring, Prescribing	N/A	1528117413	0	0	LEE, KERRI D OD	10/15/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	7786	N/A	N/A	N/A	N/A	N/A	8447 LAUREL CANYON BLVD	None	SUN VALLEY	CA	91352	3817	00	06000	34.223589	-118.3987755	Los Angeles County
336431	Ordering, Referring, Prescribing	N/A	1528188042	0	0	LAWVER, LEE C LMFT	9/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40090	N/A	N/A	N/A	N/A	N/A	130 N BRAND BLVD	202	GLENDALE	CA	91203	2644	00	06000	34.147521	-118.2549325	Los Angeles County
336443	Ordering, Referring, Prescribing	N/A	1528217478	0	0	LAUWERS, SUSAN M LMFT	1/9/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT78875	N/A	N/A	N/A	N/A	N/A	2928 SAN MARCOS AVE	None	LOS OLIVOS	CA	93441	4563	00	06000	34.665921	-120.1137515	Santa Barbara County
336448	Ordering, Referring, Prescribing	N/A	1528231891	0	0	LEDERMAN, EDITH MD	5/17/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C53935	N/A	N/A	N/A	N/A	N/A	1820 J ST	None	SACRAMENTO	CA	95811	3010	00	06000	38.57688	-121.4816625	Sacramento County
336456	Ordering, Referring, Prescribing	N/A	1528243359	0	0	LE, TUAN D MD	7/18/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A60032	N/A	N/A	N/A	N/A	N/A	1151 E HOLT AVE	STE Q	POMONA	CA	91767	5828	00	06000	34.06300002	-117.7272202	Los Angeles County
336469	Ordering, Referring, Prescribing	N/A	1528267838	0	0	LIDNER, UNI K	3/21/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D65243	N/A	N/A	N/A	N/A	N/A	13203 N 103RD AVE	H-1	SUN CITY	AZ	85351	3028	00	06000	33.604128	-112.2798915	Maricopa County
336472	Ordering, Referring, Prescribing	N/A	1528288990	0	0	LIM, JENNIFER S MD	1/14/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A63309	N/A	N/A	N/A	N/A	N/A	8363 RESEDA BLVD	11	NORTHRIDGE	CA	91324	4623	00	06000	34.22255941	-118.5361155	Los Angeles County
336478	Ordering, Referring, Prescribing	N/A	1528297645	0	0	LEE, CLARA MD	2/10/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A119777	N/A	N/A	N/A	N/A	N/A	2275 ARLINGTON DRIVE	None	SAN LEANDRO	CA	94578	1132	00	06000	37.70851907	-122.1117036	Alameda County
336483	Ordering, Referring, Prescribing	N/A	1528297900	0	0	LOFGRAN, ADAM J OD	4/10/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT34134TLG	N/A	N/A	N/A	N/A	N/A	2912 BOULDER AVENUE	None	HIGHLAND	CA	92346	6900	00	06000	34.11872283	-117.1941829	San Bernardino County
336503	Ordering, Referring, Prescribing	N/A	1528340320	0	0	LESCALE HUANTE, SHADAI LCSW	3/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW86507	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
336506	Ordering, Referring, Prescribing	N/A	1528341427	0	0	LOCKWOOD, JULIE A LMFT	4/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112044	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
336510	Ordering, Referring, Prescribing	N/A	1528345535	0	0	LAU, CLARENCE I PHARMD	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	42343	N/A	N/A	N/A	N/A	N/A	1524 POLK STREET	None	SAN FRANCISCO	CA	94109	3607	00	06000	37.79099372	-122.4207382	San Francisco County
336527	Ordering, Referring, Prescribing	N/A	1528364585	0	0	LOPEZ, ELIZABETH	11/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT48572	N/A	N/A	N/A	N/A	N/A	672 S LA FAYETTE PARK PL	None	LOS ANGELES	CA	90057	3251	00	06000	34.06045149	-118.2837744	Los Angeles County
336528	Ordering, Referring, Prescribing	N/A	1528369154	0	0	LESPINASSE, STRACHELLA NP	10/17/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019641	N/A	N/A	N/A	N/A	N/A	3801 UNIVERSITY AVE	SUITE 270	RIVERSIDE	CA	92501	3247	00	06000	33.98269641	-117.3761232	Riverside County
336531	Ordering, Referring, Prescribing	N/A	1528375953	0	0	LEE, LENETTE NP	1/8/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007068	N/A	N/A	N/A	N/A	N/A	14677 MERRILL AVE	None	FONTANA	CA	92335	4219	00	06000	34.09195549	-117.484956	San Bernardino County
336534	Ordering, Referring, Prescribing	N/A	1528378254	0	0	LAMPKIN, TRISHKA L LMFT	12/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129849	N/A	N/A	N/A	N/A	N/A	2425 BISSO LN	200	CONCORD	CA	94520	4897	00	06000	37.98393807	-122.0466953	Contra Costa County
336547	Ordering, Referring, Prescribing	N/A	1528400843	0	0	LAM, PAULINE K PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69027	N/A	N/A	N/A	N/A	N/A	4900 RIVERGRADE ROAD	None	IRWINDALE	CA	91706	1458	00	06000	34.10201565	-117.9802967	Los Angeles County
336560	Ordering, Referring, Prescribing	N/A	1528427994	0	0	LANE, NATHANIEL G	9/21/2017	Taxonomy not applicable	NA	n/a	000	Unknown	53182	N/A	N/A	N/A	N/A	N/A	767 W 19TH ST	SUITE 101	COSTA MESA	CA	92627	9262	00	06000	33.64335649	-117.930528	Orange County
336576	Ordering, Referring, Prescribing	N/A	1528445970	0	0	LEE, MICHELLE S PHARMD	4/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	68393	N/A	N/A	N/A	N/A	N/A	20414 VIA MEDICI	None	PORTER RANCH	CA	91326	4067	00	06000	34.29511532	-118.5794629	Los Angeles County
336620	Ordering, Referring, Prescribing	N/A	1528520988	0	0	LIM, YEUN MD	3/23/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177221	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DRIVE	None	SYLMAR	CA	91342	1434	00	06000	34.32450186	-118.4456317	Los Angeles County
336628	Ordering, Referring, Prescribing	N/A	1528536760	0	0	LA CROIX, DIANDRA E LCSW	5/19/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101217	N/A	N/A	N/A	N/A	N/A	39159 PASEO PADRE PKWY	None	FREMONT	CA	94538	1608	00	06000	37.5531875	-121.9805141	Alameda County
336640	Ordering, Referring, Prescribing	N/A	1528555158	0	0	LEE, EDWARD H MD	4/1/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165082	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
336659	Ordering, Referring, Prescribing	N/A	1528590064	0	0	LEE, PRISCILA DDS	2/4/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	102786	N/A	N/A	N/A	N/A	N/A	4815 WATT AVE	None	NORTH HIGHLANDS	CA	95660	5108	00	06000	38.653245	-121.3836075	Sacramento County
336675	Ordering, Referring, Prescribing	N/A	1528607041	0	0	LEE, YOOMIN	7/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77060	N/A	N/A	N/A	N/A	N/A	475 W MAIN ST	None	BRAWLEY	CA	92227	2244	00	06000	32.97865516	-115.5503473	Imperial County
336698	Ordering, Referring, Prescribing	N/A	1528648284	0	0	LOPEZ, DIANA H NP	8/16/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95022261	N/A	N/A	N/A	N/A	N/A	6368 HOLLYWOOD BLVD	None	HOLLYWOOD	CA	90028	2701	00	06000	34.1015865	-118.328976	Los Angeles County
336708	Ordering, Referring, Prescribing	N/A	1528664745	0	0	LOCKETZ, MELISSA RN	11/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	638433	N/A	N/A	N/A	N/A	N/A	2615 SIERRA MEADOWS DR	None	ROCKLIN	CA	95677	2126	00	06000	38.79183891	-121.2225706	Placer County
336741	Ordering, Referring, Prescribing	N/A	1528776754	0	0	LUGTU, JAMES ALEXANDER D PHARMD	11/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	87284	N/A	N/A	N/A	N/A	N/A	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
336744	Ordering, Referring, Prescribing	N/A	1528784527	0	0	LIU, HAO LAC	9/7/2022	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	19557	N/A	N/A	N/A	N/A	N/A	728 PACIFIC AVE	None	SAN FRANCISCO	CA	94133	4457	00	06000	37.79687859	-122.4074282	San Francisco County
336762	Ordering, Referring, Prescribing	N/A	1538129838	0	0	LANE, JOHN P LCSW	6/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	19088	N/A	N/A	N/A	N/A	N/A	11060 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	00	06000	33.90401361	-117.4750239	Riverside County
336808	Ordering, Referring, Prescribing	N/A	1538248315	0	0	LEVINA, LARISSA MD	10/29/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A64826	N/A	N/A	N/A	N/A	N/A	947 COLE AVE	None	LOS ANGELES	CA	90038	2610	00	06000	34.088499	-118.3299065	Los Angeles County
336811	Ordering, Referring, Prescribing	N/A	1538258686	0	0	LIM, JULIE L PHARMD	3/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH57773	N/A	N/A	N/A	N/A	N/A	1200 EL CAMINO REAL	None	SOUTH SAN FRANCIS	CA	94080	3208	00	06000	37.65894608	-122.440161	San Mateo County
336849	Ordering, Referring, Prescribing	N/A	1538330261	0	0	LANDA, MATTY LCSW	6/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW63306	N/A	N/A	N/A	N/A	N/A	12719 GIFFORD WAY	None	VICTORVILLE	CA	92392	7430	00	06000	34.481556	-117.382452	San Bernardino County
336862	Ordering, Referring, Prescribing	N/A	1538346879	0	0	LOMBARDO-BENJAMIN, HETHER LMFT	2/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41782	N/A	N/A	N/A	N/A	N/A	1231 E DYER RD	135	SANTA ANA	CA	92705	5606	00	06000	33.710643	-117.856773	Orange County
336874	Ordering, Referring, Prescribing	N/A	1538385356	0	0	LI, VIOLET	3/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54102	N/A	N/A	N/A	N/A	N/A	1160 BROADWAY	None	BELMONT	CA	94002	3749	00	06000	37.51546723	-122.2750458	San Mateo County
336875	Ordering, Referring, Prescribing	N/A	1538378179	0	0	LUZAR, JEFFERY R	2/16/2010	Taxonomy not applicable	NA	n/a	099	DENTIST	D44930	N/A	N/A	N/A	N/A	N/A	15301 S SAN JOSE AVE	None	COMPTON	CA	90221	3131	00	06000	33.8941921	-118.1817657	Los Angeles County
336877	Ordering, Referring, Prescribing	N/A	1538387741	0	0	LANGLEY, CYNTHIA	3/6/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	9211	N/A	N/A	N/A	N/A	N/A	22675 ALESSANDRO BLVD	None	MORENO VALLEY	CA	92553	8506	00	06000	33.91695337	-117.2672536	Riverside County
336881	Ordering, Referring, Prescribing	N/A	1538399746	0	0	LOTT, YESENIA M LCSW	7/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27890	N/A	N/A	N/A	N/A	N/A	1900 EMBARCADERO	None	OAKLAND	CA	94606	5231	00	06000	37.78265168	-122.2429168	Alameda County
336885	Ordering, Referring, Prescribing	N/A	1538410055	0	0	LECHUGA, TANYA S LCSW	8/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92358	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
336900	Ordering, Referring, Prescribing	N/A	1538437967	0	0	LE, MAITHAO D PHARMD	9/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55490	N/A	N/A	N/A	N/A	N/A	30251 MURRIETA RD	None	MENIFEE	CA	92584	8385	00	06000	33.684399	-117.2060495	Riverside County
336905	Ordering, Referring, Prescribing	N/A	1538443627	0	0	LE, KATIE K PHARMD	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52674	N/A	N/A	N/A	N/A	N/A	1795 E CAPITOL EXPY	None	SAN JOSE	CA	95121	1561	00	06000	37.30985957	-121.8089013	Santa Clara County
336906	Ordering, Referring, Prescribing	N/A	1538442850	0	0	LE, KAILYN N LCSW	3/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81113	N/A	N/A	N/A	N/A	N/A	2940 INLAND EMPIRE BLVD	None	ONTARIO	CA	91764	4898	00	06000	34.069788	-117.5884605	San Bernardino County
336908	Ordering, Referring, Prescribing	N/A	1538442785	0	0	LESIW, ROBERT PHARMD	7/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH56947	N/A	N/A	N/A	N/A	N/A	3999 FOOTHILLS BLVD	None	ROSEVILLE	CA	95747	7256	00	06000	38.75127171	-121.3093622	Placer County
336927	Ordering, Referring, Prescribing	N/A	1538477682	0	0	LEE, BORAM PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64259	N/A	N/A	N/A	N/A	N/A	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	00	06000	33.904782	-117.469323	Riverside County
336955	Ordering, Referring, Prescribing	N/A	1538523501	0	0	LOZANO, SHEREE A LMFT	5/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125870	N/A	N/A	N/A	N/A	N/A	2495 W MARCH LN	SUITE 125	STOCKTON	CA	95207	8251	00	06000	37.98503238	-121.3384819	San Joaquin County
336974	Ordering, Referring, Prescribing	N/A	1538545439	0	0	LEVY, RACHEL N LCSW	3/16/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW87034	N/A	N/A	N/A	N/A	N/A	4401 CRENSHAW BLVD	300	LOS ANGELES	CA	90043	1227	00	06000	34.00339495	-118.3318951	Los Angeles County
336985	Ordering, Referring, Prescribing	N/A	1538544796	0	0	LOMBARD, HALEY	8/17/2019	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	23546	N/A	N/A	N/A	N/A	N/A	1133 W SYCAMORE ST	None	WILLOWS	CA	95988	2601	00	06000	39.5205105	-122.2082775	Glenn County
337035	Ordering, Referring, Prescribing	N/A	1538622154	0	0	LORING, JOSEPH MD	3/26/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A195028	N/A	N/A	N/A	N/A	N/A	1680 PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3133	00	06000	40.42141164	-120.6468171	Lassen County
337047	Ordering, Referring, Prescribing	N/A	1538659206	0	0	LIM, ASHLEY S DDS	2/6/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	102430	N/A	N/A	N/A	N/A	N/A	307 PLACENTIA AVE	None	NEWPORT BEACH	CA	92663	3310	00	06000	33.62631386	-117.9310576	Orange County
337056	Ordering, Referring, Prescribing	N/A	1538682067	0	0	LI, YIFENG PHARMD	3/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75300	N/A	N/A	N/A	N/A	N/A	975 SERENO DR	ONCOLOGY PHARMACY	VALLEJO	CA	94589	2441	00	06000	38.12828446	-122.24821	Solano County
337068	Ordering, Referring, Prescribing	N/A	1538699004	0	0	LARSON, JULIE A LMFT	1/30/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124189	N/A	N/A	N/A	N/A	N/A	51 MARINA BLVD	SUITE D	PITTSBURG	CA	94565	2068	00	06000	38.0354387	-121.8837345	Contra Costa County
337072	Ordering, Referring, Prescribing	N/A	1538704002	0	0	LYONS, KEITH E LCSW	2/1/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW92724	N/A	N/A	N/A	N/A	N/A	5472 EL CAJON BLVD #100	None	SAN DIEGO	CA	92115	3622	00	06000	32.75822774	-117.0768721	San Diego County
337084	Ordering, Referring, Prescribing	N/A	1538717327	0	0	LA, ANH S DDS	2/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	107291	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DRIVE	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
337104	Ordering, Referring, Prescribing	N/A	1538787056	0	0	LE, NGUYEN T	8/24/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018185	N/A	N/A	N/A	N/A	N/A	903 E DEVONSHIRE AVE	STE D	HEMET	CA	92543	3000	00	06000	33.75116958	-116.9627485	Riverside County
337112	Ordering, Referring, Prescribing	N/A	1538821475	0	0	LITTLE, TERYN A LCSW	3/17/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	13101	N/A	N/A	N/A	N/A	N/A	51 ZACA LANE SUITE 150	None	SAN LUIS OBISPO	CA	93422	7319	00	06000	35.25138712	-120.6736091	San Luis Obispo County
337123	Ordering, Referring, Prescribing	N/A	1538858725	0	0	LAM, CLAUDIA PA-C	2/19/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA63341	N/A	N/A	N/A	N/A	N/A	3811 EL CAJON BLVD.	None	SAN DIEGO	CA	92105	3417	00	06000	32.75512069	-117.1114152	San Diego County
337141	Ordering, Referring, Prescribing	N/A	1538921770	0	0	LUNDT, HEATHER NP	1/23/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028807	N/A	N/A	N/A	N/A	N/A	1295 BROADWAY	201	CHULA VISTA	CA	91911	2982	00	06000	32.60364599	-117.0786521	San Diego County
337174	Ordering, Referring, Prescribing	N/A	1548210099	0	0	LUSHER, TESS M MD	10/10/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A43954	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
337176	Ordering, Referring, Prescribing	N/A	1548209711	0	0	LAUGHLIN, ROBERT L MD FCCP	9/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A36927	N/A	N/A	N/A	N/A	N/A	3838 SAN DIMAS ST	BLDG A SUITE 250	BAKERSFIELD	CA	93301	2284	00	06000	35.3946385	-119.008203	Kern County
337200	Ordering, Referring, Prescribing	N/A	1548303217	0	0	LY, HOA T LCSW	4/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22946	N/A	N/A	N/A	N/A	N/A	1075 E SANTA CLARA ST	None	SAN JOSE	CA	95116	2244	00	06000	37.34630891	-121.869327	Santa Clara County
337201	Ordering, Referring, Prescribing	N/A	1548311780	0	0	LORD, JANA PSYD	11/10/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY19815	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD	None	PACOIMA	CA	91331	1391	00	06000	34.27894489	-118.4044363	Los Angeles County
337206	Ordering, Referring, Prescribing	N/A	1548333693	0	0	LUK, KIMBERLY G PHARMD	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	47581	N/A	N/A	N/A	N/A	N/A	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	00	06000	37.99430233	-122.1107194	Contra Costa County
337228	Ordering, Referring, Prescribing	N/A	1548360084	0	0	LOPEZ-BERMEJO, MELISSA Z MD	7/16/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A54168	N/A	N/A	N/A	N/A	N/A	243 GREEN VALLEY RD	SUITE D	FREEDOM	CA	95019	3133	00	06000	36.93890175	-121.7705457	Santa Cruz County
337257	Ordering, Referring, Prescribing	N/A	1548445539	0	0	LOPEZ, JOEL LMFT	11/23/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT107518	N/A	N/A	N/A	N/A	N/A	10155 COLIMA ROAD	None	WHITTIER	CA	90603	2042	00	06000	33.94349601	-118.0106968	Los Angeles County
337261	Ordering, Referring, Prescribing	N/A	1548456817	0	0	LOBATO, NICOLE E PHD	6/30/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27048	N/A	N/A	N/A	N/A	N/A	2008 N GAREY AVE	None	POMONA	CA	91767	2722	00	06000	34.08295003	-117.7528173	Los Angeles County
337278	Ordering, Referring, Prescribing	N/A	1548507007	0	0	LEUNG, MICHAEL C	3/16/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D61993	N/A	N/A	N/A	N/A	N/A	1111 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3131	00	06000	35.64171	-117.669847	Kern County
337311	Ordering, Referring, Prescribing	N/A	1548563174	0	0	LESI, ADEBANKE L MD	4/23/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A115093	N/A	N/A	N/A	N/A	N/A	455 EAST COLUMBIA STREET	SUITE 201	LONG BEACH	CA	90806	1620	00	06000	33.80900524	-118.1874314	Los Angeles County
337340	Ordering, Referring, Prescribing	N/A	1548624109	0	0	LEE, DAVID LCSW	4/18/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW114865	N/A	N/A	N/A	N/A	N/A	11721TELEGRAPH RD.	A	SANTA FE SPRINGS	CA	90670	3674	00	06000	33.94629336	-118.0832752	Los Angeles County
337346	Ordering, Referring, Prescribing	N/A	1548629926	0	0	LOPEZ, REYLENA M LCSW	9/23/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	104261	N/A	N/A	N/A	N/A	N/A	2130 E 4TH ST	None	SANTA ANA	CA	92705	3818	00	06000	33.74808392	-117.836143	Orange County
337352	Ordering, Referring, Prescribing	N/A	1548640899	0	0	LUONG, JENNIFER DO	5/29/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14981	N/A	N/A	N/A	N/A	N/A	1450 E HOLT AVENUE	None	POMONA	CA	91767	5822	00	06000	34.06299829	-117.7215562	Los Angeles County
337382	Ordering, Referring, Prescribing	N/A	1548691736	0	0	LATHAM, HEATHER W CNP	7/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017941	N/A	N/A	N/A	N/A	N/A	250 S G ST	None	SAN BERNARDINO	CA	92408	0000	00	06000	34.09693522	-117.2986838	San Bernardino County
337434	Ordering, Referring, Prescribing	N/A	1548781149	0	0	LIN, MINDA MD	11/11/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170792	N/A	N/A	N/A	N/A	N/A	302 CHERRY LANE	208	MANTECA	CA	95337	4311	00	06000	37.8013889	-121.2310042	San Joaquin County
337468	Ordering, Referring, Prescribing	N/A	1548863665	0	0	LIN, MICHELLE	12/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83767	N/A	N/A	N/A	N/A	N/A	1100 EL CAMINO REAL	None	BELMONT	CA	94002	3904	00	06000	37.51941385	-122.2748458	San Mateo County
337476	Ordering, Referring, Prescribing	N/A	1548881154	0	0	LUCIO, AMY J LMFT	3/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT110580	N/A	N/A	N/A	N/A	N/A	1200 N MAIN ST	None	SANTA ANA	CA	92701	3640	00	06000	33.755175	-117.8676195	Orange County
337494	Ordering, Referring, Prescribing	N/A	1548938509	0	0	LOGAN, MORGAN A PA-C	12/1/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63783	N/A	N/A	N/A	N/A	N/A	300 HARTLE CT	None	NAPA	CA	94559	4078	00	06000	38.28326249	-122.2801759	Napa County
337496	Ordering, Referring, Prescribing	N/A	1548950306	0	0	LI, JOHNSON DMD	12/30/2024	Taxonomy not applicable	NA	n/a	000	Unknown	111140	N/A	N/A	N/A	N/A	N/A	2035 CAMFIELD AVENUE	None	COMMERCE	CA	90040	1501	00	06000	34.00869305	-118.1558956	Los Angeles County
337503	Ordering, Referring, Prescribing	N/A	1548984891	0	0	LEE, LINDA PHARMD	7/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	48424	N/A	N/A	N/A	N/A	N/A	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
337507	Ordering, Referring, Prescribing	N/A	1558005488	0	0	LO, ANDY WING HONG NP	4/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020760	N/A	N/A	N/A	N/A	N/A	451 W LINCOLN AVE	None	ANAHEIM	CA	92805	2927	00	06000	33.83445082	-117.9189372	Orange County
337511	Ordering, Referring, Prescribing	N/A	1558009332	0	0	LIMON, CYNTHIA PA-C	4/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61010	N/A	N/A	N/A	N/A	N/A	1414 S. GRAND AVE	380	LOS ANGELES	CA	90015	3072	00	06000	34.03661142	-118.2657227	Los Angeles County
337528	Ordering, Referring, Prescribing	N/A	1558070821	0	0	LEE, KIANA PA-C	12/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	62142	N/A	N/A	N/A	N/A	N/A	211 EASTMOOR AVE	None	DALY CITY	CA	94015	2036	00	06000	37.6847337	-122.4787562	San Mateo County
337558	Ordering, Referring, Prescribing	N/A	1558366674	0	0	LOUDERMILK, ALLISON MD	1/22/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A65038	N/A	N/A	N/A	N/A	N/A	444 BRUCE STREET	None	YREKA	CA	96097	3450	00	06000	41.71863548	-122.6458755	Siskiyou County
337559	Ordering, Referring, Prescribing	N/A	1558336974	0	0	LEININGER, WILLIAM M MD	8/8/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G75238	N/A	N/A	N/A	N/A	N/A	1463 SOUTH 4TH STREET	None	EL CENTRO	CA	92243	4556	00	06000	32.78037178	-115.5523224	Imperial County
337659	Ordering, Referring, Prescribing	N/A	1558627901	0	0	LEE, JENNIE E MD	10/31/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A128520	N/A	N/A	N/A	N/A	N/A	280 MACARTHUR BLVD	11TH FLOOR	OAKLAND	CA	94611	5642	00	06000	37.8242017	-122.2578306	Alameda County
337661	Ordering, Referring, Prescribing	N/A	1558632398	0	0	LEE, AMY	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53045	N/A	N/A	N/A	N/A	N/A	2000 W. WHITTIER BLVD	None	LA HABRA	CA	90631	3535	00	06000	33.93977553	-117.968895	Orange County
337663	Ordering, Referring, Prescribing	N/A	1558625749	0	0	LAW, JOHN E DMD	11/7/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62895	N/A	N/A	N/A	N/A	N/A	121 S. MOUNTAIN VIEW AVE	None	LOS ANGELES	CA	90057	2311	00	06000	34.06585428	-118.2701533	Los Angeles County
337666	Ordering, Referring, Prescribing	N/A	1558634287	0	0	LAM, WENDY	12/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54570	N/A	N/A	N/A	N/A	N/A	12155 TECH CENTER DR	None	POWAY	CA	92064	7156	00	06000	32.937048	-117.032895	San Diego County
337667	Ordering, Referring, Prescribing	N/A	1558636027	0	0	LING, SHEN-SHIN PHARMD	3/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH47386	N/A	N/A	N/A	N/A	N/A	17550 CASTLETON ST	None	CITY OF INDUSTRY	CA	91748	1701	00	06000	33.99479087	-117.9209253	Los Angeles County
337736	Ordering, Referring, Prescribing	N/A	1558773960	0	0	LITTLE, KELLI PSYD	6/14/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32605	N/A	N/A	N/A	N/A	N/A	3626 BALBOA ST.	None	SAN FRANCISCO	CA	94121	2604	00	06000	37.77571711	-122.4980286	San Francisco County
337769	Ordering, Referring, Prescribing	N/A	1558813642	0	0	LARUMBE-SMITH, STEPHANIE K CNM	11/19/2021	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	236229	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
337778	Ordering, Referring, Prescribing	N/A	1558835991	0	0	LEVINSON, MICHELLE A NP	12/18/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010707	N/A	N/A	N/A	N/A	N/A	1032 A STREET	None	HAYWARD	CA	94541	0000	00	06000	37.67439519	-122.0831733	Alameda County
337782	Ordering, Referring, Prescribing	N/A	1558841924	0	0	LOPEZ, JAZMIN A LCSW	5/8/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	115178	N/A	N/A	N/A	N/A	N/A	180 UNION PL	None	LOS ANGELES	CA	90026	5715	00	06000	34.06186536	-118.2653898	Los Angeles County
337784	Ordering, Referring, Prescribing	N/A	1558825752	0	0	LEEDER, JACQUELYN D LCSW	11/12/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW127214	N/A	N/A	N/A	N/A	N/A	11731 TELEGRAPH ROAD	K	SANTA FE SPRINGS	CA	90670	3675	00	06000	33.94630253	-118.0832082	Los Angeles County
337785	Ordering, Referring, Prescribing	N/A	1558846055	0	0	LE, ANH T PHARMD	11/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79474	N/A	N/A	N/A	N/A	N/A	7499 DUBLIN BLVD	None	DUBLIN	CA	94568	2415	00	06000	37.70527771	-121.9263117	Alameda County
337800	Ordering, Referring, Prescribing	N/A	1558868281	0	0	LARSON, LINDSAY N NP	3/22/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95008805	N/A	N/A	N/A	N/A	N/A	14623 HAWTHORNE BLVD	STE 300	LAWNDALE	CA	90260	1581	00	06000	33.898572	-118.3527775	Los Angeles County
337805	Ordering, Referring, Prescribing	N/A	1558874222	0	0	LOGAN, LAURA	10/27/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW118850	N/A	N/A	N/A	N/A	N/A	11434 B AVE	None	AUBURN	CA	95603	2603	00	06000	38.9389028	-121.1059183	Placer County
337810	Ordering, Referring, Prescribing	N/A	1558880963	0	0	LY, CHRISTINE N PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76807	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	None	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
337812	Ordering, Referring, Prescribing	N/A	1558880112	0	0	LIEU, MEI S PHARMD	7/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77066	N/A	N/A	N/A	N/A	N/A	918 E FOOTHILL BLVD	None	RIALTO	CA	92376	5366	00	06000	34.10679947	-117.352134	San Bernardino County
337837	Ordering, Referring, Prescribing	N/A	1558934232	0	0	LASALLE, CORINNE LMFT	2/8/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	144889	N/A	N/A	N/A	N/A	N/A	2008 N. GAREY	None	POMONA	CA	91767	9998	00	06000	34.08295003	-117.7528173	Los Angeles County
337838	Ordering, Referring, Prescribing	N/A	1558943555	0	0	LEE, VIVIAN PA-C	9/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63266	N/A	N/A	N/A	N/A	N/A	4320 GENESEE AVE	None	SAN DIEGO	CA	92117	4900	00	06000	32.82169422	-117.1832742	San Diego County
337864	Ordering, Referring, Prescribing	N/A	1568004257	0	0	LE, VALERIE	4/17/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014423	N/A	N/A	N/A	N/A	N/A	1569 LEXANN AVE.,	114	SAN JOSE	CA	95121	1794	00	06000	37.30790568	-121.8141983	Santa Clara County
337892	Ordering, Referring, Prescribing	N/A	1568066181	0	0	LIN, TZUTING LMFT	12/27/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	143981	N/A	N/A	N/A	N/A	N/A	8745 AERO DR	STE 330	SAN DIEGO	CA	92123	1761	00	06000	32.80965551	-117.1391563	San Diego County
337895	Ordering, Referring, Prescribing	N/A	1568069664	0	0	LIANG, JIAN QING PHARMD	8/11/2020	Taxonomy not applicable	NA	n/a	000	Unknown	82871	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
337897	Ordering, Referring, Prescribing	N/A	1568069193	0	0	LYNN, PENELOPE J LCSW	5/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91755	N/A	N/A	N/A	N/A	N/A	1815 BODIE ST	None	SANTA ROSA	CA	95403	2497	00	06000	38.466486	-122.754933	Sonoma County
337900	Ordering, Referring, Prescribing	N/A	1568072247	0	0	LIENG, KIEU	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH40296	N/A	N/A	N/A	N/A	N/A	103 N GARFIELD AVE	D	ALHAMBRA	CA	91801	3576	00	06000	34.0961716	-118.1275921	Los Angeles County
337905	Ordering, Referring, Prescribing	N/A	1568085918	0	0	LONGA, ANGELICA LCSW	3/29/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW90521	N/A	N/A	N/A	N/A	N/A	871 ENBORG CT.	100	SAN JOSE	CA	95128	2645	00	06000	37.311489	-121.933817	Santa Clara County
337910	Ordering, Referring, Prescribing	N/A	1568098556	0	0	LERMAN-SINKOFF, DOV B MD	1/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179243	N/A	N/A	N/A	N/A	N/A	500 COHASSET RD	None	CHICO	CA	95926	2260	00	06000	39.75142109	-121.8506286	Butte County
337918	Ordering, Referring, Prescribing	N/A	1568132264	0	0	LIMBACH, COLIN PA	2/14/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64089	N/A	N/A	N/A	N/A	N/A	1907 BORDER AVE	None	TORRANCE	CA	90501	3606	00	06000	33.828615	-118.3130985	Los Angeles County
337936	Ordering, Referring, Prescribing	N/A	1568176782	0	0	LIN, ANGIE CNP	9/29/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022838	N/A	N/A	N/A	N/A	N/A	709 N HILL ST	SUITE 18	LOS ANGELES	CA	90012	2361	00	06000	34.06103994	-118.2404034	Los Angeles County
337940	Ordering, Referring, Prescribing	N/A	1568195212	0	0	LAURENT, CONNIE	10/7/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022537	N/A	N/A	N/A	N/A	N/A	5050 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	00	06000	34.0776775	-117.694521	San Bernardino County
337954	Ordering, Referring, Prescribing	N/A	1568415701	0	0	LIEPMANN, PETER J MD	5/11/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G89383	N/A	N/A	N/A	N/A	N/A	2319 E WASHINGTON BLVD	SUITE #2	PASADENA	CA	91104	1945	00	06000	34.16915453	-118.1026395	Los Angeles County
337956	Ordering, Referring, Prescribing	N/A	1568403954	0	0	LOCKE, MOIRA S MD	11/15/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A101543	N/A	N/A	N/A	N/A	N/A	109 NW 2ND ST	None	VISALIA	CA	93291	3672	00	06000	36.336933	-119.292993	Tulare County
337957	Ordering, Referring, Prescribing	N/A	1568432326	0	0	LOPEZ, BEN LCSW	10/6/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW6151	N/A	N/A	N/A	N/A	N/A	995 HELLING WAY	None	NEVADA CITY	CA	95959	8619	00	06000	39.27021381	-121.0243425	Nevada County
338005	Ordering, Referring, Prescribing	N/A	1568568111	0	0	LOPEZ, YOLANDA D LMFT	2/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT91938	N/A	N/A	N/A	N/A	N/A	850 EAST WARDLOW ROAD	None	LONG BEACH	CA	90807	4628	00	06000	33.81888054	-118.182069	Los Angeles County
338008	Ordering, Referring, Prescribing	N/A	1568580777	0	0	LABISTOUR, ASHLEY C LMFT	2/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	37767	N/A	N/A	N/A	N/A	N/A	123 W. GUTIERREZ STREET	None	SANTA BARBARA	CA	93101	3424	00	06000	34.41387023	-119.6962788	Santa Barbara County
338018	Ordering, Referring, Prescribing	N/A	1568589133	0	0	LEE, EDWARD T MD	1/13/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A68112	N/A	N/A	N/A	N/A	N/A	729 FILBERT ST	None	SAN FRANCISCO	CA	94133	2760	00	06000	37.80103613	-122.4119083	San Francisco County
338024	Ordering, Referring, Prescribing	N/A	1568601235	0	0	LLOYD, CHRISTINA A LMFT	2/11/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT92407	N/A	N/A	N/A	N/A	N/A	176 HOLSTON	None	LANCASTER	CA	93535	4531	00	06000	34.6649465	-118.1286477	Los Angeles County
338025	Ordering, Referring, Prescribing	N/A	1568607885	0	0	LORCA, JERIEL A	5/6/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A109637	N/A	N/A	N/A	N/A	N/A	5400 E. OLYMPIC BLVD	None	COMMERCE	CA	90022	5147	00	06000	34.01564534	-118.1555473	Los Angeles County
338038	Ordering, Referring, Prescribing	N/A	1568626455	0	0	LIMCOLIOC, LINDA L PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60298	N/A	N/A	N/A	N/A	N/A	10990 SAN DIEGO MISSION	None	SAN DIEGO	CA	92108	2417	00	06000	32.7850186	-117.1023292	San Diego County
338042	Ordering, Referring, Prescribing	N/A	1568657096	0	0	LUCANA, SONIA LCSW	4/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27764	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	SUITE 200	SAN MATEO	CA	94403	1293	00	06000	37.54524373	-122.3205511	San Mateo County
338044	Ordering, Referring, Prescribing	N/A	1568657971	0	0	LOGAN, LAUREN N	5/13/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	26344	N/A	N/A	N/A	N/A	N/A	1625 N SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
338056	Ordering, Referring, Prescribing	N/A	1568689743	0	0	LUU, PHUONG B	11/30/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D41024	N/A	N/A	N/A	N/A	N/A	3351 EL CAMINO REAL	STE 100	ATHERTON	CA	94027	3802	00	06000	37.4659667	-122.2071835	San Mateo County
338092	Ordering, Referring, Prescribing	N/A	1568745719	0	0	LE, TANYA V PHARMD	2/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	58256	N/A	N/A	N/A	N/A	N/A	1100 RILEY ST	None	FOLSOM	CA	95630	3511	00	06000	38.670174	-121.1647815	Sacramento County
338127	Ordering, Referring, Prescribing	N/A	1568798718	0	0	LAKHANI, SHARMEEN LMFT	5/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101172	N/A	N/A	N/A	N/A	N/A	327 S K ST	None	TULARE	CA	93274	5416	00	06000	36.20476387	-119.3454489	Tulare County
338150	Ordering, Referring, Prescribing	N/A	1568825255	0	0	LUTZ, ALISON	5/9/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	196137	N/A	N/A	N/A	N/A	N/A	650 N FULTON ST	None	FRESNO	CA	93728	3404	00	06000	36.75213	-119.800333	Fresno County
338158	Ordering, Referring, Prescribing	N/A	1568842706	0	0	LIN, HSIN-YING NP	9/12/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	833436	N/A	N/A	N/A	N/A	N/A	437 N EUCLID AVE	None	ONTARIO	CA	91762	3456	00	06000	34.067988	-117.6521805	San Bernardino County
338185	Ordering, Referring, Prescribing	N/A	1568870152	0	0	LUNA, LESLIE J LMFT	3/28/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120139	N/A	N/A	N/A	N/A	N/A	3105 WILSON RD	None	BAKERSFIELD	CA	93304	5319	00	06000	35.33217634	-119.037921	Kern County
338190	Ordering, Referring, Prescribing	N/A	1568873487	0	0	LOORZ, SCOTT M LMFT	3/2/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138240	N/A	N/A	N/A	N/A	N/A	864 E SANTA CLARA ST.	None	VENTURA	CA	93001	2939	00	06000	34.27952351	-119.287537	Ventura County
338197	Ordering, Referring, Prescribing	N/A	1568885093	0	0	LOPEZ BARAJAS, LISA Y LCSW	2/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87974	N/A	N/A	N/A	N/A	N/A	1128 YUBA STREET	None	MARYSVILLE	CA	95901	4831	00	06000	39.14842621	-121.5841034	Yuba County
338199	Ordering, Referring, Prescribing	N/A	1568891794	0	0	LAI, JOSEPH H DDS	10/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS63069	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
338222	Ordering, Referring, Prescribing	N/A	1568911469	0	0	LE, QUYEN T PHARMD	3/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	75231	N/A	N/A	N/A	N/A	N/A	1339 N DAVIS RD	None	SALINAS	CA	93907	1988	00	06000	36.70358481	-121.6669768	Monterey County
338234	Ordering, Referring, Prescribing	N/A	1568942332	0	0	LY, NHU PHARMD	7/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH76618	N/A	N/A	N/A	N/A	N/A	3438 W BRADY	None	ANAHEIM	CA	92804	4705	00	06000	33.81224574	-118.0098596	Orange County
338249	Ordering, Referring, Prescribing	N/A	1568951077	0	0	LAI, JONATHAN PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76831	N/A	N/A	N/A	N/A	N/A	10990 SAN DIEGO MISSION	None	SAN DIEGO	CA	92108	2417	00	06000	32.7850186	-117.1023292	San Diego County
338254	Ordering, Referring, Prescribing	N/A	1568974814	0	0	LAI, GARY PHARMD	1/5/2022	Taxonomy not applicable	NA	n/a	000	Unknown	74673	N/A	N/A	N/A	N/A	N/A	500 E MANCHESTER AVE	None	LOS ANGELES	CA	90003	3525	00	06000	33.96010222	-118.2663418	Los Angeles County
338276	Ordering, Referring, Prescribing	N/A	1578011888	0	0	LE, VUONG PHARMD	4/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	69306	N/A	N/A	N/A	N/A	N/A	1130 BROADWAY	None	CHULA VISTA	CA	91911	2707	00	06000	32.60853	-117.083862	San Diego County
338316	Ordering, Referring, Prescribing	N/A	1578079794	0	0	LEDEZMA, WENDY C LMFT	10/19/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135407	N/A	N/A	N/A	N/A	N/A	222 S HARBOR BLVD	SUITE 650	ANAHEIM	CA	92805	3700	00	06000	33.83250163	-117.9188893	Orange County
338340	Ordering, Referring, Prescribing	N/A	1578104568	0	0	LLAMAS, JONATHAN NP	9/6/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012704	N/A	N/A	N/A	N/A	N/A	8920 WILSHIRE BLVD	425	BEVERLY HILLS	CA	90211	2004	00	06000	34.06703599	-118.3863456	Los Angeles County
338348	Ordering, Referring, Prescribing	N/A	1578118147	0	0	LEVY, CYNTHIA M LMFT	2/7/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT36012	N/A	N/A	N/A	N/A	N/A	1000 BUSINESS CENTER CIR	STE 209	NEWBURY PARK	CA	91320	1250	00	06000	34.19271	-118.9425915	Ventura County
338369	Ordering, Referring, Prescribing	N/A	1578172607	0	0	LEE, DAISY PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82634	N/A	N/A	N/A	N/A	N/A	695 S SANTA FE AVE	APT 237	LOS ANGELES	CA	90021	1300	00	06000	34.0354186	-118.230207	Los Angeles County
338387	Ordering, Referring, Prescribing	N/A	1578223210	0	0	LE, STEPHAN V PHARMD	1/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	85708	N/A	N/A	N/A	N/A	N/A	525 EL CAMINO REAL	None	MENLO PARK	CA	94025	5108	00	06000	37.451159	-122.1785406	San Mateo County
338398	Ordering, Referring, Prescribing	N/A	1578265385	0	0	LE, CHRISTINE T MD	7/1/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197350	N/A	N/A	N/A	N/A	N/A	505 S MAIN ST	SUITE 525	ORANGE	CA	92868	4553	00	06000	33.78004808	-117.8672472	Orange County
338466	Ordering, Referring, Prescribing	N/A	1578673331	0	0	LEWIS, DAVID G DDS	6/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	D02467	N/A	N/A	N/A	N/A	N/A	501 N INDIAN RD	None	SMITH RIVER	CA	95567	9509	00	06000	41.95702601	-124.2045614	Del Norte County
338478	Ordering, Referring, Prescribing	N/A	1578690434	0	0	LINSAO, STEPHANIE M LCSW	10/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97864	N/A	N/A	N/A	N/A	N/A	2750 SUTTERVILLE RD	None	SACRAMENTO	CA	95820	1024	00	06000	38.540124	-121.4786745	Sacramento County
338484	Ordering, Referring, Prescribing	N/A	1578696266	0	0	LYONS, LAWRENCE M LCSW	11/15/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	17046	N/A	N/A	N/A	N/A	N/A	205 PASADENA AVE	None	SOUTH PASADENA	CA	91030	2919	00	06000	34.11219143	-118.1709685	Los Angeles County
338496	Ordering, Referring, Prescribing	N/A	1578708533	0	0	LONG, MEREDITH N PA-C	1/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	21821	N/A	N/A	N/A	N/A	N/A	905 CALLE AMANECER	SUITE 115	SAN CLEMENTE	CA	92673	6226	00	06000	33.44951265	-117.6075825	Orange County
338497	Ordering, Referring, Prescribing	N/A	1578706503	0	0	LUM, ROBERT C	6/14/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D57989	N/A	N/A	N/A	N/A	N/A	55 E JULIAN ST	None	SAN JOSE	CA	95112	4007	00	06000	37.34118198	-121.8925795	Santa Clara County
338507	Ordering, Referring, Prescribing	N/A	1578731147	0	0	LADOUCEUR, TIZITA NP	12/12/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	17768	N/A	N/A	N/A	N/A	N/A	85 RAMONA EXPY	None	PERRIS	CA	92571	7014	00	06000	33.84444253	-117.22437	Riverside County
338517	Ordering, Referring, Prescribing	N/A	1578749115	0	0	LEE, PATTI P MD	12/21/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A85724	N/A	N/A	N/A	N/A	N/A	727 SHASTA STREET	None	REDWOOD CITY	CA	94063	2124	00	06000	37.47945362	-122.2230493	San Mateo County
338521	Ordering, Referring, Prescribing	N/A	1578751293	0	0	LAU, KWAN PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59891	N/A	N/A	N/A	N/A	N/A	3100 DUBLIN BLVD	ONCOLOGY PHARMACY	DUBLIN	CA	94568	0000	00	06000	37.70453535	-121.8586496	Alameda County
338541	Ordering, Referring, Prescribing	N/A	1578787958	0	0	LUXON, KAREN M LMFT	3/31/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97457	N/A	N/A	N/A	N/A	N/A	146 MYRTLE ST	None	SANTA CRUZ	CA	95060	4939	00	06000	36.96747168	-122.0298728	Santa Cruz County
338554	Ordering, Referring, Prescribing	N/A	1578806295	0	0	LIN, JAMES R MD	7/18/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A132388	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPWY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
338568	Ordering, Referring, Prescribing	N/A	1578831384	0	0	LANGSTON, JULIA A NP	8/13/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP11035	N/A	N/A	N/A	N/A	N/A	1510 CAPITOLA RD	None	SANTA CRUZ	CA	95062	2912	00	06000	36.97627773	-121.9846375	Santa Cruz County
338577	Ordering, Referring, Prescribing	N/A	1578845921	0	0	LAMOUREUX, ADAM D	4/3/2022	Taxonomy not applicable	NA	n/a	000	Unknown	56969	N/A	N/A	N/A	N/A	N/A	220 SYLVANIA AVE	None	SANTA CRUZ	CA	95060	2161	00	06000	36.98521615	-122.0347765	Santa Cruz County
338610	Ordering, Referring, Prescribing	N/A	1578896452	0	0	LEONE, JOANN LCSW	8/2/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	8409	N/A	N/A	N/A	N/A	N/A	5348 UNIVERSITY AVE	SUITE 108	SAN DIEGO	CA	92105	8025	00	06000	32.74909257	-117.0811685	San Diego County
338642	Ordering, Referring, Prescribing	N/A	1578925517	0	0	LAM, ANGELA MD	5/10/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A161054	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
338669	Ordering, Referring, Prescribing	N/A	1578964136	0	0	LA, AMANDA Q PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69480	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2192	00	06000	38.471625	-122.7259935	Sonoma County
338670	Ordering, Referring, Prescribing	N/A	1578964110	0	0	LIM, PETERSON L	7/6/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	D63828	N/A	N/A	N/A	N/A	N/A	3081 TEAGARDEN ST	None	SAN LEANDRO	CA	94577	5720	00	06000	37.70519163	-122.1536391	Alameda County
338684	Ordering, Referring, Prescribing	N/A	1578982971	0	0	LAM, JAMES T	5/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17474	N/A	N/A	N/A	N/A	N/A	600 N. GARFIELD AVE	101	MONTEREY PARK	CA	91754	1167	00	06000	34.06820797	-118.1228835	Los Angeles County
338721	Ordering, Referring, Prescribing	N/A	1588032411	0	0	LANE, FRANCESCA	4/3/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT119620	N/A	N/A	N/A	N/A	N/A	1100 PACIFIC MARINA	None	ALAMEDA	CA	94501	1124	00	06000	37.78281261	-122.2642985	Alameda County
338731	Ordering, Referring, Prescribing	N/A	1588037741	0	0	LEE, ANGEL PHARMD	11/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	76044	N/A	N/A	N/A	N/A	N/A	510 S VERMONT AVE	21ST FLOOR	LOS ANGELES	CA	90020	1912	00	06000	34.065	-118.291631	Los Angeles County
338744	Ordering, Referring, Prescribing	N/A	1588049563	0	0	LOW, DERRICK DMD	6/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	64736	N/A	N/A	N/A	N/A	N/A	201 E LAKEVIEW AVE	None	WOODLAKE	CA	93286	1301	00	06000	36.4172997	-119.0975768	Tulare County
338748	Ordering, Referring, Prescribing	N/A	1588057335	0	0	LIEBERMAN, ALLISON	10/28/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100073	N/A	N/A	N/A	N/A	N/A	107 N REINO RD	#1037	NEWBURY PARK	CA	91320	3710	00	06000	34.1795835	-118.9525301	Ventura County
338758	Ordering, Referring, Prescribing	N/A	1588063937	0	0	LY, LINDA LCSW	4/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW79740	N/A	N/A	N/A	N/A	N/A	720 SACRAMENTO ST	None	SAN FRANCISCO	CA	94108	2535	00	06000	37.79355846	-122.4050846	San Francisco County
338773	Ordering, Referring, Prescribing	N/A	1588069470	0	0	LIMPIADO, ELAINE J OD	9/30/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	33355	N/A	N/A	N/A	N/A	N/A	11717 BERNARDO PLAZA COU	None	SAN DIEGO	CA	92128	2419	00	06000	33.01929872	-117.0777714	San Diego County
338784	Ordering, Referring, Prescribing	N/A	1588101554	0	0	LOPEZ, KRISTINA D	7/30/2017	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	74837	N/A	N/A	N/A	N/A	N/A	236 CAJON ST	STE C	REDLANDS	CA	92373	5940	00	06000	34.05248082	-117.1805777	San Bernardino County
338798	Ordering, Referring, Prescribing	N/A	1588126445	0	0	LEE, DANIEL Y MD	3/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	A176923	N/A	N/A	N/A	N/A	N/A	5500 UNIVERSITY PKWY	None	SAN BERNARDINO	CA	92407	2318	00	06000	34.17917599	-117.3266088	San Bernardino County
338822	Ordering, Referring, Prescribing	N/A	1588166789	0	0	LOW, ROSEANNA LCSW	11/4/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	105235	N/A	N/A	N/A	N/A	N/A	515 COLUMBIA AVE	SUITE 100	LOS ANGELES	CA	90017	1209	00	06000	34.05683109	-118.265995	Los Angeles County
338829	Ordering, Referring, Prescribing	N/A	1588175863	0	0	LE, THANH-BINH PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77392	N/A	N/A	N/A	N/A	N/A	173 LOCHNESS COURT	None	ROSEVILLE	CA	95678	2918	00	06000	38.79250844	-121.2804128	Placer County
338831	Ordering, Referring, Prescribing	N/A	1588137152	0	0	LUNA, CAROLINA PA	2/8/2019	Taxonomy not applicable	NA	n/a	000	Unknown	56554	N/A	N/A	N/A	N/A	N/A	400 WEST 30H STREET	None	LOS ANGELES	CA	90007	3320	00	06000	34.09773725	-117.7265304	Los Angeles
338835	Ordering, Referring, Prescribing	N/A	1588176127	0	0	LEE, BEOM	8/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77731	N/A	N/A	N/A	N/A	N/A	500 GEARY ST	None	SAN FRANCISCO	CA	94102	1641	00	06000	37.78694922	-122.4117671	San Francisco County
338841	Ordering, Referring, Prescribing	N/A	1588196943	0	0	LIN, PEIYIN MD	3/18/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157507	N/A	N/A	N/A	N/A	N/A	4150 V ST	STE 1200	SACRAMENTO	CA	95817	1460	00	06000	38.556081	-121.4570475	Sacramento County
338853	Ordering, Referring, Prescribing	N/A	1588220271	0	0	LE, JENNIFER O LMFT	10/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	142284	N/A	N/A	N/A	N/A	N/A	1030 W WARNER AVE	None	SANTA ANA	CA	92707	3147	00	06000	33.71597598	-117.8819134	Orange County
338859	Ordering, Referring, Prescribing	N/A	1588223564	0	0	LAI, JEREMY PHARMD	9/14/2020	Taxonomy not applicable	NA	n/a	000	Unknown	79195	N/A	N/A	N/A	N/A	N/A	475 W MAIN ST	None	BRAWLEY	CA	92227	2244	00	06000	32.97865516	-115.5503473	Imperial County
338865	Ordering, Referring, Prescribing	N/A	1588228738	0	0	LY, JEANNET D NP	3/15/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011419	N/A	N/A	N/A	N/A	N/A	2100 E. ANAHEIM ST.	STE B	LONG BEACH	CA	90804	3149	00	06000	33.7825725	-118.1663865	Los Angeles County
338877	Ordering, Referring, Prescribing	N/A	1588289623	0	0	LOPEZ ESCOBAR, ELIZABETH PA-C	9/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60052	N/A	N/A	N/A	N/A	N/A	200 E ANAHEIM ST	None	WILMINGTON	CA	90744	4516	00	06000	33.78003976	-118.2608958	Los Angeles County
338882	Ordering, Referring, Prescribing	N/A	1588293963	0	0	LEE, JUSTIN MD	11/1/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183032	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
338888	Ordering, Referring, Prescribing	N/A	1588317390	0	0	LEE, CHRISTINA R PHARMD	8/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84668	N/A	N/A	N/A	N/A	N/A	8905 MONTMEDY CT	None	BAKERSFIELD	CA	93311	1580	00	06000	35.33417284	-119.1013983	Kern County
338893	Ordering, Referring, Prescribing	N/A	1588325864	0	0	LOFCHIE, ERIC B LMFT	4/13/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45788	N/A	N/A	N/A	N/A	N/A	211 RIDGEWAY AVE	None	SANTA ROSA	CA	95401	4320	00	06000	38.44919419	-122.7241333	Sonoma County
338900	Ordering, Referring, Prescribing	N/A	1588376925	0	0	LESLIE, ANTHONY NP	12/2/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023494	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
338906	Ordering, Referring, Prescribing	N/A	1588389894	0	0	LEFANTY, LISA K NP	10/19/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023047	N/A	N/A	N/A	N/A	N/A	4212 MISSOURI FLAT RD	None	PLACERVILLE	CA	95667	6269	00	06000	38.706228	-120.834891	El Dorado County
338934	Ordering, Referring, Prescribing	N/A	1588676795	0	0	LEDESMA, DAWN M LMFT	4/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49193	N/A	N/A	N/A	N/A	N/A	801 E. CHAPMAN AVE.	203	FULLERTON	CA	92831	3839	00	06000	33.87407517	-117.9110814	Orange County
338936	Ordering, Referring, Prescribing	N/A	1588675193	0	0	LEAR, MARTA C	1/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	29120	N/A	N/A	N/A	N/A	N/A	8337 TELEGRAPH RD.	SUITE 300	PICO RIVERA	CA	90660	4957	00	06000	33.96454327	-118.1134473	Los Angeles County
338947	Ordering, Referring, Prescribing	N/A	1588717847	0	0	LUCAS, LES C LMFT	2/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	17444	N/A	N/A	N/A	N/A	N/A	2540 W SHAW LN	107	FRESNO	CA	93711	2700	00	06000	36.80923946	-119.8386	Fresno County
338964	Ordering, Referring, Prescribing	N/A	1588742720	0	0	LOCKHART, JOSEPH J PHD	3/16/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY12686	N/A	N/A	N/A	N/A	N/A	232 E CANON PERDIDO ST	None	SANTA BARBARA	CA	93101	2242	00	06000	34.42349188	-119.6973758	Santa Barbara County
338971	Ordering, Referring, Prescribing	N/A	1588774988	0	0	LEAVITT, WILLIAM A MD FAAP	9/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G59258	N/A	N/A	N/A	N/A	N/A	1172 N MACLAY AVE	None	SAN FERNANDO	CA	91340	1328	00	06000	34.29582554	-118.4241314	Los Angeles County
339010	Ordering, Referring, Prescribing	N/A	1588845515	0	0	LOPEZ, LISA D LMFT	6/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT110769	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR	165	OXNARD	CA	93036	2612	00	06000	34.219566	-119.1539365	Ventura County
339033	Ordering, Referring, Prescribing	N/A	1588907786	0	0	LANDINI, KIRSTEN R LMFT	6/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT85517	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	None	OXNARD	CA	93036	9210	00	06000	34.219566	-119.1539365	Ventura County
339051	Ordering, Referring, Prescribing	N/A	1588932610	0	0	LAI, BRYON PHARMD	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	41956	N/A	N/A	N/A	N/A	N/A	2690 MISSION STREET	None	SAN FRANCISCO	CA	94110	3102	00	06000	37.75405301	-122.4186463	San Francisco County
339089	Ordering, Referring, Prescribing	N/A	1588973523	0	0	LEWIS, MICHELLE Y MD	12/13/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A112253	N/A	N/A	N/A	N/A	N/A	36101 BOB HOPE DRIVE., S	None	RANCHO MIRAGE	CA	92270	2003	00	06000	33.786126	-116.406086	Riverside County
339091	Ordering, Referring, Prescribing	N/A	1588982649	0	0	LAM, HOLLY H PHARMD	7/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56663	N/A	N/A	N/A	N/A	N/A	13063 EUCLID ST.	None	GARDEN GROVE	CA	92843	1333	00	06000	33.77287939	-117.9380083	Orange County
339103	Ordering, Referring, Prescribing	N/A	1588998512	0	0	LE, JENNY H OD	2/15/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	13763	N/A	N/A	N/A	N/A	N/A	18601 VALLEY BLVD	None	BLOOMINGTON	CA	92316	1831	00	06000	34.07045653	-117.3982455	San Bernardino County
339118	Ordering, Referring, Prescribing	N/A	1598022931	0	0	LEE, DERECK K PHARMD	1/12/2024	Taxonomy not applicable	NA	n/a	000	Unknown	62876	N/A	N/A	N/A	N/A	N/A	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	00	06000	37.78096053	-122.4637512	San Francisco County
339130	Ordering, Referring, Prescribing	N/A	1598029530	0	0	LEE, JESSICA	4/10/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	DDS64564	N/A	N/A	N/A	N/A	N/A	144 STONY POINT RD	None	SANTA ROSA	CA	95401	4122	00	06000	38.440494	-122.74353	Sonoma County
339132	Ordering, Referring, Prescribing	N/A	1598040693	0	0	LEE, BRAINARD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH52972	N/A	N/A	N/A	N/A	N/A	5467 WILSHIRE BLVD	None	LOS ANGELES	CA	90036	4219	00	06000	34.06233905	-118.3479771	Los Angeles County
339137	Ordering, Referring, Prescribing	N/A	1598042673	0	0	LEE, CAROL Y PHARMD	10/9/2018	Taxonomy not applicable	NA	n/a	000	Unknown	62094	N/A	N/A	N/A	N/A	N/A	70 W HEDDING ST	None	SAN JOSE	CA	95110	1705	00	06000	37.35249294	-121.9050815	Santa Clara County
339146	Ordering, Referring, Prescribing	N/A	1598048217	0	0	LE, THANH TAM N PHARMD	8/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56665	N/A	N/A	N/A	N/A	N/A	9550 HAGEMAN RD	None	BAKERSFIELD	CA	93312	3956	00	06000	35.39819227	-119.1084347	Kern County
339150	Ordering, Referring, Prescribing	N/A	1598044539	0	0	LOVATO, ELIZABETH CCC-SLP	8/28/2018	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	SP 23303	N/A	N/A	N/A	N/A	N/A	264 N WESTWOOD	None	PORTERVILLE	CA	93257	8963	00	06000	36.07088914	-119.0707651	Tulare County
339153	Ordering, Referring, Prescribing	N/A	1598063703	0	0	LUCAS, KELLIE PA	9/17/2017	Taxonomy not applicable	NA	n/a	000	Unknown	1950	N/A	N/A	N/A	N/A	N/A	10820 PARKSIDE DR	None	KNOXVILLE	TN	37934	1956	00	06000	35.90003918	-84.14416556	Knox County
339172	Ordering, Referring, Prescribing	N/A	1598106809	0	0	LISSNER, NICOLAI J	1/12/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106497	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	120	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
339181	Ordering, Referring, Prescribing	N/A	1598121733	0	0	LACEY, APRIL LPCC	8/21/2020	Taxonomy not applicable	NA	n/a	000	Unknown	8357	N/A	N/A	N/A	N/A	N/A	2121 WEST TEMPLE ST	None	LOS ANGELES	CA	90026	1234	00	06000	34.07053729	-118.268744	Los Angeles County
339195	Ordering, Referring, Prescribing	N/A	1598134496	0	0	LANG, BRITTNEY R LCSW	2/14/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121033	N/A	N/A	N/A	N/A	N/A	7065 INDIANA AVE	STE 110	RIVERSIDE	CA	92506	4167	00	06000	33.94000037	-117.3961722	Riverside County
339202	Ordering, Referring, Prescribing	N/A	1598133068	0	0	LAM, WILSON PHARMD	7/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH45771	N/A	N/A	N/A	N/A	N/A	45 S EL CAMINO REAL	None	MILLBRAE	CA	94030	3124	00	06000	37.59720935	-122.3865478	San Mateo County
339217	Ordering, Referring, Prescribing	N/A	1598159741	0	0	LY, DAVID L DO	10/6/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15255	N/A	N/A	N/A	N/A	N/A	303 E VANDERBILT WAY	None	SAN BERNARDINO	CA	92415	0026	00	06000	34.06872265	-117.2775832	San Bernardino County
339225	Ordering, Referring, Prescribing	N/A	1598178956	0	0	LAMBDIN-SHIRLEY, NATALIE	8/17/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103235	N/A	N/A	N/A	N/A	N/A	8912 VOLUNTEER LN	None	SACRAMENTO	CA	95826	3221	00	06000	38.55438	-121.3756965	Sacramento County
339252	Ordering, Referring, Prescribing	N/A	1598213779	0	0	LEON WILLIAMS, ANA C	8/26/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127792	N/A	N/A	N/A	N/A	N/A	501 1ST AVE	SUITE 1	SAN MATEO	CA	94401	3475	00	06000	37.56829343	-122.32232	San Mateo County
339257	Ordering, Referring, Prescribing	N/A	1598225849	0	0	LEO, HANNAH P MD	6/3/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL814	N/A	N/A	N/A	N/A	N/A	401 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2211	00	06000	37.76376114	-122.4567626	San Francisco County
339259	Ordering, Referring, Prescribing	N/A	1598230583	0	0	LEE, SEONG YEOP LCSW	7/13/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102453	N/A	N/A	N/A	N/A	N/A	2614 S. GRAND AVENUE	SUITE 320	LOS ANGELES	CA	90007	2607	00	06000	34.02596104	-118.2725694	Los Angeles County
339260	Ordering, Referring, Prescribing	N/A	1598236077	0	0	LEUNG, JOANNA LMFT	6/4/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126329	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE	300	SAN JOSE	CA	95128	1005	00	06000	37.3160785	-121.937121	Santa Clara County
339271	Ordering, Referring, Prescribing	N/A	1598259509	0	0	LEWIS, CASEY DPM	5/21/2021	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5768	N/A	N/A	N/A	N/A	N/A	2089 VALE ROAD	SUITE 12	SAN PABLO	CA	94806	0050	00	06000	37.95396781	-122.3375393	Contra Costa County
339326	Ordering, Referring, Prescribing	N/A	1598367369	0	0	LONG, GERARD W LMFT	1/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT29128	N/A	N/A	N/A	N/A	N/A	29632 HWY 299 E	None	ROUND MOUNTAIN	CA	96084	0228	00	06000	40.80385331	-121.9397745	Shasta County
339349	Ordering, Referring, Prescribing	N/A	1598402588	0	0	LEE, JOSEPH H PHARMD	9/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85225	N/A	N/A	N/A	N/A	N/A	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1057	00	06000	37.60574038	-122.0836254	Alameda County
339353	Ordering, Referring, Prescribing	N/A	1598406761	0	0	LE, JONATHAN V CNP	1/23/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95022402	N/A	N/A	N/A	N/A	N/A	4725 MARKET ST	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
339372	Ordering, Referring, Prescribing	N/A	1598505984	0	0	LANTELME, EMILIE C	12/20/2024	Taxonomy not applicable	NA	n/a	000	Unknown	ND1536	N/A	N/A	N/A	N/A	N/A	4110 SORRENTO VALLEY BLV	None	SAN DIEGO	CA	92121	1429	00	06000	32.90375674	-117.2170258	San Diego County
339382	Ordering, Referring, Prescribing	N/A	1598597064	0	0	LEE, REBECCA S PHARMD	12/16/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH88424	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
339403	Ordering, Referring, Prescribing	N/A	1598801276	0	0	LAM, CHRISTINE LMFT	12/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	81053	N/A	N/A	N/A	N/A	N/A	355 TUOLUMNE ST,	None	VALLEJO	CA	94590	5700	00	06000	38.10261225	-122.2382555	Solano County
339446	Ordering, Referring, Prescribing	N/A	1598913477	0	0	LEE, ERICA PSYD	8/27/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	30005	N/A	N/A	N/A	N/A	N/A	123 S. MONTEBELLO BLVD.	None	MONTEBELLO	CA	90640	4729	00	06000	34.00959043	-118.1084192	Los Angeles County
339451	Ordering, Referring, Prescribing	N/A	1598925901	0	0	LANGHAM, KATHRYN A MD	5/27/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A112928	N/A	N/A	N/A	N/A	N/A	302 CHERRY LN	None	MANTECA	CA	93557	4311	00	06000	37.8013889	-121.2310042	San Joaquin County
339460	Ordering, Referring, Prescribing	N/A	1598935736	0	0	LOZANO CAMHI, MICHELLE I MD	3/20/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A109562	N/A	N/A	N/A	N/A	N/A	4309 3RD AVE	None	SAN DIEGO	CA	92103	1407	00	06000	32.75638577	-117.162084	San Diego County
339464	Ordering, Referring, Prescribing	N/A	1598951311	0	0	LEE, VERONIQUE N PSYD	1/20/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28772	N/A	N/A	N/A	N/A	N/A	400 ESTUDILLO AVE	100	SAN LEANDRO	CA	94577	4999	00	06000	37.72610702	-122.1519471	Alameda County
339484	Ordering, Referring, Prescribing	N/A	1598996712	0	0	LABUCKAS, IVANA L LMFT	8/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93659	N/A	N/A	N/A	N/A	N/A	3756 SANTA ROSALIA DR	424	LOS ANGELES	CA	90008	3606	00	06000	34.00888336	-118.3389334	Los Angeles County
339490	Ordering, Referring, Prescribing	N/A	1609005800	0	0	LAU, KATHY	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57423	N/A	N/A	N/A	N/A	N/A	1200 EL CAMINO REAL	None	SOUTH SAN FRANCIS	CA	94080	3208	00	06000	37.65894608	-122.440161	San Mateo County
339493	Ordering, Referring, Prescribing	N/A	1609009430	0	0	LI, VINCENT PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62647	N/A	N/A	N/A	N/A	N/A	370 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	00	06000	37.92786635	-122.0300899	Contra Costa County
339495	Ordering, Referring, Prescribing	N/A	1609010727	0	0	LAW, DAVID S MD	1/6/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A121740	N/A	N/A	N/A	N/A	N/A	13118 SHERMAN WAY	None	NORTH HOLLYWOOD	CA	91605	4645	00	06000	34.20117448	-118.4188095	Los Angeles County
339552	Ordering, Referring, Prescribing	N/A	1609147107	0	0	LINNY, HARTANTI	8/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	66705	N/A	N/A	N/A	N/A	N/A	5638 E KINGS CANYON RD	None	FRESNO	CA	93727	4627	00	06000	36.73578229	-119.6985397	Fresno County
339553	Ordering, Referring, Prescribing	N/A	1609151612	0	0	LAM, OI L PHARMD	8/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	43243	N/A	N/A	N/A	N/A	N/A	1763 SANTA RITA ROAD	None	PLEASANTON	CA	94566	5657	00	06000	37.67630688	-121.8739119	Alameda County
339556	Ordering, Referring, Prescribing	N/A	1609152099	0	0	LIN, THAN Z PHARMD	9/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	63666	N/A	N/A	N/A	N/A	N/A	660 BAILEY RD	None	BAY POINT	CA	94565	4306	00	06000	38.01615505	-121.9419732	Contra Costa County
339560	Ordering, Referring, Prescribing	N/A	1609155092	0	0	LAO, MAI LCSW	6/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95193	N/A	N/A	N/A	N/A	N/A	9412 BIG HORN BLVD	SUITE 6	ELK GROVE	CA	95758	1101	00	06000	38.415861	-121.407957	Sacramento County
339566	Ordering, Referring, Prescribing	N/A	1609162866	0	0	LUE, STEPHANIE PHARMD	7/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH45008	N/A	N/A	N/A	N/A	N/A	5224 COLDWATER CANYON AV	None	VAN NUYS	CA	91401	6146	00	06000	34.165512	-118.4137725	Los Angeles County
339569	Ordering, Referring, Prescribing	N/A	1609170521	0	0	LIEB, BIANKA LMFT	9/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121851	N/A	N/A	N/A	N/A	N/A	2438 BUSKIRK AVE	210	PLEASANT HILL	CA	94523	4382	00	06000	37.94136332	-122.0571142	Contra Costa County
339575	Ordering, Referring, Prescribing	N/A	1609173871	0	0	LINARES, DEBBIE A CA	2/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108766	N/A	N/A	N/A	N/A	N/A	921 DAHLIA AVE	SUITE C-145	COSTA MESA	CA	92626	1709	00	06000	33.69085139	-117.8944872	Orange County
339578	Ordering, Referring, Prescribing	N/A	1609180033	0	0	LUKUSA, HEATHER NP	2/29/2024	Taxonomy not applicable	NA	n/a	000	Unknown	95029301	N/A	N/A	N/A	N/A	N/A	685 MORRO AVE	STE C	MORRO BAY	CA	93442	2233	00	06000	35.364564	-120.8511755	San Luis Obispo County
339582	Ordering, Referring, Prescribing	N/A	1609183144	0	0	LEFEVER, DANIELLE L OD	3/1/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	14063	N/A	N/A	N/A	N/A	N/A	434 7TH ST	None	EUREKA	CA	95501	1803	00	06000	40.80022571	-124.1658967	Humboldt County
339592	Ordering, Referring, Prescribing	N/A	1609196609	0	0	LEE, NORMAN W PHARMD	1/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	39898	N/A	N/A	N/A	N/A	N/A	5101 BUSINESS CENTER DR	None	FAIRFIELD	CA	94534	1624	00	06000	38.21577011	-122.1459125	Solano County
339623	Ordering, Referring, Prescribing	N/A	1609257864	0	0	LEE, JAIMIE K MD	10/29/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159233	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FLOOR SUITE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
339653	Ordering, Referring, Prescribing	N/A	1609305259	0	0	LEE, JI EUN	6/5/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174189	N/A	N/A	N/A	N/A	N/A	1550 SUPERIOR AVENUE	None	COSTA MESA	CA	92627	3653	00	06000	33.63305341	-117.9266303	Orange County
339687	Ordering, Referring, Prescribing	N/A	1609357342	0	0	LOPEZ, CAROLINA PA-C	2/21/2019	Taxonomy not applicable	NA	n/a	000	Unknown	55944	N/A	N/A	N/A	N/A	N/A	6501 GARFIELD AVE	None	BELL GARDENS	CA	90201	1805	00	06000	33.97292523	-118.1475473	Los Angeles County
339707	Ordering, Referring, Prescribing	N/A	1609390590	0	0	LAGUNA, GISELLE I LCSW	5/22/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW105860	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
339715	Ordering, Referring, Prescribing	N/A	1609402569	0	0	LAMA TAMANG, TENCHEE	10/10/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	CA	N/A	N/A	N/A	N/A	N/A	1340 ARNOLD DR	200	MARTINEZ	CA	94553	4189	00	06000	37.99250264	-122.0983907	Contra Costa County
339764	Ordering, Referring, Prescribing	N/A	1609501758	0	0	LUONG, MICHELLE C DDS	5/3/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110058	N/A	N/A	N/A	N/A	N/A	8405 BEVERLY BLVD.	None	LOS ANGELES	CA	90048	3401	00	06000	34.07607952	-118.373418	Los Angeles County
339779	Ordering, Referring, Prescribing	N/A	1609562214	0	0	LEON, CHRISTINE M PA-C	3/7/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA62475	N/A	N/A	N/A	N/A	N/A	3100 PONTE MORINO DR	None	CAMERON PARK	CA	95682	7432	00	06000	38.66252014	-120.9672091	El Dorado County
339784	Ordering, Referring, Prescribing	N/A	1609568278	0	0	LAUB, MEGHAN LCSW	7/31/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100872	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
339789	Ordering, Referring, Prescribing	N/A	1609592542	0	0	LIEU, VINSON DC	2/10/2024	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	36459	N/A	N/A	N/A	N/A	N/A	837 ADDISON ST	None	BERKELEY	CA	94710	2047	00	06000	37.86680859	-122.2969443	Alameda County
339812	Ordering, Referring, Prescribing	N/A	1609900786	0	0	LEE, JOHN R	5/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D34364	N/A	N/A	N/A	N/A	N/A	250 N SEE VEE LN	None	BISHOP	CA	93514	8130	00	06000	37.365066	-118.410912	Inyo County
339841	Ordering, Referring, Prescribing	N/A	1609944453	0	0	LEE, SAILESH P PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	42900	N/A	N/A	N/A	N/A	N/A	3900 FREEDOM CIR	201	SANTA CLARA	CA	95054	1222	00	06000	37.38769057	-121.9700955	Santa Clara County
339848	Ordering, Referring, Prescribing	N/A	1609957828	0	0	LAM, YUK MEI LCSW	11/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98766	N/A	N/A	N/A	N/A	N/A	330 E LIVE OAK AVE	None	ARCADIA	CA	91006	5617	00	06000	34.10850998	-118.0219204	Los Angeles County
339855	Ordering, Referring, Prescribing	N/A	1609968932	0	0	LEE, GRACE M LCSW	3/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS28912	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	SUITE 130	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
339863	Ordering, Referring, Prescribing	N/A	1609986686	0	0	LU, PHONG T	8/14/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	D47518	N/A	N/A	N/A	N/A	N/A	420 S GLENDORA AVE	None	WEST COVINA	CA	91790	3001	00	06000	34.06750236	-117.925203	Los Angeles County
339889	Ordering, Referring, Prescribing	N/A	1619035813	0	0	LEE, ATHENA PHARMD	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59186	N/A	N/A	N/A	N/A	N/A	9803 MILOANN ST	None	TEMPLE CITY	CA	91780	3926	00	06000	34.09568392	-118.0545208	Los Angeles County
339897	Ordering, Referring, Prescribing	N/A	1619041019	0	0	LAM, DONGTHU Q PHARMD	4/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53589	N/A	N/A	N/A	N/A	N/A	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	0000	00	06000	37.24047903	-121.7998157	Santa Clara County
339946	Ordering, Referring, Prescribing	N/A	1619161841	0	0	LI, KWAI MOON NP	8/30/2018	Taxonomy not applicable	NA	n/a	000	Unknown	15150	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVENUE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
339956	Ordering, Referring, Prescribing	N/A	1619174067	0	0	LANE, DANIEL W DO	7/28/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A10534	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	SUITE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
339962	Ordering, Referring, Prescribing	N/A	1619186764	0	0	LI, KEVIN MD	7/20/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A98063	N/A	N/A	N/A	N/A	N/A	1300 N DUTTON AVE	None	SANTA ROSA	CA	95401	7112	00	06000	38.449791	-122.733027	Sonoma County
339978	Ordering, Referring, Prescribing	N/A	1619210614	0	0	LU, JULIE P DO	2/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14804	N/A	N/A	N/A	N/A	N/A	2391 ISLAND AVE	None	SAN DIEGO	CA	92102	2941	00	06000	32.71044228	-117.1425241	San Diego County
340003	Ordering, Referring, Prescribing	N/A	1619252608	0	0	LIU, WENDY PHARMD	7/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH50906	N/A	N/A	N/A	N/A	N/A	825 MARKET STREET	None	SAN FRANCISCO	CA	94103	1901	00	06000	37.78516779	-122.4065094	San Francisco County
340004	Ordering, Referring, Prescribing	N/A	1619256146	0	0	LIN, TIMOTHY LCSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	73545	N/A	N/A	N/A	N/A	N/A	2933 N EL NIDO DR	None	ALTADENA	CA	91001	4529	00	06000	34.19549106	-118.1655134	Los Angeles County
340006	Ordering, Referring, Prescribing	N/A	1619254877	0	0	LE, PHUONG PHARMD	7/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH56628	N/A	N/A	N/A	N/A	N/A	535 S PACIFIC COAST HWY	None	REDONDO BEACH	CA	90277	4220	00	06000	33.83315029	-118.3850549	Los Angeles County
340008	Ordering, Referring, Prescribing	N/A	1619257250	0	0	LOW, STACIE PHARMD	7/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52879	N/A	N/A	N/A	N/A	N/A	275 SACRAMENTO STREET	None	SAN FRANCISVO	CA	94111	3810	00	06000	37.79435021	-122.398633	San Francisco
340045	Ordering, Referring, Prescribing	N/A	1619335551	0	0	LEVARDO, ERIN NP	1/2/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002984	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVENUE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
340047	Ordering, Referring, Prescribing	N/A	1619335254	0	0	LEE, DEANNA S	10/3/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	101771	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD RD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
340053	Ordering, Referring, Prescribing	N/A	1619345378	0	0	LOPEZ, MERCY	12/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99338	N/A	N/A	N/A	N/A	N/A	527 N ARROWHEAD AVE	None	SAN BERNARDINO	CA	92401	1251	00	06000	34.109037	-117.2895688	San Bernardino County
340061	Ordering, Referring, Prescribing	N/A	1619353257	0	0	LITMAN, MARISSA A LCSW	5/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101651	N/A	N/A	N/A	N/A	N/A	1266 14TH ST	None	OAKLAND	CA	94607	2205	00	06000	37.81022696	-122.2887619	Alameda County
340076	Ordering, Referring, Prescribing	N/A	1619370798	0	0	LIES, THERESA A LCSW	4/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94659	N/A	N/A	N/A	N/A	N/A	1221 E DYER RD	120	SANTA ANA	CA	92705	5600	00	06000	33.70872153	-117.857052	Orange County
340099	Ordering, Referring, Prescribing	N/A	1619399904	0	0	LEGER, CONSTANCE LCSW	3/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76698	N/A	N/A	N/A	N/A	N/A	1393 BAILEY DR	None	HANFORD	CA	93230	8823	00	06000	36.32726257	-119.6663418	Kings County
340129	Ordering, Referring, Prescribing	N/A	1619452828	0	0	LONG, AI N PHARMD	8/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78877	N/A	N/A	N/A	N/A	N/A	2600 MOWRY AVE	None	FREMONT	CA	94538	1619	00	06000	37.55561189	-121.9825927	Alameda County
340159	Ordering, Referring, Prescribing	N/A	1619508348	0	0	LOPEZ, GISELA LMFT	5/23/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147053	N/A	N/A	N/A	N/A	N/A	4525 W ADAMS BLVD	None	LOS ANGELES	CA	90016	3021	00	06000	34.03261147	-118.3388535	Los Angeles County
340193	Ordering, Referring, Prescribing	N/A	1619577517	0	0	LIN, ALICE PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83537	N/A	N/A	N/A	N/A	N/A	216 WESTLAKE CTR	None	DALY CITY	CA	94015	1430	00	06000	37.70123591	-122.4833751	San Mateo County
340234	Ordering, Referring, Prescribing	N/A	1619795002	0	0	LIAO, KEVIN A DMD	10/2/2024	Taxonomy not applicable	NA	n/a	000	Unknown	DDS110892	N/A	N/A	N/A	N/A	N/A	7526 MONTEREY RD	None	GILROY	CA	95020	5826	00	06000	37.00859125	-121.5694207	Santa Clara County
340242	Ordering, Referring, Prescribing	N/A	1619964244	0	0	LARSEN, DIANA L	5/27/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	12902	N/A	N/A	N/A	N/A	N/A	1469 HUMBOLDT RD	SUITE 200	CHICO	CA	95928	9203	00	06000	39.73527137	-121.8156849	Butte County
340278	Ordering, Referring, Prescribing	N/A	1629106489	0	0	LONDOT FORBES, CHRISTINE M LMFT	2/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52635	N/A	N/A	N/A	N/A	N/A	101 S B ST	None	LOMPOC	CA	93436	6933	00	06000	34.63860089	-120.4503641	Santa Barbara County
340292	Ordering, Referring, Prescribing	N/A	1629140363	0	0	LEE, MARY PHARMD	5/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55656	N/A	N/A	N/A	N/A	N/A	1011 SNEATH LANE	None	SAN BRUNO	CA	94066	3754	00	06000	37.63437084	-122.4264474	San Mateo County
340296	Ordering, Referring, Prescribing	N/A	1629143706	0	0	LAPEYROLERIE, MELANIE M LCSW	9/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29662	N/A	N/A	N/A	N/A	N/A	9960 BALDWIN PL	None	EL MONTE	CA	91731	2204	00	06000	34.07140294	-118.0516061	Los Angeles County
340377	Ordering, Referring, Prescribing	N/A	1629330527	0	0	LAIB, YUKI A	4/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT98693	N/A	N/A	N/A	N/A	N/A	1290 COMMODORE DR	None	SAN BRUNO	CA	94066	2304	00	06000	37.63134914	-122.4260472	San Mateo County
340378	Ordering, Referring, Prescribing	N/A	1629325808	0	0	LEE, JENNIFER MA OTR	5/25/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT12293	N/A	N/A	N/A	N/A	N/A	150 W. 7TH STREET	None	SAN PEDRO	CA	90731	3320	00	06000	33.73786341	-118.2810362	Los Angeles County
340402	Ordering, Referring, Prescribing	N/A	1629357223	0	0	LE, AMY N PHARMD	10/9/2018	Taxonomy not applicable	NA	n/a	000	Unknown	50944	N/A	N/A	N/A	N/A	N/A	976 LENZEN AVE	None	SAN JOSE	CA	95126	2737	00	06000	37.33463902	-121.9121497	Santa Clara County
340405	Ordering, Referring, Prescribing	N/A	1629361027	0	0	LI, TIMOTHY DO	9/27/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A12572	N/A	N/A	N/A	N/A	N/A	24910 LAS BRISAS RD	STE 105	MURRIETA	CA	92562	4010	00	06000	33.57522424	-117.1828078	Riverside County
340406	Ordering, Referring, Prescribing	N/A	1629355763	0	0	LASECKI, LYNNE PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH55366	N/A	N/A	N/A	N/A	N/A	535 S PACIFIC COAST HWY	None	REDONDO BEACH	CA	90277	4220	00	06000	33.83315029	-118.3850549	Los Angeles County
340410	Ordering, Referring, Prescribing	N/A	1629361662	0	0	LAO, JOO-ANN O	2/20/2001	Taxonomy not applicable	NA	n/a	099	DENTIST	D48137	N/A	N/A	N/A	N/A	N/A	8499 OLD REDWOOD HWY STE	STE 112 & 200	WINDSOR	CA	95492	8057	00	06000	38.54390805	-122.8015407	Sonoma County
340416	Ordering, Referring, Prescribing	N/A	1629376454	0	0	LEDESMA, DAVID A DC	7/22/2018	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	31917	N/A	N/A	N/A	N/A	N/A	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
340419	Ordering, Referring, Prescribing	N/A	1629383435	0	0	LAVELLE, LAURA C NP	6/14/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	14792	N/A	N/A	N/A	N/A	N/A	3311 PACIFIC AVE	None	LIVEMORE	CA	94550	7007	00	06000	37.67610149	-121.755159	Alameda County
340422	Ordering, Referring, Prescribing	N/A	1629382155	0	0	LAMBERTON, RONALD W MD	11/23/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G27296	N/A	N/A	N/A	N/A	N/A	1045 5TH ST	None	LOS BANOS	CA	93635	4204	00	06000	37.05986807	-120.8505485	Merced County
340425	Ordering, Referring, Prescribing	N/A	1629384649	0	0	LEW, NICOLE A LCSW	6/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64883	N/A	N/A	N/A	N/A	N/A	3200 CLAYTON RD	None	CONCORD	CA	94519	2819	00	06000	37.97283909	-122.0196497	Contra Costa County
340432	Ordering, Referring, Prescribing	N/A	1629404710	0	0	LYONS, DENISE L LCSW	12/7/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	112475	N/A	N/A	N/A	N/A	N/A	2811 H ST	None	BAKERSFIELD	CA	93301	1913	00	06000	35.38526604	-119.021172	Kern County
340448	Ordering, Referring, Prescribing	N/A	1629440136	0	0	LAC, HUNG C PHARMD	7/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73303	N/A	N/A	N/A	N/A	N/A	3500 COFFEE RD	None	MODESTO	CA	95355	1305	00	06000	37.690002	-120.976061	Stanislaus County
340467	Ordering, Referring, Prescribing	N/A	1629480660	0	0	LIN, YI-CHERN DPM	11/17/2019	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	5373	N/A	N/A	N/A	N/A	N/A	1276 HALYARD DR	None	WEST SACRAMENTO	CA	95691	3412	00	06000	38.573118	-121.5501275	Yolo County
340489	Ordering, Referring, Prescribing	N/A	1629510698	0	0	LEE, LILIAN PHARMD	9/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59406	N/A	N/A	N/A	N/A	N/A	105 N LAWRENCE AVE	None	FULLERTON	CA	92832	2022	00	06000	33.87074464	-117.9177395	Orange County
340593	Ordering, Referring, Prescribing	N/A	1629667084	0	0	LIU, JULIE Y NP	7/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	NP95016647	N/A	N/A	N/A	N/A	N/A	5562 PHILADELPHIA ST	310	CHINO	CA	91710	2466	00	06000	34.03370384	-117.6837291	San Bernardino County
340594	Ordering, Referring, Prescribing	N/A	1629657044	0	0	LIN, YEZHE MD	4/24/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A195749	N/A	N/A	N/A	N/A	N/A	1801 VICENTE ST	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
340600	Ordering, Referring, Prescribing	N/A	1629684121	0	0	LE, HELEN	1/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83233	N/A	N/A	N/A	N/A	N/A	774 ADMIRAL CALLAGHAN LN	None	VALLEJO	CA	94591	3650	00	06000	38.12591271	-122.2280142	Solano County
340624	Ordering, Referring, Prescribing	N/A	1629774294	0	0	LUI, JIM PA-C	3/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62485	N/A	N/A	N/A	N/A	N/A	954 N VERMONT AVE	None	LOS ANGELES	CA	90029	3529	00	06000	34.08896256	-118.2917211	Los Angeles County
340628	Ordering, Referring, Prescribing	N/A	1629797022	0	0	LEE, DEBBY PHARMD	8/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86687	N/A	N/A	N/A	N/A	N/A	2900 N MAIN ST	None	WALNUT CREEK	CA	94597	2035	00	06000	37.92721212	-122.0621121	Contra Costa County
340668	Ordering, Referring, Prescribing	N/A	1639223134	0	0	LINK, DANIEL MD	2/23/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G184520	N/A	N/A	N/A	N/A	N/A	1563 MISSION ST	None	SAN FRANCISCO	CA	94103	2543	00	06000	37.77327874	-122.4183559	San Francisco County
340685	Ordering, Referring, Prescribing	N/A	1639247620	0	0	LEWIS, RYAN C PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55748	N/A	N/A	N/A	N/A	N/A	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	00	06000	38.644479	-121.1349735	Sacramento County
340692	Ordering, Referring, Prescribing	N/A	1639278153	0	0	LAMBERT, PARIE E	5/23/2013	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	RN0336083	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
340694	Ordering, Referring, Prescribing	N/A	1639287642	0	0	LOERA, ROBERT A MD	9/7/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G71491	N/A	N/A	N/A	N/A	N/A	12980 FREDERICK STREET	SUITE I	MORENO VALLEY	CA	92553	5263	00	06000	33.931872	-117.2613835	Riverside County
340700	Ordering, Referring, Prescribing	N/A	1639307432	0	0	LOCKARD, MARY R	2/6/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	18984	N/A	N/A	N/A	N/A	N/A	16260 VENTURA BLVD	None	ENCINO	CA	91436	2203	00	06000	34.15687678	-118.4876342	Los Angeles County
340716	Ordering, Referring, Prescribing	N/A	1639348683	0	0	LOFTIS, BRENT DO	12/6/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A11845	N/A	N/A	N/A	N/A	N/A	3230 BEARD ROAD	SUITE 2	NAPA	CA	94558	3659	00	06000	38.3216968	-122.2953847	Napa County
340718	Ordering, Referring, Prescribing	N/A	1639352503	0	0	LIZARRAGA, JENNIFER L LMFT	10/23/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	91937	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1495	00	06000	34.32450186	-118.4456317	Los Angeles County
340729	Ordering, Referring, Prescribing	N/A	1639377609	0	0	LEMOS-MILLER, AMIE M PHD	11/6/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	23024	N/A	N/A	N/A	N/A	N/A	7216 PALM AVE	C	HIGHLAND	CA	92346	3280	00	06000	34.12296953	-117.208792	San Bernardino County
340731	Ordering, Referring, Prescribing	N/A	1639389497	0	0	LANNI, MARIA L	4/2/2013	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	RN0725638	N/A	N/A	N/A	N/A	N/A	200 UCLA MEDICAL PLAZA	STE 430	LOS ANGELES	CA	90095	8344	00	06000	34.065126	-118.446237	Los Angeles County
340769	Ordering, Referring, Prescribing	N/A	1639451339	0	0	LAI, HEUNG P PHARMD	7/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53569	N/A	N/A	N/A	N/A	N/A	3001 TARAVAL STREET	None	SAN FRANCISCO	CA	94116	2106	00	06000	37.74200588	-122.4987236	San Francisco County
340777	Ordering, Referring, Prescribing	N/A	1639453152	0	0	LEE, PEGGY C LMFT	1/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48684	N/A	N/A	N/A	N/A	N/A	1515 S. BON VIEW AVE.	None	ONTARIO	CA	91761	4408	00	06000	34.045335	-117.636444	San Bernardino County
340793	Ordering, Referring, Prescribing	N/A	1639485220	0	0	LLAMAS, NICOLE A LMFT	2/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84924	N/A	N/A	N/A	N/A	N/A	429 N SAN ANTONIO RD	None	SANTA BARBARA	CA	93110	1399	00	06000	34.44573228	-119.7804008	Santa Barbara County
340807	Ordering, Referring, Prescribing	N/A	1639503717	0	0	LOERA, ESTHER LCSW	6/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW92484	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
340824	Ordering, Referring, Prescribing	N/A	1639518939	0	0	LIQUIDANO, TANYA LCSW	4/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88680	N/A	N/A	N/A	N/A	N/A	1720 E 120TH ST	None	LOS ANGELES	CA	90059	3052	00	06000	33.92455929	-118.2423557	Los Angeles County
340833	Ordering, Referring, Prescribing	N/A	1639537897	0	0	LEE, PO-YI OD	6/10/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	33342	N/A	N/A	N/A	N/A	N/A	2791 GREEN RIVER RD	None	CORONA	CA	92882	7426	00	06000	33.87058838	-117.622429	Riverside County
340837	Ordering, Referring, Prescribing	N/A	1639548274	0	0	LANDSMAN, MEGAN M PT	6/30/2019	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	40935	N/A	N/A	N/A	N/A	N/A	1901 N RICE AVE	170-180	OXNARD	CA	93030	7912	00	06000	34.21960355	-119.1421345	Ventura County
340842	Ordering, Referring, Prescribing	N/A	1639543788	0	0	LOBB, WILLIAM	3/25/2018	Taxonomy not applicable	NA	n/a	000	Unknown	74097	N/A	N/A	N/A	N/A	N/A	1855 E COCHRAN ST	None	SIMI VALLEY	CA	93065	1111	00	06000	34.27906738	-118.7628635	Ventura County
340851	Ordering, Referring, Prescribing	N/A	1639564396	0	0	LOPEZ, CARMINA LMFT	4/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115636	N/A	N/A	N/A	N/A	N/A	2001 RIMBEY AVE	None	SAN DIEGO	CA	92154	3032	00	06000	32.56817448	-117.0910046	San Diego County
340868	Ordering, Referring, Prescribing	N/A	1639585656	0	0	LIU, CINDY C PHARMD	3/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72450	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPARTMENT 362	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
340874	Ordering, Referring, Prescribing	N/A	1639587595	0	0	LAM, LARRY T PHARMD	11/4/2018	Taxonomy not applicable	NA	n/a	000	Unknown	67916	N/A	N/A	N/A	N/A	N/A	671 S RANCHO SANTA FE RD	None	SAN MARCOS	CA	92078	3973	00	06000	33.13300154	-117.2071291	San Diego County
340896	Ordering, Referring, Prescribing	N/A	1639627698	0	0	LYMAN, JODY A LMFT	2/26/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131406	N/A	N/A	N/A	N/A	N/A	2000 EMBARCADERO COVE	400	OAKLAND	CA	94606	5334	00	06000	37.78179304	-122.2428136	Alameda County
340929	Ordering, Referring, Prescribing	N/A	1639666019	0	0	LANG, VERONICA NP	7/20/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009534	N/A	N/A	N/A	N/A	N/A	2970 HILLTOP MALL ROAD	307	RICHMOND	CA	94806	5274	00	06000	37.97819764	-122.329244	Contra Costa County
340958	Ordering, Referring, Prescribing	N/A	1639725344	0	0	LEIKUN, MELAT M LCSW	4/14/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114807	N/A	N/A	N/A	N/A	N/A	500 CITY PARKWAY	500	ORANGE	CA	92868	9286	00	06000	33.78299346	-117.895788	Orange County
340970	Ordering, Referring, Prescribing	N/A	1639738529	0	0	LEE, ERIK DO	3/26/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A22707	N/A	N/A	N/A	N/A	N/A	2007 WILSHIRE BLVD 3RD 1	None	LOS ANGELES	CA	90057	3506	00	06000	34.05752718	-118.2749855	Los Angeles County
340990	Ordering, Referring, Prescribing	N/A	1639810054	0	0	LILLENBERG, AUSTIN LCSW	5/23/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW115424	N/A	N/A	N/A	N/A	N/A	2801 SANTA MARIA WAY	None	SANTA MARIA	CA	93455	2118	00	06000	34.90914521	-120.4339538	Santa Barbara County
340996	Ordering, Referring, Prescribing	N/A	1639840390	0	0	LIEN, KATHY NP	8/31/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022454	N/A	N/A	N/A	N/A	N/A	9460 N NAME UNO	110	GILROY	CA	95020	3537	00	06000	37.037781	-121.570965	Santa Clara County
341010	Ordering, Referring, Prescribing	N/A	1639886617	0	0	LEE, SHARON OD	2/24/2023	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	35347	N/A	N/A	N/A	N/A	N/A	211 EASTMOOR AVE	None	DALY CITY	CA	94015	2036	00	06000	37.6847337	-122.4787562	San Mateo County
341042	Ordering, Referring, Prescribing	N/A	1649210048	0	0	LADWIG, MICHELLE M PA-C	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	17127	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
341086	Ordering, Referring, Prescribing	N/A	1649333089	0	0	LEE, MINNA C PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH51476	N/A	N/A	N/A	N/A	N/A	250 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1103	00	06000	37.23948065	-121.8005798	Santa Clara County
341100	Ordering, Referring, Prescribing	N/A	1649355249	0	0	LE, CHRIS PHARMD	4/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH51155	N/A	N/A	N/A	N/A	N/A	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	00	06000	33.8531521	-117.8160824	Orange County
341109	Ordering, Referring, Prescribing	N/A	1649376930	0	0	LOHR, JAMES B MD	7/7/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G63913	N/A	N/A	N/A	N/A	N/A	995 GATEWAY CENTER WAY	STE 300	SAN DIEGO	CA	92102	4500	00	06000	32.71405516	-117.1158459	San Diego County
341146	Ordering, Referring, Prescribing	N/A	1649474289	0	0	LOO, KAMELA CNP	3/2/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	12371	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
341152	Ordering, Referring, Prescribing	N/A	1649483033	0	0	LIN, HENRY C MD	3/6/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A107466	N/A	N/A	N/A	N/A	N/A	15366 11TH ST STE D	None	VICTORVILLE	CA	92395	3726	00	06000	34.530156	-117.292539	San Bernardino County
341157	Ordering, Referring, Prescribing	N/A	1649480617	0	0	LOVELACE, AUBREE LMFT	6/13/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48805	N/A	N/A	N/A	N/A	N/A	222 S HILL ST	NA	LOS ANGELES	CA	90012	3506	00	06000	34.0525918	-118.2482081	Los Angeles County
341190	Ordering, Referring, Prescribing	N/A	1649556309	0	0	LIU, CHRISTINE	9/11/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	20783	N/A	N/A	N/A	N/A	N/A	1000 S GARFIELD AVE.	None	ALHAMBRA	CA	91801	4709	00	06000	34.084557	-118.123042	Los Angeles County
341202	Ordering, Referring, Prescribing	N/A	1649590258	0	0	LU, ELAINE I MD	5/18/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A113541	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	00	06000	37.34293689	-121.9270392	Santa Clara County
341209	Ordering, Referring, Prescribing	N/A	1649598160	0	0	LYKES, AMY LMFT	5/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125836	N/A	N/A	N/A	N/A	N/A	670 PLACERVILLE DR	SUITE 2	PLACERVILLE	CA	95667	4200	00	06000	38.73161765	-120.8213885	El Dorado County
341222	Ordering, Referring, Prescribing	N/A	1649610650	0	0	LIN, ELIZABETH	2/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT97618	N/A	N/A	N/A	N/A	N/A	14535 SHERMAN CIRCLE	None	VAN NUYS	CA	91405	3087	00	06000	34.20064259	-118.450312	Los Angeles County
341239	Ordering, Referring, Prescribing	N/A	1649630914	0	0	LEE, HEE S LMFT	3/30/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105644	N/A	N/A	N/A	N/A	N/A	3727 W 6TH STREET	None	LOS ANGELES	CA	90020	5110	00	06000	34.06358655	-118.3037656	Los Angeles County
341249	Ordering, Referring, Prescribing	N/A	1649647074	0	0	LIU, JOE PHARMD	7/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76500	N/A	N/A	N/A	N/A	N/A	1363 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3912	00	06000	37.78227214	-122.4392935	San Francisco County
341262	Ordering, Referring, Prescribing	N/A	1649660770	0	0	LEWIS, BENJAMIN M DPM	6/5/2017	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	5160	N/A	N/A	N/A	N/A	N/A	810 E D ST	None	LEMOORE	CA	93245	9545	00	06000	36.30069303	-119.7694815	Kings County
341265	Ordering, Referring, Prescribing	N/A	1649670993	0	0	LASH, DAVID B PHARMD	5/8/2019	Taxonomy not applicable	NA	n/a	000	Unknown	70963	N/A	N/A	N/A	N/A	N/A	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
341331	Ordering, Referring, Prescribing	N/A	1649787789	0	0	LOTT, KRYSTAL A NP	7/3/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012099	N/A	N/A	N/A	N/A	N/A	1450 E HOLT AVENUE	None	POMONA	CA	91767	5822	00	06000	34.06299829	-117.7215562	Los Angeles County
341338	Ordering, Referring, Prescribing	N/A	1649797432	0	0	LESSIN, SCOTT A LMFT	5/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT98168	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR	None	OXNARD	CA	93036	2612	00	06000	34.219566	-119.1539365	Ventura County
341369	Ordering, Referring, Prescribing	N/A	1649848961	0	0	LI, HAORAN LCSW	7/3/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW123830	N/A	N/A	N/A	N/A	N/A	3055 WILSHIRE BLVD	SUITE 300	LOS ANGELES	CA	90010	1176	00	06000	34.06185807	-118.2880358	Los Angeles County
341382	Ordering, Referring, Prescribing	N/A	1649878521	0	0	LIN, JENNIE OD	10/9/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT34709TLG	N/A	N/A	N/A	N/A	N/A	17801 PIONEER BLVD	None	ARTESIA	CA	90701	3962	00	06000	33.8693187	-118.0823685	Los Angeles County
341386	Ordering, Referring, Prescribing	N/A	1649895947	0	0	LABOY DAVILA, JOSE ROBERTO CCC-SLP	11/12/2019	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	29536	N/A	N/A	N/A	N/A	N/A	1901 N RICE AVE	SUITE 170-180	OXNARD	CA	93030	7912	00	06000	34.21960355	-119.1421345	Ventura County
341394	Ordering, Referring, Prescribing	N/A	1649904442	0	0	LEE, ELIZABETH S PA-C	6/4/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64578	N/A	N/A	N/A	N/A	N/A	1414 S GRAND AVE	STE 380	LOS ANGELES	CA	90015	3072	00	06000	34.03661142	-118.2657227	Los Angeles County
341399	Ordering, Referring, Prescribing	N/A	1649942137	0	0	LI, WENDY PHARMD	10/5/2020	Taxonomy not applicable	NA	n/a	000	Unknown	81462	N/A	N/A	N/A	N/A	N/A	1377 N. FAIR OAKS AVE.	None	PASADENA	CA	91103	2101	00	06000	34.169598	-118.1507175	Los Angeles County
341414	Ordering, Referring, Prescribing	N/A	1649982075	0	0	LI, LULING PHARMD	1/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH86867	N/A	N/A	N/A	N/A	N/A	2300 MENDOCINO AVE	None	SANTA ROSA	CA	95403	3115	00	06000	38.463345	-122.7173355	Sonoma County
341455	Ordering, Referring, Prescribing	N/A	1659135184	0	0	LATA, SHAROON S	2/1/2024	Taxonomy not applicable	NA	n/a	000	Unknown	109842	N/A	N/A	N/A	N/A	N/A	965 EL CAMINO AVE	None	SACRAMENTO	CA	95815	2530	00	06000	38.611638	-121.4444745	Sacramento County
341460	Ordering, Referring, Prescribing	N/A	1659147817	0	0	LONSDALE, KATHRYN PT	5/23/2023	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT36520	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
341467	Ordering, Referring, Prescribing	N/A	1659193332	0	0	LOZANO, NATHALIE NP	7/9/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030986	N/A	N/A	N/A	N/A	N/A	808 W 58TH STREET	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
341473	Ordering, Referring, Prescribing	N/A	1659331296	0	0	LEGARDA, MARIS STELLA B MD	1/15/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C52834	N/A	N/A	N/A	N/A	N/A	23845 HOLMAN HWY	210	MONTEREY	CA	93940	5900	00	06000	36.57594044	-121.9132944	Monterey County
341476	Ordering, Referring, Prescribing	N/A	1659353316	0	0	LAUGHRUN, DAVID R MD	12/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G72466	N/A	N/A	N/A	N/A	N/A	522 S. SAN PEDRO STREET	None	LOS ANGELES	CA	90013	2101	00	06000	34.0436196	-118.2442541	Los Angeles County
341479	Ordering, Referring, Prescribing	N/A	1659390110	0	0	LAWTON, SUSAN MD	2/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G88199	N/A	N/A	N/A	N/A	N/A	518 GARDEN STREET	None	SANTA BARBARA	CA	93101	1606	00	06000	34.42054634	-119.6928135	Santa Barbara County
341489	Ordering, Referring, Prescribing	N/A	1659412252	0	0	LEE, CHUCK-KWAN K MD	3/28/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A29649	N/A	N/A	N/A	N/A	N/A	4151 MEXICALI DRIVE	None	BAKERSFIELD	CA	93313	2065	00	06000	35.317233	-119.081649	Kern County
341498	Ordering, Referring, Prescribing	N/A	1659422285	0	0	LIN, DENNIS J OD	7/13/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	12326	N/A	N/A	N/A	N/A	N/A	2075 S ATLANTIC BLVD	STE J	MONTEREY PARK	CA	91754	6348	00	06000	34.039943	-118.1426765	Los Angeles County
341508	Ordering, Referring, Prescribing	N/A	1659452134	0	0	LAYTONULLOA, BARBARA A NP	6/13/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	361939	N/A	N/A	N/A	N/A	N/A	8520 S BROADWAY	None	LOS ANGELES	CA	90003	3335	00	06000	33.96110579	-118.2782667	Los Angeles County
341513	Ordering, Referring, Prescribing	N/A	1659465417	0	0	LAFRENIERE, JULIE K NP	12/14/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006683	N/A	N/A	N/A	N/A	N/A	2561 CALIFORNIA PARK DR	300	CHICO	CA	95928	4208	00	06000	39.749274	-121.792491	Butte County
341516	Ordering, Referring, Prescribing	N/A	1659467728	0	0	LI, XIA MD	5/15/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A84584	N/A	N/A	N/A	N/A	N/A	1304 ECHO PARK AVE	None	LOS ANGELES	CA	90026	3318	00	06000	34.07699003	-118.2571976	Los Angeles County
341546	Ordering, Referring, Prescribing	N/A	1659526911	0	0	LOPEZ, JOEL PA	6/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	20039	N/A	N/A	N/A	N/A	N/A	12900 FREDERICK STREET	SUITE C	MORENO VALLEY	CA	92553	5266	00	06000	33.932655	-117.261383	Riverside County
341549	Ordering, Referring, Prescribing	N/A	1659530095	0	0	LLOYD, MICHAEL K MD	5/29/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A113655	N/A	N/A	N/A	N/A	N/A	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	00	06000	36.33611794	-119.6460191	Kings County
341578	Ordering, Referring, Prescribing	N/A	1659605756	0	0	LORD, STEPHANIE A PSYD	3/1/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26507	N/A	N/A	N/A	N/A	N/A	3002 ARMSTRONG ST	None	SAN DIEGO	CA	92111	5702	00	06000	32.80043242	-117.165431	San Diego County
341583	Ordering, Referring, Prescribing	N/A	1659614758	0	0	LADOUCEUR, HANNAH S LMFT	7/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120221	N/A	N/A	N/A	N/A	N/A	1801 VICENTE ST	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
341588	Ordering, Referring, Prescribing	N/A	1659622363	0	0	LOUIS, MADILYN LCSW	7/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW87945	N/A	N/A	N/A	N/A	N/A	137 N COTTONWOOD ST	None	WOODLAND	CA	95695	6646	00	06000	38.68538399	-121.7933582	Yolo County
341612	Ordering, Referring, Prescribing	N/A	1659656064	0	0	LIM, JEANNE PHARMD	6/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH65810	N/A	N/A	N/A	N/A	N/A	4616 DE LONGPRE AVE	None	LOS ANGELES	CA	90027	6076	00	06000	34.0969945	-118.2901545	Los Angeles County
341619	Ordering, Referring, Prescribing	N/A	1659662930	0	0	LOPEZ, NILDA S MD	10/29/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C182792	N/A	N/A	N/A	N/A	N/A	9300 N LOOP BLVD	STE. C	CALIFORNIA CITY	CA	93505	2269	00	06000	35.13321511	-117.9623345	Kern County
341634	Ordering, Referring, Prescribing	N/A	1659688315	0	0	LAGUNAS, KARLA	7/31/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109789	N/A	N/A	N/A	N/A	N/A	10155 COLIMA RD	None	WHITTIER	CA	90603	2042	00	06000	33.94349601	-118.0106968	Los Angeles County
341653	Ordering, Referring, Prescribing	N/A	1659725356	0	0	LIRA, CLAUDIA LCSW	12/3/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92488	N/A	N/A	N/A	N/A	N/A	9101 WHITTIER BLVD	None	PICO RIVERA	CA	90660	2405	00	06000	34.00074139	-118.0822944	Los Angeles County
341661	Ordering, Referring, Prescribing	N/A	1659732337	0	0	LOYA, CHRIS N PHARMD	4/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH68796	N/A	N/A	N/A	N/A	N/A	7095 MARKET PLACE DR	None	GOLETA	CA	93117	5905	00	06000	34.42799696	-119.873532	Santa Barbara County
341662	Ordering, Referring, Prescribing	N/A	1659734853	0	0	LEE, RANDALL MD	10/8/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A153362	N/A	N/A	N/A	N/A	N/A	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	0000	00	06000	34.03781261	-118.3755101	Los Angeles County
341666	Ordering, Referring, Prescribing	N/A	1659739324	0	0	LINARES VALDERRAMA, MARIA I MD	3/30/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A160352	N/A	N/A	N/A	N/A	N/A	625 34TH ST	STE 100 & 200	BAKERSFIELD	CA	93301	2305	00	06000	35.39046051	-119.0092725	Kern County
341683	Ordering, Referring, Prescribing	N/A	1659759074	0	0	LUZON-VIDAD, MARIETTA J NP	8/21/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95001455	N/A	N/A	N/A	N/A	N/A	20920 CHICO ST	None	CARSON	CA	90746	3603	00	06000	33.84005271	-118.2570994	Los Angeles County
341691	Ordering, Referring, Prescribing	N/A	1659769073	0	0	LUO, ZEMENG	9/30/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022858	N/A	N/A	N/A	N/A	N/A	845 JACKSON ST	B1	SAN FRANCISCO	CA	94133	4851	00	06000	37.79571919	-122.4089166	San Francisco County
341707	Ordering, Referring, Prescribing	N/A	1659796159	0	0	LE, BACHMAI T	8/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	44337	N/A	N/A	N/A	N/A	N/A	2590 N TEXAS ST	None	FAIRFIELD	CA	94533	1606	00	06000	38.27606445	-122.0340458	Solano County
341719	Ordering, Referring, Prescribing	N/A	1659814614	0	0	LIN, JUDY	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76244	N/A	N/A	N/A	N/A	N/A	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	00	06000	37.93684848	-122.361345	Contra Costa County
341757	Ordering, Referring, Prescribing	N/A	1659870129	0	0	LOPEZ MALDONADO, ANGELICA V LCSW	12/31/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127956	N/A	N/A	N/A	N/A	N/A	520 E. TULARE AVE	None	VISALIA	CA	93291	9321	00	06000	36.320679	-119.2870845	Tulare County
341765	Ordering, Referring, Prescribing	N/A	1659885424	0	0	LIN, CHRISTOPHER PHARMD	8/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77188	N/A	N/A	N/A	N/A	N/A	401 N AZUSA AVE	None	COVINA	CA	91722	3609	00	06000	34.08845439	-117.9079036	Los Angeles County
341766	Ordering, Referring, Prescribing	N/A	1659890010	0	0	LI, TIFFANY	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77064	N/A	N/A	N/A	N/A	N/A	1800 HARRISON ST	None	OAKLAND	CA	94612	3466	00	06000	37.80593773	-122.2656714	Alameda County
341786	Ordering, Referring, Prescribing	N/A	1659931830	0	0	LE, BAO LINH PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78823	N/A	N/A	N/A	N/A	N/A	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	00	06000	37.33773494	-122.0043395	Santa Clara County
341787	Ordering, Referring, Prescribing	N/A	1659938249	0	0	LEMERE, ALLISON G LMFT	9/29/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT134983	N/A	N/A	N/A	N/A	N/A	5730 PACKARD AVE	SUITE 220	MARYSVILLE	CA	95901	7118	00	06000	39.12014523	-121.5659991	Yuba County
341798	Ordering, Referring, Prescribing	N/A	1659964864	0	0	LONDHE, ANJALI PHARMD	8/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49512	N/A	N/A	N/A	N/A	N/A	2303 E VINEYARD AVE	None	OXNARD	CA	93036	2183	00	06000	34.22736735	-119.1767224	Ventura County
341800	Ordering, Referring, Prescribing	N/A	1659967776	0	0	LUTTRELL, TANYA LMFT	5/23/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123123	N/A	N/A	N/A	N/A	N/A	700 H STREET	STE 3650	SACRAMENTO	CA	95814	1224	00	06000	38.582811	-121.4959995	Sacramento County
341821	Ordering, Referring, Prescribing	N/A	1669026423	0	0	LADHAR, CRYSTAL M	8/12/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	103890	N/A	N/A	N/A	N/A	N/A	1920 MEMORIAL DR	None	CERES	CA	95307	1827	00	06000	37.600146	-120.961042	Stanislaus County
341855	Ordering, Referring, Prescribing	N/A	1669107900	0	0	LEE, HEEJUN NP	8/26/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022405	N/A	N/A	N/A	N/A	N/A	711 STONY POINT RD	None	SANTA ROSA	CA	95407	6802	00	06000	38.428848	-122.7420045	Sonoma County
341856	Ordering, Referring, Prescribing	N/A	1669126991	0	0	LINERO, SAMANTHA LMFT	8/29/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	149290	N/A	N/A	N/A	N/A	N/A	2008 N GAREY AVE	None	POMONA	CA	91767	2722	00	06000	34.08295003	-117.7528173	Los Angeles County
341857	Ordering, Referring, Prescribing	N/A	1669137089	0	0	LANIER CHAVEZ, ARIANNA	10/24/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018951	N/A	N/A	N/A	N/A	N/A	303 LOMA DRIVE	202	LOS ANGELES	CA	90017	1103	00	06000	34.0595565	-118.2659336	Los Angeles County
341879	Ordering, Referring, Prescribing	N/A	1669180600	0	0	LOPEZ, MARIBEL LCSW	1/12/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	86171	N/A	N/A	N/A	N/A	N/A	1601 PRECISION PARK LANE	None	SAN DIEGO	CA	92173	1345	00	06000	32.56692	-117.0594273	San Diego County
341887	Ordering, Referring, Prescribing	N/A	1669232088	0	0	LIN, CATHY PHARMD	4/17/2023	Taxonomy not applicable	NA	n/a	000	Unknown	64183	N/A	N/A	N/A	N/A	N/A	3020 SATURN ST	100	BREA	CA	92821	6262	00	06000	33.9089406	-117.857311	Orange County
341897	Ordering, Referring, Prescribing	N/A	1669250288	0	0	LIU, YUAN CNP	9/14/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027198	N/A	N/A	N/A	N/A	N/A	701 S ATLANTIC BLVD	100	MONTEREY PARK	CA	91754	3844	00	06000	34.05382447	-118.1363489	Los Angeles County
341912	Ordering, Referring, Prescribing	N/A	1669500666	0	0	LEE, JEFFREY M	4/21/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D39293	N/A	N/A	N/A	N/A	N/A	7526 MONTEREY ST	None	GILROY	CA	95020	5826	00	06000	37.00852861	-121.5694352	Santa Clara County
341915	Ordering, Referring, Prescribing	N/A	1669502928	0	0	LEMERT, REBECCA G	11/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46752	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
341926	Ordering, Referring, Prescribing	N/A	1669520243	0	0	LANE, LINWOOD A	11/8/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	100973	N/A	N/A	N/A	N/A	N/A	50100 GOLSH ROAD	None	VALLEY CENTER	CA	92082	5338	00	06000	33.27715948	-116.9618201	San Diego County
341934	Ordering, Referring, Prescribing	N/A	1669542627	0	0	LEWIS, DOUGLAS S	5/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D36788	N/A	N/A	N/A	N/A	N/A	333 LAWS AVE	None	UKIAH	CA	95482	6540	00	06000	39.12772164	-123.2111168	Mendocino County
341944	Ordering, Referring, Prescribing	N/A	1669563334	0	0	LEMAK, DAVID L MD	9/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G182151	N/A	N/A	N/A	N/A	N/A	10956 DONNER PASS RD	110	TRUCKEE	CA	96161	4861	00	06000	39.32625521	-120.2012059	Nevada County
341953	Ordering, Referring, Prescribing	N/A	1669595658	0	0	LEE, DIANE S PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55913	N/A	N/A	N/A	N/A	N/A	200 MUIR RD	None	MARTINEZ	CA	94553	4614	00	06000	37.99430233	-122.1107194	Contra Costa County
341977	Ordering, Referring, Prescribing	N/A	1669662102	0	0	LANDINI, JENNY LCSW	6/28/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW70173	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
341991	Ordering, Referring, Prescribing	N/A	1669702171	0	0	LARSON, SATU A NP	9/24/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	13031	N/A	N/A	N/A	N/A	N/A	21507 EAST CLIFF DR	None	SANTA CRUZ	CA	95062	4844	00	06000	36.96330203	-121.9900666	Santa Cruz County
342030	Ordering, Referring, Prescribing	N/A	1669785952	0	0	LE, VUVY H PHARMD	1/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH57175	N/A	N/A	N/A	N/A	N/A	2640 LOMITA BLVD	None	TORRANCE	CA	90505	5214	00	06000	33.80800785	-118.332844	Los Angeles County
342031	Ordering, Referring, Prescribing	N/A	1669785739	0	0	LOREDO, SHARMAN T LCSW	12/17/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64313	N/A	N/A	N/A	N/A	N/A	40 ELDRIDGE AVENUE	9C	VACAVILLE	CA	95688	6823	00	06000	38.35699577	-122.0011996	Solano County
342045	Ordering, Referring, Prescribing	N/A	1669805420	0	0	LEYVA, CYNTHIA LMFT	8/9/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	148756	N/A	N/A	N/A	N/A	N/A	1245 E SANTA CLARA ST	None	SAN JOSE	CA	95116	2337	00	06000	37.34780368	-121.8662009	Santa Clara County
342053	Ordering, Referring, Prescribing	N/A	1669817607	0	0	LEIBOW, MICHAEL S PSYD	12/21/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	31070	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	SUITE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
342059	Ordering, Referring, Prescribing	N/A	1669840534	0	0	LEE, DIANE OD	12/8/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	33345	N/A	N/A	N/A	N/A	N/A	401 E SCHOOL AVE	None	VISALIA	CA	93291	5032	00	06000	36.332757	-119.288682	Tulare County
342082	Ordering, Referring, Prescribing	N/A	1669876611	0	0	LAU, RITA	3/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71052	N/A	N/A	N/A	N/A	N/A	515 FELTON STREET	None	SAN FRANCISCO	CA	94134	1400	00	06000	37.7286304	-122.4098531	San Francisco County
342096	Ordering, Referring, Prescribing	N/A	1669903274	0	0	LOPEZ, CHRISTINA N LMFT	10/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122437	N/A	N/A	N/A	N/A	N/A	66 HURLBUT ST	None	PASADENA	CA	91105	4025	00	06000	34.12993251	-118.1516625	Los Angeles County
342165	Ordering, Referring, Prescribing	N/A	1679023857	0	0	LIN, YING Y PHARMD	10/4/2018	Taxonomy not applicable	NA	n/a	000	Unknown	63496	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE	None	SAN JOSE	CA	95128	1238	00	06000	37.3160785	-121.937121	Santa Clara County
342171	Ordering, Referring, Prescribing	N/A	1679037212	0	0	LYNCH, ANAHIS C LMFT	4/17/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146440	N/A	N/A	N/A	N/A	N/A	205 PASADENA AVE	None	SOUTH PASADENA	CA	91030	2919	00	06000	34.11219143	-118.1709685	Los Angeles County
342182	Ordering, Referring, Prescribing	N/A	1679046312	0	0	LEE, JANET	12/15/2018	Taxonomy not applicable	NA	n/a	000	Unknown	80029	N/A	N/A	N/A	N/A	N/A	3375 JEFFERSON ST	None	NAPA	CA	94558	9998	00	06000	38.32158001	-122.2995836	Napa County
342204	Ordering, Referring, Prescribing	N/A	1679074280	0	0	LAZO, GEORGE ALEXANDER F PSYD	6/14/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29901	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
342230	Ordering, Referring, Prescribing	N/A	1679117295	0	0	LOPEZ, RAUL A LCSW	2/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121104	N/A	N/A	N/A	N/A	N/A	1055 W HENDERSON AVE	None	PORTERVILLE	CA	93257	1490	00	06000	36.08036906	-119.0410926	Tulare County
342247	Ordering, Referring, Prescribing	N/A	1679137780	0	0	LACH, REBECCA L MD	4/4/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177922	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
342273	Ordering, Referring, Prescribing	N/A	1679213037	0	0	LOPEZ BLAKE, BRENDA I	12/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA62055	N/A	N/A	N/A	N/A	N/A	1182 N EUCLID ST	None	ANAHEIM	CA	92801	1900	00	06000	33.849909	-117.9416115	Orange County
342288	Ordering, Referring, Prescribing	N/A	1679261721	0	0	LEVERENCE, SARAH M CCC-SLP	5/12/2022	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	27671	N/A	N/A	N/A	N/A	N/A	1901 N RICE AVE	170-180	OXNARD	CA	93030	7912	00	06000	34.21960355	-119.1421345	Ventura County
342292	Ordering, Referring, Prescribing	N/A	1679290407	0	0	LIM, SEYON	10/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	87062	N/A	N/A	N/A	N/A	N/A	1799 MARLOW RD	None	SANTA ROSA	CA	95401	4474	00	06000	38.452095	-122.752836	Sonoma County
342309	Ordering, Referring, Prescribing	N/A	1679565964	0	0	LUCHETTI, MARY ELLEN MD	5/31/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G65392	N/A	N/A	N/A	N/A	N/A	9781 BLUE LARKSPUR LN	None	MONTEREY	CA	93940	6509	00	06000	36.57152408	-121.8037459	Monterey County
342312	Ordering, Referring, Prescribing	N/A	1679557862	0	0	LASICH, CHRISTINA L MD	10/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A68111	N/A	N/A	N/A	N/A	N/A	1165 S. DORA STREET, STE	None	UKIAH	CA	95482	6353	00	06000	39.13602308	-123.2095502	Mendocino County
342321	Ordering, Referring, Prescribing	N/A	1679609788	0	0	LUKASIK, MEGHAN K PHD	7/24/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY15869	N/A	N/A	N/A	N/A	N/A	25170 HANCOCK AVE	None	MURRIETA	CA	92562	5969	00	06000	33.565149	-117.1823815	Riverside County
342355	Ordering, Referring, Prescribing	N/A	1679670673	0	0	LOSSY, PANNA S	5/1/2013	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G00080810	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
342357	Ordering, Referring, Prescribing	N/A	1679673271	0	0	LENINGTON, LARA	10/29/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	17204	N/A	N/A	N/A	N/A	N/A	1663 DOMINICAN WAY SUITE	None	SANTA CRUZ	CA	95065	1556	00	06000	36.99029729	-121.9809324	Santa Cruz County
342371	Ordering, Referring, Prescribing	N/A	1679712947	0	0	LEE KIM, CINDY MD	11/21/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A109891	N/A	N/A	N/A	N/A	N/A	1 HOPE DR	None	TUSTIN	CA	92782	0221	00	06000	33.71470753	-117.8323965	Orange County
342401	Ordering, Referring, Prescribing	N/A	1679776785	0	0	LAU, KIM P PHARMD	3/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52192	N/A	N/A	N/A	N/A	N/A	1800 HARRISON ST	FLOOR 13	OAKLAND	CA	94612	3466	00	06000	37.80593773	-122.2656714	Alameda County
342405	Ordering, Referring, Prescribing	N/A	1679779755	0	0	LAUTER, JENNIFER S	6/4/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY24554	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS ROAD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
342412	Ordering, Referring, Prescribing	N/A	1679797674	0	0	LEE, SPENCER A	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53587	N/A	N/A	N/A	N/A	N/A	4131 GEARY BLVD	B25	SAN FRANCISCO	CA	94118	3101	00	06000	37.78096053	-122.4637512	San Francisco County
342420	Ordering, Referring, Prescribing	N/A	1679811186	0	0	LIRA, LORI E LMFT	5/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT35891	N/A	N/A	N/A	N/A	N/A	1330 W RAMSEY ST	None	BANNING	CA	92220	4477	00	06000	33.92538854	-116.8912035	Riverside County
342438	Ordering, Referring, Prescribing	N/A	1679845184	0	0	LACEY, ABIGAIL CNM	5/16/2019	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	NMW236038	N/A	N/A	N/A	N/A	N/A	1685 E MAIN STREET	SUITE 301	EL CAJON	CA	92021	5292	00	06000	32.81132509	-116.9192044	San Diego County
342480	Ordering, Referring, Prescribing	N/A	1679937395	0	0	LEE, JESSICA PHARMD	11/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	66726	N/A	N/A	N/A	N/A	N/A	707 CONTRA COSTA BLVD	None	PLEASANT HILL	CA	94523	1516	00	06000	37.97098068	-122.0633635	Contra Costa County
342485	Ordering, Referring, Prescribing	N/A	1679940225	0	0	LOPEZ, MARIEVA G LMFT	1/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116176	N/A	N/A	N/A	N/A	N/A	2001 E. 4TH ST	116	SANTA ANA	CA	92705	9999	00	06000	33.74826075	-117.8385386	Orange County
342581	Ordering, Referring, Prescribing	N/A	1689092926	0	0	LOPEZ, YESENIA LMFT	7/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120043	N/A	N/A	N/A	N/A	N/A	2940 LNLAND EMPIRE BLVD	None	ONTARIO	CA	91764	0607	00	06000	34.069788	-117.5884605	San Bernardino County
342622	Ordering, Referring, Prescribing	N/A	1689151128	0	0	LIN, POLLY P LMFT	6/23/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133103	N/A	N/A	N/A	N/A	N/A	401 W CIVIC CENTER DR	STE 600	SANTA ANA	CA	92701	4515	00	06000	33.75157353	-117.870921	Orange County
342634	Ordering, Referring, Prescribing	N/A	1689170920	0	0	LIU, MING Z MD MPH	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166167	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
342651	Ordering, Referring, Prescribing	N/A	1689199598	0	0	LETCHINGER, MARTHA L	4/20/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107740	N/A	N/A	N/A	N/A	N/A	1119 PACIFIC AVE.	SUITE 200	SANTA CRUZ	CA	95060	0000	00	06000	36.9722444	-122.0256836	Santa Cruz County
342663	Ordering, Referring, Prescribing	N/A	1689215998	0	0	LEE, YOUNJIN M	3/30/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	103897	N/A	N/A	N/A	N/A	N/A	12362 BEACH BLVD	STE 10	STANTON	CA	90680	3944	00	06000	33.78298855	-117.9927453	Orange County
342731	Ordering, Referring, Prescribing	N/A	1689410607	0	0	LYNCH, CHRISTINA LCSW	8/30/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26187	N/A	N/A	N/A	N/A	N/A	350 W BROOKSIDE	None	BEAUMONT	CA	92223	7202	00	06000	33.963327	-116.9848215	Riverside County
342770	Ordering, Referring, Prescribing	N/A	1689726200	0	0	LEE, DAVID W	8/3/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D36784	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
342789	Ordering, Referring, Prescribing	N/A	1689790073	0	0	LAIDLAW, JOHN K LMFT	1/10/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44560	N/A	N/A	N/A	N/A	N/A	10737 CAMINO RUIZ	235	SAN DIEGO	CA	92126	2359	00	06000	32.91416051	-117.1437943	San Diego County
342798	Ordering, Referring, Prescribing	N/A	1689818833	0	0	LOPEZ-RIVERA, NORMA A CCC-SLP	3/2/2020	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	15105	N/A	N/A	N/A	N/A	N/A	203 E BADILLO ST	None	COVINA	CA	91723	2116	00	06000	34.08632348	-117.8873145	Los Angeles County
342799	Ordering, Referring, Prescribing	N/A	1689802548	0	0	LEE, PETER C PHARMD	2/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61310	N/A	N/A	N/A	N/A	N/A	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	00	06000	34.21980849	-118.4301135	Los Angeles County
342807	Ordering, Referring, Prescribing	N/A	1689826091	0	0	LANGHURST, TRACY L	2/1/2018	Taxonomy not applicable	NA	n/a	000	Unknown	53046	N/A	N/A	N/A	N/A	N/A	535 AIRPORT RD	None	HOOPA	CA	95546	1288	00	06000	41.04169689	-123.6656063	Humboldt County
342810	Ordering, Referring, Prescribing	N/A	1689834020	0	0	LOPEZ-PATEL, MARIA MD	1/19/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A99570	N/A	N/A	N/A	N/A	N/A	1828 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2400	00	06000	34.05023174	-118.2154927	Los Angeles County
342825	Ordering, Referring, Prescribing	N/A	1689862146	0	0	LEE, JINA D	3/9/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D56028	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
342826	Ordering, Referring, Prescribing	N/A	1689864340	0	0	LIND, NICKOLAS L MD	4/12/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A35559	N/A	N/A	N/A	N/A	N/A	81709 DR CARREON BLVD	E-1	INDIO	CA	92201	5578	00	06000	33.70733082	-116.2400326	Riverside County
342836	Ordering, Referring, Prescribing	N/A	1689888216	0	0	LAGUNA, PAULINA LCSW	8/31/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28506	N/A	N/A	N/A	N/A	N/A	6061 EAST AVE	None	ETIWANDA	CA	91739	2218	00	06000	34.14421719	-117.514554	San Bernardino County
342868	Ordering, Referring, Prescribing	N/A	1689941726	0	0	LUNG, ERIN LMFT	12/8/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT87979	N/A	N/A	N/A	N/A	N/A	861 AUTO CENTER DRIVE	None	PALMDALE	CA	93551	4493	00	06000	34.59142164	-118.14665	Los Angeles County
342871	Ordering, Referring, Prescribing	N/A	1689943516	0	0	LEGARRETA, DEBORA LCSW	7/11/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101865	N/A	N/A	N/A	N/A	N/A	6800 OWENSMOUTH AVE #160	None	CANOGA PARK	CA	91303	3159	00	06000	34.194276	-118.6014945	Los Angeles County
342908	Ordering, Referring, Prescribing	N/A	1699016980	0	0	LEE, DAVID J DO	4/19/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14782	N/A	N/A	N/A	N/A	N/A	1975 VERDUGO BLVD	None	LA CANADA	CA	91011	3022	00	06000	34.20501855	-118.219857	Los Angeles County
342918	Ordering, Referring, Prescribing	N/A	1699043620	0	0	LE, THINH T PHARMD	8/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH56615	N/A	N/A	N/A	N/A	N/A	550 S GRAND AVE	None	GLENDORA	CA	91741	4211	00	06000	34.129584	-117.872534	Los Angeles County
342928	Ordering, Referring, Prescribing	N/A	1699057208	0	0	LIBERATO-LIM, JUSTINE A PHARMD	1/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71832	N/A	N/A	N/A	N/A	N/A	11450 SAN PABLO AVE	None	EL CERRITO	CA	94530	1917	00	06000	37.92212809	-122.3160667	Contra Costa County
342941	Ordering, Referring, Prescribing	N/A	1699066795	0	0	LI, EDWARD MD	12/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158004	N/A	N/A	N/A	N/A	N/A	101 S FICKETT ST	None	LOS ANGELES	CA	90033	4017	00	06000	34.04231839	-118.2075342	Los Angeles County
342968	Ordering, Referring, Prescribing	N/A	1699108027	0	0	LE, ANNIE N NP	3/2/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002025	N/A	N/A	N/A	N/A	N/A	368 FELL ST	None	SAN FRANCISCO	CA	94102	5144	00	06000	37.77587758	-122.4234278	San Francisco County
342969	Ordering, Referring, Prescribing	N/A	1699103085	0	0	LOERA, RODOLFO LCSW	6/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88144	N/A	N/A	N/A	N/A	N/A	1801 S. POPLAR	None	SANTA ANA	CA	92868	2941	00	06000	33.72358134	-117.8872543	Orange County
342987	Ordering, Referring, Prescribing	N/A	1699140863	0	0	LAU, HELEN S LCSW	5/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	15998	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
343002	Ordering, Referring, Prescribing	N/A	1699176453	0	0	LEFEBVRE, MICHELLE E PSYD	11/22/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31959	N/A	N/A	N/A	N/A	N/A	1560 MARKET STREET	None	REDDING	CA	96001	1023	00	06000	40.58346871	-122.390608	Shasta County
343012	Ordering, Referring, Prescribing	N/A	1699188854	0	0	LOPEZ, JOE LMFT	12/11/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104467	N/A	N/A	N/A	N/A	N/A	905 E 8TH ST	None	LOS ANGELES	CA	90021	1848	00	06000	34.03639545	-118.2465917	Los Angeles County
343026	Ordering, Referring, Prescribing	N/A	1699218610	0	0	LOGAN, GREGORY LMFT	5/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112204	N/A	N/A	N/A	N/A	N/A	370 W. CRENSHAW BLVD.	E-100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
343030	Ordering, Referring, Prescribing	N/A	1699220590	0	0	LINSLEY, LAURIE L LMFT	1/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117199	N/A	N/A	N/A	N/A	N/A	5168 HONPIE RD	None	PLACERVILLE	CA	95667	8682	00	06000	38.6943603	-120.9018271	El Dorado County
343044	Ordering, Referring, Prescribing	N/A	1699247650	0	0	LIZARDO, JESSICA LCSW	9/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	104421	N/A	N/A	N/A	N/A	N/A	3301 E. 12TH ST.	259	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
343050	Ordering, Referring, Prescribing	N/A	1699258640	0	0	LE, TRAM Q PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH74184	N/A	N/A	N/A	N/A	N/A	5695 ALTON PKWY	None	IRVINE	CA	92618	4059	00	06000	33.66846665	-117.786127	Orange County
343085	Ordering, Referring, Prescribing	N/A	1699327486	0	0	LEE, LINDA PHARMD	4/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79354	N/A	N/A	N/A	N/A	N/A	1263 E ARQUES AVE	None	SUNNYVALE	CA	94085	4701	00	06000	37.38060846	-121.9896672	Santa Clara County
343105	Ordering, Referring, Prescribing	N/A	1699373480	0	0	LUTZ, SUSANA PSYD	2/4/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY17270	N/A	N/A	N/A	N/A	N/A	510 S VERMONT AVE	None	LOS ANGELES	CA	90020	1912	00	06000	34.065	-118.291631	Los Angeles County
343118	Ordering, Referring, Prescribing	N/A	1699394403	0	0	LU, STEVEN E	7/15/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	104931	N/A	N/A	N/A	N/A	N/A	650 S ZEDIKER AVE	BLDG 3	PARLIER	CA	93648	2667	00	06000	36.60500164	-119.5210273	Fresno County
343149	Ordering, Referring, Prescribing	N/A	1699461772	0	0	LUBWAMA, PROSCOVIA B NP	7/11/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024849	N/A	N/A	N/A	N/A	N/A	251 E AVENUE K6	None	LANCASTER	CA	93535	4509	00	06000	34.6694965	-118.1264085	Los Angeles County
343169	Ordering, Referring, Prescribing	N/A	1699590471	0	0	LEAHONG, HOPETON NP	11/18/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032938	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
343184	Ordering, Referring, Prescribing	N/A	1699763672	0	0	LORNE, ALLISON M CNM	8/24/2017	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	2013	N/A	N/A	N/A	N/A	N/A	415 E CHAPEL ST	None	SANTA MARIA	CA	93454	4517	00	06000	34.95431543	-120.4307344	Santa Barbara County
343185	Ordering, Referring, Prescribing	N/A	1699773127	0	0	LILLIS, CHRISTOPHER MD	8/30/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C137799	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
343205	Ordering, Referring, Prescribing	N/A	1699808774	0	0	LANKTREE, MAUREEN E LMFT	12/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38157	N/A	N/A	N/A	N/A	N/A	12099 W WASHINGTON BLVD	200	LOS ANGELES	CA	90066	2622	00	06000	33.99748876	-118.4239234	Los Angeles County
343212	Ordering, Referring, Prescribing	N/A	1699816108	0	0	LOPEZ-SHAMS, MARIA C	1/30/1995	Taxonomy not applicable	NA	n/a	099	DENTIST	D37579	N/A	N/A	N/A	N/A	N/A	3415 MARTIN LUTHER KING	JR BLVD	SACRAMENTO	CA	95817	3648	00	06000	38.54376	-121.4644095	Sacramento County
343257	Ordering, Referring, Prescribing	N/A	1699922153	0	0	LIVINGSTON, RONYA PSYD	6/10/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28037	N/A	N/A	N/A	N/A	N/A	1227 E LOS ANGELES AVE	None	SIMI VALLEY	CA	93065	2871	00	06000	34.27181352	-118.7762625	Ventura County
343284	Ordering, Referring, Prescribing	N/A	1700027703	0	0	LOZA, GUSTAVO A PA-C	1/28/2018	Taxonomy not applicable	NA	n/a	000	Unknown	PA19788	N/A	N/A	N/A	N/A	N/A	3045 FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5837	00	06000	33.97305955	-118.2139451	Los Angeles County
343310	Ordering, Referring, Prescribing	N/A	1700083672	0	0	LUCAS, PATRICE L PHARMD	6/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	68335	N/A	N/A	N/A	N/A	N/A	275 HOSPITAL PKWY	625	SAN JOSE	CA	95119	1106	00	06000	37.23951066	-121.8013511	Santa Clara County
343330	Ordering, Referring, Prescribing	N/A	1700116779	0	0	LANDEIS, WILLIAM K PHARMD	7/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70464	N/A	N/A	N/A	N/A	N/A	925 ORANGE AVE	None	CORONADO	CA	92118	2609	00	06000	32.68677093	-117.1792108	San Diego County
343333	Ordering, Referring, Prescribing	N/A	1700121118	0	0	LETICA, VICTORIA A LMFT	3/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110089	N/A	N/A	N/A	N/A	N/A	15701 LORENZO AVENUE	None	SAN LORENZO	CA	94580	1407	00	06000	37.68026079	-122.1379698	Alameda County
343412	Ordering, Referring, Prescribing	N/A	1700212958	0	0	LOPEZ, ARIELLE	10/10/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	118542	N/A	N/A	N/A	N/A	N/A	767 N HILL ST.	400	LOS ANGELES	CA	90012	2381	00	06000	34.06255157	-118.2397077	Los Angeles County
343426	Ordering, Referring, Prescribing	N/A	1700236098	0	0	LADUMOR, BHAVESH G DDS	1/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	103564	N/A	N/A	N/A	N/A	N/A	201 E LAKEVIEW AVE	None	WOODLAKE	CA	93286	1301	00	06000	36.4172997	-119.0975768	Tulare County
343430	Ordering, Referring, Prescribing	N/A	1700254166	0	0	LUCERO, GABRIELA K LCSW	2/23/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107043	N/A	N/A	N/A	N/A	N/A	1 HOPE DR	None	TUSTIN	CA	92782	0221	00	06000	33.71470753	-117.8323965	Orange County
343431	Ordering, Referring, Prescribing	N/A	1700253986	0	0	LOPEZ, VANESSA LMFT	6/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT119968	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	260A	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
343433	Ordering, Referring, Prescribing	N/A	1700252285	0	0	LAVIAN, MELODY E PSYD	12/15/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29452	N/A	N/A	N/A	N/A	N/A	21081 S. WESTERN AVE	295	TORRANCE	CA	90501	1707	00	06000	33.83886841	-118.3093605	Los Angeles County
343448	Ordering, Referring, Prescribing	N/A	1700288594	0	0	LI, AMY Y PHARMD	3/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH71355	N/A	N/A	N/A	N/A	N/A	1800 HARRISON STREET	13TH FLOOR	OAKLAND	CA	94612	3466	00	06000	37.80593773	-122.2656714	Alameda County
343484	Ordering, Referring, Prescribing	N/A	1700344538	0	0	LE, CURTIS DDS	2/26/2023	Taxonomy not applicable	NA	n/a	000	Unknown	105777	N/A	N/A	N/A	N/A	N/A	8233 E. STOCKTON BLVD	STE D	SACRAMENTO	CA	95828	8203	00	06000	38.459628	-121.4095815	Sacramento County
343493	Ordering, Referring, Prescribing	N/A	1700346939	0	0	LAU, TIFFANY W	4/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	79816	N/A	N/A	N/A	N/A	N/A	450 10TH ST	None	SAN FRANCISCO	CA	94103	4304	00	06000	37.77094095	-122.4105065	San Francisco County
343496	Ordering, Referring, Prescribing	N/A	1700359585	0	0	LINDSEY, TERRI R RN	2/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	743181	N/A	N/A	N/A	N/A	N/A	1300 BAKER STREET	None	BAKERSFIELD	CA	93305	4326	00	06000	35.38256022	-118.990868	Kern County
343565	Ordering, Referring, Prescribing	N/A	1700456126	0	0	LUCAS, NATALIE NP	11/27/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020087	N/A	N/A	N/A	N/A	N/A	10700 MACARTHUR BLVD	None	OAKLAND	CA	94605	5298	00	06000	37.74201242	-122.151048	Alameda County
343579	Ordering, Referring, Prescribing	N/A	1700498227	0	0	LAM, DOMINIQUE H OD	8/10/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34614	N/A	N/A	N/A	N/A	N/A	32245 MISSION TRAIL,	D4	LAKE ELSINORE	CA	92530	4528	00	06000	33.65526061	-117.2976756	Riverside County
343591	Ordering, Referring, Prescribing	N/A	1700544582	0	0	LOPEZ, MICHAEL D PHARMD	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77369	N/A	N/A	N/A	N/A	N/A	3550 ROUND BARN BLVD	109	SANTA ROSA	CA	95403	1796	00	06000	38.476152	-122.7257685	Sonoma County
343609	Ordering, Referring, Prescribing	N/A	1700642311	0	0	LAZARO, CARL VIRGIL B PA-C	3/14/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64242	N/A	N/A	N/A	N/A	N/A	22310 WARDHAM AVE	None	HAWAIIAN GARDENS	CA	90716	1740	00	06000	33.82667708	-118.0650149	Los Angeles County
343612	Ordering, Referring, Prescribing	N/A	1700649985	0	0	LEE, IRENE NP	12/14/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95028382	N/A	N/A	N/A	N/A	N/A	190 E. HIGHLAND AVENUE	None	SAN BERNARDINO	CA	92404	3658	00	06000	34.1360043	-117.2826788	San Bernardino County
343616	Ordering, Referring, Prescribing	N/A	1700658879	0	0	LI, CHEN RN	7/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95022353	N/A	N/A	N/A	N/A	N/A	4100 NORMAL ST	None	SAN DIEGO	CA	92103	2653	00	06000	32.75524466	-117.1465638	San Diego County
343629	Ordering, Referring, Prescribing	N/A	1700857265	0	0	LOPEZ, CARMEN I MD	3/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A35812	N/A	N/A	N/A	N/A	N/A	67 E ASHLAN AVE	None	FRESNO	CA	93704	3518	00	06000	36.7939172	-119.8122805	Fresno County
343634	Ordering, Referring, Prescribing	N/A	1700880267	0	0	LEE, SEUNG KWON MD	3/23/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C54971	N/A	N/A	N/A	N/A	N/A	6620 COYLE AVE STE 408	STE 408	CARMICHAEL	CA	95608	6338	00	06000	38.66751	-121.310028	Sacramento County
343650	Ordering, Referring, Prescribing	N/A	1700917804	0	0	LOVEJOY, STEPHEN M LMFT	12/21/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46478	N/A	N/A	N/A	N/A	N/A	5150 E PACIFIC COAST HWY	100	LONG BEACH	CA	90804	3312	00	06000	33.7831762	-118.1333125	Los Angeles County
343660	Ordering, Referring, Prescribing	N/A	1700946035	0	0	LUCCHESI, NICOLE M LMFT	11/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45497	N/A	N/A	N/A	N/A	N/A	1119 E MONTE VISTA AVE	None	VACAVILLE	CA	95688	3009	00	06000	38.36024633	-121.9763983	Solano County
343666	Ordering, Referring, Prescribing	N/A	1700954716	0	0	LE, CHIEU-UYEN PHARMD	3/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH52089	N/A	N/A	N/A	N/A	N/A	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	00	06000	37.23951066	-121.8013511	Santa Clara County
343674	Ordering, Referring, Prescribing	N/A	1700970761	0	0	LEE, MO LOUISE F PHARMD	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH50188	N/A	N/A	N/A	N/A	N/A	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
343685	Ordering, Referring, Prescribing	N/A	1710003702	0	0	LIANG-KRUKAR, BARBARA PHARMD	10/19/2019	Taxonomy not applicable	NA	n/a	000	Unknown	39655	N/A	N/A	N/A	N/A	N/A	727 SHASTA STREET	STE 203	REDWOOD CITY	CA	94063	2124	00	06000	37.47945362	-122.2230493	San Mateo County
343687	Ordering, Referring, Prescribing	N/A	1700975976	0	0	LIU, DAVID M MD	5/30/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C56003	N/A	N/A	N/A	N/A	N/A	4816 E 3RD ST	None	LOS ANGELES	CA	90022	1602	00	06000	34.03327647	-118.16037	Los Angeles County
343714	Ordering, Referring, Prescribing	N/A	1710054606	0	0	LEE, CHIN MD	7/9/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A39014	N/A	N/A	N/A	N/A	N/A	1403 W. LOMITA BLVD.	SUITE 100	HARBOR CITY	CA	90710	2084	00	06000	33.79785936	-118.3016552	Los Angeles County
343718	Ordering, Referring, Prescribing	N/A	1710066170	0	0	LIN, MAUREEN M LMFT	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43449	N/A	N/A	N/A	N/A	N/A	802 BREWSTER AVE	None	REDWOOD CITY	CA	94063	1510	00	06000	37.48873991	-122.2339433	San Mateo County
343722	Ordering, Referring, Prescribing	N/A	1710066709	0	0	LAI, JENNIFER B	4/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50539	N/A	N/A	N/A	N/A	N/A	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	00	06000	38.00450116	-122.5540001	Marin County
343754	Ordering, Referring, Prescribing	N/A	1710166814	0	0	LAM, RITA S L	5/4/2017	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	48703	N/A	N/A	N/A	N/A	N/A	3850 17TH ST	None	SAN FRANCISCO	CA	94114	2031	00	06000	37.76272129	-122.4318522	San Francisco County
343760	Ordering, Referring, Prescribing	N/A	1710179387	0	0	LIPUMANO-SANCHEZ, LULETTE F	1/15/2004	Taxonomy not applicable	NA	n/a	099	DENTIST	D50950	N/A	N/A	N/A	N/A	N/A	517 S MADERA AVE	None	KERMAN	CA	93630	1523	00	06000	36.72710606	-120.060325	Fresno County
343770	Ordering, Referring, Prescribing	N/A	1710197041	0	0	LEMASTER, SHANNON H MD	11/29/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A115681	N/A	N/A	N/A	N/A	N/A	201 N. CIVIC DR	183	WALNUT CREEK	CA	94596	3864	00	06000	37.91024298	-122.0593495	Contra Costa County
343789	Ordering, Referring, Prescribing	N/A	1710237292	0	0	LAITINEN, MARYJANE C LMFT	3/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114593	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	100	GILROY	CA	95020	3675	00	06000	37.03080985	-121.5741639	Santa Clara County
343797	Ordering, Referring, Prescribing	N/A	1710254917	0	0	LY, NHAN T PHARMD	7/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62885	N/A	N/A	N/A	N/A	N/A	20505 SHERMAN WAY	None	CANOGA PARK	CA	91306	3427	00	06000	34.20115951	-118.5802425	Los Angeles County
343820	Ordering, Referring, Prescribing	N/A	1710283239	0	0	LAKOMA, KRISTIN	11/26/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC13779	N/A	N/A	N/A	N/A	N/A	2200 DEL PASO BLVD	None	SACRAMENTO	CA	95815	3102	00	06000	38.609991	-121.4506125	Sacramento County
343829	Ordering, Referring, Prescribing	N/A	1710294657	0	0	LETTIERI, EMILY LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT110740	N/A	N/A	N/A	N/A	N/A	3951 PERFORMANCE DR	SUITE G	SACRAMENTO	CA	95838	3264	00	06000	38.639979	-121.464099	Sacramento County
343838	Ordering, Referring, Prescribing	N/A	1710301270	0	0	LIM, SE C OD	7/8/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	14835	N/A	N/A	N/A	N/A	N/A	1730 E 17TH ST. #G	None	SANTA ANA	CA	92705	8624	00	06000	33.758649	-117.8430255	Orange County
343863	Ordering, Referring, Prescribing	N/A	1710354295	0	0	LILE, WALTER M	3/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100824	N/A	N/A	N/A	N/A	N/A	339 PAJARO ST STE B	None	SALINAS	CA	93901	3400	00	06000	36.6725294	-121.6522021	Monterey County
343871	Ordering, Referring, Prescribing	N/A	1710360250	0	0	LALWANI, MEGHA MD	6/22/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158647	N/A	N/A	N/A	N/A	N/A	22675 ALESSANDRO BLVD	None	MORENO VALLEY	CA	92553	8551	00	06000	33.91695337	-117.2672536	Riverside County
343878	Ordering, Referring, Prescribing	N/A	1710364039	0	0	LOMELI, NICOLE LMFT	7/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT96331	N/A	N/A	N/A	N/A	N/A	811 WEST TELEGRAPH ROAD	None	SANTA PAULA	CA	93012	8520	00	06000	34.33991633	-119.08577	Ventura County
343926	Ordering, Referring, Prescribing	N/A	1710434873	0	0	LIN, VICKY MSW LCSW	6/10/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101923	N/A	N/A	N/A	N/A	N/A	1224 VINE ST	None	LOS ANGELES	CA	90038	1612	00	06000	34.093332	-118.326603	Los Angeles County
343944	Ordering, Referring, Prescribing	N/A	1710467170	0	0	LAIRD, JESSICA PSYD	2/1/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSB94028121	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE	300	SAN JOSE	CA	95128	2631	00	06000	37.3160785	-121.937121	Santa Clara County
343948	Ordering, Referring, Prescribing	N/A	1710475330	0	0	LIN, ELAINE J PHARMD	4/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	78369	N/A	N/A	N/A	N/A	N/A	1001 METRO CENTER BLVD	None	FOSTER CITY	CA	94404	2177	00	06000	37.56120852	-122.2739553	San Mateo County
343970	Ordering, Referring, Prescribing	N/A	1710516174	0	0	LIU, JONATHAN Y MD MPH	9/13/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187360	N/A	N/A	N/A	N/A	N/A	3250 WILSHIRE BLVD	320	LOS ANGELES	CA	90010	1577	00	06000	34.06176363	-118.2932622	Los Angeles County
343976	Ordering, Referring, Prescribing	N/A	1710523410	0	0	LARROSA, ESTEFANIA MD	9/4/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183648	N/A	N/A	N/A	N/A	N/A	1620 ALPINE BLVD	STE 110	ALPINE	CA	91901	1103	00	06000	32.83781579	-116.7799366	San Diego County
344014	Ordering, Referring, Prescribing	N/A	1710654660	0	0	LEWIS, SHAELAH E	9/29/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95154322	N/A	N/A	N/A	N/A	N/A	50 BRANSCOMB ROAD	None	LAYTONVILLE	CA	95454	0870	00	06000	39.68781544	-123.4842982	Mendocino County
344018	Ordering, Referring, Prescribing	N/A	1710662002	0	0	LEE, JOSHUA D MD	8/30/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189740	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
344045	Ordering, Referring, Prescribing	N/A	1710974365	0	0	LANOUETTE, GREGORY W MD	11/30/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G60237	N/A	N/A	N/A	N/A	N/A	10121 PINE AVENUE	SUITE 301	TRUCKEE	CA	96161	4835	00	06000	39.3245308	-120.2013097	Nevada County
344046	Ordering, Referring, Prescribing	N/A	1710967914	0	0	LIU, MARK Y DO	2/7/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A22527	N/A	N/A	N/A	N/A	N/A	535 AIRPORT RD.	None	HOOPA	CA	95546	1288	00	06000	41.04169689	-123.6656063	Humboldt County
344069	Ordering, Referring, Prescribing	N/A	1720081029	0	0	LAM, DAWN Y OD FAAO	11/14/2023	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	12599	N/A	N/A	N/A	N/A	N/A	5460 E LA PALMA AVE	None	ANAHEIM	CA	92807	2023	00	06000	33.85983003	-117.7966383	Orange County
344070	Ordering, Referring, Prescribing	N/A	1720071160	0	0	LYNCH, KAREN M	9/3/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D53543	N/A	N/A	N/A	N/A	N/A	133 W MAIN ST	STE 100	EL CAJON	CA	92020	3325	00	06000	32.79492453	-116.9627861	San Diego County
344095	Ordering, Referring, Prescribing	N/A	1720141401	0	0	LAWSON, MARGARET J CNP	5/31/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	482690	N/A	N/A	N/A	N/A	N/A	1 HARPST ST	None	ARCATA	CA	95521	8222	00	06000	40.87420204	-124.0791833	Humboldt County
344097	Ordering, Referring, Prescribing	N/A	1720151202	0	0	LLOY, MAUREEN C PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50081	N/A	N/A	N/A	N/A	N/A	3240 ARDEN WAY	SUITE 105	SACRAMENTO	CA	95825	0325	00	06000	38.594898	-121.3884765	Sacramento County
344101	Ordering, Referring, Prescribing	N/A	1720158371	0	0	LARINA, MARGARITA PHARMD	4/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	56889	N/A	N/A	N/A	N/A	N/A	220 SYLVANIA AVE	None	SANTA CRUZ	CA	95060	2161	00	06000	36.98521615	-122.0347765	Santa Cruz County
344106	Ordering, Referring, Prescribing	N/A	1720166903	0	0	LUU, JENNIFER K PSYD	5/20/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY23812	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS	SUITE 220	MISSION VIEJO	CA	92691	6441	00	06000	33.56536541	-117.670334	Orange County
344110	Ordering, Referring, Prescribing	N/A	1720171507	0	0	LEUTE, ERIC J MD	11/4/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A80832	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
344115	Ordering, Referring, Prescribing	N/A	1720174659	0	0	LOPEZ, PATRICIA B RN PNP	8/8/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	557	N/A	N/A	N/A	N/A	N/A	1453 W TEMPLE ST	None	LOS ANGELES	CA	90026	5648	00	06000	34.06757953	-118.2579864	Los Angeles County
344160	Ordering, Referring, Prescribing	N/A	1720283419	0	0	LA ROSA, MARIA M LMFT	5/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT34865	N/A	N/A	N/A	N/A	N/A	79844 BETHPAGE AVE	None	INDIO	CA	92201	0922	00	06000	33.72135825	-116.2715074	Riverside County
344168	Ordering, Referring, Prescribing	N/A	1720294184	0	0	LEE, LAMBERT T	7/19/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D40958	N/A	N/A	N/A	N/A	N/A	2500 W 8TH ST	#106	LOS ANGELES	CA	90057	3860	00	06000	34.05685316	-118.2823508	Los Angeles County
344171	Ordering, Referring, Prescribing	N/A	1720270739	0	0	LEVINGER, CARL L PHD	12/17/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY15608	N/A	N/A	N/A	N/A	N/A	5110 W. GOLDLEAF CIRCLE	None	LOS ANGELES	CA	90056	1287	00	06000	33.98790164	-118.367233	Los Angeles County
344178	Ordering, Referring, Prescribing	N/A	1720317993	0	0	LEE-GARCIA, FELICIA M LMFT	6/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102484	N/A	N/A	N/A	N/A	N/A	1309 EVANS AVE.	None	SAN FRANCISCO	CA	94124	1705	00	06000	37.74005234	-122.3834106	San Francisco County
344191	Ordering, Referring, Prescribing	N/A	1720337728	0	0	LEE, STACY P LCSW	6/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW74873	N/A	N/A	N/A	N/A	N/A	1965 LIVE OAK BLVD	None	YUBA CITY	CA	95991	8850	00	06000	39.15563037	-121.620091	Sutter County
344194	Ordering, Referring, Prescribing	N/A	1720338650	0	0	LEROY, PATRICK N PHARMD	5/31/2018	Taxonomy not applicable	NA	n/a	000	Unknown	58396	N/A	N/A	N/A	N/A	N/A	1017 ELLINGTON ST	None	DELANO	CA	93215	2621	00	06000	35.76891908	-119.2515219	Kern County
344202	Ordering, Referring, Prescribing	N/A	1720352446	0	0	LOPEZ, LUISA G LMFT	6/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	101544	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	BUILDING 2	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
344219	Ordering, Referring, Prescribing	N/A	1720364201	0	0	LE, VICTORIA M PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49632	N/A	N/A	N/A	N/A	N/A	14885 TELEGRAGH RD	None	LA MIRADA	CA	90638	0000	00	06000	33.91748456	-118.0134841	Los Angeles County
344258	Ordering, Referring, Prescribing	N/A	1720420508	0	0	LOCQUIAO, JESIREY I D	4/24/2017	Taxonomy not applicable	NA	n/a	000	Unknown	23079	N/A	N/A	N/A	N/A	N/A	5959 TRUXTON AVE	STE 100	BAKERSFIED	CA	93309	0436	00	06000	35.36306164	-119.0711264	Kern County
344264	Ordering, Referring, Prescribing	N/A	1720427644	0	0	LIANG, CYNTHIA PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH67320	N/A	N/A	N/A	N/A	N/A	1800 HARRISON ST	None	OAKLAND	CA	94612	3429	00	06000	37.80593773	-122.2656714	Alameda County
344270	Ordering, Referring, Prescribing	N/A	1720434848	0	0	LU, HSIAOAI E CNP	9/19/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003757	N/A	N/A	N/A	N/A	N/A	954 W FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
344279	Ordering, Referring, Prescribing	N/A	1720448160	0	0	LUU, DANNY PHARMD	3/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73318	N/A	N/A	N/A	N/A	N/A	30116 EIGENBRODT WAY	None	UNION CITY	CA	94587	1225	00	06000	37.60846354	-122.0715526	Alameda County
344286	Ordering, Referring, Prescribing	N/A	1720448962	0	0	LOPEZ AZPEITIA, LILIANA L LMFT	12/19/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134717	N/A	N/A	N/A	N/A	N/A	625 34TH STE	100 & 200	BAKERSFIELD	CA	93301	2305	00	06000	35.39046051	-119.0092725	Kern County
344288	Ordering, Referring, Prescribing	N/A	1720453020	0	0	LEE, LUCY Z NP	5/11/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95002827	N/A	N/A	N/A	N/A	N/A	23962 ALICIA PKWY	I-1	MISSION VIEJO	CA	92691	3940	00	06000	33.61418475	-117.6795692	Orange County
344302	Ordering, Referring, Prescribing	N/A	1720471436	0	0	LEE, NANCY C PHARMD	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71354	N/A	N/A	N/A	N/A	N/A	6064 ALPINE BLUE DR.	None	SAN RAMON	CA	94582	5835	00	06000	37.75875491	-121.910639	Contra Costa County
344305	Ordering, Referring, Prescribing	N/A	1720472277	0	0	LEE, BRYAN J MD	11/21/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152378	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL, SUITE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
344309	Ordering, Referring, Prescribing	N/A	1720480882	0	0	LAWS, LAUREN	7/23/2018	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	NMW235675	N/A	N/A	N/A	N/A	N/A	1530 S. OLIVE STREET	None	LOS ANGELES	CA	90015	0000	00	06000	34.03542552	-118.2652073	Los Angeles County
344331	Ordering, Referring, Prescribing	N/A	1720509847	0	0	LANGDON, BRENDA LMFT	11/10/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130722	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
344348	Ordering, Referring, Prescribing	N/A	1720532468	0	0	LAM, HONG T	3/15/2018	Taxonomy not applicable	NA	n/a	000	Unknown	51738	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	None	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
344376	Ordering, Referring, Prescribing	N/A	1720570179	0	0	LIN, YI HUA	5/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69808	N/A	N/A	N/A	N/A	N/A	9713 BASE LINE RD	None	RANCHO CUCAMONGA	CA	91730	1408	00	06000	34.12151451	-117.5930955	San Bernardino County
344419	Ordering, Referring, Prescribing	N/A	1720640212	0	0	LIANG, JUSTINA PHARMD	10/11/2018	Taxonomy not applicable	NA	n/a	000	Unknown	78904	N/A	N/A	N/A	N/A	N/A	70 W HEDDING ST	None	SAN JOSE	CA	95110	1705	00	06000	37.35249294	-121.9050815	Santa Clara County
344421	Ordering, Referring, Prescribing	N/A	1720644610	0	0	LOCK, DIAMANTINA LMFT	2/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99730	N/A	N/A	N/A	N/A	N/A	2540 W SHAW LN	107	FRESNO	CA	93711	2700	00	06000	36.80923946	-119.8386	Fresno County
344431	Ordering, Referring, Prescribing	N/A	1720680325	0	0	LEE, JULIA Y	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82231	N/A	N/A	N/A	N/A	N/A	305 N BREED ST	None	LOS ANGELES	CA	90033	1801	00	06000	34.04750163	-118.208751	Los Angeles County
344441	Ordering, Referring, Prescribing	N/A	1720706393	0	0	LEE, ASHLEY L PHARMD	9/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	86429	N/A	N/A	N/A	N/A	N/A	1326 BENTLEY CT.	None	WEST COVINA	CA	91791	1003	00	06000	34.04654979	-117.887917	Los Angeles County
344448	Ordering, Referring, Prescribing	N/A	1720723869	0	0	LARKINS, CAMILLE LMFT	12/17/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT152098	N/A	N/A	N/A	N/A	N/A	6957 N FIGUEROA ST	None	LOS ANGELES	CA	90042	1245	00	06000	34.12873587	-118.18774	Los Angeles County
344473	Ordering, Referring, Prescribing	N/A	1720814858	0	0	LUM, TARYN AU	9/6/2024	Taxonomy not applicable	NA	n/a	003	AUDIOLOGISTS	AU3959	N/A	N/A	N/A	N/A	N/A	20920 CHICO ST	None	CARSON	CA	90746	3603	00	06000	33.84005271	-118.2570994	Los Angeles County
344499	Ordering, Referring, Prescribing	N/A	1730190505	0	0	LIN, YONG S CA	1/16/2018	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	2407	N/A	N/A	N/A	N/A	N/A	210 N CHESTER AVE	None	BAKERSFIELD	CA	93308	4841	00	06000	35.407179	-119.0208925	Kern County
344512	Ordering, Referring, Prescribing	N/A	1730203787	0	0	LEE, LUNDY PHARMD	3/18/2018	Taxonomy not applicable	NA	n/a	000	Unknown	70467	N/A	N/A	N/A	N/A	N/A	1571 SAN ELIJO RD S	None	SAN MARCOS	CA	92078	2044	00	06000	33.09729386	-117.2002867	San Diego County
344558	Ordering, Referring, Prescribing	N/A	1730280157	0	0	LUNIANSKI, IRWIN L MD	2/3/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G14572	N/A	N/A	N/A	N/A	N/A	4444 CALLE REAL	None	SANTA BARBARA	CA	93110	1002	00	06000	34.44240122	-119.7765542	Santa Barbara County
344621	Ordering, Referring, Prescribing	N/A	1730442468	0	0	LU, JENNIFER Y PHARMD	10/2/2018	Taxonomy not applicable	NA	n/a	000	Unknown	50002	N/A	N/A	N/A	N/A	N/A	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
344715	Ordering, Referring, Prescribing	N/A	1730607425	0	0	LEONCIO, BERNADETTE F	9/18/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	101689	N/A	N/A	N/A	N/A	N/A	8627 ATLANTIC AVE	None	SOUTH GATE	CA	90280	3501	00	06000	33.95462085	-118.1838426	Los Angeles County
344729	Ordering, Referring, Prescribing	N/A	1730633843	0	0	LOPEZ, JULIA A LMFT	2/22/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124489	N/A	N/A	N/A	N/A	N/A	290 IOOF AVE	None	GILROY	CA	95020	5204	00	06000	37.01377513	-121.5685719	Santa Clara County
344736	Ordering, Referring, Prescribing	N/A	1730634486	0	0	LONNERDAL, IDA N LMFT	5/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT119219	N/A	N/A	N/A	N/A	N/A	455 FIRST STREET	None	WOODLAND	CA	95695	4023	00	06000	38.675781	-121.773122	Yolo County
344737	Ordering, Referring, Prescribing	N/A	1730646449	0	0	LEWIS, EMILY LMFT	1/30/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134056	N/A	N/A	N/A	N/A	N/A	1360 N DUTTON AVE	C	SANTA ROSA	CA	95401	4687	00	06000	38.450583	-122.7337065	Sonoma County
344746	Ordering, Referring, Prescribing	N/A	1730654989	0	0	LINGBERG, TERESA E RN	10/30/2017	Taxonomy not applicable	NA	n/a	000	Unknown	365592	N/A	N/A	N/A	N/A	N/A	5000 W CYPRESS	None	VISALIA	CA	93277	8300	00	06000	36.324207	-119.3463225	Tulare County
344770	Ordering, Referring, Prescribing	N/A	1730689258	0	0	LOREDO, CAROLINE B OT	4/3/2024	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	26273	N/A	N/A	N/A	N/A	N/A	1108 S EL CAMINO REAL	None	SAN MATEO	CA	94402	2804	00	06000	37.55635875	-122.3187345	San Mateo County
344798	Ordering, Referring, Prescribing	N/A	1730738733	0	0	LOMONGSOD, ALEXA C NP	1/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019821	N/A	N/A	N/A	N/A	N/A	39500 LIBERTY ST	None	FREMONT	CA	94538	2211	00	06000	37.54845774	-121.9773463	Alameda County
344845	Ordering, Referring, Prescribing	N/A	1730855974	0	0	LEE, JASMINE H PHARMD	6/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75902	N/A	N/A	N/A	N/A	N/A	9580 GARDEN GROVE BLVD	108	GARDEN GROVE	CA	92844	1589	00	06000	33.7739485	-117.9654615	Orange County
344901	Ordering, Referring, Prescribing	N/A	1740306489	0	0	LOERA, MEGAN M LCSW	6/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82813	N/A	N/A	N/A	N/A	N/A	3200 CLAYTON RD	None	CONCORD	CA	94519	2819	00	06000	37.97283909	-122.0196497	Contra Costa County
344908	Ordering, Referring, Prescribing	N/A	1740311703	0	0	LEGASPI, JOSE J LCSW	1/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW74498	N/A	N/A	N/A	N/A	N/A	631A MAPLE AVE	None	LOS ANGELES	CA	90014	2102	00	06000	34.04327665	-118.2485423	Los Angeles County
344925	Ordering, Referring, Prescribing	N/A	1740357490	0	0	LUONG, SYLVIA PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57163	N/A	N/A	N/A	N/A	N/A	7248 CLEAR VISTA CT	None	SAN JOSE	CA	95138	1393	00	06000	37.23590912	-121.7543903	Santa Clara County
344927	Ordering, Referring, Prescribing	N/A	1740343524	0	0	LEUNG, KA CHING B PHARMD	4/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH51237	N/A	N/A	N/A	N/A	N/A	9333 IMPERIAL HWY H03R55	None	DOWNEY	CA	90242	2812	00	06000	33.918975	-118.1291985	Los Angeles County
344930	Ordering, Referring, Prescribing	N/A	1740368828	0	0	LISS, WILLIAM MD	4/25/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G74006	N/A	N/A	N/A	N/A	N/A	9460 NO NAME UNO	STE 210	GILROY	CA	95020	3532	00	06000	37.037781	-121.570965	Santa Clara County
344936	Ordering, Referring, Prescribing	N/A	1740396563	0	0	LOOS, KIMBERLY DDS	7/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS40372	N/A	N/A	N/A	N/A	N/A	515 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8342	00	06000	41.77269652	-124.199019	Del Norte County
344943	Ordering, Referring, Prescribing	N/A	1740409432	0	0	LEE, AMANDA S LCSW	10/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74719	N/A	N/A	N/A	N/A	N/A	5348 UNIVERSITY AVE	STE 108	SAN DIEGO	CA	92105	8025	00	06000	32.74909257	-117.0811685	San Diego County
344958	Ordering, Referring, Prescribing	N/A	1740409614	0	0	LOPEZ-CHAVELAS, ANAMARIA LCSW	5/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	90146	N/A	N/A	N/A	N/A	N/A	3250 WILSHIRE BLVD	SUITE 500	LOS ANGELES	CA	90010	1427	00	06000	34.06176363	-118.2932622	Los Angeles County
344987	Ordering, Referring, Prescribing	N/A	1740523422	0	0	LEE, BRIAN W DO	9/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17452	N/A	N/A	N/A	N/A	N/A	3701 BROADWAY	105	OAKLAND	CA	94611	5613	00	06000	37.82533768	-122.258094	Alameda County
344990	Ordering, Referring, Prescribing	N/A	1740532506	0	0	LU, DERIK K LCSW	9/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW104415	N/A	N/A	N/A	N/A	N/A	9353 VALLEY BLVD	None	ROSEMEAD	CA	91770	1923	00	06000	34.08115618	-118.0651957	Los Angeles County
344997	Ordering, Referring, Prescribing	N/A	1740540277	0	0	LARA, MARIA G LMFT	3/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108932	N/A	N/A	N/A	N/A	N/A	4258 TELEGRAPH RD	None	VENTURA	CA	93003	3706	00	06000	34.27458778	-119.2375085	Ventura County
345005	Ordering, Referring, Prescribing	N/A	1740561414	0	0	LIU, AMY PHARMD	1/29/2020	Taxonomy not applicable	NA	n/a	000	Unknown	71000	N/A	N/A	N/A	N/A	N/A	1335 WEBSTER ST	None	SAN FRANCISCO	CA	94115	4277	00	06000	37.78279538	-122.4309399	San Francisco County
345012	Ordering, Referring, Prescribing	N/A	1740567676	0	0	LUU, PRISCILLA T PHARMD	8/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54426	N/A	N/A	N/A	N/A	N/A	401 N AZUSA AVE	None	COVINA	CA	91722	3609	00	06000	34.08845439	-117.9079036	Los Angeles County
345019	Ordering, Referring, Prescribing	N/A	1740571199	0	0	LOPEZ-ROSARIO, MARIA C MD	12/29/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156723	N/A	N/A	N/A	N/A	N/A	100 W WALNUT ST STE 375	None	PASADENA	CA	91124	0001	00	06000	34.14963648	-118.1522925	Los Angeles County
345030	Ordering, Referring, Prescribing	N/A	1740607605	0	0	LIN, JONATHAN K MD	7/18/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139569	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
345071	Ordering, Referring, Prescribing	N/A	1740670140	0	0	LALONDE, MOLLY A NP	1/21/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013740	N/A	N/A	N/A	N/A	N/A	2200 TYDD STREET	None	EUREKA	CA	95501	1284	00	06000	40.80241902	-124.1462268	Humboldt County
345096	Ordering, Referring, Prescribing	N/A	1740698430	0	0	LEE, RASHIDA	9/12/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000971	N/A	N/A	N/A	N/A	N/A	2633 E 27TH ST	None	OAKLAND	CA	94601	1912	00	06000	37.79111794	-122.2219009	Alameda County
345102	Ordering, Referring, Prescribing	N/A	1740707082	0	0	LOPEZ, VANESSA LCSW	12/19/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW127819	N/A	N/A	N/A	N/A	N/A	25910 ACERO	160	MISSION VIEJO	CA	92691	2790	00	06000	33.61712389	-117.6780482	Orange County
345126	Ordering, Referring, Prescribing	N/A	1740736248	0	0	LUU, LATONIA PHARMD	4/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74812	N/A	N/A	N/A	N/A	N/A	3553 WHIPPLE ROAD	BUILDING B, MED 4, RM 33	UNION CITY	CA	94587	1507	00	06000	37.60573981	-122.0835989	Alameda County
345132	Ordering, Referring, Prescribing	N/A	1740747534	0	0	LU, ALYSSA LMFT	2/10/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131096	N/A	N/A	N/A	N/A	N/A	902 S MYRTLE AVE	None	MONROVIA	CA	91016	3427	00	06000	34.14233552	-118.0008646	Los Angeles County
345133	Ordering, Referring, Prescribing	N/A	1740750785	0	0	LEE, DIANA Y NP	2/19/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006722	N/A	N/A	N/A	N/A	N/A	14372 BEACH BLVD	None	WESTMINSTER	CA	92683	4578	00	06000	33.75341465	-117.989413	Orange County
345135	Ordering, Referring, Prescribing	N/A	1740748284	0	0	LINDGREN, KERRY E RN PHN	5/22/2018	Taxonomy not applicable	NA	n/a	000	Unknown	790772	N/A	N/A	N/A	N/A	N/A	930 WESTACRE RD	None	WEST SACRAMENTO	CA	95691	3224	00	06000	38.57772188	-121.5306566	Yolo County
345137	Ordering, Referring, Prescribing	N/A	1740751338	0	0	LOVE, AJAH LMFT	1/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124069	N/A	N/A	N/A	N/A	N/A	9713 SANTA MONICA BLVD.	201	BEVERLY HILLS	CA	90210	4236	00	06000	34.06835061	-118.4076858	Los Angeles County
345211	Ordering, Referring, Prescribing	N/A	1740891142	0	0	LESCANO, JESSICA K LCSW	3/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	65666	N/A	N/A	N/A	N/A	N/A	1 SANTA BARBARA RD	None	PLEASANT HILL	CA	94523	4215	00	06000	37.937538	-122.0669775	Contra Costa County
345229	Ordering, Referring, Prescribing	N/A	1740953751	0	0	LAW, RACHEL PHARMD	9/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85106	N/A	N/A	N/A	N/A	N/A	275 HOSPITAL PKWY	625	SAN JOSE	CA	95119	1106	00	06000	37.23951066	-121.8013511	Santa Clara County
345235	Ordering, Referring, Prescribing	N/A	1740959014	0	0	LY, TONY L	9/30/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	106486	N/A	N/A	N/A	N/A	N/A	2180 N MAIN ST	None	SALINAS	CA	93906	1735	00	06000	36.72675972	-121.6563161	Monterey County
345238	Ordering, Referring, Prescribing	N/A	1740980200	0	0	LE, AMY NP	4/10/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024367	N/A	N/A	N/A	N/A	N/A	970 EMBARCADERO DEL MAR	None	ISLA VISTA	CA	93117	4869	00	06000	34.411707	-119.857011	Santa Barbara County
345257	Ordering, Referring, Prescribing	N/A	1750055885	0	0	LINLO-SYRIOTIS, ASHLEY NP	8/1/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026394	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	BLDG 3	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
345265	Ordering, Referring, Prescribing	N/A	1750060570	0	0	LEVINS-TRAIL, ALEXANDRA LMFT	7/12/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	140399	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
345296	Ordering, Referring, Prescribing	N/A	1750393609	0	0	LEWIS, DEANNA L PA-C	6/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61174	N/A	N/A	N/A	N/A	N/A	400 WEST PUEBLO	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
345317	Ordering, Referring, Prescribing	N/A	1750423943	0	0	LACEY, TRACY C LMFT	12/14/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46112	N/A	N/A	N/A	N/A	N/A	140 MAYHEW WAY	SUITE 103	PLEASANT HILL	CA	94523	4328	00	06000	37.93664097	-122.0572179	Contra Costa County
345331	Ordering, Referring, Prescribing	N/A	1750443743	0	0	LUCCHESI, MICHAEL D LMFT	12/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	81180	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
345334	Ordering, Referring, Prescribing	N/A	1750449864	0	0	LEE, PHOEBE PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	42941	N/A	N/A	N/A	N/A	N/A	700 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5439	00	06000	37.43308793	-121.8951311	Santa Clara County
345339	Ordering, Referring, Prescribing	N/A	1750462453	0	0	LEON, LISA LCSW	11/10/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW21035	N/A	N/A	N/A	N/A	N/A	10355 SLUSHER DR	None	SANTA FE SPRINGS	CA	90670	7353	00	06000	33.94228286	-118.0779517	Los Angeles County
345341	Ordering, Referring, Prescribing	N/A	1750470795	0	0	LUPTRAWAN, ALENDA A	12/4/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D46291	N/A	N/A	N/A	N/A	N/A	437 N EUCLID AVE	None	ONTARIO	CA	91762	3456	00	06000	34.067988	-117.6521805	San Bernardino County
345374	Ordering, Referring, Prescribing	N/A	1750548640	0	0	LUU, THAN AN MD	12/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A101119	N/A	N/A	N/A	N/A	N/A	709 N HILL ST	None	LOS ANGELES	CA	90012	2361	00	06000	34.06103994	-118.2404034	Los Angeles County
345379	Ordering, Referring, Prescribing	N/A	1750581575	0	0	LYON, ALEXIS M LMFT	4/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49374	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
345405	Ordering, Referring, Prescribing	N/A	1750657532	0	0	LOOMIS, ALLISON N LMFT	1/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84776	N/A	N/A	N/A	N/A	N/A	2821 H STREET	None	BAKERSFIELD	CA	93301	1004	00	06000	35.38560771	-119.0211608	Kern County
345420	Ordering, Referring, Prescribing	N/A	1750665436	0	0	LOPEZ, LARRY S	7/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63795	N/A	N/A	N/A	N/A	N/A	3250 LAKESHORE AVE	None	OAKLAND	CA	94610	2720	00	06000	37.81051525	-122.2446621	Alameda County
345444	Ordering, Referring, Prescribing	N/A	1750709184	0	0	LUELLEN, BRIAN E DO	11/2/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16596	N/A	N/A	N/A	N/A	N/A	355 TUOLUMNE ST	1400	VALLEJO	CA	94590	5700	00	06000	38.10261225	-122.2382555	Solano County
345452	Ordering, Referring, Prescribing	N/A	1750706925	0	0	LIM, LIZBETH TRACY T NP	5/5/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN737835	N/A	N/A	N/A	N/A	N/A	400 WEST 30TH STREET	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
345462	Ordering, Referring, Prescribing	N/A	1750734968	0	0	LAU, RICKY LCSW	3/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100834	N/A	N/A	N/A	N/A	N/A	9353 VALLEY BLVD	None	ROSEMEAD	CA	91770	1932	00	06000	34.08115618	-118.0651957	Los Angeles County
345466	Ordering, Referring, Prescribing	N/A	1750740296	0	0	LLORENTE, ERIC LMFT	5/10/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125913	N/A	N/A	N/A	N/A	N/A	3810 ROSIN CT	170	SACRAMENTO	CA	95834	1656	00	06000	38.637702	-121.474773	Sacramento County
345490	Ordering, Referring, Prescribing	N/A	1750758587	0	0	LIMON, MARIA M LCSW	1/19/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95305	N/A	N/A	N/A	N/A	N/A	4141 STATE ST	None	SANTA BARBARA	CA	93110	1814	00	06000	34.4404695	-119.7612045	Santa Barbara County
345492	Ordering, Referring, Prescribing	N/A	1750768677	0	0	LAM, HELEN C MD	8/21/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A147341	N/A	N/A	N/A	N/A	N/A	975 SERENO DR	None	VALLEJO	CA	94589	2441	00	06000	38.12828446	-122.24821	Solano County
345507	Ordering, Referring, Prescribing	N/A	1750790978	0	0	LOUDON, TASHA C LMFT	1/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106068	N/A	N/A	N/A	N/A	N/A	988 MCCOURTNEY RD	STE. 102	GRASS VALLEY	CA	95949	7400	00	06000	39.2089732	-121.0729043	Nevada County
345535	Ordering, Referring, Prescribing	N/A	1750843868	0	0	LUNNY, KATHRYN F MD	2/23/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176496	N/A	N/A	N/A	N/A	N/A	3800 W CHAPMAN AVE	500	ORANGE	CA	92868	1638	00	06000	33.78885849	-117.8950802	Orange County
345536	Ordering, Referring, Prescribing	N/A	1750833125	0	0	LMFT, SUSAN L LMFT	11/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113352	N/A	N/A	N/A	N/A	N/A	1125 W. 6TH ST	SUITE 103	LOS ANGELES	CA	90017	1896	00	06000	34.05441139	-118.2628642	Los Angeles County
345541	Ordering, Referring, Prescribing	N/A	1750852877	0	0	LANE-PARKS, MARLA M LMFT	9/18/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128173	N/A	N/A	N/A	N/A	N/A	401 ROLAND WAY	SUITE 150	OAKLAND	CA	94621	2034	00	06000	37.74106765	-122.2051051	Alameda County
345543	Ordering, Referring, Prescribing	N/A	1750856662	0	0	LIU, CHERYL PA-C	9/13/2019	Taxonomy not applicable	NA	n/a	000	Unknown	57206	N/A	N/A	N/A	N/A	N/A	2333 S MOONEY BLVD	None	VISALIA	CA	93277	6228	00	06000	36.308682	-119.3154255	Tulare County
345549	Ordering, Referring, Prescribing	N/A	1750863569	0	0	LOPEZ-TAPIA, MELISSA LCSW	4/10/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW121990	N/A	N/A	N/A	N/A	N/A	21545 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	2947	00	06000	34.413021	-118.514534	Los Angeles County
345555	Ordering, Referring, Prescribing	N/A	1750874418	0	0	LOVELL, ROSE H MD	7/1/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173402	N/A	N/A	N/A	N/A	N/A	21507 E CLIFF DR	None	SANTA CRUZ	CA	95062	4844	00	06000	36.96330203	-121.9900666	Santa Cruz County
345559	Ordering, Referring, Prescribing	N/A	1750876777	0	0	LOPEZ-SANCHEZ, KIMBERLY S MSW LCSW	7/20/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW109285	N/A	N/A	N/A	N/A	N/A	300 E 15TH ST	None	MERCED	CA	95341	6217	00	06000	37.29443362	-120.4719616	Merced County
345561	Ordering, Referring, Prescribing	N/A	1750891065	0	0	LAVI, ELLIOT PHARMD	7/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77391	N/A	N/A	N/A	N/A	N/A	13231 VICTORY BLVD	None	VAN NUYS	CA	91401	2025	00	06000	34.18670546	-118.42164	Los Angeles County
345578	Ordering, Referring, Prescribing	N/A	1750918397	0	0	LORENZO QUINTERO, ANABELL Y MD	11/15/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183217	N/A	N/A	N/A	N/A	N/A	1611 1ST STREET	None	BAKERSFIELD	CA	93304	2901	00	06000	35.35506651	-119.020518	Kern County
345580	Ordering, Referring, Prescribing	N/A	1750924858	0	0	LAVAGNINO, LINDA LMFT	5/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT113346	N/A	N/A	N/A	N/A	N/A	17337 VENTURA BLVD.	SUITE 218	ENCINO	CA	91316	3994	00	06000	34.16102943	-118.5108514	Los Angeles County
345594	Ordering, Referring, Prescribing	N/A	1750955167	0	0	LAFLEUR, CHERIE L NP	8/22/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017202	N/A	N/A	N/A	N/A	N/A	940 SYLVA LN	B	SONORA	CA	95370	5969	00	06000	37.98764779	-120.3681842	Tuolumne County
345606	Ordering, Referring, Prescribing	N/A	1750987855	0	0	LEWALLEN, JULINA C PA-C	5/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA59182	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
345625	Ordering, Referring, Prescribing	N/A	1760022503	0	0	LEE, SANGYUNE G PHARMD	8/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81664	N/A	N/A	N/A	N/A	N/A	4211 AVALON BLVD	None	LOS ANGELES	CA	90011	5622	00	06000	34.007238	-118.2653065	Los Angeles County
345643	Ordering, Referring, Prescribing	N/A	1760042535	0	0	LICANO, MAYRA LCSW	1/8/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW103880	N/A	N/A	N/A	N/A	N/A	4200 ASHE RD	None	BAKERSFIELD	CA	93313	2029	00	06000	35.316864	-119.0744405	Kern County
345647	Ordering, Referring, Prescribing	N/A	1760061253	0	0	LEE, KRISTEN MD	6/18/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A196979	N/A	N/A	N/A	N/A	N/A	2116 ARLINGTON AVE	STE 100	LOS ANGELES	CA	90018	1336	00	06000	34.037415	-118.3176815	Los Angeles County
345697	Ordering, Referring, Prescribing	N/A	1760407936	0	0	LYAPIS, VICTOR	3/13/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A54424	N/A	N/A	N/A	N/A	N/A	2186 GEARY BLVD	104	SAN FRANCISCO	CA	94115	3456	00	06000	37.78343395	-122.4392245	San Francisco County
345709	Ordering, Referring, Prescribing	N/A	1760488621	0	0	LYNCH, MARC E DO	1/25/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	6261	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	SUITE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
345721	Ordering, Referring, Prescribing	N/A	1760514293	0	0	LONG, ROBERT P CRNA	9/13/2021	Taxonomy not applicable	NA	n/a	018	NURSE ANESTHETISTS	95001599	N/A	N/A	N/A	N/A	N/A	250 N FIRST STREET	None	BLYTHE	CA	92225	1702	00	06000	33.61293	-114.5955035	Riverside County
345735	Ordering, Referring, Prescribing	N/A	1760522809	0	0	LEE, ANGEL P PHARMD	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54149	N/A	N/A	N/A	N/A	N/A	6643 E PASEO FIESTA	None	ANAHEIM	CA	92807	4212	00	06000	33.8497924	-117.7631513	Orange County
345741	Ordering, Referring, Prescribing	N/A	1760537682	0	0	LEE, SUSAN K LCSW	10/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW14008	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	SUITE 280	SAN MATEO	CA	94403	4324	00	06000	37.54524373	-122.3205511	San Mateo County
345747	Ordering, Referring, Prescribing	N/A	1760553713	0	0	LE, GIAO Q PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH47618	N/A	N/A	N/A	N/A	N/A	9400 ROSECRANS AVE	1W157	BELLFLOWER	CA	90706	2246	00	06000	33.9040752	-118.1328995	Los Angeles County
345767	Ordering, Referring, Prescribing	N/A	1760601876	0	0	LEWIS, THOMAS E	9/8/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D22376	N/A	N/A	N/A	N/A	N/A	343 OAK ST	None	RED BLUFF	CA	96080	3304	00	06000	40.17616563	-122.2349564	Tehama County
345784	Ordering, Referring, Prescribing	N/A	1760671085	0	0	LOPEZ, DENISE E MSW LCSW	9/29/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79719	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
345796	Ordering, Referring, Prescribing	N/A	1760681316	0	0	LICON, SARA LCSW	11/2/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80557	N/A	N/A	N/A	N/A	N/A	801 E KATELLA AVE	None	ANAHEIM	CA	92805	6614	00	06000	33.80344749	-117.8986365	Orange County
345837	Ordering, Referring, Prescribing	N/A	1760761464	0	0	LEVANDOSKI, DANA LCSW	5/16/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	104760	N/A	N/A	N/A	N/A	N/A	652 PETALUMA AVE	H	SEBASTOPOL	CA	95472	4256	00	06000	38.39662494	-122.8201368	Sonoma County
345843	Ordering, Referring, Prescribing	N/A	1760767727	0	0	LE, KATHERINE Y PHARMD	8/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH61367	N/A	N/A	N/A	N/A	N/A	33975 DATE PALM DR	None	CATHEDRAL CITY	CA	92234	4732	00	06000	33.80200337	-116.4581495	Riverside County
345850	Ordering, Referring, Prescribing	N/A	1760769871	0	0	LE, LOC P PHARMD	7/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH61688	N/A	N/A	N/A	N/A	N/A	3500 COFFEE RD	None	MODESTO	CA	95355	1305	00	06000	37.690002	-120.976061	Stanislaus County
345868	Ordering, Referring, Prescribing	N/A	1760809941	0	0	LAPE, ALEXANDRA CNM	6/21/2023	Taxonomy not applicable	NA	n/a	082	LICENSED MIDWIVES	LM712	N/A	N/A	N/A	N/A	N/A	3309 RENNER DR	None	FORTUNA	CA	95540	3119	00	06000	40.58239969	-124.1358904	Humboldt County
345889	Ordering, Referring, Prescribing	N/A	1760843726	0	0	LORENZ, KARA LCSW	2/7/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	113583	N/A	N/A	N/A	N/A	N/A	339 PAJARO ST	SUITE D	SALINAS	CA	93901	3400	00	06000	36.6725294	-121.6522021	Monterey County
345905	Ordering, Referring, Prescribing	N/A	1760852750	0	0	LOPEZ-SUAREZ, MARISELA LMFT	3/2/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT145499	N/A	N/A	N/A	N/A	N/A	3000 PARKER RD	ROOM 20	RICHMOND	CA	94806	2742	00	06000	37.9690797	-122.3241653	Contra Costa County
345957	Ordering, Referring, Prescribing	N/A	1760930846	0	0	LOEHLEIN, AMY LCSW	2/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121121	N/A	N/A	N/A	N/A	N/A	8912 VOLUNTEER LANE	None	SACRAMENTO	CA	95826	3221	00	06000	38.55438	-121.3756965	Sacramento County
345958	Ordering, Referring, Prescribing	N/A	1760930861	0	0	LATTANZI-SILVEUS, MARGARET LMFT	2/25/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138069	N/A	N/A	N/A	N/A	N/A	1801 VICENTE STREET	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
346013	Ordering, Referring, Prescribing	N/A	1770027740	0	0	LANGUIDO, LAUREN PHD	11/22/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34699	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE.	SUITE 300	SAN JOSE	CA	95128	2680	00	06000	37.3160785	-121.937121	Santa Clara County
346032	Ordering, Referring, Prescribing	N/A	1770033235	0	0	LI, JOANNE PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75613	N/A	N/A	N/A	N/A	N/A	3782 W MARTIN LUTHER KIN	None	LOS ANGELES	CA	90008	1703	00	06000	34.01256774	-118.338339	Los Angeles County
346037	Ordering, Referring, Prescribing	N/A	1770059487	0	0	LI, MARY PHARMD	11/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	79735	N/A	N/A	N/A	N/A	N/A	27220 HEATHER RIDGE RD	None	LAGUNA NIGUEL	CA	92677	3418	00	06000	33.56677119	-117.7120863	Orange County
346075	Ordering, Referring, Prescribing	N/A	1770142614	0	0	LE, TRANG T PHARMD	10/3/2018	Taxonomy not applicable	NA	n/a	000	Unknown	75883	N/A	N/A	N/A	N/A	N/A	129 BERNAL RD	None	SAN JOSE	CA	95119	1303	00	06000	37.232892	-121.774725	Santa Clara County
346084	Ordering, Referring, Prescribing	N/A	1770148983	0	0	LEE, EUI PHARMD	10/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	79697	N/A	N/A	N/A	N/A	N/A	4860 Y ST	1210	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
346091	Ordering, Referring, Prescribing	N/A	1770190340	0	0	LEE, ALEXANDER NP	7/27/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015019	N/A	N/A	N/A	N/A	N/A	7212 ORANGETHORPE AVE ST	STE 9A	BUENA PARK	CA	90621	4668	00	06000	33.85890953	-118.007244	Orange County
346132	Ordering, Referring, Prescribing	N/A	1770503757	0	0	LAY, TWYILA D NP	8/29/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	7643	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVENUE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
346141	Ordering, Referring, Prescribing	N/A	1770567059	0	0	LAZOVA, ROSSITZA Z MD	10/27/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C141409	N/A	N/A	N/A	N/A	N/A	2420 SAMARITAN DRIVE	None	SAN JOSE	CA	95124	3907	00	06000	37.25107191	-121.946105	Santa Clara County
346142	Ordering, Referring, Prescribing	N/A	1770561516	0	0	LURLAY, ANGELA NP	4/5/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	13724	N/A	N/A	N/A	N/A	N/A	344 E 6TH STREET	None	MADERA	CA	93638	3631	00	06000	36.96288964	-120.0556279	Madera County
346144	Ordering, Referring, Prescribing	N/A	1770582967	0	0	LAVIAN, DAVID MD	9/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A46370	N/A	N/A	N/A	N/A	N/A	4849 VAN NUYS	STE 102	SHERMAN OAKS	CA	91403	2102	00	06000	34.159113	-118.4487465	Los Angeles County
346164	Ordering, Referring, Prescribing	N/A	1770626434	0	0	LEUCHT, CHRISTOPHER A PHD	4/6/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY16446	N/A	N/A	N/A	N/A	N/A	2550 E. FOOTHILL BLVD	2ND FLOOR	PASADENA	CA	91107	3408	00	06000	34.14979153	-118.0979955	Los Angeles County
346195	Ordering, Referring, Prescribing	N/A	1770700908	0	0	LEE, JENNIFER J MD	4/9/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A120644	N/A	N/A	N/A	N/A	N/A	929 CLAY ST	SUITE 105	SAN FRANCISCO	CA	94108	1568	00	06000	37.79398652	-122.4083496	San Francisco County
346211	Ordering, Referring, Prescribing	N/A	1770747917	0	0	LEE, LIEZL GRACE T LMFT	3/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT51690	N/A	N/A	N/A	N/A	N/A	1290 COMMODORE DRIVE	None	SAN BRUNO	CA	94066	2304	00	06000	37.63134914	-122.4260472	San Mateo County
346220	Ordering, Referring, Prescribing	N/A	1770761140	0	0	LEE, BENJAMIN C	2/19/2008	Taxonomy not applicable	NA	n/a	099	DENTIST	D56740	N/A	N/A	N/A	N/A	N/A	2950 INTERNATIONAL BLVD	None	OAKLAND	CA	94601	2228	00	06000	37.77893032	-122.2284286	Alameda County
346240	Ordering, Referring, Prescribing	N/A	1770808842	0	0	LEE, FELIX DC	10/21/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC27255	N/A	N/A	N/A	N/A	N/A	12640 HESPERIA ROAD	SUITE C	VICTORVILLE	CA	92395	7753	00	06000	34.48056876	-117.2907887	San Bernardino County
346258	Ordering, Referring, Prescribing	N/A	1770854978	0	0	LIPMAN, LAURETTE S LPCC	1/20/2020	Taxonomy not applicable	NA	n/a	000	Unknown	7364	N/A	N/A	N/A	N/A	N/A	2310 1ST STREET	None	NAPA	CA	94559	2239	00	06000	38.29806271	-122.2989388	Napa County
346272	Ordering, Referring, Prescribing	N/A	1770872285	0	0	LOWENBURG, BENJAMIN MD	9/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C179733	N/A	N/A	N/A	N/A	N/A	400 CONCAR DR	None	SAN MATEO	CA	94402	2681	00	06000	37.55338259	-122.3076528	San Mateo County
346280	Ordering, Referring, Prescribing	N/A	1770877789	0	0	LOPEZ, MARCELA LCSW	2/17/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100056	N/A	N/A	N/A	N/A	N/A	110 S. MONTCLAIR ST.	SUITE 205	BAKERSFIELD	CA	93309	3111	00	06000	35.35373011	-119.0546591	Kern County
346286	Ordering, Referring, Prescribing	N/A	1770883498	0	0	LOPEZ, SOLOMON I PHARMD	1/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	64713	N/A	N/A	N/A	N/A	N/A	475 W MAIN ST	None	BRAWLEY	CA	92227	2244	00	06000	32.97865516	-115.5503473	Imperial County
346304	Ordering, Referring, Prescribing	N/A	1770917601	0	0	LI, ALEXANDER W	7/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69500	N/A	N/A	N/A	N/A	N/A	6701 CARNELIAN ST	None	RANCHO CUCAMONGA	CA	91701	4556	00	06000	34.13214	-117.6161915	San Bernardino County
346305	Ordering, Referring, Prescribing	N/A	1770917452	0	0	LOPEZ, STACI E LMFT	12/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112219	N/A	N/A	N/A	N/A	N/A	401 W CIVIC CENTER DR	SUITE 800	SANTA ANA	CA	92701	4515	00	06000	33.75157353	-117.870921	Orange County
346318	Ordering, Referring, Prescribing	N/A	1770945131	0	0	LIU, CATERINA Y MD	4/9/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150712	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
346327	Ordering, Referring, Prescribing	N/A	1770955171	0	0	LYONS, DANIEL P PHARMD	7/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72671	N/A	N/A	N/A	N/A	N/A	1050 GILMAN ST	None	BERKELEY	CA	94710	1532	00	06000	37.8792	-122.296293	Alameda County
346329	Ordering, Referring, Prescribing	N/A	1770958720	0	0	LAW, ELAINE J PHARMD	4/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61049	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPRESSWAY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
346334	Ordering, Referring, Prescribing	N/A	1770965741	0	0	LE-TAN, TRANG	3/22/2018	Taxonomy not applicable	NA	n/a	000	Unknown	69922	N/A	N/A	N/A	N/A	N/A	1608 BROADWAY ST	None	EL CAJON	CA	92021	0000	00	06000	32.8077497	-116.9207335	San Diego County
346337	Ordering, Referring, Prescribing	N/A	1770969321	0	0	LEBARON, MELODY	4/14/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125542	N/A	N/A	N/A	N/A	N/A	16552 SUNHILL DR.	None	VICTORVILLE	CA	92395	4518	00	06000	34.5068043	-117.2986245	San Bernardino County
346342	Ordering, Referring, Prescribing	N/A	1770973950	0	0	LEE, EDWARD H PHARMD	5/23/2019	Taxonomy not applicable	NA	n/a	000	Unknown	RPH64512	N/A	N/A	N/A	N/A	N/A	2655 W OLYMPIC BLVD	SUITE 104	LOS ANGELES	CA	90006	2800	00	06000	34.05243121	-118.289956	Los Angeles County
346345	Ordering, Referring, Prescribing	N/A	1770980708	0	0	LAQUI, AILEEN PHARMD	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH71882	N/A	N/A	N/A	N/A	N/A	7155 VAN NUYSBLVD	None	VAN NUYS	CA	91405	3006	00	06000	34.20063829	-118.4487784	Los Angeles County
346371	Ordering, Referring, Prescribing	N/A	1780005769	0	0	LEMUS, CLAUDIA A LCSW	3/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW89254	N/A	N/A	N/A	N/A	N/A	560 S ST LOUIS ST	None	LOS ANGELES	CA	90033	4320	00	06000	34.03924138	-118.2172475	Los Angeles County
346385	Ordering, Referring, Prescribing	N/A	1780046979	0	0	LIKENESS, CARRIE L LMFT	4/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT104533	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
346386	Ordering, Referring, Prescribing	N/A	1780045369	0	0	LUNA, JULIE LMFT	7/16/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139470	N/A	N/A	N/A	N/A	N/A	315 S WATERMAN AVE	None	EL CENTRO	CA	92243	2215	00	06000	32.79121151	-115.5741235	Imperial County
346413	Ordering, Referring, Prescribing	N/A	1780092841	0	0	LEVIN, HANNAH T LCSW	3/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94419	N/A	N/A	N/A	N/A	N/A	902 S MYRTLE AVE	None	MONROVIA	CA	91016	3427	00	06000	34.14233552	-118.0008646	Los Angeles County
346431	Ordering, Referring, Prescribing	N/A	1780107433	0	0	LOGAN, MARK A NP	2/21/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013193	N/A	N/A	N/A	N/A	N/A	2750 E WASHINGTON BLVD	230	PASADENA	CA	91107	1448	00	06000	34.1680038	-118.0943955	Los Angeles County
346436	Ordering, Referring, Prescribing	N/A	1780115014	0	0	LEE, SYDNEY MD	12/26/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170885	N/A	N/A	N/A	N/A	N/A	1350 S. ORANGE AVE	None	FRESNO	CA	93702	3463	00	06000	36.728883	-119.763677	Fresno County
346439	Ordering, Referring, Prescribing	N/A	1780117077	0	0	LIN, WEI-CHEN MD	3/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159164	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
346444	Ordering, Referring, Prescribing	N/A	1780121988	0	0	LY, ANA H PHARMD	10/21/2020	Taxonomy not applicable	NA	n/a	000	Unknown	75362	N/A	N/A	N/A	N/A	N/A	150 N RENO ST	None	LOS ANGELES	CA	90026	0000	00	06000	34.07274763	-118.2804096	Los Angeles County
346490	Ordering, Referring, Prescribing	N/A	1780230805	0	0	LOWERHOUSE, ERIN L RN CPNP	2/14/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012464	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
346509	Ordering, Referring, Prescribing	N/A	1780273870	0	0	LAU, CARMEN PHARMD	7/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH83039	N/A	N/A	N/A	N/A	N/A	1435 HIGH ST	None	DELANO	CA	93215	1714	00	06000	35.77502393	-119.2484146	Kern County
346511	Ordering, Referring, Prescribing	N/A	1780281667	0	0	LEE, GINA W PA-C	3/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58590	N/A	N/A	N/A	N/A	N/A	815 S ARDMORE AVE	1ST FLOOR	LOS ANGELES	CA	90005	2597	00	06000	34.05717	-118.3020395	Los Angeles County
346529	Ordering, Referring, Prescribing	N/A	1780341479	0	0	LITTEN, HALEY L PA	7/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61418	N/A	N/A	N/A	N/A	N/A	21001 SHERMAN WAY	SUITE 9	CANOGA PARK	CA	91303	1760	00	06000	34.20113553	-118.5912126	Los Angeles County
346538	Ordering, Referring, Prescribing	N/A	1780356386	0	0	LAYFIELD, ANGELA LCSW	10/22/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	126879	N/A	N/A	N/A	N/A	N/A	3478 BUSKIRK AVE.	STE 260	PLEASANT HILL	CA	94523	4344	00	06000	37.93963113	-122.0591644	Contra Costa County
346540	Ordering, Referring, Prescribing	N/A	1780352070	0	0	LAMAR, KRISTY LCSW	11/28/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	86304	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
346555	Ordering, Referring, Prescribing	N/A	1780452326	0	0	LYNCH, KELLY CNP	10/24/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027832	N/A	N/A	N/A	N/A	N/A	954 W FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
346580	Ordering, Referring, Prescribing	N/A	1780697607	0	0	LUPEIKA, DEBRA L MD	2/11/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A70796	N/A	N/A	N/A	N/A	N/A	2526 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14934389	-122.2195713	Tehama County
346589	Ordering, Referring, Prescribing	N/A	1780708271	0	0	LEON, DAVID LCSW	2/7/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24285	N/A	N/A	N/A	N/A	N/A	1910 OLYMPIC BLVD	365	WALNUT CREEK	CA	94596	0000	00	06000	37.89453628	-122.0662326	Contra Costa County
346598	Ordering, Referring, Prescribing	N/A	1780719526	0	0	LISKIN, DAMIEN M LCSW	12/4/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW19891	N/A	N/A	N/A	N/A	N/A	1000 VETERAN AVE	None	LOS ANGELES	CA	90024	2704	00	06000	34.0605595	-118.4499527	Los Angeles County
346613	Ordering, Referring, Prescribing	N/A	1780759514	0	0	LEE, LINDA PHARMD	4/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57483	N/A	N/A	N/A	N/A	N/A	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	00	06000	33.904782	-117.469323	Riverside County
346622	Ordering, Referring, Prescribing	N/A	1780783472	0	0	LUCIA, DARRYL MD	12/3/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G77606	N/A	N/A	N/A	N/A	N/A	355 TUOLUMNE ST	None	VALLEJO	CA	94590	5700	00	06000	38.10261225	-122.2382555	Solano County
346638	Ordering, Referring, Prescribing	N/A	1780817577	0	0	LAUREOLA, MELISSA L DDS	7/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	58477	N/A	N/A	N/A	N/A	N/A	8041 NEWMAN AVE	None	HUNTINGTON BEACH	CA	92647	7034	00	06000	33.70481104	-117.9882948	Orange County
346646	Ordering, Referring, Prescribing	N/A	1780826792	0	0	LWIN, ALICIA	8/1/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A107142	N/A	N/A	N/A	N/A	N/A	7223 N. FAIR AVE.	None	SUN VALLEY	CA	91352	4964	00	06000	34.201944	-118.374718	Los Angeles County
346650	Ordering, Referring, Prescribing	N/A	1780835801	0	0	LE, STEVEN K MD	8/29/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A104836	N/A	N/A	N/A	N/A	N/A	11100 WARNER AVE	114	FOUNTAIN VALLEY	CA	92708	7506	00	06000	33.716291	-117.9355051	Orange County
346657	Ordering, Referring, Prescribing	N/A	1780858068	0	0	LEE, CHRISTOPHER LCSW	5/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74709	N/A	N/A	N/A	N/A	N/A	2034 DE LA VINA STREET	None	SANTA BARBARA	CA	93105	3814	00	06000	34.4295686	-119.7179965	Santa Barbara County
346668	Ordering, Referring, Prescribing	N/A	1780897496	0	0	LEON, GIGI M	3/9/2018	Taxonomy not applicable	NA	n/a	000	Unknown	55423	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
346669	Ordering, Referring, Prescribing	N/A	1780899260	0	0	LIPUMANO-PICAZO, LERIDA	5/1/2023	Taxonomy not applicable	NA	n/a	000	Unknown	40848	N/A	N/A	N/A	N/A	N/A	1830 COMMERCIAL WAY	None	SANTA CRUZ	CA	95065	1819	00	06000	36.98837145	-121.9802206	Santa Cruz County
346670	Ordering, Referring, Prescribing	N/A	1780890749	0	0	LEE, JULIANE OD	5/9/2014	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	12165	N/A	N/A	N/A	N/A	N/A	207 S SANTA ANITA ST	SUITE P25	SAN GABRIEL	CA	91776	1145	00	06000	34.10072807	-118.1066296	Los Angeles County
346675	Ordering, Referring, Prescribing	N/A	1780911248	0	0	LUCKY, DANIEL NP	2/28/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	19377	N/A	N/A	N/A	N/A	N/A	1349 MAIN ST	None	NEWMAN	CA	95360	1326	00	06000	37.31496518	-121.0225535	Stanislaus County
346679	Ordering, Referring, Prescribing	N/A	1780917146	0	0	LEONARD, JENNIFER LMFT	3/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT83319	N/A	N/A	N/A	N/A	N/A	600 S COMMONWEALTH AVE	None	LOS ANGELES	CA	90005	4001	00	06000	34.06328086	-118.2856343	Los Angeles County
346707	Ordering, Referring, Prescribing	N/A	1780962043	0	0	LANDA, ALLISON M LMFT	5/6/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53342	N/A	N/A	N/A	N/A	N/A	25096 JEFFERSON AVE	STE C4	MURRIETA	CA	92562	1705	00	06000	33.55467605	-117.2033531	Riverside County
346753	Ordering, Referring, Prescribing	N/A	1790052728	0	0	LOWENTHAL, JULIA	5/1/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0801123	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
346763	Ordering, Referring, Prescribing	N/A	1790057412	0	0	LE, BO PHARMD	10/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH65419	N/A	N/A	N/A	N/A	N/A	33975 DATE PALM DR	None	CATHEDRAL CITY	CA	92234	4736	00	06000	33.80200337	-116.4581495	Riverside County
346768	Ordering, Referring, Prescribing	N/A	1790063691	0	0	LINVILLE, TIFFANY N PT	7/30/2019	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	37977	N/A	N/A	N/A	N/A	N/A	1901 N RICE AVE	170-180	OXNARD	CA	93030	7912	00	06000	34.21960355	-119.1421345	Ventura County
346778	Ordering, Referring, Prescribing	N/A	1790068294	0	0	LE, TRUC H PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58357	N/A	N/A	N/A	N/A	N/A	780 E. SANTA CLARA ST	None	SAN JOSE	CA	95112	1909	00	06000	37.34353562	-121.8749754	Santa Clara County
346796	Ordering, Referring, Prescribing	N/A	1790089738	0	0	LUJAN, MARIA Y LMFT	11/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	78371	N/A	N/A	N/A	N/A	N/A	19231 VICTORY BLVD.	SUITE 110	RESEDA	CA	91335	6300	00	06000	34.18659852	-118.552221	Los Angeles County
346802	Ordering, Referring, Prescribing	N/A	1790098713	0	0	LEE, SOLIM B NP	1/23/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	16313	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
346809	Ordering, Referring, Prescribing	N/A	1790114734	0	0	LE CLAIR WONNELL, SARAH PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69092	N/A	N/A	N/A	N/A	N/A	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	00	06000	37.43378232	-121.8920598	Santa Clara County
346815	Ordering, Referring, Prescribing	N/A	1790124782	0	0	LEE, YUJIN MD	9/4/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145596	N/A	N/A	N/A	N/A	N/A	1080 EMELINE AVE	BLDG D	SANTA CRUZ	CA	95060	1966	00	06000	36.99191102	-122.0176744	Santa Cruz County
346869	Ordering, Referring, Prescribing	N/A	1790204659	0	0	LIN, TIFFANY J NP	8/13/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007355	N/A	N/A	N/A	N/A	N/A	6501 GARFIELD AVE	None	BELL GARDENS	CA	90201	1805	00	06000	33.97292523	-118.1475473	Los Angeles County
346882	Ordering, Referring, Prescribing	N/A	1790221497	0	0	LO-VANG, YING CNP	1/10/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005181	N/A	N/A	N/A	N/A	N/A	202 MIRA LOMA DR	None	OROVILLE	CA	95965	3500	00	06000	39.52218619	-121.5525282	Butte County
346910	Ordering, Referring, Prescribing	N/A	1790252070	0	0	LE, LYNN M PA-C	3/23/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PA56052	N/A	N/A	N/A	N/A	N/A	1045 N LAKE AVE	None	PASADENA	CA	91104	4596	00	06000	34.16394511	-118.1324885	Los Angeles County
346921	Ordering, Referring, Prescribing	N/A	1790267953	0	0	LAWHON, NICHOLAS PHARMD	8/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	77056	N/A	N/A	N/A	N/A	N/A	1459 MAIN ST	None	RAMONA	CA	92065	2128	00	06000	33.03801505	-116.8758987	San Diego County
346965	Ordering, Referring, Prescribing	N/A	1790343887	0	0	LE, CHRISTOPHER M DO	5/23/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21164	N/A	N/A	N/A	N/A	N/A	515 COLUMBIA AVE	SUITE #200	LOS ANGELES	CA	90017	1209	00	06000	34.05683109	-118.265995	Los Angeles County
346981	Ordering, Referring, Prescribing	N/A	1790388395	0	0	LEE, NICOLE J PHARMD	11/13/2020	Taxonomy not applicable	NA	n/a	000	Unknown	83846	N/A	N/A	N/A	N/A	N/A	1001 E. LATHAM AVE SUITE	None	HEMET	CA	92543	4435	00	06000	33.74937254	-116.961804	Riverside County
346990	Ordering, Referring, Prescribing	N/A	1790431328	0	0	LEE, SUZIE PHARMD	5/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84342	N/A	N/A	N/A	N/A	N/A	37323 FREMONT BLVD	None	FREMONT	CA	94536	3702	00	06000	37.55820562	-122.0070406	Alameda County
346997	Ordering, Referring, Prescribing	N/A	1790438208	0	0	LIN, JOANN NP	11/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95019239	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
347004	Ordering, Referring, Prescribing	N/A	1790453157	0	0	LE, DONG PHARMD	8/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	84487	N/A	N/A	N/A	N/A	N/A	2203 MISSION ST	None	SANTA CRUZ	CA	95060	5221	00	06000	36.9619042	-122.0454945	Santa Cruz County
347014	Ordering, Referring, Prescribing	N/A	1790492486	0	0	LEE, CHANESE NP	10/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023093	N/A	N/A	N/A	N/A	N/A	32460 CROWN VALLEY PKWY	112	DANA POINT	CA	92629	3302	00	06000	33.49207811	-117.7198768	Orange County
347043	Ordering, Referring, Prescribing	N/A	1790802445	0	0	LOI, NGOC LCSW	6/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW63571	N/A	N/A	N/A	N/A	N/A	3270 KERNER BLVD	STE B	SAN RAFAEL	CA	94901	4840	00	06000	37.96108677	-122.5017451	Marin County
347059	Ordering, Referring, Prescribing	N/A	1790817310	0	0	LOO, ADRIANA LMFT	5/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT42821	N/A	N/A	N/A	N/A	N/A	2351 CARDINAL LN	ANNEX B	SAN DIEGO	CA	92123	3743	00	06000	32.7867927	-117.1601935	San Diego County
347079	Ordering, Referring, Prescribing	N/A	1790858132	0	0	LAW, CHRISTINE W PHARMD	4/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50827	N/A	N/A	N/A	N/A	N/A	30116 EIGENBRODT WAY	None	UNION CITY	CA	94587	1225	00	06000	37.60846354	-122.0715526	Alameda County
347081	Ordering, Referring, Prescribing	N/A	1790857506	0	0	LEE, ELISA S MD	8/8/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A78433	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL STREET	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
347088	Ordering, Referring, Prescribing	N/A	1790863884	0	0	LIU, SAMUEL K MD	6/30/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G64755	N/A	N/A	N/A	N/A	N/A	1680 PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3133	00	06000	40.42141164	-120.6468171	Lassen County
347092	Ordering, Referring, Prescribing	N/A	1790876720	0	0	LUND, ERIN MD	9/6/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A96724	N/A	N/A	N/A	N/A	N/A	301 6TH STREET	SUITE 214	SANTA ROSA	CA	95401	4154	00	06000	38.440269	-122.7188745	Sonoma County
347093	Ordering, Referring, Prescribing	N/A	1790881381	0	0	LAI, CHUN C MD	6/7/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A72495	N/A	N/A	N/A	N/A	N/A	47825 OASIS STREET	None	INDIO	CA	92201	6950	00	06000	33.70112861	-116.2209066	Riverside County
347095	Ordering, Referring, Prescribing	N/A	1790869055	0	0	LEUNG, GEORGE	6/11/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC15504	N/A	N/A	N/A	N/A	N/A	767 N HILL ST	200	LOS ANGELES	CA	90012	2343	00	06000	34.06255157	-118.2397077	Los Angeles County
347100	Ordering, Referring, Prescribing	N/A	1790902997	0	0	LANE, ANDREA L	12/5/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA18134	N/A	N/A	N/A	N/A	N/A	10737 CAMINO RUIZ	MEDICAL MALL SUITE 220	SAN DIEGO	CA	92126	2363	00	06000	32.91416051	-117.1437943	San Diego County
347123	Ordering, Referring, Prescribing	N/A	1790968071	0	0	LOHSE, STEPHANIE R LCSW	4/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW21917	N/A	N/A	N/A	N/A	N/A	4150 UTE DR	None	SAN DIEGO	CA	92117	5853	00	06000	32.80925642	-117.2018921	San Diego County
347135	Ordering, Referring, Prescribing	N/A	1790978534	0	0	LEVY-BOYD, SONYA D LCSW	1/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	65663	N/A	N/A	N/A	N/A	N/A	1211 5 ST.	None	EUREKA	CA	95501	1154	00	06000	40.80305422	-124.1581436	Humboldt County
347154	Ordering, Referring, Prescribing	N/A	1801025275	0	0	LO, VERNA MD	2/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A107248	N/A	N/A	N/A	N/A	N/A	1990 41ST AVE.	None	SAN FRANCISCO	CA	94116	1101	00	06000	37.74984135	-122.4997872	San Francisco County
347155	Ordering, Referring, Prescribing	N/A	1801010574	0	0	LEONARD, NATALIA NP	12/5/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0359065	N/A	N/A	N/A	N/A	N/A	1602 THOMAS AVENUE	None	SAN DIEGO	CA	92019	4423	00	06000	32.79693604	-117.2397272	San Diego County
347177	Ordering, Referring, Prescribing	N/A	1801068416	0	0	LOPEZ-MORALES, ANGELA M LMFT	3/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109796	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	SUITE 130	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
347199	Ordering, Referring, Prescribing	N/A	1801084363	0	0	LEE, CHUNG LCSW	12/23/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25816	N/A	N/A	N/A	N/A	N/A	529 SOUTH MAPLE AVE	None	LOS ANGELES	CA	90013	1511	00	06000	34.04465262	-118.2472846	Los Angeles County
347204	Ordering, Referring, Prescribing	N/A	1801127493	0	0	LIPUMANO, TRISHA L	2/7/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0635908	N/A	N/A	N/A	N/A	N/A	601 W 19TH ST.	None	COSTA MESA	CA	92627	5060	00	06000	33.64341274	-117.9236037	Orange County
347217	Ordering, Referring, Prescribing	N/A	1801144381	0	0	LIU, SI K PHARMD	3/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65554	N/A	N/A	N/A	N/A	N/A	1800 HARRISON ST	FL 13	OAKLAND	CA	94612	3466	00	06000	37.80593773	-122.2656714	Alameda County
347246	Ordering, Referring, Prescribing	N/A	1801181375	0	0	LOVELACE, NATASHA P LMFT	8/31/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT98540	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
347282	Ordering, Referring, Prescribing	N/A	1801235700	0	0	LONDONO, DIANA P MD	7/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173775	N/A	N/A	N/A	N/A	N/A	46100 WASHINGTON STREET	None	LA QUINTA	CA	92253	2042	00	06000	33.7160676	-116.2947656	Riverside County
347302	Ordering, Referring, Prescribing	N/A	1801264213	0	0	LOPEZ-JIMENEZ, ROSA L LCSW	2/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93992	N/A	N/A	N/A	N/A	N/A	1720 E 120TH ST	None	LOS ANGELES	CA	90059	3052	00	06000	33.92455929	-118.2423557	Los Angeles County
347309	Ordering, Referring, Prescribing	N/A	1801263058	0	0	LE-LEAVITT, COLLEEN	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72959	N/A	N/A	N/A	N/A	N/A	111 S MAIN ST ORANGE CA	None	ORANGE	CA	92868	2842	00	06000	33.787512	-117.867272	Orange County
347351	Ordering, Referring, Prescribing	N/A	1801327044	0	0	LEIBRANDT, RYAN	5/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A172836	N/A	N/A	N/A	N/A	N/A	10535 HOSPITAL WAY	None	MATHER	CA	95655	4200	00	06000	38.572443	-121.2965235	Sacramento County
347363	Ordering, Referring, Prescribing	N/A	1801344569	0	0	LEE, PATRICK S PHARMD	2/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	74885	N/A	N/A	N/A	N/A	N/A	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	00	06000	37.48892015	-122.218747	San Mateo County
347368	Ordering, Referring, Prescribing	N/A	1801347562	0	0	LY, LINNA PHARMD	10/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH75167	N/A	N/A	N/A	N/A	N/A	1719 E WALNUT ST	None	PASADENA	CA	91106	1611	00	06000	34.14957646	-118.115019	Los Angeles County
347387	Ordering, Referring, Prescribing	N/A	1801394762	0	0	LE, CHAU T NP	4/24/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029907	N/A	N/A	N/A	N/A	N/A	2130 STOCKTON BLVD	300	SACRAMENTO	CA	95817	1337	00	06000	38.557593	-121.4616735	Sacramento County
347395	Ordering, Referring, Prescribing	N/A	1801417902	0	0	LA, HONG S CNP	4/23/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95190377	N/A	N/A	N/A	N/A	N/A	9024 SNIKTAW LANE	None	FORT JONES	CA	96032	9408	00	06000	41.59983924	-122.9748122	Siskiyou County
347447	Ordering, Referring, Prescribing	N/A	1801526868	0	0	LATHAM, CASSANDRA PT	12/26/2023	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	305376	N/A	N/A	N/A	N/A	N/A	10431 COMMERCE ST	A	REDLANDS	CA	92374	0110	00	06000	34.06427678	-117.2416506	San Bernardino County
347455	Ordering, Referring, Prescribing	N/A	1801552419	0	0	LONGMAN, DARYN PA-C	6/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61175	N/A	N/A	N/A	N/A	N/A	2200 TYDD STREET	None	EUREKA	CA	95501	1284	00	06000	40.80241902	-124.1462268	Humboldt County
347462	Ordering, Referring, Prescribing	N/A	1801556618	0	0	LANGHANS, HESSENA	5/17/2023	Taxonomy not applicable	NA	n/a	000	Unknown	12464	N/A	N/A	N/A	N/A	N/A	2531 W WOODLAND DR	None	ANAHEIM	CA	92801	2637	00	06000	33.8492705	-117.973044	Orange County
347498	Ordering, Referring, Prescribing	N/A	1801921184	0	0	LEE, JUNG S LCSW	3/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS26279	N/A	N/A	N/A	N/A	N/A	850 EAST FOOTHILL BOULEV	None	RIALTO	CA	92376	5230	00	06000	34.10679449	-117.3542535	San Bernardino County
347534	Ordering, Referring, Prescribing	N/A	1811012909	0	0	LEE, NADINE Y PHARMD	3/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55141	N/A	N/A	N/A	N/A	N/A	25821 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	00	06000	33.78906668	-118.293942	Los Angeles County
347542	Ordering, Referring, Prescribing	N/A	1811023351	0	0	LANCASTER, SUSAN A	12/7/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D30901	N/A	N/A	N/A	N/A	N/A	250 JUANA AVE	102	SAN LEANDRO	CA	94577	4841	00	06000	37.72390995	-122.1526333	Alameda County
347553	Ordering, Referring, Prescribing	N/A	1811029192	0	0	LOIZZO, MICHAEL LMFT	3/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	37682	N/A	N/A	N/A	N/A	N/A	3881 S. WESTERN AVENUE.	None	LOS ANGELES	CA	90062	1105	00	06000	34.015032	-118.308937	Los Angeles County
347560	Ordering, Referring, Prescribing	N/A	1811052897	0	0	LUCAS, PETER MD	1/19/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G50158	N/A	N/A	N/A	N/A	N/A	145 CARSON VIEW	None	MARKLEEVILLE	CA	96120	9636	00	06000	38.80664209	-119.8025457	Alpine County
347600	Ordering, Referring, Prescribing	N/A	1811139884	0	0	LOUIE, LILA NP	3/2/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF23360	N/A	N/A	N/A	N/A	N/A	815 HYDE ST	STE. 100	SAN FRANCISCO	CA	94109	5998	00	06000	37.78855	-122.416917	San Francisco County
347604	Ordering, Referring, Prescribing	N/A	1811161771	0	0	LINAM, MARK S DPM	10/31/2017	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E3500	N/A	N/A	N/A	N/A	N/A	16660 PARAMOUNT BLVD	101	PARAMOUNT	CA	90723	5457	00	06000	33.882723	-118.1599535	Los Angeles County
347629	Ordering, Referring, Prescribing	N/A	1811202716	0	0	LANGFORD, MATTHEW OD	11/13/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	14030	N/A	N/A	N/A	N/A	N/A	11717 BERNARDO PLAZA COU	105	SAN DIEGO	CA	92128	2419	00	06000	33.01929872	-117.0777714	San Diego County
347644	Ordering, Referring, Prescribing	N/A	1811243793	0	0	LEWIS, MELVIN R LMFT	3/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116259	N/A	N/A	N/A	N/A	N/A	2151 COLLEGE AVE	None	BAKERSFIELD	CA	93305	4113	00	06000	35.3830369	-118.9680991	Kern County
347667	Ordering, Referring, Prescribing	N/A	1811270416	0	0	LE, QUINN PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65781	N/A	N/A	N/A	N/A	N/A	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	00	06000	38.12828446	-122.24821	Solano County
347669	Ordering, Referring, Prescribing	N/A	1811270283	0	0	LUU, JAMES-DUC T PHARMD	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55567	N/A	N/A	N/A	N/A	N/A	10990 WARNER AVE	SUITE A	FOUNTAIN VALLEY	CA	92708	1818	00	06000	33.7162557	-117.9373439	Orange County
347684	Ordering, Referring, Prescribing	N/A	1811283765	0	0	LE, HAI MD	7/24/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C175227	N/A	N/A	N/A	N/A	N/A	2035 E BALL RD	STE 200	ANAHEIM	CA	92806	5159	00	06000	33.81812448	-117.8880075	Orange County
347686	Ordering, Referring, Prescribing	N/A	1811296858	0	0	LANDRUM, ARIEL L LMFT	3/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT91156	N/A	N/A	N/A	N/A	N/A	21000 PLUMMER STREET	None	CHASTWORTH	CA	91311	4903	00	06000	34.24271597	-118.5915861	Los Angeles County
347709	Ordering, Referring, Prescribing	N/A	1811344229	0	0	LOU, JEREMY MD	6/2/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154518	N/A	N/A	N/A	N/A	N/A	7601 E. IMPERIAL HWY	None	DOWNEY	CA	90242	3456	00	06000	33.929829	-118.157607	Los Angeles County
347712	Ordering, Referring, Prescribing	N/A	1811358104	0	0	LEUNG, VIVIAN B PT	5/18/2021	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	300203	N/A	N/A	N/A	N/A	N/A	728 PACIFIC AVE	301	SAN FRANCISCO	CA	94133	4457	00	06000	37.79687859	-122.4074282	San Francisco County
347718	Ordering, Referring, Prescribing	N/A	1811363781	0	0	LEGGETT, SARA LMFT	11/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT129219	N/A	N/A	N/A	N/A	N/A	3433 AMERICAN RIVER DRIV	SUITE A	SACRAMENTO	CA	95864	5742	00	06000	38.57022	-121.385277	Sacramento County
347741	Ordering, Referring, Prescribing	N/A	1811390644	0	0	LOTA, APRIL R LCSW	4/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW90333	N/A	N/A	N/A	N/A	N/A	17053 E FOOTHILL BLVD	None	FONTANA	CA	92335	3574	00	06000	34.10655148	-117.432828	San Bernardino County
347748	Ordering, Referring, Prescribing	N/A	1811404460	0	0	LINDO, RAVEN LMFT	3/7/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT138399	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	401	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
347761	Ordering, Referring, Prescribing	N/A	1811413040	0	0	LOZANO, DIANA LCSW	3/14/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	129235	N/A	N/A	N/A	N/A	N/A	1300 S GRAND AVE	None	SANTA ANA	CA	92705	4434	00	06000	33.73222238	-117.8504455	Orange County
347782	Ordering, Referring, Prescribing	N/A	1811438740	0	0	LOPEZ, CYNTHIA L NP	3/30/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005864	N/A	N/A	N/A	N/A	N/A	2880 HULEN PLACE	None	RIVERSIDE	CA	90527	2606	00	06000	33.986934	-117.3538725	Riverside County
347809	Ordering, Referring, Prescribing	N/A	1811481914	0	0	LIN, DANA DPM	4/25/2023	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	5731	N/A	N/A	N/A	N/A	N/A	121 S LONG BEACH BLVD	None	COMPTON	CA	90221	3423	00	06000	33.89475493	-118.2080292	Los Angeles County
347832	Ordering, Referring, Prescribing	N/A	1811534779	0	0	LUMBANG, IRMA PHARMD	5/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	81470	N/A	N/A	N/A	N/A	N/A	7000 AUBURN BLVD	None	CITRUS HEIGHTS	CA	95621	4342	00	06000	38.689875	-121.2975585	Sacramento County
347838	Ordering, Referring, Prescribing	N/A	1811534878	0	0	LEE, SUSAN	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78117	N/A	N/A	N/A	N/A	N/A	710 S BROADWAY	SUITE 300	WALNUT CREEK	CA	94596	5294	00	06000	37.89702115	-122.0569066	Contra Costa County
347854	Ordering, Referring, Prescribing	N/A	1811585565	0	0	LEE, ELAINE DDS	1/12/2024	Taxonomy not applicable	NA	n/a	000	Unknown	105110	N/A	N/A	N/A	N/A	N/A	8321 E. STOCKTON BLVD	C	SACRAMENTO	CA	95828	8203	00	06000	38.45932851	-121.4061701	Sacramento County
347857	Ordering, Referring, Prescribing	N/A	1811594286	0	0	LUNA, NATHANAEL J PHARMD	1/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	83337	N/A	N/A	N/A	N/A	N/A	4630 BORDER VILLAGE RD	SUITE K	SAN YSIDRO	CA	92173	3121	00	06000	32.54777512	-117.0357457	San Diego County
347858	Ordering, Referring, Prescribing	N/A	1811586670	0	0	LEW, CARI LCSW	10/27/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	118844	N/A	N/A	N/A	N/A	N/A	9333 TECH CENTER DR	STE 100	SACRAMENTO	CA	95628	2583	00	06000	38.563839	-121.3521435	Sacramento County
347860	Ordering, Referring, Prescribing	N/A	1811583057	0	0	LEE, EDWARD PHARMD	6/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	83954	N/A	N/A	N/A	N/A	N/A	620 S GRAMERCY PLACE	417	LOS ANGELES	CA	90005	0000	00	06000	34.062939	-118.3128125	Los Angeles County
347870	Ordering, Referring, Prescribing	N/A	1811610603	0	0	LLAVE, EMILIANO PHARMD	9/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86753	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	None	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
347890	Ordering, Referring, Prescribing	N/A	1811695752	0	0	LALWANI, PARKASH G PT	2/15/2023	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT302761	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
347892	Ordering, Referring, Prescribing	N/A	1811712920	0	0	LAKE, RAMONA A RN BS	11/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95105675	N/A	N/A	N/A	N/A	N/A	1200 N CHESTER AVE	None	BAKERSFIELD	CA	93308	3521	00	06000	35.41618962	-119.0210663	Kern County
347896	Ordering, Referring, Prescribing	N/A	1811719909	0	0	LI, YAN	10/21/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032654	N/A	N/A	N/A	N/A	N/A	511 N BROOKHURST ST	None	ANAHEIM	CA	92801	5231	00	06000	33.839253	-117.959068	Orange County
347957	Ordering, Referring, Prescribing	N/A	1821128315	0	0	LOPEZ FLEGEANCE, IRIS C LMFT	1/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50364	N/A	N/A	N/A	N/A	N/A	1902 ROYALTY DR	#240	POMONA	CA	91767	3030	00	06000	34.07791925	-117.746146	Los Angeles County
347963	Ordering, Referring, Prescribing	N/A	1821131624	0	0	LUKEMAN, GAYLE E LMFT	2/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43536	N/A	N/A	N/A	N/A	N/A	1445 VETERANS MEMORIAL C	None	YUBA CITY	CA	95993	3011	00	06000	39.14469836	-121.6380819	Sutter County
347965	Ordering, Referring, Prescribing	N/A	1821140732	0	0	LAM, THUAN LCSW	12/15/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28937	N/A	N/A	N/A	N/A	N/A	10605 BALBOA BLVD	100	GRANADA HILLS	CA	91344	6342	00	06000	34.263378	-118.5022965	Los Angeles County
347974	Ordering, Referring, Prescribing	N/A	1821157520	0	0	LYNN, LISA LCSW	7/6/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW13674	N/A	N/A	N/A	N/A	N/A	2050 FAIRMONT DR	None	SAN LEANDRO	CA	94578	1001	00	06000	37.710738	-122.1146415	Alameda County
347975	Ordering, Referring, Prescribing	N/A	1821148446	0	0	LERMA, IRMA R LMFT	9/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT31359	N/A	N/A	N/A	N/A	N/A	2335 COUNTRY HILLS DR	None	ANTIOCH	CA	94509	7319	00	06000	37.97021462	-121.7841321	Contra Costa County
347986	Ordering, Referring, Prescribing	N/A	1821179409	0	0	LUEVANO, ROCIO O LCSW	11/13/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23089	N/A	N/A	N/A	N/A	N/A	4701 E CESAR E CHAVEZ AV	2ND FLOOR	LOS ANGELES	CA	90022	1209	00	06000	34.04062547	-118.1643975	Los Angeles County
347995	Ordering, Referring, Prescribing	N/A	1821191750	0	0	LEVY, JOSHUA MD	1/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G12758	N/A	N/A	N/A	N/A	N/A	4910 VAN NUYS BLVD	303	SHERMAN OAKS	CA	91403	1701	00	06000	34.15979697	-118.4486826	Los Angeles County
348008	Ordering, Referring, Prescribing	N/A	1821227554	0	0	LARSON, JANNA A MD	12/22/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A114315	N/A	N/A	N/A	N/A	N/A	1325 S MISSION RD	None	FALLBROOK	CA	92028	4006	00	06000	33.36872811	-117.2508824	San Diego County
348030	Ordering, Referring, Prescribing	N/A	1821286576	0	0	LORONA, PAUL J LMFT	4/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80000	N/A	N/A	N/A	N/A	N/A	3125 MYERS ST	None	RIVERSIDE	CA	92503	5527	00	06000	33.90932558	-117.4428095	Riverside County
348037	Ordering, Referring, Prescribing	N/A	1821298118	0	0	LAWRENCE, ANGELENE M MD	3/9/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A96723	N/A	N/A	N/A	N/A	N/A	3117 WILSON RD	None	BAKERSFIELD	CA	93304	5319	00	06000	35.33217251	-119.0385045	Kern County
348042	Ordering, Referring, Prescribing	N/A	1821303009	0	0	LE, KEVIN K LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111643	N/A	N/A	N/A	N/A	N/A	871 ENBORG CT	None	SAN JOSE	CA	95128	2645	00	06000	37.311489	-121.933817	Santa Clara County
348049	Ordering, Referring, Prescribing	N/A	1821291733	0	0	LEE, HANNAH J LCSW	12/21/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26041	N/A	N/A	N/A	N/A	N/A	1816 SOUTH FIGUEROA STRE	6TH FLOOR	LOS ANGELES	CA	90015	3422	00	06000	34.03542929	-118.2713663	Los Angeles County
348051	Ordering, Referring, Prescribing	N/A	1821324559	0	0	LINSAO, AMY W PSYD	4/5/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34977	N/A	N/A	N/A	N/A	N/A	2425 BISSO LN	SUITE 200	CONCORD	CA	94520	4886	00	06000	37.98393807	-122.0466953	Contra Costa County
348125	Ordering, Referring, Prescribing	N/A	1821447590	0	0	LE, DUNG	8/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	74441	N/A	N/A	N/A	N/A	N/A	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
348133	Ordering, Referring, Prescribing	N/A	1821461492	0	0	LOPEZ, YADIRA LMFT	10/30/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112820	N/A	N/A	N/A	N/A	N/A	5350 MACHADO RD	None	CULVER CITY	CA	90230	8800	00	06000	33.99781622	-118.3966503	Los Angeles County
348135	Ordering, Referring, Prescribing	N/A	1821462581	0	0	LE, PHILIP PHARMD	7/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH73838	N/A	N/A	N/A	N/A	N/A	16108 FOOTHILL BLVD	None	FONTANA	CA	92335	3356	00	06000	34.10659147	-117.4529823	San Bernardino County
348146	Ordering, Referring, Prescribing	N/A	1821474560	0	0	LE, RACHAEL PHARMD	2/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	72840	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVENUE	SUITE 220B	SAN JOSE	CA	95128	0000	00	06000	37.3160785	-121.937121	Santa Clara County
348148	Ordering, Referring, Prescribing	N/A	1821477035	0	0	LEWMAN, BRENDA LMFT	4/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106905	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
348170	Ordering, Referring, Prescribing	N/A	1821517608	0	0	LOZANO, ERIC M PHARMD	4/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH76974	N/A	N/A	N/A	N/A	N/A	7373 WEST LANE	None	STOCKTON	CA	95210	0000	00	06000	38.017701	-121.297869	San Joaquin County
348196	Ordering, Referring, Prescribing	N/A	1821548298	0	0	LE, DUY N PHARMD	3/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	64986	N/A	N/A	N/A	N/A	N/A	2103 S ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	6801	00	06000	34.03885159	-118.1443719	Los Angeles County
348275	Ordering, Referring, Prescribing	N/A	1821723727	0	0	LEE, SAMANTHA R NP	7/20/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021871	N/A	N/A	N/A	N/A	N/A	8233 E. STOCKTON BLVD	STE D	SACRAMENTO	CA	95828	8203	00	06000	38.459628	-121.4095815	Sacramento County
348290	Ordering, Referring, Prescribing	N/A	1821764127	0	0	LAM, RYAN Q PHARMD	8/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84826	N/A	N/A	N/A	N/A	N/A	795 E 2ND ST	None	POMONA	CA	91766	1854	00	06000	34.05845654	-117.7423951	Los Angeles County
348299	Ordering, Referring, Prescribing	N/A	1821866245	0	0	LYNCH, XIFENG F	11/13/2023	Taxonomy not applicable	NA	n/a	000	Unknown	WL6248	N/A	N/A	N/A	N/A	N/A	40930 FREMONT BLVD	None	FREMONT	CA	94538	4375	00	06000	37.53353137	-121.9601832	Alameda County
348302	Ordering, Referring, Prescribing	N/A	1821820325	0	0	LOWE, LYNZI LCSW	11/5/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114347	N/A	N/A	N/A	N/A	N/A	714 N. WHITE STREET	None	HANFORD	CA	93230	2379	00	06000	36.332613	-119.6395665	Kings County
348304	Ordering, Referring, Prescribing	N/A	1831108091	0	0	LAW, SHU Y	8/31/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D51487	N/A	N/A	N/A	N/A	N/A	740 SOLANO ST	None	CORNING	CA	96021	3352	00	06000	39.92792649	-122.175513	Tehama County
348312	Ordering, Referring, Prescribing	N/A	1831146174	0	0	LUONG, MING J NP	12/16/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	11004	N/A	N/A	N/A	N/A	N/A	4448 YORK BLVD	None	LOS ANGELES	CA	90041	3328	00	06000	34.12374025	-118.2188529	Los Angeles County
348314	Ordering, Referring, Prescribing	N/A	1831147172	0	0	LAMBERT, ERICA MD	5/1/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A71168	N/A	N/A	N/A	N/A	N/A	4141 STATE STREET	SUITE B3	SANTA BARBARA	CA	93110	1814	00	06000	34.4404695	-119.7612045	Santa Barbara County
348317	Ordering, Referring, Prescribing	N/A	1831149475	0	0	LEE, KENNETH S MD	1/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A53421	N/A	N/A	N/A	N/A	N/A	4455 W 117TH ST	300	HAWTHORNE	CA	90250	2241	00	06000	33.92825048	-118.3539285	Los Angeles County
348318	Ordering, Referring, Prescribing	N/A	1831171719	0	0	LANE, INGVILD G MD	10/26/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C53026	N/A	N/A	N/A	N/A	N/A	1 SCRIPPS DRIVE	SUITE 202	SACRAMENTO	CA	95825	6206	00	06000	38.573181	-121.4118135	Sacramento County
348327	Ordering, Referring, Prescribing	N/A	1831185230	0	0	LEDEE-LEWIS, KAREN A NP	10/17/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	11165	N/A	N/A	N/A	N/A	N/A	6107 N FIRST ST	SUITE 103	FRESNO	CA	93710	5406	00	06000	36.8252391	-119.7723926	Fresno County
348359	Ordering, Referring, Prescribing	N/A	1831255017	0	0	LOPEZ ANDRZEJEK, MARIA I PHARMD	11/4/2019	Taxonomy not applicable	NA	n/a	000	Unknown	52970	N/A	N/A	N/A	N/A	N/A	2424 MISSION STREET	None	SAN FRANCISCO	CA	94110	2415	00	06000	37.75816928	-122.4190376	San Francisco County
348362	Ordering, Referring, Prescribing	N/A	1831275122	0	0	LOUIE, SARAH S PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55861	N/A	N/A	N/A	N/A	N/A	1200 EL CAMINO REAL	None	SOUTH SAN FRANCIS	CA	94080	3208	00	06000	37.65894608	-122.440161	San Mateo County
348365	Ordering, Referring, Prescribing	N/A	1831285188	0	0	LEE, SARAH J	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	40217	N/A	N/A	N/A	N/A	N/A	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
348371	Ordering, Referring, Prescribing	N/A	1831303650	0	0	LEE, SUNYOUNG PHARMD	11/4/2020	Taxonomy not applicable	NA	n/a	000	Unknown	56977	N/A	N/A	N/A	N/A	N/A	2000 PHYSICIANS PLAZA BL	None	BAKERSFIELD	CA	93301	1277	00	06000	35.396994	-119.0084938	Kern County
348373	Ordering, Referring, Prescribing	N/A	1831310663	0	0	LIU, STANLEY S	5/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D61438	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
348397	Ordering, Referring, Prescribing	N/A	1831354596	0	0	LARA LOPEZ, YARABI LMFT	12/22/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	136724	N/A	N/A	N/A	N/A	N/A	828 S BASCOM AVE	STE 190	SAN JOSE	CA	95128	2651	00	06000	37.31225204	-121.9317854	Santa Clara County
348437	Ordering, Referring, Prescribing	N/A	1831459346	0	0	LEE, XEE NP	5/29/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN823557	N/A	N/A	N/A	N/A	N/A	444 W EL MONTE WAY	None	DINUBA	CA	93618	1500	00	06000	36.54592542	-119.39921	Tulare County
348440	Ordering, Referring, Prescribing	N/A	1831456474	0	0	LIU, YUAN MD	10/8/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133774	N/A	N/A	N/A	N/A	N/A	3727 W 6TH ST.	SUITE 200	LOS ANGELES	CA	90020	5108	00	06000	34.06358655	-118.3037656	Los Angeles County
348450	Ordering, Referring, Prescribing	N/A	1831477900	0	0	LEE, ANNE PHARMD	4/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	48774	N/A	N/A	N/A	N/A	N/A	520 N LONE HILL AVE	None	SAN DIMAS	CA	91773	1725	00	06000	34.111836	-117.825957	Los Angeles County
348461	Ordering, Referring, Prescribing	N/A	1831491786	0	0	LYNN, MICHAEL DC	4/19/2017	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	16198	N/A	N/A	N/A	N/A	N/A	1455 PARK BLVD	None	ORANGE GROVE	CA	93646	9322	00	06000	36.62466137	-119.3227461	Fresno County
348490	Ordering, Referring, Prescribing	N/A	1831547249	0	0	LOPEZ, LETICIA	2/24/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004130	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
348494	Ordering, Referring, Prescribing	N/A	1831551910	0	0	LE, THUY M MD	3/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150394	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
348508	Ordering, Referring, Prescribing	N/A	1831566025	0	0	LENT, ALLYSON LCSW	12/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99285	N/A	N/A	N/A	N/A	N/A	1930 MARKET STREET	None	SAN FRANCISCO	CA	94102	6228	00	06000	37.77037155	-122.4255051	San Francisco County
348509	Ordering, Referring, Prescribing	N/A	1831567320	0	0	LEON, BRENDA LMFT	8/13/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT139617	N/A	N/A	N/A	N/A	N/A	649 E ALBERTONI ST	None	CARSON	CA	90746	1538	00	06000	33.87194399	-118.2643054	Los Angeles County
348514	Ordering, Referring, Prescribing	N/A	1831581065	0	0	LAIMER, HANNAH DO	6/21/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16590	N/A	N/A	N/A	N/A	N/A	2440 W TAHOE AVE	None	CARUTHERS	CA	93609	9476	00	06000	36.54046763	-119.83553	Fresno County
348536	Ordering, Referring, Prescribing	N/A	1831614098	0	0	LABARBERA, JULIA NP	6/26/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006981	N/A	N/A	N/A	N/A	N/A	2336 SANTA MONICA BLVD	304	SANTA MONICA	CA	90404	2067	00	06000	34.03136627	-118.4766854	Los Angeles County
348584	Ordering, Referring, Prescribing	N/A	1831676121	0	0	LOI, MINERVA S	3/7/2022	Taxonomy not applicable	NA	n/a	099	DENTIST	102035	N/A	N/A	N/A	N/A	N/A	630 DRAKE AVE	None	SAUSALITO	CA	94965	1107	00	06000	37.87340883	-122.515085	Marin County
348594	Ordering, Referring, Prescribing	N/A	1831680446	0	0	LEE, ANDREW J LAC	12/20/2020	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC18116	N/A	N/A	N/A	N/A	N/A	3980 SAN PABLO DAM RD	STE 205	EL SOBRANTE	CA	94803	2826	00	06000	37.96546353	-122.3118407	Contra Costa County
348653	Ordering, Referring, Prescribing	N/A	1831781145	0	0	LY, VINCENT	5/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64342	N/A	N/A	N/A	N/A	N/A	701 S ATLANTIC BLVD	SUITE 168	MONTEREY PARK	CA	91754	3866	00	06000	34.05382447	-118.1363489	Los Angeles County
348660	Ordering, Referring, Prescribing	N/A	1831801760	0	0	LEE, JENNIFER	4/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	78957	N/A	N/A	N/A	N/A	N/A	13652 CANTARA ST	MOB4 AREA 105 PHARMACY A	PANORAMA CITY	CA	91402	5423	00	06000	34.21980849	-118.4301135	Los Angeles County
348666	Ordering, Referring, Prescribing	N/A	1831832716	0	0	LEPE-CHOWDHURY, PAOLA R MD	9/11/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A190454	N/A	N/A	N/A	N/A	N/A	455 OCONNOR DR	None	SAN JOSE	CA	95128	1633	00	06000	37.326654	-121.939897	Santa Clara County
348689	Ordering, Referring, Prescribing	N/A	1831912187	0	0	LA, ALEXANDRITE	10/23/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032716	N/A	N/A	N/A	N/A	N/A	3055 MCKEE RD	None	SAN JOSE	CA	95127	1835	00	06000	37.37435097	-121.836765	Santa Clara County
348715	Ordering, Referring, Prescribing	N/A	1841079753	0	0	LONG, MARY K NP	7/2/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030912	N/A	N/A	N/A	N/A	N/A	199 E WEBSTER ST	None	COLUSA	CA	95932	0019	00	06000	39.20737704	-122.0004043	Colusa County
348726	Ordering, Referring, Prescribing	N/A	1841232717	0	0	LAI, MAI K MD	5/29/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A90320	N/A	N/A	N/A	N/A	N/A	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
348727	Ordering, Referring, Prescribing	N/A	1841223294	0	0	LIPPI, KELLY A NP	2/11/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	15563	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVENUE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
348745	Ordering, Referring, Prescribing	N/A	1841314168	0	0	LYON, COLLEEN S LCSW	9/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27257	N/A	N/A	N/A	N/A	N/A	14700 MANZANITA PARK ROA	None	BEAUMONT	CA	92223	3026	00	06000	33.909579	-116.971155	Riverside County
348751	Ordering, Referring, Prescribing	N/A	1841324456	0	0	LEE, SANDY O MD	7/5/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A71522	N/A	N/A	N/A	N/A	N/A	1401 AVOCADO AVE	709	NEWPORT BEACH	CA	92660	7710	00	06000	33.61235015	-117.8704573	Orange County
348766	Ordering, Referring, Prescribing	N/A	1841361961	0	0	LESTRANGE, RENEE A LMFT	6/27/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT36831	N/A	N/A	N/A	N/A	N/A	15235 BURBANK BLVD.	SUITE A3	SHERMAN OAKS	CA	91411	3500	00	06000	34.17211848	-118.465128	Los Angeles County
348771	Ordering, Referring, Prescribing	N/A	1841367430	0	0	LIN, CHRISTINA C PHARMD	4/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	48936	N/A	N/A	N/A	N/A	N/A	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3000	00	06000	33.904782	-117.469323	Riverside County
348778	Ordering, Referring, Prescribing	N/A	1841380938	0	0	LIN, LISA H PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51275	N/A	N/A	N/A	N/A	N/A	4175 E LA PALMA AVE	240	ANAHEIM	CA	92807	1842	00	06000	33.85947346	-117.8265479	Orange County
348788	Ordering, Referring, Prescribing	N/A	1841395993	0	0	LOHARUKA, PRABHU D MD	4/29/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A46415	N/A	N/A	N/A	N/A	N/A	4201 TORRANCE BLVD	380	TORRANCE	CA	90503	4501	00	06000	33.8375955	-118.358748	Los Angeles County
348803	Ordering, Referring, Prescribing	N/A	1841414927	0	0	LAMBERT, KELLY M LMFT	2/8/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47995	N/A	N/A	N/A	N/A	N/A	1061 EASTSHORE HIGHWAY	SUITE 209	ALBANY	CA	94710	0000	00	06000	37.88404533	-122.3081077	Alameda County
348808	Ordering, Referring, Prescribing	N/A	1841434495	0	0	LOUCKS, CHRISTOPHER S MD	4/23/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	MD20120431	N/A	N/A	N/A	N/A	N/A	1100 CENTRAL AVE SE	None	ALBUQUERQUE	NM	87106	4930	00	06000	35.08239279	-106.6353509	Bernalillo County
348854	Ordering, Referring, Prescribing	N/A	1841527611	0	0	LE, THUCDOAN T PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH62782	N/A	N/A	N/A	N/A	N/A	30116 EIGENBRODT WAY	None	UNION CITY	CA	94587	1225	00	06000	37.60846354	-122.0715526	Alameda County
348869	Ordering, Referring, Prescribing	N/A	1841543642	0	0	LOMELI, MABEL LCSW	6/13/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	115844	N/A	N/A	N/A	N/A	N/A	11731 TELEGRAPH RD	K	SANTA FE SPRINGS	CA	90670	3675	00	06000	33.94630253	-118.0832082	Los Angeles County
348887	Ordering, Referring, Prescribing	N/A	1841560422	0	0	LE, SARAH N PHARMD	8/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH66604	N/A	N/A	N/A	N/A	N/A	118 E BASELINE RD	None	RIALTO	CA	92376	0000	00	06000	34.12138457	-117.3698386	San Bernardino County
348888	Ordering, Referring, Prescribing	N/A	1841569738	0	0	LEONG, MICHELLE T	1/23/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D60642	N/A	N/A	N/A	N/A	N/A	16650 HIGHWAY 76	None	PAUMA VALLEY	CA	92061	9524	00	06000	33.29361295	-116.9693519	San Diego County
348898	Ordering, Referring, Prescribing	N/A	1841575636	0	0	LAVERTY, MELISSA A LMFT	5/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103058	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY STE 2	STE 207	SANTA ROSA	CA	95407	5486	00	06000	38.425266	-122.749875	Sonoma County
348912	Ordering, Referring, Prescribing	N/A	1841584786	0	0	LOPEZ ACOSTA, OSCAR A	7/5/2022	Taxonomy not applicable	NA	n/a	099	DENTIST	60403	N/A	N/A	N/A	N/A	N/A	1454 E SECOND ST	None	SAN BERNARDINO	CA	92408	0118	00	06000	34.1035953	-117.2563723	San Bernardino County
348949	Ordering, Referring, Prescribing	N/A	1841652989	0	0	LEON, EMILY LMFT	1/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT117153	N/A	N/A	N/A	N/A	N/A	815 N EL CENTRO AVE	None	LOS ANGELES	CA	90038	3805	00	06000	34.08577365	-118.3244665	Los Angeles County
348958	Ordering, Referring, Prescribing	N/A	1841682234	0	0	LE, PHUONGVI PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70991	N/A	N/A	N/A	N/A	N/A	3237 E CHAPMAN AVE	None	ORANGE	CA	92869	3709	00	06000	33.78782753	-117.8188425	Orange County
348971	Ordering, Referring, Prescribing	N/A	1841702198	0	0	LE, MYVAN PHARMD	3/26/2018	Taxonomy not applicable	NA	n/a	000	Unknown	77546	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD.	None	JACKSON	CA	95642	0121	00	06000	38.36981229	-120.8002806	Amador County
348975	Ordering, Referring, Prescribing	N/A	1841707338	0	0	LAM, THUY T PHARMD	8/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH77990	N/A	N/A	N/A	N/A	N/A	643 SANTA CRUZ AVE	None	MENLO PARK	CA	94025	0000	00	06000	37.45242157	-122.183849	San Mateo County
348976	Ordering, Referring, Prescribing	N/A	1841704905	0	0	LAIM, JOHNNY PHARMD	10/12/2018	Taxonomy not applicable	NA	n/a	000	Unknown	77345	N/A	N/A	N/A	N/A	N/A	1071 EL CAMINO REAL	None	REDWOOD CITY	CA	94063	0000	00	06000	37.48446	-122.230134	San Mateo County
348989	Ordering, Referring, Prescribing	N/A	1841718046	0	0	LEE, SERENA LCSW	2/22/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121160	N/A	N/A	N/A	N/A	N/A	661 W 1ST STREET	SUITE G	TUSTIN	CA	92801	1301	00	06000	33.74578153	-117.831231	Orange County
349005	Ordering, Referring, Prescribing	N/A	1841744349	0	0	LOPEZ, ESPERANZA LMFT	8/15/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	148877	N/A	N/A	N/A	N/A	N/A	440 EXCHANGE	250	IRVINE	CA	92602	1390	00	06000	33.71504086	-117.7849539	Orange County
349017	Ordering, Referring, Prescribing	N/A	1841759974	0	0	LANTZ, LINNEA M DO	3/30/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19416	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BOULEVARD	None	SACRAMENTO	CA	95817	2309	00	06000	38.555181	-121.4566785	Sacramento County
349031	Ordering, Referring, Prescribing	N/A	1841781812	0	0	LAGRANDEUR, WESTON MD	3/7/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194474	N/A	N/A	N/A	N/A	N/A	455 OCONNOR DR	200	SAN JOSE	CA	95128	1633	00	06000	37.326654	-121.939897	Santa Clara County
349058	Ordering, Referring, Prescribing	N/A	1841831955	0	0	LEWIS, KEVIN P CRNA	10/4/2019	Taxonomy not applicable	NA	n/a	018	NURSE ANESTHETISTS	95001206	N/A	N/A	N/A	N/A	N/A	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
349059	Ordering, Referring, Prescribing	N/A	1841832250	0	0	LIU, YEN-CHUN PHARMD	4/5/2022	Taxonomy not applicable	NA	n/a	000	Unknown	80113	N/A	N/A	N/A	N/A	N/A	17550 CASTLETON ST	None	CITY OF INDUSTRY	CA	91748	1701	00	06000	33.99479087	-117.9209253	Los Angeles County
349060	Ordering, Referring, Prescribing	N/A	1841835766	0	0	LAMBERT, MICHAELA M	10/23/2019	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	236077	N/A	N/A	N/A	N/A	N/A	1357 OAKLAND BOULEVARD	None	WALNUT CREEK	CA	94596	4303	00	06000	37.89795717	-122.0701674	Contra Costa County
349096	Ordering, Referring, Prescribing	N/A	1841943214	0	0	LAM, NANCY PHARMD	1/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	85841	N/A	N/A	N/A	N/A	N/A	1757 W SAN CARLOS ST	None	SAN JOSE	CA	95128	5222	00	06000	37.32350418	-121.9244334	Santa Clara County
349107	Ordering, Referring, Prescribing	N/A	1841959905	0	0	LIEN, JEFFREY T PHARMD	9/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85301	N/A	N/A	N/A	N/A	N/A	227 SHORELINE HWY	None	MILL VALLEY	CA	94941	3678	00	06000	37.88055641	-122.5240059	Marin County
349114	Ordering, Referring, Prescribing	N/A	1841998242	0	0	LIN, SHANSHAN NP	6/2/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025455	N/A	N/A	N/A	N/A	N/A	5050 SAN BERNARDINO STRE	None	MONTCLAIR	CA	91763	2326	00	06000	34.0776775	-117.694521	San Bernardino County
349138	Ordering, Referring, Prescribing	N/A	1851068704	0	0	LE, JESSICA V PHARMD	8/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84725	N/A	N/A	N/A	N/A	N/A	100 W WALNUT AVE	None	VISALIA	CA	93277	5367	00	06000	36.313209	-119.292516	Tulare County
349193	Ordering, Referring, Prescribing	N/A	1851432470	0	0	LLOYD, TASONA S PA-C	12/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA17701	N/A	N/A	N/A	N/A	N/A	25825 S. VERMONT AVE	None	HARBOR CITY	CA	90710	3518	00	06000	33.7892965	-118.2937327	Los Angeles County
349198	Ordering, Referring, Prescribing	N/A	1851434609	0	0	LOPEZ, VENANCIO LMFT	8/28/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104343	N/A	N/A	N/A	N/A	N/A	1830 S CENTRAL ST	None	VISALIA	CA	93277	4418	00	06000	36.314271	-119.311362	Tulare County
349244	Ordering, Referring, Prescribing	N/A	1851544043	0	0	LIMB, VIVIAN E PHARMD	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	43584	N/A	N/A	N/A	N/A	N/A	25825 S VERMONT	None	HARBOR CITY	CA	90710	3929	00	06000	33.7892965	-118.2937327	Los Angeles County
349246	Ordering, Referring, Prescribing	N/A	1851556138	0	0	LENTZ, MEGAN LMFT	6/1/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86515	N/A	N/A	N/A	N/A	N/A	350 MAIN ST	None	QUINCY	CA	95971	9375	00	06000	39.9367	-120.9457587	Plumas County
349257	Ordering, Referring, Prescribing	N/A	1851578744	0	0	LECLERE, OSCAR A LCSW	12/31/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29268	N/A	N/A	N/A	N/A	N/A	10515 BALBOA BLVD	376	GRANADA HILLS	CA	91344	6343	00	06000	34.261497	-118.502318	Los Angeles County
349264	Ordering, Referring, Prescribing	N/A	1851590996	0	0	LOZANO, NIA T MD	9/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A89255	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
349268	Ordering, Referring, Prescribing	N/A	1851604839	0	0	LOBO-MARWAH, ERIN C DDS	3/27/2024	Taxonomy not applicable	NA	n/a	000	Unknown	DDS60185	N/A	N/A	N/A	N/A	N/A	3743 S. LA BREA AVE.	None	LOS ANGELES	CA	90016	5309	00	06000	34.01991	-118.355626	Los Angeles County
349279	Ordering, Referring, Prescribing	N/A	1851620439	0	0	LEE, DAE P PSYD	5/16/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY23104	N/A	N/A	N/A	N/A	N/A	12220 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	00	06000	34.28134147	-118.4023977	Los Angeles County
349296	Ordering, Referring, Prescribing	N/A	1851646806	0	0	LA LONDE, PAMELA	6/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	40191	N/A	N/A	N/A	N/A	N/A	4801 CENTRAL AVE	None	RICHMOND	CA	94804	5801	00	06000	37.89726914	-122.3212101	Contra Costa County
349308	Ordering, Referring, Prescribing	N/A	1851668941	0	0	LEUNG, LISA S PHARMD	8/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH48559	N/A	N/A	N/A	N/A	N/A	8201 GREENLEAF AVE	None	WHITTIER	CA	90602	2910	00	06000	33.96517117	-118.0376617	Los Angeles County
349325	Ordering, Referring, Prescribing	N/A	1851679302	0	0	LEON, HECTOR DDS	12/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS60497	N/A	N/A	N/A	N/A	N/A	2756 S ELM AVE	None	FRESNO	CA	93706	5435	00	06000	36.70090897	-119.7908648	Fresno County
349337	Ordering, Referring, Prescribing	N/A	1851704605	0	0	LEE, HANG T NP	9/12/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	718756	N/A	N/A	N/A	N/A	N/A	437 N EUCLID AVE	None	ONTARIO	CA	91762	3456	00	06000	34.067988	-117.6521805	San Bernardino County
349340	Ordering, Referring, Prescribing	N/A	1851709414	0	0	LAKSANA, MICHELLE PA-C	5/14/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PA51795	N/A	N/A	N/A	N/A	N/A	12442 LIMONITE AVENUE	205	EASTVALE	CA	91752	0001	00	06000	33.97511454	-117.5531895	Riverside County
349365	Ordering, Referring, Prescribing	N/A	1851737688	0	0	LOTH, VANNDY L NP	6/30/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95012662	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVENUE	300	SAN JOSE	CA	95128	2680	00	06000	37.3160785	-121.937121	Santa Clara County
349369	Ordering, Referring, Prescribing	N/A	1851744320	0	0	LOTHROP, ANDREW J PHARMD	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73907	N/A	N/A	N/A	N/A	N/A	99 MONTECILLO RD	BUILDING 2	SAN RAFAEL	CA	94903	3308	00	06000	38.00450116	-122.5540001	Marin County
349372	Ordering, Referring, Prescribing	N/A	1851754279	0	0	LEVINE, ELIZABETH MD	3/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A168035	N/A	N/A	N/A	N/A	N/A	721 RIVER DRIVE	STE A	FORT BRAGG	CA	95437	5403	00	06000	39.43204627	-123.801581	Mendocino County
349383	Ordering, Referring, Prescribing	N/A	1851764005	0	0	LI, HELEN	5/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	73454	N/A	N/A	N/A	N/A	N/A	451 S AIRPORT BLVD	None	SOUTH SAN FRANCIS	CA	94080	6909	00	06000	37.64178187	-122.4026525	San Mateo County
349384	Ordering, Referring, Prescribing	N/A	1851767925	0	0	LEMUS, ROXANA LCSW	12/30/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127952	N/A	N/A	N/A	N/A	N/A	18670 CARTER ST	None	TUOLUMNE	CA	95379	9637	00	06000	37.96149491	-120.236264	Tuolumne County
349406	Ordering, Referring, Prescribing	N/A	1851794259	0	0	LAU, BEATRICE CHU LCSW	5/23/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	77523	N/A	N/A	N/A	N/A	N/A	320 S GARFIELD AVE	202	ALHAMBRA	CA	91801	3886	00	06000	34.09184212	-118.1245127	Los Angeles County
349423	Ordering, Referring, Prescribing	N/A	1851816789	0	0	LIN, CHRISTINE PHARMD	4/4/2018	Taxonomy not applicable	NA	n/a	000	Unknown	77674	N/A	N/A	N/A	N/A	N/A	800 REDWOOD HWY FRONTAGE	STE 110	MILL VALLEY	CA	94941	2350	00	06000	37.89804048	-122.5157393	Marin County
349426	Ordering, Referring, Prescribing	N/A	1851831416	0	0	LEE, KIRA C	9/13/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	103603	N/A	N/A	N/A	N/A	N/A	8316 FOOTHILL BLVD	None	SUNLAND	CA	91040	2850	00	06000	34.25966652	-118.314342	Los Angeles County
349439	Ordering, Referring, Prescribing	N/A	1851846927	0	0	LANDEROS, ISBETH LMFT	12/9/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT134098	N/A	N/A	N/A	N/A	N/A	40849 FREMONT BLVD	None	FREMONT	CA	94538	4306	00	06000	37.53438356	-121.9618278	Alameda County
349454	Ordering, Referring, Prescribing	N/A	1851869580	0	0	LEE, SHINHWA PHARMD	3/5/2024	Taxonomy not applicable	NA	n/a	000	Unknown	RPH74447	N/A	N/A	N/A	N/A	N/A	2655 W OLYMPIC BLVD	104	LOS ANGELES	CA	90006	2800	00	06000	34.05243121	-118.289956	Los Angeles County
349461	Ordering, Referring, Prescribing	N/A	1851878680	0	0	LEONG, SCOTT M PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76857	N/A	N/A	N/A	N/A	N/A	3801 HOWE ST	None	OAKLAND	CA	94611	5312	00	06000	37.8242732	-122.2568561	Alameda County
349502	Ordering, Referring, Prescribing	N/A	1851954473	0	0	LEE, TIFFANY PHARMD	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79172	N/A	N/A	N/A	N/A	N/A	1451 ROCKY RIDGE DR	2214	ROSEVILLE	CA	95661	3002	00	06000	38.75341372	-121.2471694	Placer County
349505	Ordering, Referring, Prescribing	N/A	1851953970	0	0	LUU, AMY V PA-C	12/29/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PA59016	N/A	N/A	N/A	N/A	N/A	728 E VALLEY PARKWAY	None	ESCONDIDO	CA	92025	3052	00	06000	33.12769389	-117.0730873	San Diego County
349516	Ordering, Referring, Prescribing	N/A	1861002081	0	0	LY, LINDA PHARMD	7/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH82549	N/A	N/A	N/A	N/A	N/A	217 ALMA ST	None	PALO ALTO	CA	94301	1017	00	06000	37.44563438	-122.1673764	Santa Clara County
349537	Ordering, Referring, Prescribing	N/A	1861038986	0	0	LUI, JULIA S PHARMD	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81607	N/A	N/A	N/A	N/A	N/A	250 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1103	00	06000	37.23948065	-121.8005798	Santa Clara County
349538	Ordering, Referring, Prescribing	N/A	1861050460	0	0	LEWIS, MARIA J PHD	1/19/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33435	N/A	N/A	N/A	N/A	N/A	5580 CALLE REAL	None	GOLETA	CA	93111	1646	00	06000	34.44131559	-119.8184752	Santa Barbara County
349551	Ordering, Referring, Prescribing	N/A	1861084188	0	0	LEMMON, DONALD L LCSW	5/12/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101505	N/A	N/A	N/A	N/A	N/A	11512 B AVE	None	AUBURN	CA	95603	2605	00	06000	38.93969517	-121.1046397	Placer County
349556	Ordering, Referring, Prescribing	N/A	1861095739	0	0	LIN, ADAM P PHARMD	8/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83878	N/A	N/A	N/A	N/A	N/A	3434 HIGH ST	None	OAKLAND	CA	94619	1859	00	06000	37.78638461	-122.1965622	Alameda County
349570	Ordering, Referring, Prescribing	N/A	1861149163	0	0	LOOKINGBILL, LINDSAY LMFT	2/20/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145163	N/A	N/A	N/A	N/A	N/A	1236 CHAPALA ST	None	SANTA BARBARA	CA	93101	3116	00	06000	34.42310529	-119.7066629	Santa Barbara County
349606	Ordering, Referring, Prescribing	N/A	1861490559	0	0	LECKIE, ROBERT MD	7/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G86763	N/A	N/A	N/A	N/A	N/A	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43816059	-120.6279677	Lassen County
349618	Ordering, Referring, Prescribing	N/A	1861526865	0	0	LITTLE, ROBERT M DC	9/18/2022	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC29670	N/A	N/A	N/A	N/A	N/A	1695 N SUNRISE WAY	203	PALM SPRINGS	CA	92262	3701	00	06000	33.844239	-116.5282075	Riverside County
349633	Ordering, Referring, Prescribing	N/A	1861550816	0	0	LUCE, SATOKO LCSW	11/13/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW22597	N/A	N/A	N/A	N/A	N/A	3751 STOCKER ST	None	VIEW PARK	CA	90008	5101	00	06000	34.00616017	-118.3385751	Los Angeles County
349639	Ordering, Referring, Prescribing	N/A	1861557506	0	0	LEVERRIER, REGINA MD	1/4/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G170039	N/A	N/A	N/A	N/A	N/A	47825 OASIS ST	None	INDIO	CA	92201	6950	00	06000	33.70112861	-116.2209066	Riverside County
349641	Ordering, Referring, Prescribing	N/A	1861566648	0	0	LEE, PATRICIA PHARMD	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50109	N/A	N/A	N/A	N/A	N/A	275 HOSPITAL PKWY	470	SAN JOSE	CA	95119	1106	00	06000	37.23951066	-121.8013511	Santa Clara County
349646	Ordering, Referring, Prescribing	N/A	1861570640	0	0	LEAVITT, RICHARD M MD	5/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G36239	N/A	N/A	N/A	N/A	N/A	1200 CONCORD AVE	#450	CONCORD	CA	94520	4953	00	06000	37.98072455	-122.0545603	Contra Costa County
349655	Ordering, Referring, Prescribing	N/A	1861599888	0	0	LIN, PATRICIA A MD	6/22/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G66214	N/A	N/A	N/A	N/A	N/A	216 W LOS ANGELES DR.	None	VISTA	CA	92083	3101	00	06000	33.21246686	-117.247328	San Diego County
349685	Ordering, Referring, Prescribing	N/A	1861692105	0	0	LAYTON, MICHAEL PA	11/15/2023	Taxonomy not applicable	NA	n/a	000	Unknown	55454	N/A	N/A	N/A	N/A	N/A	18661 HWY 120	None	SONORA	CA	95321	0550	00	06000	37.83754781	-120.2332428	Tuolumne County
349707	Ordering, Referring, Prescribing	N/A	1861734238	0	0	LLAMAS-SANDOVAL, RUBY J PHARMD	4/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67842	N/A	N/A	N/A	N/A	N/A	141 N SWALL DR	7	LOS ANGELES	CA	90048	3036	00	06000	34.07653473	-118.3858367	Los Angeles County
349731	Ordering, Referring, Prescribing	N/A	1861772584	0	0	LO, CATHERINE L PHARMD	7/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50192	N/A	N/A	N/A	N/A	N/A	7299 LAGUNA BLVD	None	ELK GROVE	CA	95758	5059	00	06000	38.424105	-121.418532	Sacramento County
349737	Ordering, Referring, Prescribing	N/A	1861773046	0	0	LLAMAS, CLAUDIA LCSW	3/31/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96231	N/A	N/A	N/A	N/A	N/A	3517 CAMINO DEL RIO S	SUITE 407	SAN DIEGO	CA	92108	4026	00	06000	32.77777042	-117.1179225	San Diego County
349742	Ordering, Referring, Prescribing	N/A	1861777534	0	0	LUK, JOYCE Y PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH66160	N/A	N/A	N/A	N/A	N/A	30116 EIGENBRODT WAY	None	UNION CITY	CA	94587	1225	00	06000	37.60846354	-122.0715526	Alameda County
349766	Ordering, Referring, Prescribing	N/A	1861822603	0	0	LEE, HAZEL A	6/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT104701	N/A	N/A	N/A	N/A	N/A	10 DOUGLAS DR.	SUITE 140	MARTINEZ	CA	94553	4078	00	06000	37.99546221	-122.1222474	Contra Costa County
349792	Ordering, Referring, Prescribing	N/A	1861853715	0	0	LAW, LINDSEY MD	11/2/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152839	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DRIVE	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
349810	Ordering, Referring, Prescribing	N/A	1861881187	0	0	LAYTON, NIKOLE M LCSW	9/21/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW104163	N/A	N/A	N/A	N/A	N/A	604 W OCEAN AVE	None	LOMPOC	CA	93436	6630	00	06000	34.63897253	-120.4643468	Santa Barbara County
349828	Ordering, Referring, Prescribing	N/A	1861915498	0	0	LEUPOLD, STEPHEN W LMFT	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40562	N/A	N/A	N/A	N/A	N/A	2225 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5441	00	06000	38.425482	-122.75262	Sonoma County
349845	Ordering, Referring, Prescribing	N/A	1861943821	0	0	LEE, HEATHER A LCSW	8/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96000	N/A	N/A	N/A	N/A	N/A	560 COHASSET RD	175	CHICO	CA	95926	2281	00	06000	39.7519137	-121.8477606	Butte County
349884	Ordering, Referring, Prescribing	N/A	1871001024	0	0	LASTRA, AMALIA M LCSW	4/12/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101067	N/A	N/A	N/A	N/A	N/A	800 SCENIC DR	None	MODESTO	CA	95350	6131	00	06000	37.64722447	-120.9836925	Stanislaus County
349885	Ordering, Referring, Prescribing	N/A	1861999005	0	0	LEE, JONGSERK R DO	1/20/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17556	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
349898	Ordering, Referring, Prescribing	N/A	1871017806	0	0	LUNA, NANCY R LCSW	12/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99296	N/A	N/A	N/A	N/A	N/A	1722 S LEWIS RD	None	CAMARILLO	CA	93012	8520	00	06000	34.18921316	-119.0340743	Ventura County
349901	Ordering, Referring, Prescribing	N/A	1871025098	0	0	LEE, SEUNG KYUM	1/3/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158158	N/A	N/A	N/A	N/A	N/A	14515 HAMLIN ST	None	VAN NUYS	CA	91411	1686	00	06000	34.18869729	-118.4492498	Los Angeles County
349905	Ordering, Referring, Prescribing	N/A	1871027748	0	0	LEES, ANDREW F MD	2/20/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194003	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST.	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
349918	Ordering, Referring, Prescribing	N/A	1871041830	0	0	LIMON, JOSE A LMFT	5/10/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT132679	N/A	N/A	N/A	N/A	N/A	17635 INDUSTRIAL FARM RD	None	BAKERSFIELD	CA	93308	9520	00	06000	35.512308	-119.113119	Kern County
349957	Ordering, Referring, Prescribing	N/A	1871096669	0	0	LAM, PHUONG-QUANG H MD	5/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166002	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
349964	Ordering, Referring, Prescribing	N/A	1871101766	0	0	LACROIX, CAMILLE LCSW	1/21/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	128244	N/A	N/A	N/A	N/A	N/A	679 S NEW HAMPSHIRE AVE	400	LOS ANGELES	CA	90005	1355	00	06000	34.06107902	-118.2929191	Los Angeles County
349966	Ordering, Referring, Prescribing	N/A	1871120154	0	0	LEE, JACQUELINE MD	2/11/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176328	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
349975	Ordering, Referring, Prescribing	N/A	1871130930	0	0	LIN, GRACE PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81464	N/A	N/A	N/A	N/A	N/A	1200 DISCOVERY DR	None	BAKERSFIELD	CA	93309	7032	00	06000	35.36397746	-119.0589062	Kern County
349985	Ordering, Referring, Prescribing	N/A	1871153312	0	0	LEE, ANN H MD	11/7/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182298	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR.	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
349991	Ordering, Referring, Prescribing	N/A	1871164822	0	0	LAKES, MIRIAM C NP	7/30/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017948	N/A	N/A	N/A	N/A	N/A	747 CHANNEL ST	None	STOCKTON	CA	95202	2628	00	06000	37.956109	-121.2815511	San Joaquin County
349993	Ordering, Referring, Prescribing	N/A	1871171264	0	0	LAURI, EMILY K LCSW	6/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81725	N/A	N/A	N/A	N/A	N/A	21507 E CLIFF DR	None	SANTA CRUZ	CA	95062	4844	00	06000	36.96330203	-121.9900666	Santa Cruz County
350000	Ordering, Referring, Prescribing	N/A	1871176370	0	0	LIM, JOYCE	1/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH44667	N/A	N/A	N/A	N/A	N/A	160 E. ARTESIA ST SUITE	None	POMONA	CA	91767	2924	00	06000	34.07556833	-117.7507835	Los Angeles County
350011	Ordering, Referring, Prescribing	N/A	1871215210	0	0	LUONG, MAY DDS	12/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	108038	N/A	N/A	N/A	N/A	N/A	540 E ARTESIA BLVD	None	LONG BEACH	CA	90805	1476	00	06000	33.87435148	-118.186947	Los Angeles County
350015	Ordering, Referring, Prescribing	N/A	1871227751	0	0	LE, MICHELLE PA-C	10/24/2023	Taxonomy not applicable	NA	n/a	000	Unknown	61669	N/A	N/A	N/A	N/A	N/A	5205 MELROSE AVE	None	LOS ANGELES	CA	90038	3144	00	06000	34.08354051	-118.314009	Los Angeles County
350024	Ordering, Referring, Prescribing	N/A	1871254177	0	0	LOPEZ, YECENIA DC	12/5/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	35000	N/A	N/A	N/A	N/A	N/A	41840 ENTERPRISE CIR N	None	TEMECULA	CA	92590	5654	00	06000	33.51730799	-117.1697125	Riverside County
350039	Ordering, Referring, Prescribing	N/A	1871336826	0	0	LOPEZ-GARCIA, MARIELA LCSW	7/1/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100749	N/A	N/A	N/A	N/A	N/A	1303 SAN CARLOS AVE	None	SAN CARLOS	CA	94070	2317	00	06000	37.50572931	-122.2621879	San Mateo County
350044	Ordering, Referring, Prescribing	N/A	1871369132	0	0	LAZARO, MARIE JOY DDS	11/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109671	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE FL 1	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
350054	Ordering, Referring, Prescribing	N/A	1871520775	0	0	LIMSICO, SIEOW Y	11/24/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D51986	N/A	N/A	N/A	N/A	N/A	1525 SILVER AVE	None	SAN FRANCISCO	CA	94134	1229	00	06000	37.73224392	-122.4063707	San Francisco County
350055	Ordering, Referring, Prescribing	N/A	1871505537	0	0	LOWY, ADAM F MD	2/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	G171603	N/A	N/A	N/A	N/A	N/A	905 E 8TH ST	None	LOS ANGELES	CA	90021	1848	00	06000	34.03639545	-118.2465917	Los Angeles County
350059	Ordering, Referring, Prescribing	N/A	1871536532	0	0	LIU, YI HUI MD	2/19/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A75175	N/A	N/A	N/A	N/A	N/A	4725 MARKET ST	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
350079	Ordering, Referring, Prescribing	N/A	1871620864	0	0	LEGENZA, SHARON A	1/17/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	12732	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
350080	Ordering, Referring, Prescribing	N/A	1871612945	0	0	LATTA-CLARK, CAROLYN L LMFT	5/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT42636	N/A	N/A	N/A	N/A	N/A	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	00	06000	34.1268333	-117.2705634	San Bernardino County
350081	Ordering, Referring, Prescribing	N/A	1871624064	0	0	LENGUA, ROBERTA A LMFT	2/16/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39723	N/A	N/A	N/A	N/A	N/A	790 E. BONITA AVE	None	POMONA	CA	91767	1906	00	06000	34.09621447	-117.737406	Los Angeles County
350084	Ordering, Referring, Prescribing	N/A	1871625830	0	0	LYNN, LILIANA D LMFT	12/9/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44668	N/A	N/A	N/A	N/A	N/A	503 W BADILLO ST	None	COVINA	CA	91722	3787	00	06000	34.0864027	-117.8990187	Los Angeles County
350110	Ordering, Referring, Prescribing	N/A	1871661918	0	0	LEE, NICOLETTE C LCSW	2/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82860	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
350115	Ordering, Referring, Prescribing	N/A	1871670307	0	0	LACEY, KATHLEEN C LCSW	5/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW20388	N/A	N/A	N/A	N/A	N/A	982 MISSION STREET	None	SAN FRANCISCO	CA	94103	2911	00	06000	37.7813638	-122.4082438	San Francisco County
350224	Ordering, Referring, Prescribing	N/A	1871875534	0	0	LOCHRIDGE, KYLE C PA-C	12/7/2018	Taxonomy not applicable	NA	n/a	000	Unknown	56359	N/A	N/A	N/A	N/A	N/A	544 N GLENDALE AVE	None	GLENDALE	CA	91206	3311	00	06000	34.15454904	-118.2429872	Los Angeles County
350227	Ordering, Referring, Prescribing	N/A	1871877043	0	0	LEE, TEAK K PHARMD	7/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH61718	N/A	N/A	N/A	N/A	N/A	4940 VAN NUYS BLVD, STE	STE 104	SHERMAN OAKS	CA	91403	1736	00	06000	34.160589	-118.4486715	Los Angeles County
350271	Ordering, Referring, Prescribing	N/A	1871940668	0	0	LORENZ, RAELYNNE SPRACKLEN CCC-SLP	4/5/2020	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	SP10794	N/A	N/A	N/A	N/A	N/A	1901 N RICE AVE	None	OXNARD	CA	93030	7912	00	06000	34.21960355	-119.1421345	Ventura County
350272	Ordering, Referring, Prescribing	N/A	1871933879	0	0	LIPMAN, RACHEL E RN CPNP	6/19/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	850110	N/A	N/A	N/A	N/A	N/A	1530 S. OLIVE ST	None	LOS ANGELES	CA	90015	3023	00	06000	34.03542552	-118.2652073	Los Angeles County
350295	Ordering, Referring, Prescribing	N/A	1871973347	0	0	LOPEZ, CYNTHIA PHARMD	3/31/2018	Taxonomy not applicable	NA	n/a	000	Unknown	47504	N/A	N/A	N/A	N/A	N/A	8880 VALLEY VIEW ST	None	BUENA PARK	CA	90620	3562	00	06000	33.83457051	-118.0271385	Orange County
350304	Ordering, Referring, Prescribing	N/A	1871983023	0	0	LIAO, TZU YI PA-C	1/27/2018	Taxonomy not applicable	NA	n/a	000	Unknown	PA52167	N/A	N/A	N/A	N/A	N/A	210 N GARFIELD AVE	203	MONTEREY PARK	CA	91754	1746	00	06000	34.064181	-118.122834	Los Angeles County
350321	Ordering, Referring, Prescribing	N/A	1881017341	0	0	LEROUX, HILLARY	2/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103653	N/A	N/A	N/A	N/A	N/A	142 E. CALIFORNIA AVE.	None	FRESNO	CA	93706	3642	00	06000	36.72133047	-119.810421	Fresno County
350344	Ordering, Referring, Prescribing	N/A	1881050565	0	0	LOCK, JUSTIN L LMFT	7/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105936	N/A	N/A	N/A	N/A	N/A	137 N COTTONWOOD STREET	None	WOODLAND	CA	95695	6646	00	06000	38.68538399	-121.7933582	Yolo County
350414	Ordering, Referring, Prescribing	N/A	1881138295	0	0	LOPEZ, ALISA G LCSW	12/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99402	N/A	N/A	N/A	N/A	N/A	500 W FOSTER RD	None	SANTA MARIA	CA	93455	3620	00	06000	34.88351329	-120.4428974	Santa Barbara County
350415	Ordering, Referring, Prescribing	N/A	1881138907	0	0	LASAM, MARIA L NP	9/3/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006401	N/A	N/A	N/A	N/A	N/A	250 SOUTH G ST	None	SAN BERNARDINO	CA	92410	3320	00	06000	34.09693522	-117.2986838	San Bernardino County
350421	Ordering, Referring, Prescribing	N/A	1881154037	0	0	LOYOLA, MARY ANN P NP	3/14/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011408	N/A	N/A	N/A	N/A	N/A	8851 CENTER DR	SUITE 505	LA MESA	CA	91942	3032	00	06000	32.78189749	-117.0075062	San Diego County
350456	Ordering, Referring, Prescribing	N/A	1881208916	0	0	LAMAY, LESLIE A LCSW	7/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	123946	N/A	N/A	N/A	N/A	N/A	200 MICHIGAN AVE	None	VISTA	CA	92084	5424	00	06000	33.2038743	-117.2421678	San Diego County
350475	Ordering, Referring, Prescribing	N/A	1881244846	0	0	LO, CIARA NP	6/25/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014080	N/A	N/A	N/A	N/A	N/A	325 E 7TH ST	None	LOS ANGELES	CA	90014	2209	00	06000	34.04209386	-118.2486813	Los Angeles County
350494	Ordering, Referring, Prescribing	N/A	1881274405	0	0	LAPLANA, GERALDINE D NP	4/20/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017183	N/A	N/A	N/A	N/A	N/A	1701 STINE RD	None	BAKERSFIELD	CA	93309	4827	00	06000	35.33828383	-119.0513543	Kern County
350502	Ordering, Referring, Prescribing	N/A	1881308898	0	0	LEBA, NICOLE PHD	4/3/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34023	N/A	N/A	N/A	N/A	N/A	995 POTRERO AVE	BLDG 80, STE 8000-S	SAN FRANCISCO	CA	94110	2859	00	06000	37.75729541	-122.4066641	San Francisco County
350524	Ordering, Referring, Prescribing	N/A	1881431690	0	0	LOPEZ, KIMBERLY NP	6/28/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95030836	N/A	N/A	N/A	N/A	N/A	27555 YNEZ RD	105	TEMECULA	CA	92591	4687	00	06000	33.50370608	-117.1492569	Riverside County
350539	Ordering, Referring, Prescribing	N/A	1881612281	0	0	LONGHITANO, MARIA MD	3/31/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A44620	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD	200	PACOOIMA	CA	91331	1393	00	06000	34.27894489	-118.4044363	Los Angeles County
350543	Ordering, Referring, Prescribing	N/A	1881629814	0	0	LADIA, LOUELLA C MD	7/6/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A70487	N/A	N/A	N/A	N/A	N/A	7907 OSTROW ST	F	SAN DIEGO	CA	92111	3635	00	06000	32.81328129	-117.1542832	San Diego County
350585	Ordering, Referring, Prescribing	N/A	1881756906	0	0	LOWE, SONYA PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	47308	N/A	N/A	N/A	N/A	N/A	200 MUIR RD	None	MARTINEZ	CA	94553	4614	00	06000	37.99430233	-122.1107194	Contra Costa County
350630	Ordering, Referring, Prescribing	N/A	1881860666	0	0	LOZARES-LEWIS, ELEANORE MD	8/19/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A111742	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIR	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
350647	Ordering, Referring, Prescribing	N/A	1881884682	0	0	LAZO, MARIA ANNA C PSYD	4/27/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY25602	N/A	N/A	N/A	N/A	N/A	3301 EAST 12TH ST	SUITE 259	OAKLAND	CA	94601	3424	00	06000	37.77617499	-122.2247899	Alameda County
350649	Ordering, Referring, Prescribing	N/A	1881924124	0	0	LEONARD, KRISTIN B NP	6/16/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	11804	N/A	N/A	N/A	N/A	N/A	5925 W LAS POSITAS BLVD	100	PLEASANTON	CA	94588	8537	00	06000	37.68360997	-121.8990082	Alameda County
350661	Ordering, Referring, Prescribing	N/A	1881942407	0	0	LUNA, NATALIA I LCSW	5/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW85979	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
350679	Ordering, Referring, Prescribing	N/A	1881963098	0	0	LLAMAS, MARIA A LMFT	11/25/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116567	N/A	N/A	N/A	N/A	N/A	1111 N CHINA LAKE BLVD	190	RIDGECREST	CA	93555	3131	00	06000	35.64171	-117.669847	Kern County
350684	Ordering, Referring, Prescribing	N/A	1881977551	0	0	LEUNG, GABRIEL PHARMD	10/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	51702	N/A	N/A	N/A	N/A	N/A	4860 Y STREET	#1200	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
350699	Ordering, Referring, Prescribing	N/A	1881978328	0	0	LANE, CELESTE K LCSW	12/8/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW68508	N/A	N/A	N/A	N/A	N/A	790 E BONITA AVE	101	POMONA	CA	91767	1906	00	06000	34.09621447	-117.737406	Los Angeles County
350700	Ordering, Referring, Prescribing	N/A	1881995785	0	0	LEE, EILEEN C PHARMD	1/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51790	N/A	N/A	N/A	N/A	N/A	5431 CLAYTON RD	None	CLAYTON	CA	94517	1039	00	06000	37.953792	-121.953483	Contra Costa County
350719	Ordering, Referring, Prescribing	N/A	1891038386	0	0	LOPEZ, GLORIA C LMFT	10/27/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128907	N/A	N/A	N/A	N/A	N/A	5800 HANNUM AVE	SUITE 260	CULVER CITY	CA	90230	6553	00	06000	33.98724995	-118.3858338	Los Angeles County
350726	Ordering, Referring, Prescribing	N/A	1891054029	0	0	LESSANS, MICHELLE LCSW	4/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW69534	N/A	N/A	N/A	N/A	N/A	425 DIVISADERO ST	300	SAN FRANCISCO	CA	94117	2242	00	06000	37.77336026	-122.4375022	San Francisco County
350755	Ordering, Referring, Prescribing	N/A	1891095865	0	0	LEE, STANLEY C PHARMD	11/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	35260	N/A	N/A	N/A	N/A	N/A	989 SUNRISE AVE	None	ROSEVILLE	CA	95661	4506	00	06000	38.73110774	-121.272042	Placer County
350765	Ordering, Referring, Prescribing	N/A	1891100103	0	0	LOO, TERRANCE PHARMD	1/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77701	N/A	N/A	N/A	N/A	N/A	800 REDWOOD HWY FRTG RD	SUITE 110	MILL VALLEY	CA	94941	2351	00	06000	37.89804048	-122.5157393	Marin County
350771	Ordering, Referring, Prescribing	N/A	1891120663	0	0	LEE, SARA J LMFT	11/24/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT100398	N/A	N/A	N/A	N/A	N/A	1540 E COLORADO ST	None	GLENDALE	CA	91205	1514	00	06000	34.1427285	-118.230039	Los Angeles County
350779	Ordering, Referring, Prescribing	N/A	1891104162	0	0	LIU, KAREN PHARMD	1/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74626	N/A	N/A	N/A	N/A	N/A	13255 BLACK MOUNTAIN ROA	None	SAN DIEGO	CA	92130	6613	00	06000	32.95881607	-117.1266381	San Diego County
350805	Ordering, Referring, Prescribing	N/A	1891163762	0	0	LOPEZ, MICHELLE LCSW	6/16/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW115922	N/A	N/A	N/A	N/A	N/A	221 N ARDMORE AVE	None	LOS ANGELES	CA	90004	4503	00	06000	34.0759476	-118.301939	Los Angeles County
350817	Ordering, Referring, Prescribing	N/A	1891178638	0	0	LAM, JULIA MD	11/21/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144473	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
350829	Ordering, Referring, Prescribing	N/A	1891196754	0	0	LOERA, MARI LCSW	3/31/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88995	N/A	N/A	N/A	N/A	N/A	3303 N BROADWAY	None	LOS ANGELES	CA	90031	2803	00	06000	34.07380397	-118.20586	Los Angeles County
350844	Ordering, Referring, Prescribing	N/A	1891216792	0	0	LAI, PEI-CHING LAC	9/12/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC17550	N/A	N/A	N/A	N/A	N/A	1000 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4709	00	06000	34.084557	-118.123042	Los Angeles County
350848	Ordering, Referring, Prescribing	N/A	1891239844	0	0	LU, SUNNY	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75814	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
350865	Ordering, Referring, Prescribing	N/A	1891261129	0	0	LE, JADE PHARMD	10/12/2018	Taxonomy not applicable	NA	n/a	000	Unknown	79663	N/A	N/A	N/A	N/A	N/A	950 W HAMILTON AVE	None	CAMPBELL	CA	95008	0406	00	06000	37.29405053	-121.9665695	Santa Clara County
350869	Ordering, Referring, Prescribing	N/A	1891268348	0	0	LUSZCZ, KATHRYN LMFT	6/25/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133406	N/A	N/A	N/A	N/A	N/A	5650 MOUNT ACKERLY DR	None	SAN DIEGO	CA	92111	4016	00	06000	32.80910151	-117.1793115	San Diego County
350881	Ordering, Referring, Prescribing	N/A	1891298675	0	0	LOPEZ, CLAUDIA L	3/18/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164335	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
350901	Ordering, Referring, Prescribing	N/A	1891342044	0	0	LIEU, KEVIN L MD	7/7/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187744	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
350911	Ordering, Referring, Prescribing	N/A	1891356671	0	0	LE, ALAN D NP	3/17/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020360	N/A	N/A	N/A	N/A	N/A	298 BERNAL RD	None	SAN JOSE	CA	95119	1809	00	06000	37.215603	-121.7858355	Santa Clara County
350922	Ordering, Referring, Prescribing	N/A	1891369435	0	0	LEANOS, JEANNETTE D PHARMD	12/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85684	N/A	N/A	N/A	N/A	N/A	1811 S SAN JACINTO AVE	None	SAN JACINTO	CA	92583	5605	00	06000	33.76873264	-116.9587477	Riverside County
350959	Ordering, Referring, Prescribing	N/A	1891520896	0	0	LEVESQUE, LINDSAY	6/28/2024	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	236465	N/A	N/A	N/A	N/A	N/A	1441 N TRACY BLVD	None	TRACY	CA	95376	0000	00	06000	37.744731	-121.4350375	San Joaquin County
350976	Ordering, Referring, Prescribing	N/A	1891718565	0	0	LAM, TRANG T MD	10/11/2013	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A00066764	N/A	N/A	N/A	N/A	N/A	7761 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92841	4200	00	06000	33.77387145	-117.9966555	Orange County
350978	Ordering, Referring, Prescribing	N/A	1891772026	0	0	LEE, STEPHEN MD FACOG	7/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A32681	N/A	N/A	N/A	N/A	N/A	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	00	06000	34.01597577	-118.1003516	Los Angeles County
350987	Ordering, Referring, Prescribing	N/A	1891813283	0	0	LO, YANG A LMFT	3/12/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44982	N/A	N/A	N/A	N/A	N/A	2756 S ELM AVE	None	FRESNO	CA	93706	5435	00	06000	36.70090897	-119.7908648	Fresno County
351012	Ordering, Referring, Prescribing	N/A	1891843348	0	0	LUNDT, LESLIE P MD	2/3/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G55544	N/A	N/A	N/A	N/A	N/A	315 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	00	06000	34.444881	-119.7793725	Santa Barbara County
351013	Ordering, Referring, Prescribing	N/A	1891842951	0	0	LITVINOV, LARISA PHD	11/19/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY22171	N/A	N/A	N/A	N/A	N/A	21081 SOUTH WESTERN AVEN	SUITE 295	TORRANCE	CA	90501	1707	00	06000	33.83886841	-118.3093605	Los Angeles County
351021	Ordering, Referring, Prescribing	N/A	1891858155	0	0	LEE, JUNE K PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49884	N/A	N/A	N/A	N/A	N/A	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	00	06000	34.06477215	-117.9845382	Los Angeles County
351028	Ordering, Referring, Prescribing	N/A	1891872073	0	0	LODRIGUITO, IDA Z MD	12/11/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A61893	N/A	N/A	N/A	N/A	N/A	4510 E PACIFIC COAST HWY	SUITE 600	LONG BEACH	CA	90804	3279	00	06000	33.78815204	-118.1400821	Los Angeles County
351032	Ordering, Referring, Prescribing	N/A	1891888467	0	0	LAU, GAYLE Y PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	47351	N/A	N/A	N/A	N/A	N/A	450 6TH AVENUE	None	SAN FRANCISCO	CA	94118	3010	00	06000	37.7802547	-122.4642049	San Francisco County
351037	Ordering, Referring, Prescribing	N/A	1891919528	0	0	LAPOINTE, JANICE T LMFT	4/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48072	N/A	N/A	N/A	N/A	N/A	5650 MOUNT ACKERLY DR	None	SAN DIEGO	CA	92111	4016	00	06000	32.80910151	-117.1793115	San Diego County
351038	Ordering, Referring, Prescribing	N/A	1891913596	0	0	LEVIN, ASHLEY LCSW	1/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24753	N/A	N/A	N/A	N/A	N/A	3680 E. IMPERIAL HWY	220	LYNWOOD	CA	90262	2659	00	06000	33.93211641	-118.2011728	Los Angeles County
351071	Ordering, Referring, Prescribing	N/A	1891986675	0	0	LOMELI, CESILIA NP	1/5/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	4911	N/A	N/A	N/A	N/A	N/A	1276 TAMSEN ST	None	CAMBRIA	CA	93428	3325	00	06000	35.56338081	-121.0914183	San Luis Obispo County
351087	Ordering, Referring, Prescribing	N/A	1902021942	0	0	LUCIO, ROSA E LMFT	10/22/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	43270	N/A	N/A	N/A	N/A	N/A	1925 E DAKOTA AVE	None	FRESNO	CA	93726	4821	00	06000	36.78683208	-119.7876584	Fresno County
351106	Ordering, Referring, Prescribing	N/A	1902067390	0	0	LOGAN, JOSHUA E MD	10/11/2017	Taxonomy not applicable	NA	n/a	000	Unknown	A115432	N/A	N/A	N/A	N/A	N/A	2637 SHADELANDS DR	STE A	WALNUT CREEK	CA	94598	2512	00	06000	37.925712	-122.021856	Contra Costa County
351112	Ordering, Referring, Prescribing	N/A	1902081318	0	0	LABRUNDA, MICHELLE A MD	9/12/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	ME104815	N/A	N/A	N/A	N/A	N/A	1350 S HICKORY STREET	None	MELBOURNE	FL	32901	3278	00	06000	28.0881	-80.61354601	Brevard County
351134	Ordering, Referring, Prescribing	N/A	1902116023	0	0	LEDERER, LAUREN E LMFT	7/10/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	87857	N/A	N/A	N/A	N/A	N/A	676 PISMO ST	None	SAN LUIS OBISPO	CA	93401	3945	00	06000	35.27640631	-120.6628883	San Luis Obispo County
351151	Ordering, Referring, Prescribing	N/A	1902153489	0	0	LIU, FRANK K	3/23/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D61729	N/A	N/A	N/A	N/A	N/A	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	00	06000	37.53384106	-121.9607241	Alameda County
351159	Ordering, Referring, Prescribing	N/A	1902162795	0	0	LOVE, STEPHANIE A LMFT	7/24/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	90680	N/A	N/A	N/A	N/A	N/A	18880 CHERRY VALLEY BLVD	None	TUOLUMNE	CA	95379	0121	00	06000	37.96511668	-120.2399015	Tuolumne County
351163	Ordering, Referring, Prescribing	N/A	1902147978	0	0	LIVINGSTON, NANCY A	3/18/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0428790	N/A	N/A	N/A	N/A	N/A	100 MEDICAL PLAZA	STE 630 E	LOS ANGELES	CA	90095	0001	00	06000	34.06544724	-118.4459249	Los Angeles County
351166	Ordering, Referring, Prescribing	N/A	1902167901	0	0	LAZARUS, JENNY L MD	4/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A168579	N/A	N/A	N/A	N/A	N/A	1133 W SYCAMORE ST	None	WILLOWS	CA	95988	2601	00	06000	39.5205105	-122.2082775	Glenn County
351176	Ordering, Referring, Prescribing	N/A	1902177165	0	0	LIDDICOAT, MARION E PHARMD	7/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55954	N/A	N/A	N/A	N/A	N/A	700 TWELVE BRIDGES DR	None	LINCOLN	CA	95648	8824	00	06000	38.85127671	-121.2882649	Placer County
351186	Ordering, Referring, Prescribing	N/A	1902188790	0	0	LE, NATALIE PHARMD	7/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH49964	N/A	N/A	N/A	N/A	N/A	1313 S. HARBOR BLVD	None	ANAHEIMN	CA	92802	1234	00	06000	33.812073	-117.9198	Orange County
351200	Ordering, Referring, Prescribing	N/A	1902216955	0	0	LOURENCO, FRANK	8/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	70615	N/A	N/A	N/A	N/A	N/A	1366 EAST AVE	None	CHICO	CA	95926	7336	00	06000	39.76111951	-121.8226455	Butte County
351218	Ordering, Referring, Prescribing	N/A	1902256324	0	0	LOPEZ, LUBIANKA LCSW	4/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW67578	N/A	N/A	N/A	N/A	N/A	1290 COMMODORE DR	None	SAN BRUNO	CA	94066	2304	00	06000	37.63134914	-122.4260472	San Mateo County
351220	Ordering, Referring, Prescribing	N/A	1902262157	0	0	LLAMAS, WENDY LCSW	3/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85521	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	402	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
351242	Ordering, Referring, Prescribing	N/A	1902289226	0	0	LEEM, DAESOON MD	4/20/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155852	N/A	N/A	N/A	N/A	N/A	15095 AMARGOSA BLVD.	BLDG 1 SUITE 102	VICTORVILLE	CA	92394	1879	00	06000	34.52479785	-117.3303132	San Bernardino County
351260	Ordering, Referring, Prescribing	N/A	1902319676	0	0	LEE, JANICE S DDS	1/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS101894	N/A	N/A	N/A	N/A	N/A	1684 W KATELLA AVE	None	ANAHEIM	CA	92802	3015	00	06000	33.80306495	-117.9406754	Orange County
351277	Ordering, Referring, Prescribing	N/A	1902342074	0	0	LEHAVI, DORENE LCSW	4/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW16753	N/A	N/A	N/A	N/A	N/A	5601 W SLAUSON AVE	192	CULVER CITY	CA	90230	6582	00	06000	33.98900447	-118.37979	Los Angeles County
351287	Ordering, Referring, Prescribing	N/A	1902358237	0	0	LEON, FLOR M PA-C	9/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	53788	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
351291	Ordering, Referring, Prescribing	N/A	1902357767	0	0	LEONG, BRANDON E DDS	6/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS100802	N/A	N/A	N/A	N/A	N/A	3425 N FIRST STREET	None	FRESNO	CA	93726	6821	00	06000	36.78186519	-119.7726482	Fresno County
351298	Ordering, Referring, Prescribing	N/A	1902369333	0	0	LOPEZ, ADELINA NP	5/16/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011583	N/A	N/A	N/A	N/A	N/A	303 S C ST	None	LOMPOC	CA	93436	7305	00	06000	34.63525845	-120.451628	Santa Barbara County
351355	Ordering, Referring, Prescribing	N/A	1902580426	0	0	LOHNES, ELLIE J PA-C	7/18/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63071	N/A	N/A	N/A	N/A	N/A	1550 BROADWAY	None	SAN DIEGO	CA	92101	5713	00	06000	32.71579987	-117.1499238	San Diego County
351362	Ordering, Referring, Prescribing	N/A	1902678121	0	0	LANGBEHN, ASHLEY L RDHAP	12/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	26604	N/A	N/A	N/A	N/A	N/A	57019 YUCCA TRAIL	C	YUCCA VALLEY	CA	92284	7909	00	06000	34.1205273	-116.4202324	San Bernardino County
351396	Ordering, Referring, Prescribing	N/A	1902924277	0	0	LANE CABRERA, RACHEL	6/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT98895	N/A	N/A	N/A	N/A	N/A	6615 VALLEY HI DR	None	SACRAMENTO	CA	95823	7076	00	06000	38.470986	-121.4276985	Sacramento County
351414	Ordering, Referring, Prescribing	N/A	1902936792	0	0	LOPEZ, MARIVEL R LMFT	2/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	85047	N/A	N/A	N/A	N/A	N/A	9951 HORN RD	B	SACRAMENTO	CA	95827	1955	00	06000	38.577654	-121.3244235	Sacramento County
351432	Ordering, Referring, Prescribing	N/A	1902967029	0	0	LAI-STEPHENS, JENNIFER W PHARMD	4/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49066	N/A	N/A	N/A	N/A	N/A	4647 ZION AVE	2ND FLOOR NEPHROLOGY	SAN DIEGO	CA	92120	2507	00	06000	32.79293009	-117.0952438	San Diego County
351436	Ordering, Referring, Prescribing	N/A	1902967904	0	0	LUCIO, JULITA M	3/12/2001	Taxonomy not applicable	NA	n/a	099	DENTIST	D47938	N/A	N/A	N/A	N/A	N/A	14550 HAYNES ST	None	VAN NUYS	CA	91411	1613	00	06000	34.18967817	-118.4506446	Los Angeles County
351438	Ordering, Referring, Prescribing	N/A	1902978265	0	0	LOMBARD, CHRISTINA L LMFT	1/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53377	N/A	N/A	N/A	N/A	N/A	2615 SOUTH MILLER ST. SU	None	SANTA MARIA	CA	93455	1775	00	06000	34.91141828	-120.4320168	Santa Barbara County
351456	Ordering, Referring, Prescribing	N/A	1912027806	0	0	LEE, RONALD S	9/28/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D32734	N/A	N/A	N/A	N/A	N/A	1525 SILVER AVE	None	SAN FRANCISCO	CA	94134	1229	00	06000	37.73224392	-122.4063707	San Francisco County
351468	Ordering, Referring, Prescribing	N/A	1912042847	0	0	LODGEN, ERICA D LMFT	9/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFC33650	N/A	N/A	N/A	N/A	N/A	3601 CALLE TECATE	201	CAMARILLO	CA	93012	5056	00	06000	34.22151847	-119.021535	Ventura County
351469	Ordering, Referring, Prescribing	N/A	1912047291	0	0	LAWLER, MARIA	5/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112966	N/A	N/A	N/A	N/A	N/A	2406 ARMSTRONG ST	None	LIVERMORE	CA	94551	7617	00	06000	37.699371	-121.812038	Alameda County
351476	Ordering, Referring, Prescribing	N/A	1912057043	0	0	LUDMER, CAREN PSYD	9/29/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY10661	N/A	N/A	N/A	N/A	N/A	1700 PIERCE ST	102	SAN FRANCISCO	CA	94115	3108	00	06000	37.78590598	-122.436579	San Francisco County
351489	Ordering, Referring, Prescribing	N/A	1912057431	0	0	LICAUCO, CECILE CATHERINE N DDS	12/30/2023	Taxonomy not applicable	NA	n/a	000	Unknown	40656	N/A	N/A	N/A	N/A	N/A	670 COUNTY RD 83	None	CANBY	CA	96015	9722	00	06000	41.44344745	-120.8718025	Modoc County
351494	Ordering, Referring, Prescribing	N/A	1912083858	0	0	LEE, ROBIN S PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50701	N/A	N/A	N/A	N/A	N/A	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	00	06000	34.06477215	-117.9845382	Los Angeles County
351497	Ordering, Referring, Prescribing	N/A	1912096918	0	0	LEUNG, SELINA Q PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	48343	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	362	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
351499	Ordering, Referring, Prescribing	N/A	1912096280	0	0	LUSHER, FRANK R MD	5/20/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C33258	N/A	N/A	N/A	N/A	N/A	15336 DEVONSHIRE AVE	SUITE1	MISSION HILLS	CA	91345	2766	00	06000	34.25726849	-118.4664285	Los Angeles County
351502	Ordering, Referring, Prescribing	N/A	1912120866	0	0	LOUI, HANNAH PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53588	N/A	N/A	N/A	N/A	N/A	4131 GEARY BLVD	B25	SAN FRANCISCO	CA	94118	3101	00	06000	37.78096053	-122.4637512	San Francisco County
351532	Ordering, Referring, Prescribing	N/A	1912190877	0	0	LI, SHIHWEI H LMFT	4/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	92442	N/A	N/A	N/A	N/A	N/A	4519 SAN JUAN AVE.	None	FREMONT	CA	94536	5544	00	06000	37.55819297	-122.0230384	Alameda County
351559	Ordering, Referring, Prescribing	N/A	1912254707	0	0	LEE, SAMUEL K Y	2/12/2018	Taxonomy not applicable	NA	n/a	000	Unknown	67341	N/A	N/A	N/A	N/A	N/A	3756 SANTA ROSALIA DR	None	LOS ANGELES	CA	90008	3606	00	06000	34.00888336	-118.3389334	Los Angeles County
351569	Ordering, Referring, Prescribing	N/A	1912260647	0	0	LO, SUSAN	10/2/2018	Taxonomy not applicable	NA	n/a	000	Unknown	45404	N/A	N/A	N/A	N/A	N/A	660 S. FAIROAK AVE	#1057	SUNNYVALE	CA	94086	7913	00	06000	37.36471133	-122.0239733	Santa Clara County
351580	Ordering, Referring, Prescribing	N/A	1912276122	0	0	LE, PHUONG PHARMD	8/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53220	N/A	N/A	N/A	N/A	N/A	1661 MCKEE RD	None	SAN JOSE	CA	95116	1236	00	06000	37.35773116	-121.8613412	Santa Clara County
351584	Ordering, Referring, Prescribing	N/A	1912283615	0	0	LA, DEREK O PHARMD	8/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	55409	N/A	N/A	N/A	N/A	N/A	6170 HAMNER AVE	None	MIRA LOMA	CA	91752	3121	00	06000	33.9764878	-117.5582535	Riverside County
351603	Ordering, Referring, Prescribing	N/A	1912301904	0	0	LA FOND, DEBORAH B LMFT	8/15/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT34640	N/A	N/A	N/A	N/A	N/A	155 E. CAMPBELL AVENUE	SUITE 107	CAMPBELL	CA	95008	2063	00	06000	37.28709998	-121.9470958	Santa Clara County
351609	Ordering, Referring, Prescribing	N/A	1912309204	0	0	LE, ELIZABETH K PHARMD	3/24/2018	Taxonomy not applicable	NA	n/a	000	Unknown	71432	N/A	N/A	N/A	N/A	N/A	6688 ALHAMBRA AVE	None	MARTINEZ	CA	94553	0001	00	06000	37.95842069	-122.0930882	Contra Costa County
351625	Ordering, Referring, Prescribing	N/A	1912331414	0	0	LACY, CHRISTINE M LCSW	9/26/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	86008	N/A	N/A	N/A	N/A	N/A	21507 E CLIFF DR	None	SANTA CRUZ	CA	95062	4844	00	06000	36.96330203	-121.9900666	Santa Cruz County
351629	Ordering, Referring, Prescribing	N/A	1912336587	0	0	LING, JENNIFER LCSW	3/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28880	N/A	N/A	N/A	N/A	N/A	2000 EMBARCADERO COVE	400	OAKLAND	CA	94606	5300	00	06000	37.78179304	-122.2428136	Alameda County
351632	Ordering, Referring, Prescribing	N/A	1912342882	0	0	LI HOU, DONG LCSW	8/15/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27007	N/A	N/A	N/A	N/A	N/A	3300 CAPITOL AVE	BLDG. B	FREMONT	CA	94538	1514	00	06000	37.55270431	-121.9826871	Alameda County
351666	Ordering, Referring, Prescribing	N/A	1912387119	0	0	LIPANOVICH, COLLEEN NP	6/29/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002478	N/A	N/A	N/A	N/A	N/A	400 WEST PUEBLO	None	SANTA BARBARA	CA	93105	0000	00	06000	34.42887662	-119.7237878	Santa Barbara County
351688	Ordering, Referring, Prescribing	N/A	1912420506	0	0	LE, KHUYEN K PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64195	N/A	N/A	N/A	N/A	N/A	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	00	06000	36.84133078	-119.7824983	Fresno County
351689	Ordering, Referring, Prescribing	N/A	1912425117	0	0	LAWRENCE, SHANNON M	9/15/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	17743	N/A	N/A	N/A	N/A	N/A	2509 PICO BLVD	None	SANTA MONICA	CA	90405	1828	00	06000	34.02287459	-118.4631175	Los Angeles County
351722	Ordering, Referring, Prescribing	N/A	1912468075	0	0	LOWE, SHONA C MD MPH	4/12/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177648	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	0000	00	06000	33.83155851	-118.2920625	Los Angeles County
351760	Ordering, Referring, Prescribing	N/A	1912533860	0	0	LEMUS, MARIA NP	10/11/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014244	N/A	N/A	N/A	N/A	N/A	6513 ATLANTIC AVE	None	BELL	CA	90201	2521	00	06000	33.97682869	-118.1872451	Los Angeles County
351771	Ordering, Referring, Prescribing	N/A	1912551151	0	0	LIVELY-ENDICOTT, HANNAH R MD	5/5/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178376	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
351784	Ordering, Referring, Prescribing	N/A	1912568064	0	0	LE, THUYMIEN T PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH58712	N/A	N/A	N/A	N/A	N/A	25 N. 14TH ST.	110	SAN JOSE	CA	95112	6208	00	06000	37.34293357	-121.8775187	Santa Clara County
351908	Ordering, Referring, Prescribing	N/A	1922203835	0	0	LOPEZ, MANUEL S	6/3/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D47636	N/A	N/A	N/A	N/A	N/A	133 W MAIN ST	STE 100	EL CAJON	CA	92020	3325	00	06000	32.79492453	-116.9627861	San Diego County
351921	Ordering, Referring, Prescribing	N/A	1922265081	0	0	LIESE, FRANCISCA C	3/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25766	N/A	N/A	N/A	N/A	N/A	1359 N. GRAND AVE	None	COVINA	CA	91724	1016	00	06000	34.104681	-117.872706	Los Angeles County
351933	Ordering, Referring, Prescribing	N/A	1922268556	0	0	LEE, KEVIN MD	9/21/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A111339	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95127	1439	00	06000	37.34293689	-121.9270392	Santa Clara County
351936	Ordering, Referring, Prescribing	N/A	1922298496	0	0	LIM, KAREN P	7/25/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A99015	N/A	N/A	N/A	N/A	N/A	3133 N MILBROOK AVE	None	FRESNO	CA	93703	1425	00	06000	36.77841	-119.7635455	Fresno County
351939	Ordering, Referring, Prescribing	N/A	1922306737	0	0	LEWIS, WANDA R PHARMD	3/18/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH47465	N/A	N/A	N/A	N/A	N/A	155 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3005	00	06000	34.13579917	-118.1534676	Los Angeles County
351962	Ordering, Referring, Prescribing	N/A	1922341825	0	0	LAHEY, MICHAEL MD	11/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165821	N/A	N/A	N/A	N/A	N/A	450 FREEPORT PKWY	None	COPPELL	TX	75019	0000	00	06000	32.96248199	-97.01491463	Dallas County
351976	Ordering, Referring, Prescribing	N/A	1922366780	0	0	LEM, BRENT M MD	5/14/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A119419	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL ST	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
351984	Ordering, Referring, Prescribing	N/A	1922381706	0	0	LUU, ELIZABETH U PHARMD	7/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH56336	N/A	N/A	N/A	N/A	N/A	19001 BROOKHURST STREET	None	HUNTINGTON BEACH	CA	92646	2551	00	06000	33.6863847	-117.9541714	Orange County
352045	Ordering, Referring, Prescribing	N/A	1922476779	0	0	LOPEZ ESQUEDA, TRACY A LCSW	11/12/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91976	N/A	N/A	N/A	N/A	N/A	1 CIVIC PLAZA DR	None	CARSON	CA	90745	2243	00	06000	33.8328256	-118.2592958	Los Angeles County
352054	Ordering, Referring, Prescribing	N/A	1922485747	0	0	LASYONE, LUKAS N MD	5/5/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146036	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPRESSWAY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
352055	Ordering, Referring, Prescribing	N/A	1922485895	0	0	LIANG, JENNA KAI FEN NP	9/11/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001384	N/A	N/A	N/A	N/A	N/A	1450 NORIEGA ST	None	SAN FRANCISCO	CA	94122	4432	00	06000	37.75412598	-122.4794467	San Francisco County
352077	Ordering, Referring, Prescribing	N/A	1922502962	0	0	LOALLEN, WEEI MD	9/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164892	N/A	N/A	N/A	N/A	N/A	8910 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1104	00	06000	32.83150953	-117.136431	San Diego County
352086	Ordering, Referring, Prescribing	N/A	1922523208	0	0	LEE, CHELSEA M PSYD	2/25/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31596	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
352096	Ordering, Referring, Prescribing	N/A	1922539337	0	0	LODHI, SHAFI A	12/3/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170954	N/A	N/A	N/A	N/A	N/A	902 S MYRTLE AVE	None	MONROVIA	CA	91016	3427	00	06000	34.14233552	-118.0008646	Los Angeles County
352116	Ordering, Referring, Prescribing	N/A	1922559822	0	0	LEEWOOD, CELIA K LPCC	11/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	10714	N/A	N/A	N/A	N/A	N/A	370 S. CRENSHAW BLVD.	SUITE E100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
352141	Ordering, Referring, Prescribing	N/A	1922612381	0	0	LU, THANG N PHARMD	9/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82084	N/A	N/A	N/A	N/A	N/A	7929 LOWER SACRAMENTO RD	None	STOCKTON	CA	95210	3723	00	06000	38.021913	-121.3230885	San Joaquin County
352142	Ordering, Referring, Prescribing	N/A	1922595701	0	0	LEEPER, MEGAN A PA-C	7/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA55212	N/A	N/A	N/A	N/A	N/A	200 S WELLS ROAD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
352163	Ordering, Referring, Prescribing	N/A	1922656966	0	0	LIM, STEPHANIE LCSW	10/23/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	116294	N/A	N/A	N/A	N/A	N/A	520 S LA FAYETTE PARK PL	#300	LOS ANGELES	CA	90057	5400	00	06000	34.06392003	-118.2826062	Los Angeles County
352173	Ordering, Referring, Prescribing	N/A	1922698406	0	0	LEW, JARRETT R PA-C	2/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59215	N/A	N/A	N/A	N/A	N/A	6368 HOLLYWOOD BLVD	None	LOS ANGELES	CA	90028	6320	00	06000	34.1015865	-118.328976	Los Angeles County
352180	Ordering, Referring, Prescribing	N/A	1922721810	0	0	LUAN, BRENDA V DDS	9/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	107946	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
352184	Ordering, Referring, Prescribing	N/A	1922742857	0	0	LOW, MATTHEW DDS	7/16/2024	Taxonomy not applicable	NA	n/a	000	Unknown	DDS110330	N/A	N/A	N/A	N/A	N/A	100 PHILLIPS DRIVE	None	SAUSALITO	CA	94965	1172	00	06000	37.87309986	-122.5132921	Marin County
352196	Ordering, Referring, Prescribing	N/A	1922775303	0	0	LEE, JAMES J DC	6/9/2022	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC34981	N/A	N/A	N/A	N/A	N/A	451 W LINCOLN AVE	100	ANAHEIM	CA	92805	2927	00	06000	33.83445082	-117.9189372	Orange County
352201	Ordering, Referring, Prescribing	N/A	1922779404	0	0	LEE, SAM K OD	8/9/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34986	N/A	N/A	N/A	N/A	N/A	200 MINOR HALL	None	BERKELEY	CA	94720	2020	00	06000	37.87133398	-122.2545466	Alameda County
352246	Ordering, Referring, Prescribing	N/A	1932230851	0	0	LOPEZ, ELIZABETH LCSW	7/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28513	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
352302	Ordering, Referring, Prescribing	N/A	1932364171	0	0	LEONARD, NATASHIA LMFT	6/17/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133294	N/A	N/A	N/A	N/A	N/A	323 N PRAIRIE AVE	SUITE 350	INGLEWOOD	CA	90301	4502	00	06000	33.966333	-118.3439975	Los Angeles County
352306	Ordering, Referring, Prescribing	N/A	1932386976	0	0	LEE, BILL HO L	2/27/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D45901	N/A	N/A	N/A	N/A	N/A	9719 RANCHO VERDE DR	None	BAKERSFIELD	CA	93311	0000	00	06000	35.31991993	-119.111133	Kern County
352314	Ordering, Referring, Prescribing	N/A	1932400256	0	0	LIMAS, DANIELLE J PHARMD	3/20/2018	Taxonomy not applicable	NA	n/a	000	Unknown	64966	N/A	N/A	N/A	N/A	N/A	2808 COUNTRY CLUB BLVD	None	STOCKTON	CA	95204	3957	00	06000	37.96368589	-121.3381492	San Joaquin County
352329	Ordering, Referring, Prescribing	N/A	1932426608	0	0	LUKINS, DANIELLE L LMFT	8/31/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	01432	N/A	N/A	N/A	N/A	N/A	1559 WATASHEAMU RD	None	GARDNERVILLE	NV	89460	7455	00	06000	38.90016089	-119.7157447	Douglas County
352353	Ordering, Referring, Prescribing	N/A	1932479987	0	0	LINAMAN, EMILY LCSW	6/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81425	N/A	N/A	N/A	N/A	N/A	2387 LISA LANE	None	PLEASANT HILL	CA	94523	3949	00	06000	37.94521553	-122.051844	Contra Costa County
352354	Ordering, Referring, Prescribing	N/A	1932481090	0	0	LEE, YEN PHARMD	7/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH70409	N/A	N/A	N/A	N/A	N/A	2627 PACIFIC AVE	None	LONG BEACH	CA	90806	2610	00	06000	33.80511396	-118.1937379	Los Angeles County
352366	Ordering, Referring, Prescribing	N/A	1932491099	0	0	LIN, YENNI PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64241	N/A	N/A	N/A	N/A	N/A	23621 S. MAIN STREET	None	CARSON	CA	90745	5473	00	06000	33.810615	-118.2757055	Los Angeles County
352376	Ordering, Referring, Prescribing	N/A	1932515467	0	0	LIKENS, MATTHEW LMFT	4/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT102194	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
352386	Ordering, Referring, Prescribing	N/A	1932529138	0	0	LEE, PHILIP MD	1/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A149198	N/A	N/A	N/A	N/A	N/A	9353 VALLEY BLVD	None	ROSEMEAD	CA	91770	1923	00	06000	34.08115618	-118.0651957	Los Angeles County
352391	Ordering, Referring, Prescribing	N/A	1932532132	0	0	LOPEZ, AMY J LCSW	6/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	89983	N/A	N/A	N/A	N/A	N/A	5284 ADOLFO RD	STE. 210	CAMARILLO	CA	93012	6787	00	06000	34.21515637	-118.9970881	Ventura County
352408	Ordering, Referring, Prescribing	N/A	1932550639	0	0	LESTER, SHAWN M	4/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72841	N/A	N/A	N/A	N/A	N/A	39400 PASEO PADRE PARKWA	None	FREMONT	CA	94538	2310	00	06000	37.55102172	-121.9759026	Alameda County
352442	Ordering, Referring, Prescribing	N/A	1932602836	0	0	LEYVA-GUTIERREZ, MAYRA LMFT	12/12/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT136402	N/A	N/A	N/A	N/A	N/A	2621 OSWELL ST	None	BAKERSFIELD	CA	93306	3172	00	06000	35.393283	-118.9496505	Kern County
352447	Ordering, Referring, Prescribing	N/A	1932607678	0	0	LE, VALERIE B	11/16/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	102267	N/A	N/A	N/A	N/A	N/A	55 E JULIAN ST	None	SAN JOSE	CA	95112	4007	00	06000	37.34118198	-121.8925795	Santa Clara County
352537	Ordering, Referring, Prescribing	N/A	1932746096	0	0	LEE TAM, JUDY T PHARMD	12/5/2019	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81173	N/A	N/A	N/A	N/A	N/A	525 EL CAMINO REAL	None	MILLBRAE	CA	94030	2030	00	06000	37.60370496	-122.393958	San Mateo County
352546	Ordering, Referring, Prescribing	N/A	1932767225	0	0	LOPEZ, ALEXIS H LMFT	8/30/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	141235	N/A	N/A	N/A	N/A	N/A	1414 N. CALIFORNIA ST.	None	STOCKTON	CA	95202	9520	00	06000	37.96761084	-121.2883234	San Joaquin County
352554	Ordering, Referring, Prescribing	N/A	1932790599	0	0	LIOU, YIH SHIUAN LAC	4/2/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC19018	N/A	N/A	N/A	N/A	N/A	728 PACIFIC AVE	503	SAN FRANCISCO	CA	94133	4457	00	06000	37.79687859	-122.4074282	San Francisco County
352565	Ordering, Referring, Prescribing	N/A	1932833928	0	0	LOYA, RAVEN A NP	6/15/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95021338	N/A	N/A	N/A	N/A	N/A	19353 VICTORY BLVD	None	RESEDA	CA	91335	6302	00	06000	34.18659936	-118.5552114	Los Angeles County
352569	Ordering, Referring, Prescribing	N/A	1932844149	0	0	LEE, JOO HYUN DDS	11/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108719	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
352588	Ordering, Referring, Prescribing	N/A	1932897444	0	0	LEE, MAO NP	1/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023923	N/A	N/A	N/A	N/A	N/A	4929 E KINGS CANYON RD	None	FRESNO	CA	93727	3812	00	06000	36.73603152	-119.730573	Fresno County
352592	Ordering, Referring, Prescribing	N/A	1932963451	0	0	LUU, ASHLEY M PA-C	2/23/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64157	N/A	N/A	N/A	N/A	N/A	6120 SEVILLE AVE	None	HUNTINGTON PARK	CA	90255	2911	00	06000	33.98438021	-118.2226279	Los Angeles County
352608	Ordering, Referring, Prescribing	N/A	1942257324	0	0	LUNDEEN, TIFFANY B CNM	10/15/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	235694	N/A	N/A	N/A	N/A	N/A	1030 NEVIN AVE	None	RICHMOND	CA	94801	3122	00	06000	37.93680005	-122.3591889	Contra Costa County
352610	Ordering, Referring, Prescribing	N/A	1942243910	0	0	LI, SIQING MD	11/1/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A75930	N/A	N/A	N/A	N/A	N/A	1359 N GRAND AVE	None	COVINA	CA	91724	1016	00	06000	34.104681	-117.872706	Los Angeles County
352621	Ordering, Referring, Prescribing	N/A	1942309349	0	0	LIM, MICHELLE PHARMD	3/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54314	N/A	N/A	N/A	N/A	N/A	7 MCMURTY CT	None	ALAMEDA	CA	94502	7799	00	06000	37.73980801	-122.2578739	Alameda County
352623	Ordering, Referring, Prescribing	N/A	1942304373	0	0	LEE, THOMAS T MD	1/30/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A37294	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	SUITE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
352630	Ordering, Referring, Prescribing	N/A	1942324983	0	0	LOMAS, JENNIFER N LCSW	10/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25211	N/A	N/A	N/A	N/A	N/A	3680 E IMPERIAL HWY	220	LYNWOD	CA	90262	2663	00	06000	33.93211641	-118.2011728	Los Angeles County
352635	Ordering, Referring, Prescribing	N/A	1942331012	0	0	LEWIS, JOHN P LMFT	3/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49371	N/A	N/A	N/A	N/A	N/A	5121 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2656	00	06000	35.35413152	-119.058471	Kern County
352656	Ordering, Referring, Prescribing	N/A	1942368386	0	0	LYONS, AARON L LMFT	3/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43345	N/A	N/A	N/A	N/A	N/A	109 PARMAC RD	1	CHICO	CA	95926	2294	00	06000	39.75358764	-121.8505893	Butte County
352660	Ordering, Referring, Prescribing	N/A	1942371596	0	0	LOVE, AMY K LMFT	12/15/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	43303	N/A	N/A	N/A	N/A	N/A	1234 EMPIRE ST	None	FAIRFIELD	CA	94533	5711	00	06000	38.25037548	-122.049045	Solano County
352662	Ordering, Referring, Prescribing	N/A	1942373451	0	0	LEE, AEYON PHARMD	5/16/2022	Taxonomy not applicable	NA	n/a	000	Unknown	39723	N/A	N/A	N/A	N/A	N/A	11260 WHITE ROCK RD	None	RANCHO CORDOVA	CA	95742	6571	00	06000	38.587968	-121.2636915	Sacramento County
352679	Ordering, Referring, Prescribing	N/A	1942430749	0	0	LIM, SOY M	5/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D58458	N/A	N/A	N/A	N/A	N/A	9380 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3749	00	06000	33.9215355	-117.4442978	Riverside County
352690	Ordering, Referring, Prescribing	N/A	1942459730	0	0	LORANG, MELISSA	5/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110124	N/A	N/A	N/A	N/A	N/A	2801 MEADOW LARK DR	None	SAN DIEGO	CA	92123	2709	00	06000	32.793462	-117.154293	San Diego County
352694	Ordering, Referring, Prescribing	N/A	1942463534	0	0	LOUIE, WAYLEY D MD	1/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A99894	N/A	N/A	N/A	N/A	N/A	1403 W LOMITA BLVD	None	HARBOR CITY	CA	90710	2084	00	06000	33.79785936	-118.3016552	Los Angeles County
352737	Ordering, Referring, Prescribing	N/A	1942553011	0	0	LEE, ERICA M PHARMD	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	68154	N/A	N/A	N/A	N/A	N/A	825 MARKET ST	None	SAN FRANCISCO	CA	94103	1901	00	06000	37.78516779	-122.4065094	San Francisco County
352738	Ordering, Referring, Prescribing	N/A	1942559646	0	0	LEYVA, DEANNA M LCSW	4/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74296	N/A	N/A	N/A	N/A	N/A	439 W 97TH ST	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
352742	Ordering, Referring, Prescribing	N/A	1942575360	0	0	LOUROKIS, MARILIN LMFT	11/24/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110312	N/A	N/A	N/A	N/A	N/A	10155 COLIMA RD	None	WHITTIER	CA	90603	0000	00	06000	33.94349601	-118.0106968	Los Angeles County
352746	Ordering, Referring, Prescribing	N/A	1942577010	0	0	LONG, JENNA L	1/24/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA21282	N/A	N/A	N/A	N/A	N/A	2690 PACIFIC AVE	STE 370	LONG BEACH	CA	90806	2661	00	06000	33.805854	-118.1936805	Los Angeles County
352765	Ordering, Referring, Prescribing	N/A	1942585393	0	0	LEE, LINNA H	8/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH47995	N/A	N/A	N/A	N/A	N/A	3382 CASTRO VALLEY BLVD	None	CASTRO VALLEY	CA	94546	5623	00	06000	37.69560262	-122.0767052	Alameda County
352769	Ordering, Referring, Prescribing	N/A	1942605902	0	0	LAW, LOK-TING A PHARMD	11/3/2018	Taxonomy not applicable	NA	n/a	000	Unknown	64585	N/A	N/A	N/A	N/A	N/A	13255 BLACK MOUNTAIN RD	None	SAN DIEGO	CA	92129	2658	00	06000	32.95881607	-117.1266381	San Diego County
352790	Ordering, Referring, Prescribing	N/A	1942638937	0	0	LEVIN, NICOLE LCSW	2/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92898	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVE	None	CULVER CITY	CA	90230	0000	00	06000	34.01334411	-118.3970131	Los Angeles County
352793	Ordering, Referring, Prescribing	N/A	1942642343	0	0	LUCAS, LARISSA A LMFT	3/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93807	N/A	N/A	N/A	N/A	N/A	100 W WALNUT ST	SUITE 375	PASADENA	CA	91124	0002	00	06000	34.14963648	-118.1522925	Los Angeles County
352800	Ordering, Referring, Prescribing	N/A	1942653167	0	0	LEE, CHARLENE	11/14/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	3688	N/A	N/A	N/A	N/A	N/A	819 W IOWA AVE,	None	SUNNYVALE	CA	94086	3217	00	06000	37.37432124	-122.0405899	Santa Clara County
352807	Ordering, Referring, Prescribing	N/A	1942628177	0	0	LUCAS, KAMIKO O LMFT	12/14/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42951	N/A	N/A	N/A	N/A	N/A	24077 STATE HIGHWAY49	None	NEVADA CITY	CA	95959	8519	00	06000	39.321882	-121.0992075	Nevada County
352816	Ordering, Referring, Prescribing	N/A	1942663166	0	0	LEE, DAVID R MD	3/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152391	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
352849	Ordering, Referring, Prescribing	N/A	1942724695	0	0	LEUNG, LAWRENCE G LCSW	6/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94981	N/A	N/A	N/A	N/A	N/A	680 LANGSDORF DR	200	FULLERTON	CA	92831	3702	00	06000	33.87673088	-117.8824577	Orange County
352875	Ordering, Referring, Prescribing	N/A	1942764477	0	0	LUM, YUIN-WAH T NP	12/6/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95010663	N/A	N/A	N/A	N/A	N/A	1000 EUCLID AVENUE	None	NATIONAL CITY	CA	91950	3856	00	06000	32.68067201	-117.0804893	San Diego County
352877	Ordering, Referring, Prescribing	N/A	1942761903	0	0	LO, CARRIE MD	3/28/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL657	N/A	N/A	N/A	N/A	N/A	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
352919	Ordering, Referring, Prescribing	N/A	1942857107	0	0	LAD, NIKISHA LCSW	1/25/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	120676	N/A	N/A	N/A	N/A	N/A	2400 E 8TH ST	STE A	NATIONAL CITY	CA	91950	2956	00	06000	32.6827769	-117.0820394	San Diego County
352928	Ordering, Referring, Prescribing	N/A	1942878491	0	0	LAKER, GRIFFIN DDS	10/16/2022	Taxonomy not applicable	NA	n/a	000	Unknown	106174	N/A	N/A	N/A	N/A	N/A	581 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3260	00	06000	36.0695765	-119.0301795	Tulare County
352936	Ordering, Referring, Prescribing	N/A	1942887849	0	0	LYNCH, REBECCA MD	3/17/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194395	N/A	N/A	N/A	N/A	N/A	204 E BEACH ST	None	WATSONVILLE	CA	95076	4809	00	06000	36.91224802	-121.7541363	Santa Cruz County
352937	Ordering, Referring, Prescribing	N/A	1942903596	0	0	LOPEZ, LAURA NP	3/23/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024698	N/A	N/A	N/A	N/A	N/A	600 B STREET	BUILDING A-C	LIVINGSTON	CA	95334	9593	00	06000	37.38589253	-120.734559	Merced County
352938	Ordering, Referring, Prescribing	N/A	1942897608	0	0	LAMBERT, CAROL LCSW	11/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27553	N/A	N/A	N/A	N/A	N/A	401 VERNON ST	STE. B	ROSEVILLE	CA	95678	2600	00	06000	38.74793156	-121.2853565	Placer County
352942	Ordering, Referring, Prescribing	N/A	1942921424	0	0	LU, JODIE M PA-C	2/9/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64070	N/A	N/A	N/A	N/A	N/A	1693 FLANIGAN DR	#100	SAN JOSE	CA	95121	1683	00	06000	37.31874246	-121.8234636	Santa Clara County
352948	Ordering, Referring, Prescribing	N/A	1942924832	0	0	LORIA, CAMILLE B DDS	9/18/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS107923	N/A	N/A	N/A	N/A	N/A	2801 S SAN PEDRO ST	None	LOS ANGELES	CA	90011	2023	00	06000	34.01966657	-118.2625434	Los Angeles County
352958	Ordering, Referring, Prescribing	N/A	1942965314	0	0	LIWAG, JANOLIVER G PHARMD	9/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85187	N/A	N/A	N/A	N/A	N/A	2700 WILLOW PASS RD	None	BAY POINT	CA	94565	6603	00	06000	38.0267885	-121.94163	Contra Costa County
352991	Ordering, Referring, Prescribing	N/A	1952072662	0	0	LUONG, AMY T PHARMD	7/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH84404	N/A	N/A	N/A	N/A	N/A	9550 HAGEMAN RD	None	BAKERSFIELD	CA	93312	3956	00	06000	35.39819227	-119.1084347	Kern County
352993	Ordering, Referring, Prescribing	N/A	1952084345	0	0	LIBOVA, YELENA	7/19/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026023	N/A	N/A	N/A	N/A	N/A	1134 BLAKE ST	None	BERKELEY	CA	94702	2003	00	06000	37.8604595	-122.287664	Alameda County
352997	Ordering, Referring, Prescribing	N/A	1952120255	0	0	LEWIS, ILANA K	10/10/2024	Taxonomy not applicable	NA	n/a	000	Unknown	ND1513	N/A	N/A	N/A	N/A	N/A	200 1/2 W CYPRESS ST	None	GLENDALE	CA	91204	2605	00	06000	34.12981853	-118.2565838	Los Angeles County
353004	Ordering, Referring, Prescribing	N/A	1952132938	0	0	LEE, CAROL DMD	8/9/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110528	N/A	N/A	N/A	N/A	N/A	3701 J ST	201	SACRAMENTO	CA	95816	5542	00	06000	38.571237	-121.4566245	Sacramento County
353046	Ordering, Referring, Prescribing	N/A	1952433609	0	0	LOPEZ, MARIBEL LMFT	3/10/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49996	N/A	N/A	N/A	N/A	N/A	251 E HACKETT DRIVE	P9A	MODESTO	CA	95358	9800	00	06000	37.58764784	-120.9907809	Stanislaus County
353068	Ordering, Referring, Prescribing	N/A	1952484842	0	0	LIU, CHRISTINA K PHD	4/18/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY13089	N/A	N/A	N/A	N/A	N/A	720 SACRAMENTO STREET	CHINATOWN CHILD DEVELOPM	SAN FRANCISCO	CA	94108	2535	00	06000	37.79355846	-122.4050846	San Francisco County
353090	Ordering, Referring, Prescribing	N/A	1952556938	0	0	LEFLORE, GLENDA NP	11/8/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	8357	N/A	N/A	N/A	N/A	N/A	7821 AVALON BLVD	None	LOS ANGELES	CA	90003	2358	00	06000	33.969393	-118.265197	Los Angeles County
353126	Ordering, Referring, Prescribing	N/A	1952628422	0	0	LAZARIN, MARGAUX	9/22/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14488	N/A	N/A	N/A	N/A	N/A	2500 CALIFORNIA STREET	STE. A	MOUNTAIN VIEW	CA	94040	0000	00	06000	37.40337202	-122.1063817	Santa Clara County
353138	Ordering, Referring, Prescribing	N/A	1952654386	0	0	LARSEN, ASHLEY M	6/12/2017	Taxonomy not applicable	NA	n/a	000	Unknown	22639	N/A	N/A	N/A	N/A	N/A	1975 VERDUGO BLVD	None	LA CANADA	CA	91011	3022	00	06000	34.20501855	-118.219857	Los Angeles County
353146	Ordering, Referring, Prescribing	N/A	1952664401	0	0	LABBAD, GABRIEL E MD DO	6/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169121	N/A	N/A	N/A	N/A	N/A	2210 MESA DRIVE	5	OCEANSIDE	CA	92054	0676	00	06000	33.20786753	-117.3579677	San Diego County
353154	Ordering, Referring, Prescribing	N/A	1952677783	0	0	LOPEZ, ALLISSA D LPCC	3/31/2020	Taxonomy not applicable	NA	n/a	000	Unknown	5695	N/A	N/A	N/A	N/A	N/A	820 34TH ST	None	BAKERSFIELD	CA	93301	2283	00	06000	35.39053308	-119.0117133	Kern County
353190	Ordering, Referring, Prescribing	N/A	1952748915	0	0	LEWIS, CHRYSTIE L LMFT	3/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107333	N/A	N/A	N/A	N/A	N/A	27035 WHITMAN ST	None	HAYWARD	CA	94544	4027	00	06000	37.642579	-122.0660134	Alameda County
353193	Ordering, Referring, Prescribing	N/A	1952748865	0	0	LIANG, CINDY LCSW	3/31/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76293	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
353204	Ordering, Referring, Prescribing	N/A	1952753691	0	0	LI, HOYAN J PA	10/29/2017	Taxonomy not applicable	NA	n/a	000	Unknown	53651	N/A	N/A	N/A	N/A	N/A	665 NORTH D ST	None	SAN BERNARDINO	CA	92401	1109	00	06000	34.111737	-117.2918735	San Bernardino County
353209	Ordering, Referring, Prescribing	N/A	1952763799	0	0	LEE RODRIGUEZ, CHRISTIAN A	11/5/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150818	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	FL 4 STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
353245	Ordering, Referring, Prescribing	N/A	1952828220	0	0	LAU, HELENA PHARMD	3/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74743	N/A	N/A	N/A	N/A	N/A	21255 BURBANK BLVD	SUITE 150	WOODLAND HILLS	CA	91367	6674	00	06000	34.17331011	-118.5940107	Los Angeles County
353248	Ordering, Referring, Prescribing	N/A	1952832099	0	0	LUQMAAN, MADINAH LCSW	6/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93190	N/A	N/A	N/A	N/A	N/A	837 ADDISON ST	None	BERKELEY	CA	94701	0000	00	06000	37.86680859	-122.2969443	Alameda County
353267	Ordering, Referring, Prescribing	N/A	1952844532	0	0	LEE, JIYOON M PHARMD	4/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	75527	N/A	N/A	N/A	N/A	N/A	2901 LOS FELIZ BLVD	None	LOS ANGELES	CA	90039	1502	00	06000	34.129008	-118.263933	Los Angeles County
353297	Ordering, Referring, Prescribing	N/A	1952904906	0	0	LIEN, AMY C PHARMD	3/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82873	N/A	N/A	N/A	N/A	N/A	9461 SEAN WAY	None	WESTMINSTER	CA	92683	7437	00	06000	33.73138228	-117.9640242	Orange County
353304	Ordering, Referring, Prescribing	N/A	1952923120	0	0	LU, MAGGIE PHARMD	2/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79916	N/A	N/A	N/A	N/A	N/A	1647 N HACIENDA BLVD	None	LA PUENTE	CA	91744	1137	00	06000	34.04917664	-117.9454719	Los Angeles County
353307	Ordering, Referring, Prescribing	N/A	1952911554	0	0	LIMOSNERO, GLENN LMFT	2/2/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT144750	N/A	N/A	N/A	N/A	N/A	800 N STATE ST	None	UKIAH	CA	95482	3410	00	06000	39.15774044	-123.2085769	Mendocino County
353337	Ordering, Referring, Prescribing	N/A	1952965733	0	0	LYERLY, JOHN S MD	6/18/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A196992	N/A	N/A	N/A	N/A	N/A	220 WEST 11TH STREET	None	TRACY	CA	95376	3944	00	06000	37.73967351	-121.4300925	San Joaquin County
353356	Ordering, Referring, Prescribing	N/A	1962032961	0	0	LAPLANA, JOEY G NP	5/6/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013711	N/A	N/A	N/A	N/A	N/A	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
353357	Ordering, Referring, Prescribing	N/A	1962035998	0	0	LAUSER, DANIELLE M LMFT	4/18/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT116582	N/A	N/A	N/A	N/A	N/A	735 STATE STREET	SUITE 416A	SANTA BARBARA	CA	93101	5552	00	06000	34.41942344	-119.6991527	Santa Barbara County
353363	Ordering, Referring, Prescribing	N/A	1962039685	0	0	LUNDQUIST, ARIANA M MD	2/9/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184199	N/A	N/A	N/A	N/A	N/A	625 34TH ST	100 & 200	BAKERSFIELD	CA	93301	2305	00	06000	35.39046051	-119.0092725	Kern County
353372	Ordering, Referring, Prescribing	N/A	1962057133	0	0	LODIN, LAIS M DDS	1/15/2022	Taxonomy not applicable	NA	n/a	000	Unknown	104240	N/A	N/A	N/A	N/A	N/A	1031 WATERLOO RD	None	STOCKTON	CA	95205	4256	00	06000	37.96732496	-121.2723543	San Joaquin County
353383	Ordering, Referring, Prescribing	N/A	1962079624	0	0	LUDWICK, ANDREA	12/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019543	N/A	N/A	N/A	N/A	N/A	2460 17TH AVE	#1030	SANTA CRUZ	CA	95062	1860	00	06000	36.98523885	-121.9817539	Santa Cruz County
353389	Ordering, Referring, Prescribing	N/A	1962096339	0	0	LEON-TOSCANO, TANA A NP	5/31/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016341	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
353412	Ordering, Referring, Prescribing	N/A	1962176768	0	0	LIU, JENNY PHARMD	5/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH84612	N/A	N/A	N/A	N/A	N/A	1220 W FOOTHILL BLVD	None	AZUSA	CA	91702	2819	00	06000	34.13048487	-117.9261514	Los Angeles County
353447	Ordering, Referring, Prescribing	N/A	1962476028	0	0	LEFF, MONICA P MD	4/29/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G41128	N/A	N/A	N/A	N/A	N/A	4800 E LOS COYOTES DIAGO	None	LONG BEACH	CA	90815	2897	00	06000	33.79304077	-118.1378147	Los Angeles County
353485	Ordering, Referring, Prescribing	N/A	1962586255	0	0	LANDER, DIEN D PHARMD	4/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52057	N/A	N/A	N/A	N/A	N/A	2015 CALLE DE LOS ALAMOS	None	SAN CLEMENTE	CA	92672	4312	00	06000	33.41048392	-117.6099009	Orange County
353501	Ordering, Referring, Prescribing	N/A	1962618553	0	0	LIMA, TRACIE A LCSW	12/15/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24320	N/A	N/A	N/A	N/A	N/A	818 MAIN ST	None	YREKA	CA	96097	9538	00	06000	41.74151683	-122.6329014	Siskiyou County
353510	Ordering, Referring, Prescribing	N/A	1962641126	0	0	LILES, BRANDI D PHD	12/15/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26903	N/A	N/A	N/A	N/A	N/A	3671 BUSINESS DRIVE	110	SACRAMENTO	CA	95820	2165	00	06000	38.54133	-121.41891	Sacramento County
353518	Ordering, Referring, Prescribing	N/A	1962654319	0	0	LURIE, MELISSA K PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61602	N/A	N/A	N/A	N/A	N/A	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	00	06000	34.17030266	-118.5881699	Los Angeles County
353541	Ordering, Referring, Prescribing	N/A	1962697508	0	0	LAMBERT, TY S LMFT	2/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT150373	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE.	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
353544	Ordering, Referring, Prescribing	N/A	1962697219	0	0	LARA, AGUSTIN J MD	1/16/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A97569	N/A	N/A	N/A	N/A	N/A	507 S ATLANTIC BLVD	None	LOS ANGELES	CA	90022	2628	00	06000	34.0269721	-118.1553658	Los Angeles County
353565	Ordering, Referring, Prescribing	N/A	1962744417	0	0	LY, DERICK L DO	1/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A13326	N/A	N/A	N/A	N/A	N/A	850 E FOOTHILL BLVD	None	RIALTO	CA	92376	5230	00	06000	34.10679449	-117.3542535	San Bernardino County
353573	Ordering, Referring, Prescribing	N/A	1962755777	0	0	LE, LINDA PHARMD	7/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67749	N/A	N/A	N/A	N/A	N/A	2501 W MAGNOLIA BLVD	None	BURBANK	CA	91505	3030	00	06000	34.17187593	-118.3351483	Los Angeles County
353592	Ordering, Referring, Prescribing	N/A	1962777037	0	0	LY, ANHDAO T	4/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	48160	N/A	N/A	N/A	N/A	N/A	951 PALOMAR AIRPORT RD	None	CARLSBAD	CA	92011	1110	00	06000	33.12192014	-117.3157437	San Diego County
353599	Ordering, Referring, Prescribing	N/A	1962779165	0	0	LE, TIFFANY T PHARMD	8/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57696	N/A	N/A	N/A	N/A	N/A	11950 VALLEY VIEW ST	None	GARDEN GROVE	CA	92845	1239	00	06000	33.7890093	-118.0283611	Orange County
353600	Ordering, Referring, Prescribing	N/A	1962785006	0	0	LEE, JIHEE C PHARMD	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	48075	N/A	N/A	N/A	N/A	N/A	2055 N PERRIS BLVD	None	PERRIS	CA	92571	2509	00	06000	33.80930628	-117.2260719	Riverside County
353611	Ordering, Referring, Prescribing	N/A	1962797274	0	0	LOVE, NICOLE R NP	5/23/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	752320	N/A	N/A	N/A	N/A	N/A	3030 EXPLORER DRIVE	None	SACRAMENTO	CA	95827	2728	00	06000	38.563362	-121.332429	Sacramento County
353618	Ordering, Referring, Prescribing	N/A	1962804765	0	0	LUNEAU, MICHELLE NP	6/22/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001414	N/A	N/A	N/A	N/A	N/A	2017 FIRST AVENUE	SUITE 100	SAN DIEGO	CA	92101	9001	00	06000	32.72646147	-117.1638767	San Diego County
353619	Ordering, Referring, Prescribing	N/A	1962805416	0	0	LO, CHUI-YEE	10/10/2018	Taxonomy not applicable	NA	n/a	000	Unknown	45854	N/A	N/A	N/A	N/A	N/A	70 W HEDDING ST	None	SAN JOSE	CA	95110	1705	00	06000	37.35249294	-121.9050815	Santa Clara County
353650	Ordering, Referring, Prescribing	N/A	1962841114	0	0	LEONG, WILBUR PHARMD	3/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69921	N/A	N/A	N/A	N/A	N/A	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	00	06000	37.7802547	-122.4642049	San Francisco County
353659	Ordering, Referring, Prescribing	N/A	1962858423	0	0	LIU, HUI S	5/20/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	100194	N/A	N/A	N/A	N/A	N/A	525 ROBERTS LANE	None	BAKERSFIELD	CA	93308	4799	00	06000	35.40860151	-119.0317455	Kern County
353662	Ordering, Referring, Prescribing	N/A	1962864819	0	0	LI, MENGLU MD	3/1/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154438	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
353669	Ordering, Referring, Prescribing	N/A	1962875773	0	0	LEYVA, VERONICA LMFT	4/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139210	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	207	SANTA ROSA	CA	95407	5478	00	06000	38.425266	-122.749875	Sonoma County
353676	Ordering, Referring, Prescribing	N/A	1962883843	0	0	LEUNG, CHRISTINE P	11/16/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	100765	N/A	N/A	N/A	N/A	N/A	355 CENTRAL AVE	None	FILLMORE	CA	93015	1920	00	06000	34.40028802	-118.9137057	Ventura County
353698	Ordering, Referring, Prescribing	N/A	1962916643	0	0	LE, KACIE F PHARMD	7/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH74522	N/A	N/A	N/A	N/A	N/A	2950 S ARCHIBALD AVE	None	ONTARIO	CA	91761	7303	00	06000	34.019559	-117.5936625	San Bernardino County
353707	Ordering, Referring, Prescribing	N/A	1962936930	0	0	LOPEZ, NOE NP	4/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95013248	N/A	N/A	N/A	N/A	N/A	17264 FOOTHILL BLVD	A	FONTANA	CA	92335	9043	00	06000	34.10678654	-117.4277541	San Bernardino County
353715	Ordering, Referring, Prescribing	N/A	1962949669	0	0	LEE, HYEON HYE PHARMD	3/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76583	N/A	N/A	N/A	N/A	N/A	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	00	06000	37.33773494	-122.0043395	Santa Clara County
353743	Ordering, Referring, Prescribing	N/A	1962999623	0	0	LUE, TING Y	9/27/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	104098	N/A	N/A	N/A	N/A	N/A	2950 INTERNATIONAL BLVD	None	OAKLAND	CA	94601	2228	00	06000	37.77893032	-122.2284286	Alameda County
353774	Ordering, Referring, Prescribing	N/A	1972044006	0	0	LE, TRAM ANH PHARMD	10/4/2018	Taxonomy not applicable	NA	n/a	000	Unknown	75747	N/A	N/A	N/A	N/A	N/A	4520 SUNSET BLVD	None	LOS ANGELES	CA	90027	0001	00	06000	34.09811411	-118.2879528	Los Angeles County
353784	Ordering, Referring, Prescribing	N/A	1972064962	0	0	LOVATO, TIFFANY S	5/23/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010944	N/A	N/A	N/A	N/A	N/A	5225 FIORE TER	D215	SAN DIEGO	CA	92122	5647	00	06000	32.87042789	-117.2031451	San Diego County
353795	Ordering, Referring, Prescribing	N/A	1972086445	0	0	LAUPPE, CORINNE LMFT	9/19/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40594	N/A	N/A	N/A	N/A	N/A	935 14TH ST	None	MARYSVILLE	CA	95901	4129	00	06000	39.14964403	-121.5996697	Yuba County
353804	Ordering, Referring, Prescribing	N/A	1972103059	0	0	LEAL, TRACY L LMFT	8/25/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT141153	N/A	N/A	N/A	N/A	N/A	9445 FAIRWAY VIEW PL	100	RANCHO CUCAMONGA	CA	91730	0930	00	06000	34.08193054	-117.5597308	San Bernardino County
353806	Ordering, Referring, Prescribing	N/A	1972112167	0	0	LE, PAULA PHARMD	4/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	53096	N/A	N/A	N/A	N/A	N/A	2700 PARK AVE	None	TUSTIN	CA	92782	2708	00	06000	33.69923603	-117.821646	Orange County
353812	Ordering, Referring, Prescribing	N/A	1972120343	0	0	LE, UY Q PHARMD	7/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80482	N/A	N/A	N/A	N/A	N/A	918 E FOOTHILL BLVD	None	RIALTO	CA	92376	5367	00	06000	34.10679947	-117.352134	San Bernardino County
353827	Ordering, Referring, Prescribing	N/A	1972155968	0	0	LOZANO, KATHY N	3/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79294	N/A	N/A	N/A	N/A	N/A	7373 WEST LN	None	STOCKTON	CA	95209	8209	00	06000	38.017701	-121.297869	San Joaquin County
353828	Ordering, Referring, Prescribing	N/A	1972139079	0	0	LEE, KAREN NP	12/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95014211	N/A	N/A	N/A	N/A	N/A	10544 SPENCEVILLE ROAD	None	PENN VALLEY	CA	95946	2046	00	06000	39.19618415	-121.1776527	Nevada County
353830	Ordering, Referring, Prescribing	N/A	1972162485	0	0	LE, THUYTRAM T PHARMD	4/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52786	N/A	N/A	N/A	N/A	N/A	129 BERNAL ROAD	None	SAN JOSE	CA	95119	9511	00	06000	37.232892	-121.774725	Santa Clara County
353859	Ordering, Referring, Prescribing	N/A	1972236107	0	0	LEE, DANIEL B DDS	11/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	108385	N/A	N/A	N/A	N/A	N/A	1141 PEAR TREE LN	120	NAPA	CA	94558	6484	00	06000	38.32125908	-122.2921523	Napa County
353864	Ordering, Referring, Prescribing	N/A	1972236594	0	0	LEVIN, YAEL	1/16/2025	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY35637	N/A	N/A	N/A	N/A	N/A	3301 E 12TH ST	SUITE 259	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
353871	Ordering, Referring, Prescribing	N/A	1972266286	0	0	LOPEZ, DAVID X NP	9/15/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95022668	N/A	N/A	N/A	N/A	N/A	1971 E 4TH ST	200	SANTA ANA	CA	92705	3917	00	06000	33.7482685	-117.83934	Orange County
353872	Ordering, Referring, Prescribing	N/A	1972267631	0	0	LETU, SCOTT P PA-C	10/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60306	N/A	N/A	N/A	N/A	N/A	661 W. 1ST ST	None	TUSTIN	CA	92780	2939	00	06000	33.74578153	-117.831231	Orange County
353873	Ordering, Referring, Prescribing	N/A	1972271336	0	0	LENOX, GAVIN PA	10/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63021	N/A	N/A	N/A	N/A	N/A	147 N BRENT ST.	None	VENTURA	CA	93003	2809	00	06000	34.2746295	-119.2573399	Ventura County
353876	Ordering, Referring, Prescribing	N/A	1972273787	0	0	LOGAN, TENDERLY R	12/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	LEP3183	N/A	N/A	N/A	N/A	N/A	675 CLOVER VALLEY RD	None	UPPER LAKE	CA	95485	9220	00	06000	39.16501887	-122.9026424	Lake County
353892	Ordering, Referring, Prescribing	N/A	1972544948	0	0	LONGCHAMP, CARLA MD	7/10/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G76332	N/A	N/A	N/A	N/A	N/A	1300 N DUTTON AVE	STE A	SANTA ROSA	CA	95401	7108	00	06000	38.449791	-122.733027	Sonoma County
353923	Ordering, Referring, Prescribing	N/A	1972638542	0	0	LESTI, RENEE LMFT	7/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80104	N/A	N/A	N/A	N/A	N/A	51 MARINA BLVD	None	PITTSBURG	CA	94565	2068	00	06000	38.0354387	-121.8837345	Contra Costa County
353925	Ordering, Referring, Prescribing	N/A	1972639391	0	0	LOPEZ, NORMA E LCSW	3/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW66591	N/A	N/A	N/A	N/A	N/A	205 PACIFICA AVE	None	BAY POINT	CA	94565	2904	00	06000	38.0339697	-121.9654883	Contra Costa County
353926	Ordering, Referring, Prescribing	N/A	1972636595	0	0	LAMERS, MARK L	9/20/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	21592	N/A	N/A	N/A	N/A	N/A	720 WOOD ST	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
353951	Ordering, Referring, Prescribing	N/A	1972682698	0	0	LOW, JULIE E MD	8/16/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G65632	N/A	N/A	N/A	N/A	N/A	1725 W 17TH ST	None	SANTA ANA	CA	92706	2316	00	06000	33.75999552	-117.892593	Orange County
353959	Ordering, Referring, Prescribing	N/A	1972685089	0	0	LARSEN, WAYNE T OD	6/18/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	5169	N/A	N/A	N/A	N/A	N/A	1328 S MISSION RD	None	FALLBROOK	CA	92028	4006	00	06000	33.36868654	-117.2507699	San Diego County
353965	Ordering, Referring, Prescribing	N/A	1972723260	0	0	LANZON, JESSE L DDS	5/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS56306	N/A	N/A	N/A	N/A	N/A	1111 EAST OCEAN AVE.	STE 9	LOMPOC	CA	93436	7419	00	06000	34.63889719	-120.4447732	Santa Barbara County
353996	Ordering, Referring, Prescribing	N/A	1972777316	0	0	LEIER, TIM MD	12/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C144900	N/A	N/A	N/A	N/A	N/A	36101 BOB HOPE DR.	SUITE A1	RANCHO MIRAGE	CA	92270	2002	00	06000	33.786126	-116.406086	Riverside County
354006	Ordering, Referring, Prescribing	N/A	1972803450	0	0	LEE, ALLISON C PHARMD	12/4/2018	Taxonomy not applicable	NA	n/a	000	Unknown	47785	N/A	N/A	N/A	N/A	N/A	1025 ALHAMBRA BLVD	None	SACRAMENTO	CA	95816	5212	00	06000	38.571894	-121.4649	Sacramento County
354010	Ordering, Referring, Prescribing	N/A	1972804284	0	0	LAU, DENNY S PHARMD	1/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH41219	N/A	N/A	N/A	N/A	N/A	850 LA PLAYA ST	None	SAN FRANCISCO	CA	94121	3219	00	06000	37.77251021	-122.5099565	San Francisco County
354023	Ordering, Referring, Prescribing	N/A	1972832699	0	0	LINDELL, KATHLEEN M LMFT	8/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	88581	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
354056	Ordering, Referring, Prescribing	N/A	1972883676	0	0	LAYSECA, GABRIELA P LMFT	1/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT35961	N/A	N/A	N/A	N/A	N/A	1515 S BON VIEW AVE	None	ONTARIO	CA	91761	4408	00	06000	34.045335	-117.636444	San Bernardino County
354058	Ordering, Referring, Prescribing	N/A	1972886372	0	0	LEUNG, VIVIAN W PHARMD	8/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH60897	N/A	N/A	N/A	N/A	N/A	308 UNIVERSITY AVE	None	SAN DIEGO	CA	92103	3009	00	06000	32.74829652	-117.162279	San Diego County
354059	Ordering, Referring, Prescribing	N/A	1972888543	0	0	LEE, STEVE	1/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	41960	N/A	N/A	N/A	N/A	N/A	2000 MARKET PLACE DR	None	MONTEREY PARK	CA	91755	7402	00	06000	34.03672674	-118.1057236	Los Angeles County
354100	Ordering, Referring, Prescribing	N/A	1972933430	0	0	LARKIN, JESSICA L	1/20/2017	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	40769	N/A	N/A	N/A	N/A	N/A	24422 AVENIDA DE LA CARL	STE 100	LAGUNA HILLS	CA	92653	3636	00	06000	33.56726005	-117.705397	Orange County
354132	Ordering, Referring, Prescribing	N/A	1972977544	0	0	LE, QUOC SINH P PHARMD	6/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	73891	N/A	N/A	N/A	N/A	N/A	470 N SANTA CRUZ AVE	None	LOS GATOS	CA	95030	5313	00	06000	37.23162694	-121.9796316	Santa Clara County
354145	Ordering, Referring, Prescribing	N/A	1972989606	0	0	LASKY, TIFFANY L LCSW	10/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	97597	N/A	N/A	N/A	N/A	N/A	1031 25TH ST	None	SAN DIEGO	CA	92102	2102	00	06000	32.716404	-117.1402635	San Diego County
354146	Ordering, Referring, Prescribing	N/A	1972995686	0	0	LI, GINA LCSW	11/10/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	105460	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
354151	Ordering, Referring, Prescribing	N/A	1982002739	0	0	LUNA, SHAWN J	5/4/2017	Taxonomy not applicable	NA	n/a	000	Unknown	51984	N/A	N/A	N/A	N/A	N/A	49063 ROAD 426	STE C & D	OAKHURST	CA	93644	9487	00	06000	37.33186891	-119.6510247	Madera County
354171	Ordering, Referring, Prescribing	N/A	1982034195	0	0	LOGAN, ANNALEAH PSYD	6/29/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	25893	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
354188	Ordering, Referring, Prescribing	N/A	1982066684	0	0	LAM, MAYNARD PHARMD	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75271	N/A	N/A	N/A	N/A	N/A	1263 E ARQUES AVE	None	SUNNYVALE	CA	94085	4701	00	06000	37.38060846	-121.9896672	Santa Clara County
354194	Ordering, Referring, Prescribing	N/A	1982068243	0	0	LOPEZ, JOSE MD	4/18/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A172347	N/A	N/A	N/A	N/A	N/A	513 PARNASSUS AVE RM S-2	0628	SAN FRANCISCO	CA	94143	2205	00	06000	37.76344756	-122.4581992	San Francisco County
354208	Ordering, Referring, Prescribing	N/A	1982085635	0	0	LABABIDI, SUZANNE L MD	4/3/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A161696	N/A	N/A	N/A	N/A	N/A	1101 N CHERRY ST	None	TULARE	CA	93274	2231	00	06000	36.22333808	-119.337575	Tulare County
354210	Ordering, Referring, Prescribing	N/A	1982091260	0	0	LOERA, LORNA C LCSW	3/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76786	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	SUITE 405	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
354237	Ordering, Referring, Prescribing	N/A	1982146502	0	0	LAMBOURNE, NEVILLE DC	2/3/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	36022	N/A	N/A	N/A	N/A	N/A	9380 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92503	3749	00	06000	33.9215355	-117.4442978	Riverside County
354248	Ordering, Referring, Prescribing	N/A	1982166112	0	0	LONGCOR, ALICIA LMFT	5/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99986	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
354270	Ordering, Referring, Prescribing	N/A	1982194577	0	0	LUVIANO, MARISOL LCSW	6/4/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122960	N/A	N/A	N/A	N/A	N/A	520 E TULARE AVE	None	VISALIA	CA	93292	3629	00	06000	36.320679	-119.2870845	Tulare County
354296	Ordering, Referring, Prescribing	N/A	1982236329	0	0	LY, HANNAH E LMFT	12/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT129711	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE	300	SAN JOSE	CA	95128	2631	00	06000	37.3160785	-121.937121	Santa Clara County
354325	Ordering, Referring, Prescribing	N/A	1982319380	0	0	LIU, ANNIE MD	1/18/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183898	N/A	N/A	N/A	N/A	N/A	289 W. HUNTINGTON DRIVE	SUITE 208	ARCADIA	CA	91007	3495	00	06000	34.13549119	-118.0419175	Los Angeles County
354327	Ordering, Referring, Prescribing	N/A	1982328506	0	0	LEE, JUNG IN PA-C	12/20/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63849	N/A	N/A	N/A	N/A	N/A	3255 WILSHIRE BLVD	100	LOS ANGELES	CA	90010	1404	00	06000	34.0618166	-118.2932612	Los Angeles County
354329	Ordering, Referring, Prescribing	N/A	1982358479	0	0	LIN, EMILY M NP	12/13/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95019417	N/A	N/A	N/A	N/A	N/A	1800 MT VERNON AVE.	None	BAKERSFIELD	CA	93306	3302	00	06000	35.383626	-118.967417	Kern County
354331	Ordering, Referring, Prescribing	N/A	1982360285	0	0	LIM, MICHELLE PHARMD	10/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85374	N/A	N/A	N/A	N/A	N/A	115 E LAKE BLVD	None	REDDING	CA	96003	2508	00	06000	40.61032419	-122.3732707	Shasta County
354339	Ordering, Referring, Prescribing	N/A	1982374179	0	0	LEE, AMY PHARMD	9/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85124	N/A	N/A	N/A	N/A	N/A	22 SAN PEDRO RD	None	DALY CITY	CA	94014	2528	00	06000	37.68893852	-122.4669569	San Mateo County
354350	Ordering, Referring, Prescribing	N/A	1982482006	0	0	LAWSON, CORTNEY B CNP	7/10/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025879	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
354417	Ordering, Referring, Prescribing	N/A	1982781241	0	0	LEON, ESMERALDA LCSW	3/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW21986	N/A	N/A	N/A	N/A	N/A	1055 W HENDERSON AVE	#2	PORTERVILLE	CA	93257	1490	00	06000	36.08036906	-119.0410926	Tulare County
354437	Ordering, Referring, Prescribing	N/A	1982833547	0	0	LEW, QUAN J MD	2/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A121070	N/A	N/A	N/A	N/A	N/A	7402 HOLLISTER AVE	None	GOLETA	CA	93117	2583	00	06000	34.42987025	-119.8878468	Santa Barbara County
354449	Ordering, Referring, Prescribing	N/A	1982850632	0	0	LANGROODI, MATIN R LMFT	6/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT51035	N/A	N/A	N/A	N/A	N/A	3133 N MILLBROOK AVE	None	FRESNO	CA	93703	1425	00	06000	36.77841	-119.7635455	Fresno County
354455	Ordering, Referring, Prescribing	N/A	1982860615	0	0	LEE, KATHERINE E PHARMD	5/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61151	N/A	N/A	N/A	N/A	N/A	1142 S DIAMOND BAR BLVD,	215	DIAMOND BAR	CA	91765	2203	00	06000	34.00260751	-117.8100398	Los Angeles County
354507	Ordering, Referring, Prescribing	N/A	1982971875	0	0	LEE, STUART PHARMD	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57393	N/A	N/A	N/A	N/A	N/A	1501 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4001	00	06000	34.01184449	-118.1170258	Los Angeles County
354510	Ordering, Referring, Prescribing	N/A	1982974341	0	0	LOPEZ, CLAUDIA E LMFT	11/4/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47342	N/A	N/A	N/A	N/A	N/A	897 GRANITE DR	None	PASADENA	CA	91101	3501	00	06000	34.13703447	-118.1317905	Los Angeles County
354513	Ordering, Referring, Prescribing	N/A	1982978581	0	0	LE, TRINH PHARMD	1/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	66947	N/A	N/A	N/A	N/A	N/A	2090 HARBISON DRIVE	None	VACAVILLE	CA	95687	3100	00	06000	38.36230294	-121.9634742	Solano County
354525	Ordering, Referring, Prescribing	N/A	1982986063	0	0	LORDS, BONNIE LCSW	6/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW74703	N/A	N/A	N/A	N/A	N/A	6850 MORRO RD	None	ATASCADERO	CA	93422	4123	00	06000	35.48202343	-120.6660628	San Luis Obispo County
354568	Ordering, Referring, Prescribing	N/A	1992061113	0	0	LAZO, ISABEL M MD	11/10/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A131473	N/A	N/A	N/A	N/A	N/A	280 W MACARTHUR BLVD	11TH FL	OAKLAND	CA	94611	5642	00	06000	37.8242017	-122.2578306	Alameda County
354578	Ordering, Referring, Prescribing	N/A	1992078356	0	0	LASZLO PAINE, ANKA	11/2/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	20691	N/A	N/A	N/A	N/A	N/A	1330 LINCOLN AVENUE	201	SAN RAFAEL	CA	94901	2142	00	06000	37.97629089	-122.5226851	Marin County
354596	Ordering, Referring, Prescribing	N/A	1992098743	0	0	LIM, DANIEL J PHARMD	12/5/2022	Taxonomy not applicable	NA	n/a	000	Unknown	57126	N/A	N/A	N/A	N/A	N/A	245 S. FETTERLY AVE	None	LOS ANGELES	CA	90022	1605	00	06000	34.03404953	-118.1609476	Los Angeles County
354597	Ordering, Referring, Prescribing	N/A	1992102552	0	0	LOK, JENNY OD PC	8/1/2021	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT994	N/A	N/A	N/A	N/A	N/A	2521 E 15TH STREET	None	CASPER	WY	82609	4126	00	06000	42.834753	-106.2938295	Natrona County
354628	Ordering, Referring, Prescribing	N/A	1992140602	0	0	LONG, RICHELLE PHD	11/16/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27361	N/A	N/A	N/A	N/A	N/A	3331 POWER INN RD	SUITE 140	SACRAMENTO	CA	95826	3889	00	06000	38.543391	-121.4077095	Sacramento County
354631	Ordering, Referring, Prescribing	N/A	1992149264	0	0	LOPEZ, CASIE E LMFT	2/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52559	N/A	N/A	N/A	N/A	N/A	25910 ACERO	160	MISSION VIEJO	CA	92691	2790	00	06000	33.61712389	-117.6780482	Orange County
354645	Ordering, Referring, Prescribing	N/A	1992174742	0	0	LUO, KRISTINA N PHARMD	5/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74112	N/A	N/A	N/A	N/A	N/A	1800 HARRISON STREET	13TH FLOOR	OAKLAND	CA	94612	9429	00	06000	37.80593773	-122.2656714	Alameda County
354647	Ordering, Referring, Prescribing	N/A	1992174965	0	0	LARA, JESSICA A PSYD	1/18/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	30688	N/A	N/A	N/A	N/A	N/A	2200 TYDD ST	None	EUREKA	CA	95501	1284	00	06000	40.80241902	-124.1462268	Humboldt County
354667	Ordering, Referring, Prescribing	N/A	1992213623	0	0	LO, LEE DDS	3/13/2024	Taxonomy not applicable	NA	n/a	000	Unknown	102216	N/A	N/A	N/A	N/A	N/A	3800 FLORIN RD	None	SACRAMENTO	CA	95823	1802	00	06000	38.495052	-121.463874	Sacramento County
354674	Ordering, Referring, Prescribing	N/A	1992230593	0	0	LANUZA, MARK J DO	11/15/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18460	N/A	N/A	N/A	N/A	N/A	1000 EUCLID AVE	None	NATIONAL CITY	CA	91950	0000	00	06000	32.68067201	-117.0804893	San Diego County
354712	Ordering, Referring, Prescribing	N/A	1992287718	0	0	LYONS, JOHN DAVID A MD	10/20/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A167265	N/A	N/A	N/A	N/A	N/A	2098 S CENTRAL AVE	None	LOS ANGELES	CA	90011	1235	00	06000	34.0227101	-118.2521314	Los Angeles County
354714	Ordering, Referring, Prescribing	N/A	1992302996	0	0	LAI, LILLIAN W LCSW	7/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94656	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVENUE	SUITE 300	SAN JOSE	CA	95128	0000	00	06000	37.3160785	-121.937121	Santa Clara County
354730	Ordering, Referring, Prescribing	N/A	1992347900	0	0	LARIOS, ERIC S PHARMD	8/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH74751	N/A	N/A	N/A	N/A	N/A	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	00	06000	38.38851772	-121.9382798	Solano County
354738	Ordering, Referring, Prescribing	N/A	1992352496	0	0	LOPEZ MATEO, VICENTA A LCSW	11/2/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW127078	N/A	N/A	N/A	N/A	N/A	1515 W CAMERON AVE	#350	WEST COVINA	CA	91790	2726	00	06000	34.06871052	-117.9422359	Los Angeles County
354742	Ordering, Referring, Prescribing	N/A	1992355267	0	0	LERNER, MELANIE E LCSW	4/29/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122266	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
354745	Ordering, Referring, Prescribing	N/A	1992364905	0	0	LEAL, ELISA PSYD	9/23/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	28330	N/A	N/A	N/A	N/A	N/A	4605 LANKERSHIM BLVD	STE 545	NORTH HOLLYWOOD	CA	91602	1892	00	06000	34.15389329	-118.3679999	Los Angeles County
354758	Ordering, Referring, Prescribing	N/A	1992386312	0	0	LE, TIFFANY PA-C	6/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59103	N/A	N/A	N/A	N/A	N/A	1 HOPE DR	None	TUSTIN	CA	92782	0221	00	06000	33.71470753	-117.8323965	Orange County
354767	Ordering, Referring, Prescribing	N/A	1992415723	0	0	LIBAO, ALDRAINE H PHARMD	12/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	87466	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
354773	Ordering, Referring, Prescribing	N/A	1992448690	0	0	LAIRD, ANGELA PA-C	7/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61400	N/A	N/A	N/A	N/A	N/A	3030 EXPLORER DR	None	SACRAMENTO	CA	95827	2728	00	06000	38.563362	-121.332429	Sacramento County
354778	Ordering, Referring, Prescribing	N/A	1992451074	0	0	LAU, EMILY DDS	10/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	108220	N/A	N/A	N/A	N/A	N/A	6501 GARFIELD AVE	None	BELL GARDENS	CA	90201	1805	00	06000	33.97292523	-118.1475473	Los Angeles County
354787	Ordering, Referring, Prescribing	N/A	1992471650	0	0	LADRINGAN, MICHELLE B NP	1/12/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019393	N/A	N/A	N/A	N/A	N/A	202 GLACIER DR	None	MARTINEZ	CA	94553	4826	00	06000	37.988865	-122.087427	Contra Costa County
354795	Ordering, Referring, Prescribing	N/A	1992534804	0	0	LY, VIVIAN PHARMD	7/29/2024	Taxonomy not applicable	NA	n/a	000	Unknown	89706	N/A	N/A	N/A	N/A	N/A	2143 FOOTHILL BLVD	None	LA VERNE	CA	91750	2942	00	06000	34.11289169	-117.7633964	Los Angeles County
354839	Ordering, Referring, Prescribing	N/A	1992835102	0	0	LUJAN, LUCIA E LCSW	2/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26659	N/A	N/A	N/A	N/A	N/A	439 W 97TH ST	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
354853	Ordering, Referring, Prescribing	N/A	1992850523	0	0	LEDESMA, HOLLY M OT	3/23/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT6029	N/A	N/A	N/A	N/A	N/A	2311 W. EL SEGUNDO BLVD.	None	HAWTHORNE	CA	90250	3315	00	06000	33.91647947	-118.3189815	Los Angeles County
354858	Ordering, Referring, Prescribing	N/A	1992859912	0	0	LYON, JENNIFER E LMFT	1/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46888	N/A	N/A	N/A	N/A	N/A	1360 E LASSEN AVE	None	CHICO	CA	95973	7823	00	06000	39.77359746	-121.8420053	Butte County
354859	Ordering, Referring, Prescribing	N/A	1992856363	0	0	LYLE, WENDY K PHD	12/17/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	18277	N/A	N/A	N/A	N/A	N/A	1908 N BEALE RD	STE E	MARYSVILLE	CA	95901	6937	00	06000	39.1278388	-121.5457994	Yuba County
354919	Ordering, Referring, Prescribing	N/A	1992970537	0	0	LANGAARD LO, KELLY LCSW	9/6/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26616	N/A	N/A	N/A	N/A	N/A	915 54TH ST	None	OAKLAND	CA	94608	3142	00	06000	37.83820074	-122.2744091	Alameda County